Yolonda Colson, MD, PhD: The Importance of Community in Careers and Leadership

 In the past, thoracic surgery has been a male-dominated specialty. In fact, when Dr. Yolonda Colson passed her boards in the early 2000s, just over 100 women had joined the field ahead of her. And then in her first attending role, she was one of the only woman in her division. But over the course of her career, she’s watched the number of women in thoracic surgery grow steadily to more than 300 women practicing around the country today. 

Now, as the chief of the Division of Thoracic Surgery at Mass General, Yolonda recognizes the value of diversity in the field. In her first year as chief, she’s already hired two additional female thoracic surgeons, and works closely with her teams and trainees to help them build careers that can accommodate both their professional and personal aspirations. Her surgical specialty is lung cancer, the most common cancer worldwide. She is working hard to improve care, particularly for women and non-smokers.

So welcome, Yolonda.

A:   Very nice to be here. Thank you.

Q:You are fairly new to Mass. General. So I'm wondering if we can start by having you talk a little bit about what it’s been like to be appointed the new Division Chief for Thoracic Surgery.

A:  It’s really a dream come true for me, to have the opportunity to lead the field from such a prestigious place as Massachusetts General Hospital, something I never thought I’d have the opportunity to do. 

I also think it’s really exciting to have the chance to help people grow. I  think it’s a really special opportunity to have the ability to really highlight the role that academics plays in how we move the field forward, and to show that you can balance both that academic mission and the science and changing the world, with how we take care of patients with compassion.

And I think that’s a really important balance. And I think doing that from Massachusetts General Hospital, one, really sends a strong message, but it also shows that it’s possible.

Q:   If you think back to a younger self, you said you wouldn’t have imagined doing something like this. Did you have a vision for where you thought you would be? Or has it kind of evolved over time? 

A:   I think it’s important for everyone to understand that you have a direction, and you have an idea of where you think you can go. But, if you stay open to opportunities, things will present themselves. And you may end up far further than you anticipated, because you just didn’t know what was possible.

And I think that’s particularly true in surgery and medicine and opportunities for women because, when I started, women weren’t doing the field at all, or a few were. The first woman who was board-certified was in 1961.

But, as you grow and opportunities present themselves, you meet great mentors. You meet people who can dream for you. And I think your vision evolves. And so I started out, you know, where I went to college. And that wasn’t very common, from where I came from. 

And then there was the opportunity for medical school, I really found surgery was what I really liked. And I found mentors who didn’t think twice that I was a woman to do that. 

And, if you work hard, and you apply yourself, and you are open to that opportunity, and you follow that passion of what you love, you can end up in really amazing places, because you haven't limited yourself.

Q:   When you think back, was there a moment when you shifted what you thought you could do?

A:   I think there's an evolution, one step at a time. And I think there are key moments, where you realize that you really like surgery, and somebody says to you, “How are we going to get you there?” I didn’t start medical school necessarily thinking I would necessarily do surgery, right. But when I was doing my PhD, I met a bunch of cardio thoracic surgeons who I thought, it was terrific. 

And I think those are the really special moments, you recognize that you're making a turn to do something that you really love, or is like an opportunity you didn’t expect.

Q:   How do you talk yourself through those moments of, you know, sort of taking down a barrier, so to speak?

A:   I think, first, you have to be really honest. “What is the barrier? And how much of it is that I'm thinking someone else is thinking something? How much of it’s real? How much of it is that I don’t want to try it and fail? How much of it is that I'm perceiving that it won't be very welcome?

Because the worst I can do is try and somebody says, “No.” And I did that a lot, right. I would apply for different things. I applied for different chief jobs. And you wouldn’t get those. But then you have to look at it and decide, can I learn? Can I be better? Is there a better way to approach this?

Some very wise person once told me, “Sometimes you're a giraffe, and they want a rhinoceros. And it doesn’t mean that you're not a good giraffe,” right? So you have to understand what's you and what you can fix and what isn't you. And I think if you break it down, you’ll realize, a lot of times, the barriers are you not being willing to try.

Q:   Yeah.

A:  And it was just nice for me that the best job in the country needed a giraffe. I just had to wait for it, right. 

I think it’s particularly important for women to recognize that, because there's so many balls that we’re juggling, that we’re trying to figure out that you're thinking you're failing at everything. And I know we’ve talked before about the 80% rule in our house, which is that you have to get it about 80% right, 80% of the time. And, if you can do that and realize that there's nothing perfect, and that the house won't run quite perfect, maybe that paper that you wrote wasn’t perfect the first time. And I think that help gives people space. And then, they’ll try more things, because they're not looking at it as failure, they're looking at it as they're getting closer.

Q:   You're in this new position. You are the first woman to join the service. I know in your first year, you’ve hired two more women. And so really working to increase the diversity of the team. Can you talk about your outlook on why you’ve made that a part of your work, and why you're putting emphasis on doing that?

A:   I think that whenever we can take our small worlds and make them more like a community, and particularly the communities that we serve, I think we have a better way to relate to them, and a better way to understand to them.

And so I think the more diverse that we have ourselves, then we can reach out and understand what maybe we’re not seeing in our community. And I also think, by having that diversity, it allows us to see things that we can't see, or new solutions. Because maybe there's a different perspective. 

But understanding what the challenges are for everybody in the division, and having the diversity actually gives flexibility to everybody in the group. And it lets our patients, maybe they feel more comfortable with one person than the other. 

Q:   Have you seen that the mentality of the team who’s been here shift and change? 

A:  When you think about how you add people to a community, and to a group, you have to add them, so that it’s a benefit to them. And so, strategically thinking about, “What can I do that helps the whole group? And who’s that right person?”

And so, each of the people we've brought in has actually helped accomplish a goal that the whole group needs to do, and so we brought in a robotic surgeon. And we have a very successful robotic surgeon. But making it so it’s more in the culture.

And so what I've seen is more interest in learning new techniques, how to help each other. And I think they’ve always had that. It’s just setting it up so there's more opportunity.

The other thing that I think is important about having more than one person is that it allows them to work together. So, if you bring additional people with this same direction and the same goal, they now become a team, rather than one person.

Q:   Right. It’s sort of that there's a lot of science behind this, the creative pairs.

A:   Yeah. They can bounce ideas. And somebody can say, “That’ll never work.” And I think it’s particularly good when the diversity is they’re from somewhere else, so they’ve seen different aspects. And then, they can talk to each other about, “This works here. This doesn’t work here. Here’s the barrier. Here’s not. 

Q: Thinking back to the beginning of your career, you entered at a time when there were very few women to look to. So what was that like? And were there models or mentors along the way who helped you through that process?

A:   I think it gets back a little bit to the idea of perceived barriers, and either naively or whatever, just marching ahead. And I think that when I first went to medical school, and there was a cardiothoracic surgeon who was giving a lecture, I think it would have been easy for me to think, “Yeah. But it’s this guy who’s giving this. And there aren’t any women who are cardio thoracic surgeons. So I won't go see him.”

And then, it would have ended. And for whatever reason, I decided, could I just come talk to him? Because I thought what they were talking about, which was heart transplant, was a fantastic thing to do. And when I went there, he was completely open to the idea.

Actually, I would work in his lab. He had all the residents and lab fellows who were there at the time. They were doing open heart surgery, and, testing heart valves. Had them teach me. He said, “Teach her to sew.” It was not anything unusual, except that there were no women in the lab.

And he didn’t think twice about it. And so that became a very big mentor. 

I think my dad was really influential in my life, because he just thought I could do anything. And it never struck him as odd.

Then I think, as you move along, if you find mentors who understand what your value is, and can give you advice, they help you with the people who tell you, “You're going to have to choose one or the other. You can't do a family life and have that.”—You’ll hear those things. But, if you know there's a core of people that you trust, who will tell you honestly, and advise you, and help you figure out how to be successful rather than to say yes or no, those are the people you select along the way.

And so there's been a number of people, because of my field, most of them are men. But there have been some fabulous women colleagues that, when we started, we all had our cell phones. We all texted each other. We would send birthday presents to each other, because we were all by ourselves. And you’d get this big present that said, “We know it’s your birthday.” And it was support in that way. And we still talk and mentor each other.

Q:  You mentioned your dad as one of your mentors. And you said previously, you came from a place where college wasn’t necessarily the expectation. Yet you went off to college. Can you talk a little bit about how those pieces fit together?

A:  I grew up on a farm in Minnesota. It was a great place to start, because I think you learn basic rules. You learn that everybody has to work. Some days you have bad days, and good days. You have bad seasons. And you get wiped out by floods and all those things, but you have to get resilient. And you’ve got to build it back. And I think that’s really important things to learn, and to understand that community is really important. Because that’s how it gets you through those bad times. It’s also how you kind of bring the harvest in, right. And it sounds kind of rural, I guess. But it’s the same how you go through life and build things.

A lot of people in our school didn’t go to college. They went to a local college. They certainly didn’t go off to an engineering school in New York. And, like I said, my dad graduated from college when I was in medical school, because he decided, I could do it, he could do it. And so he went back and finished his degree. 

Q:   It’s neat how your father was a mentor for you, and then it’s almost like you became a mentor for your father in some ways, and kind of that back-and-forth.

A: Since I went to Mayo Medical School, I actually could live at home. So I could live on the farm, and drive in. And it was interesting, because he would come down and say, “Well I have this to do today for class.” And I would have my stuff to do. And I think it was a big thing for him, because his father died early, so he couldn’t finish his college.

And so going back was like completing the circle. And it was really important to him. And that helped me realize, why I needed to do this. 

Q:  I want to shift back to the present, now. You are now a specialist in lung cancer and surgical interventions for that. Could you talk about how you got into that specialization and what that work looks like?

A:   I think, if you're open to what's around you, and thinking about opportunities, you'll find your place where you feel most useful. And throughout my training I found that I really enjoyed the lung cancer patients. And I think giving them the space, because there's so much shame in that space that, you know, everyone assumes that they smoked, or is still smoking. And I think having that compassion, and talking to them, is kind of what drew me to it. And they're so grateful.

And I think the thought was, there was no successes. And we know that surgery, actually, there is a lot of success. And you see these patients for years, and they become really special.

Q:  Could you talk a little bit more about that? Do we know more about what causes those non-smoking related cancers?

A:  We don’t. We know there's some other risk factors, like radon and things like that. And clearly, smoking’s the biggest risk factor. But when we as providers and caregivers recognize that the majority of people stop smoking, that it’s a little easier to not quite be so judgmental.

And in women, there's a significant number who are non-smokers. And certainly, more women are nonsmokers that have lung cancer than men are non-smokers. And we don’t have a great answer to that. And it doesn’t mean that it’s not important, because more women still die of lung cancer than breast, ovarian, uterine cancers combined.

A:   So it is a real problem. But understanding why is important, because they don’t meet criteria for screening, because they're not smokers. And so although it is a smaller proportion, it’s still a significant number of women. It’s about equivalent to those that are getting ovarian cancer, in terms of size.

And so I think understanding what that cause is, is an area for research that we’re really starting to try to determine. Is it environment? What are the mutations? They tend to have a higher incidence of a specific mutation. So we know there's something going on. We just don’t have all the answers.

Which is really hard. Because now, we have a group of women who are worried that they could get it. But we don’t know how to tell them what the risk factor is.

But I do think if there is something on a scan, recognizing that the fact that they're not a smoker doesn’t mean it’s not a cancer, particularly in women, is an important one. Because then, they just need to be followed and referred and evaluated, so that we don’t miss it.

Q: You mentioned support for female patients. And why is it important to have those supportive spaces? 

A:   It’s really interesting, because if we think about it, women are the caregivers and coordinate a lot of the care. So there's a very powerful space and role that they occupy, because maybe they take care of their own health, but they also usually take care of most of the health in their family. 

Q:  Can you talk a little bit about The Women’s Lung Cancer Forum, and what that is?

A:   So it’s actually been over a decade, now, initially started out as women who I removed their lung cancer by surgery, or we treated in other fashions. And what I noticed was there was a real need for them for education and to understand. In the era when it was started, the perception was is, most people with lung cancer died, largely because they were found later.

But there was no place to have discussions for, if you had surgery, and what did you need to know about your disease? And so we created an educational forum which also allowed the patients to get to meet each other, and talk about it, because there's such stigma about, “I have lung cancer,” that people don’t want to talk about it. 

And over the years, they’ve become quite a community, and will raise dollars for fundraising. They’ve been advocates for new legislation. And really, to understand, how do we support them, and what to do. And I've learned a lot from them.

And it’s interesting, because then they go out and advocate. They actually have some statistics and some facts, and can talk about what to do. So they get a lot of education. But I think we’re so busy, we don’t always do.

Q:   And when it comes to treating lung cancer in women, are there particular types that are most common, compared to men? 

A:   So women tend to have more adenocarcinoma in general. And I think there's a shift happening among the men as well, but particularly women who are non-smokers. So it is a very interesting subset. 

I think that—that the Cancer Center here has been national leaders in understanding those mechanisms and what the right treatment for those are, and looking for new drugs and new ways to fight resistance. 

Q:   And when you look forward in thinking about, how the field can or should change to provide better treatments, how are you thinking about that?

A: I think one is for us to really understand how patients get into the system. And one of the studies that we did was to just start tracking how patients got to me. And what I found was they came from multiple pathways, multiple sources, had had multiple workups and tests done. And so it was a very complicated way that a patient would get to me.

And so, by streamlining that, making it so there's a place to go, figuring out what the workup needs to be, and actually strategically doing it, not just navigating people to 22 locations, but figure out which three they need to go to, and coordinating that, we found that we could actually take very complex people, or people with a lot of social barriers, and could actually get them in. And you could cut the time by almost half.

And I think that’s really what's going to be important, because time is lives in lung cancer, that the longer we take to get people in, then we lose the opportunity to treat them earlier. And so I think that’s a big piece of it, is streamlining care. And then the second is really about experience.

They're scared. They have a bad disease. And I think it’s our obligation to give them hope, but also to do it in a caring way, that they understand we’re on their team. And it’s not that that doesn’t happen, but I think focusing on that and figuring out how to do it better would be great.

And I think putting it in perspective, and telling people that there's a cure, and that it can be treated, is really important. 

Q:  How are you approaching things like streamlining care?

A:   Some of it’s really easy and straightforward. You work to make sure that the whole team that you're—that you work with understands that there's a scared person on the other end of the phone.  And so answering the phone as quickly as possible, and getting them an appointment, is really important, not just from a business sense, but from patient care sense. That that actually has a human component to it. 

And so putting in systems that allow those things to happen, to figure out where we’re not giving the best experience, those are pretty straightforward. Then I think it’s figuring out how you construct the whole system. 

There's a nodule clinic here which is tremendous. And I think that will be really useful, in terms of not missing things, and not having people go to 15 different places. And so we can actually work with that, to figure out how to streamline that, and how to triage accordingly. So that we can give the best care to everybody. 

Q:   I always wonder, having a job like yours, where you're confronting patients, I assume most every day, who have these dire diagnoses, what is that like? And how do you prepare yourself to give that news, and to do that work?

A:   I think it’s a balance between really caring and not getting so sad you can't show up for work every day, because there are some things that are really sad. But I think you can really gain from the perspective that, if you listen and you care, and you’ve done your best for them, that that meant a lot that you did that. And that, if you're honest, and you really genuinely care about them, that you’ve already given them treatment in that sense. Because it’s a lonely place to be, to have something that’s a life-threatening illness.

 It’s seeing patients every day like that puts it in perspective, so you understand how lucky you are. And I think showing that you care is kind of a way to rejuvenate yourself.

Q:  Being a surgeon is a highly demanding job. So how have you built a career that accommodates that reality, but also the reality and the sometimes chaos of having a family, and having a personal life?

A:   Chaos is a good word. And I think part of it is recognizing that it won't be perfect, having a really good team. And that means your spouse, your significant other, your family. And I think respecting their needs as well, and understanding that we’re kind of all in it together.

As I went through my career, we set up little rituals. Like if I wasn’t on call, we had pancakes every Saturday. And you try to schedule what you can around those activities. And you can't predict the emergency, but I think sometimes, work can be all-encompassing, that we’re not very good about setting out this period of time

So I would always read to the kids at night, even though it was like 9:30-10 o’clock. So I wasn’t that great of a mom doing that. But it was setting aside that time that you're special, that I think sends the right message. And they understand. And it actually makes them part of a bigger cause, because now they're helping me take care of patients, which translates to them feeling good, too.

Q:   It’s been such a pleasure talking with you.

A:   This has been great.

Q:   Before I let you go, I have my final five questions. What's the best advice you’ve ever gotten?

A:   Probably believe in yourself, and it’s okay if you're a giraffe.

Q:   What rituals help you have a successful day?

A:   I think sometimes being a little mindful of your environment and space. So sometimes just thinking about the sunset, or sunrise, is usually more likely. And recognizing how lucky we really are, that lets you sit to know, as the day comes, you're going to do your best. And things will be fine.

And then, when you see your dog at night, everything’s always fine to the dog. So that’s all that matters, right?

Q:  What was your first job?

A:   So first job was just working on the farm. And then, I worked at a grocery store stocking shelves. I'm really good at bagging groceries!

Q:   What do you consider your super power to be?

A:   I guess I would say the super power is probably compassion, and believing in people.

Q: What are you curious about right now?

A:   I'm reading a book called These Truths, which is about American history, not told as a real history book, but kind of how America was formed and has, over the years, changed and ebb and flow, which I think is really important in the current era, to understand sometimes how much of this goes around, and comes around. And they are continuing things that we as a country worked through.

And I—And I think that’s really interesting. And then, I think kind of related to that, is community, and how our lives are very fractured, and how we build community now that everyone is so busy. 

Q:   Thank you, Yolonda. It’s been such a pleasure talking with you today.

A:   It’s been terrific. Thank you.