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Carol Rumack – It's OK to be different!

2020; Elsevier BV; Volume: 70; Linguagem: Inglês

10.1016/j.clinimag.2020.10.031

1873-4499

Lucy B. Spalluto, Elizabeth Kagan Arleo,

Ethics in medical practice

Carol Rumack (nee Masters) learned at a young age that "it's OK to be different" [[1]Personal email correspondence (August 19, 2020 and September 17, 2020) and phone interview (August 19, 2020) between Dr. Spalluto and Dr. Rumack.Google Scholar]. Carol's mother, Ruth Masters MD, a practicing physician, was one of only two women in her medical school class of 1936 and used this phrase often. Through her mother, Carol learned the importance of equal opportunity, embracing individuality, and fostering curiosity in her early years. Carol Rumack was the third child of four born to Ruth and Raymond Masters, both physicians. Her parents met in medical school at the University of Pittsburgh Medical Center. Her father, a general practitioner, was drafted into the army in February 1942 and deployed to the Surgeon General's office in Washington, DC where he was trained in the new Medicine of Radiation injury. He became medical director of a Westinghouse Bettis Nuclear Engine Submarine plant after the war. Carol was born shortly after the family's move to Washington, DC at Walter Reed Hospital in 1943 during the midst of WWII. Her mother was not able to actively practice medicine during this time with 3 young children at home to care for and concerns that her husband would be deployed overseas. Following the war, Carol's family returned home to the family farm in rural Pennsylvania, near Pittsburgh, where her parents had started a private practice in her grandfather's house. She spent her childhood surrounded by acres of corn and learned to drive on an International Harvester Farmall tractor. She and her brother and sisters rode the bus to the local public school every day. Carol spent as much of her free time as she could accompanying her mother, who primarily practiced obstetrics, to the office and hospital 4 days a week. She also rode along with her mother as she made house calls, visiting patients in their homes. These home visits allowed Carol to visit a socioeconomically diverse population and see the direct impact of medical care in the community. Her parents would charge patients a prorated fee based on the economic status, often as low as one dollar. It was during these formative years, at age 5, that Carol decided she too wanted to be a physician, just like her mother – despite her teachers repeatedly telling her that girls could only be nurses and teachers. During hospital visits and house calls, Carol decided early on that she wanted to be in charge of the patient care, making the care decisions and writing the orders herself. Her first medical career aspiration was to be a cardiac surgeon. With two working parents, the Masters family had live-in nannies to watch the children until the youngest went off to college. Each of the Masters children went on to pursue a unique career - Carol's sister Mary became a paralegal, her brother John a commercial pilot, and her sister Sara a musician. After graduating from high school, Carol enrolled at the University of Chicago for her undergraduate studies. It was here that she met her husband, Barry Rumack, an undergraduate one year ahead of her. Following Barry's graduation, the young couple married and moved to Madison, WI where Barry would pursue his medical degree at the University of Wisconsin and Carol would finish her final year of college, officially graduating from the University of Wisconsin in 1965. It was in Wisconsin that Carol finally was able to pursue her dream of becoming a physician. She enrolled and completed her first three years of medical school at the University of Wisconsin and then completed her final year of medical school at the University of Colorado School of Medicine (CUSOM), as her husband began his pediatric residency. Their daughter Becky was born in Denver in 1968. She was awarded her Doctor of Medicine degree from the University of Wisconsin in 1969. During her medical school years, Carol found that she did not enjoy surgery rotations as much as she initially thought she would. She found, instead that she loved pediatrics. Following medical school graduation, Dr. Rumack moved to Baltimore, MD to pursue an internship in pediatrics at the University of Maryland while her husband was assigned to the NIH Cancer Center for 2 years during the Vietnam War. Dr. Rumack arranged to work with Drs. John Dorst and Richard Heller, pediatric radiologists at the Johns Hopkins Hospital, during the 2nd year of her husband's NIH commitment. During that year off from residency, the Rumack's son Marc, who is now a pilot with American Airlines, was born. While she had been planning to return to CUSOM to finish her residency in pediatrics, this experience opened her eyes to the world of pediatric radiology. When she returned to Denver, she asked the Radiology Chair if she could be an extra radiology resident and he agreed. Dr. Rumack's career in radiology had officially begun. Following her radiology residency, Dr. Rumack went on to become the CUSOM's first pediatric radiology fellow (1974–1975). After fellowship, Dr. Rumack applied for many radiology positions. She was denied several, and told, quite bluntly that it was because she was a woman. The Denver General Hospital offered Dr. Rumack her first position, which she accepted and went on to start and lead the hospital's pediatric radiology service. As CUSOM had refused to give Dr. Rumack an official faculty appointment, she was initially hired as a contract employee rather than a faculty member. Within a year at Denver General Hospital, Dr. Rumack had demonstrated her value to the institution and was invited to join the faculty as an Instructor. As she faced the challenges that the hiring process and transition to faculty presented, Dr. Rumack recognized the critical need to support women in radiology and joined the formation group of the American Association of Women Radiologists (now American Association for Women in Radiology - AAWR) and went on to become the first AAWR president (Fig. 1). She believed women needed a safe space in the workplace. She knew women could be physicians (she had shadowed her own mother, a physician, at an early age). She encountered no difficulty in being accepted to medical school or to residency. However, the radiology hiring process had presented a major gender barrier. Dr. Rumack quickly rose through the academic ranks, becoming an Assistant Professor in 1978, Associate Professor in 1982, and Professor in 1990. In 1992, Dr. Rumack became the Associate Dean of Graduate Medical Education for CUSOM, a position she continues to hold today. The lasting impact of Dr. Rumack on generations of radiology trainees will be profound. Dr. Rumack has been involved in numerous state and national radiology organizations and served on multiple editorial boards. She is a Fellow of the ACR, the AAWR, and the Society of Radiologists in Ultrasound (SRU). Dr. Rumack has served on the Board of Directors of the Academy of Radiology Research (ARR), the Accreditation Council for Graduate Medical Education (ACGME), the American Institute for Radiologic Pathology (AIRP), the Society of Pediatric Radiology (SPR), and on the American Institute of Ultrasound in Medicine (AIUM) Board of Governors. She was also an oral board examiner for the American Board of Radiology (ABR). Not only did she serve as the 1981 Founding President of the AAWR, but she was also the 2009 President of the American College of Radiology (ACR). She has authored over 60 peer reviewed publications, held numerous research grants, delivered over 150 invited lectures, contributed to numerous book chapters, and presented more than 80 scientific abstracts. Dr. Rumack' s textbook, Diagnostic Ultrasound, now in the 5th edition is widely recognized as the definitive reference on this subject in clinical radiology. Dr. Rumack identifies the single greatest challenge she faced during her career as getting her first job as a radiologist. One radiology chair told her that he had previously hired one woman faculty member and she committed suicide so he would never hire a woman again. A private practice group told her they had 20 men and don't hire women because they get pregnant and quit. An additional challenge Dr. Rumack identified earlier in her career was the frequency at which women were asked to join committees, without reciprocal representation in committee leadership. Women were asked to join committees in order to increase diverse representation, but were expected to hold non‑leadership roles such as secretary. Dr. Rumack was influenced by several prominent mentors. Dr. John Dorst, one of the very first radiologists she worked with was a primary influencer of her career path and decision to pursue radiology. He served as an excellent role model in his interactions on daily rounds with both pediatricians and patients. Dr. Richard Heller was a great teacher who always brought joy and curiosity to every teaching encounter. Dr. Henry Kempe, Chair of Pediatrics at the University of Colorado while she was a radiology resident, influenced her decision to pursue pediatric radiology as well and to convince the CUSOM Chair of Radiology to accept her as the department's first pediatric radiology fellow. Dr. Rumack' s recognition by colleagues and peers is largely based on her research and scientific contributions. The most significant for which she has been recognized is the understanding of intracranial hemorrhage (ICH) in premature infants. She received the Pioneer award from the Society for Pediatric Radiology (SPR) for this research. This breakthrough research was very difficult. When she presented her findings for the first time at the American Roentgen Ray Society (ARRS) in 1977 she raised the concern that bleeding into the brain in premature infants was poorly understood and that further study was warranted. She continued with this research to define the incidence, timing, and outcome of what was generally accepted as a rare event. She was fortunate to have access to the newly acquired Computerized Tomographic (CT) scanner to study these premature newborn babies in a consistent and highly accurate method. Since there was only 1 other CT scanner in Colorado at that time, she was able to study these premature infants from across the city of Denver. This work allowed her to prove that these hemorrhages occurred in 55% of newborn infants under 32 weeks gestation (8 weeks early) as opposed to the commonly accepted rate of 5% shown in previous autopsy studies. These studies reported in the American Journal of Roentgenology in 1979 proved conclusively that hemorrhage in the brain could be identified by ultrasound in utero. These breakthroughs allowed for study of the brain through the neonatal anterior fontanelle with ultrasound rather than exposing the infant to the ionizing radiation associated with CT. Further, having this absolute correlation meant that the baby could be studied in the intensive care nursery rather than having to move a fragile premature infant to the CT scanner located in the radiology department. She considers this to be her greatest scientific achievement. Numerous organizations have recognized Dr. Rumack for her outstanding contributions to the field of radiology. These awards include the AAWR Alice Ettinger Award (2001), AAWR Marie Curie Award (2006), the SPR Pioneer Award (2007), the ARRS Gold Medal (2009), the SPR Gold Medal (2011), the ACR Gold Medal (2014), and the Colorado Radiological Society Gold Medal (2015). Of the many awards Dr. Rumack has received, she considers the ACR Gold Medal to be the most important (Fig. 2). In 2014, when Dr. Rumack won this ACR Gold Medal, only 7 other women had received award [[2]American College of Radiology Gold medal award.https://www.acr.org/Member-Resources/Fellowship-Honors/Gold-MedalGoogle Scholar]. A supportive home environment was critical to Dr. Rumack's career success. This support included her husband who provided positive reinforcement and continuously encouraged her to succeed while also sharing the parenting duties for their two children. They decided with their first child that childcare was essential and had in-home nannies until the children went to college. In fact, as an intern, most of her salary paid for that nanny's support. The support of these dedicated people allowed Dr. Rumack to travel to national meetings, join national committees, and share her expertise with the field of radiology nationally. Dr. Rumack offers three critical pieces of advice to early career radiologists: Be Curious, Find Your Passion, and remember, It's OK to be Different. All authors substantially contributed to the design of the work, the writing and revision of the letter, approved the final version of the letter and are accountable for the letter's contents. None. Dr. Arleo is the Editor-in-Chief of Clinical Imaging. The authors wish to thank Dr. Rumack for granting a personal interview and reviewing the article prior to peer review [[1]Personal email correspondence (August 19, 2020 and September 17, 2020) and phone interview (August 19, 2020) between Dr. Spalluto and Dr. Rumack.Google Scholar].