Women Physicians 'Step Into the Discomfort,' Push for Change

Ingrid Hein

November 22, 2019

At one point in her career, Joneigh Khaldun, MD, thought she needed to quiet her voice.

"I had always been opinionated," she explained, "but I saw it caused a stink; people got upset. Somewhere in my late teens to early 20s, I just went quiet. I wanted to be a good doctor." As a black woman, Khaldun said she didn't want to stand out.

She recalled the moment when she was asked to re-engage with her voice: it was in medical school. The chief resident pulled her aside and said, "You know this stuff. Why do you never say anything when we're in rounds? I want you to be more aggressive and speak up."

That encouraged her to use her voice again.

A second moment came during her recovery from a life-threatening bilateral hematoma, when, she said, she realized, "I'm supposed to be here. I've got things to say."

That's when she asked, "How do I get into public policy?" Today, Khaldun is chief medical executive for Michigan and chief deputy director for health in the Michigan Department of Health and Human Services.

Women physicians are a unique breed, Dara Kass, MD, explained during a panel discussion with Khaldun and others on the ascent of women in medicine at the American College of Emergency Physicians 2019 Scientific Assembly in Denver.

"We are cultured to be the center of our families, and then at work we are at the center of care for our patients. We are always balancing the needs of other people with our own." That's part of our value, she said.

And it's going to take a cultural shift before the power of women in medicine is equal to that of men, said Kass, who is from the Columbia University Medical Center in New York City.

A Cultural Shift

Female physiology is not the biggest part of the conversation, she explained. "There are only a few times when being physiologically female affects your career; the rest of the time it's cultural."

Everyone in the field needs to push for that shift, she said. "We come from a national culture of not supporting anybody through anything." But when people in power lead from a place of humanity and experience, they "can be agents of change."

Stand up and say, "I'm not going to make a woman or a person of color solve the problems that have been burdening them historically," she told the audience.

Speak out about personal conflicts between family time and work time, "and when male faculty members have a baby, encourage them to take paternity leave," she said.

"We need to invest in solutions that allow people to stay in the workforce," Kass added. The first 3 months after someone has a baby — "specifically women, but even the nonbirth parent — are the most vulnerable times in a career."

"The idea that we don't lean into the humanity of those moments as a system is offensive to me as a free-thinking human. We all need to be agents of change," she said.

Acknowledgment that there's a problem is the first step, said Hiral Tipirneni, MD, who is currently running to be a Democratic congressional candidate in Arizona, a "reddish-purple state," and believes she has a unique perspective to offer in politics.

As a physician with experience on the frontlines of an emergency department, "we see all aspects of our society, where policy has succeeded and where it has failed," she said.

Uphill Climb

As a visible minority and a woman, Tipirneni is constantly reminded of her uphill battle to ascend to leadership. She recounted making a call to a constituent to discuss issues in the community and introduce herself. She was told, "You're brown, you're a woman. I'm not sure you're going to resonate in this community."

She calmly told that person, "You've just distilled me down to my gender and the color of my skin. Let's talk about your family." She then had a conversation about healthcare, Medicaid, and his wife's disability. They connected, Tipirneni reported, and "he ended up being one of the people at the town hall who brought 20 of his neighbors."

"We had common ground. It wasn't about ideology. It was about empathy, rapport, connection." These are skills we learn as physicians, she said. "I know something about the issues, the facts, and have the critical-thinking skills."

It's important that people in power stand up and support women and minority leaders. Her husband is doing his part, Tipirneni said. When she attends political events with her family, people often go straight to him, assuming he is the candidate. Her husband graciously corrects their mistake, telling them, "I'm the arm candy."

It will take at least 50 years for women in medicine to reach equity in leadership, according to a recent report that describes a "leaky pipeline," in which women and under-represented minorities in academic medicine are lost during the ascent to leadership and remain under-represented. The authors call for term limits for senior leaders, who are disproportionately white and male, as a method of "unplugging the pipeline."

To speed up change, everyone needs to step up. "Be an intentional ally. Step into the discomfort. Push yourself to say, I am going to sponsor women and under-represented minorities in medicine," said Megan Ranney, MD, from Rhode Island Hospital in Providence, who was a member of the panel.

A Forum for Women in Emergency Medicine

Kass is a cofounder and coeditor-in-chief of the online Feminem forum for women working in emergency medicine.

The forum was started to create a space where experiences and solutions could be shared, she explained. "We saw that every organization within medicine was having a conversation about women's issues, but people weren't coming together; the problem one woman solved wasn't being shared with others."

Feminem is inclusive and men are invited to the table to discuss bottom-line issues, which run the gamut from the pay gap in medicine, to how the loss of a woman in leadership affects all staff, to how to retain people, she explained.

As women, we can't take the conversation personally, she pointed out. When someone says the pay gap isn't real, that it's just about the choices women make, "I don't tell them they're wrong," Kass said.

She said she tells people to look at the challenges women face. "Are women choosing to stay home with their families because there's no way to have a flexible work environment? Are they choosing to make less money because they'd have to work a certain percentage of nights and weekends to make it equitable? Why are there only two choices? Can't there be a third choice?"

When students ask Kass about pushing for change, she said she tells them that it's good to advocate for change, but "we have to respect the system we are growing up in."

The problems are going to be here when you finish; they're not going away overnight. "You don't have to do all the work right now. Be active, but you don't have to be a disruptor," she said.

"If you're going to be loud and proud, you have to expect a backlash." Context matters, and there are consequences. "That's okay. That's how changes are made," she said.

American College of Emergency Physicians (ACEP) 2019 Scientific Assembly. Presented October 27, 2019.

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