What to do when it is your turn [and it is always your turn]

From the 10/23/2020 newsletter

Director’s Corner

 

What to do when it is your turn [and it is always your turn]

 

 Adina Kalet, MD MPH

 

 This week Dr. Kalet celebrates our focus on women in medicine by reflecting on what it has meant to be an underrepresented “minority” in medicine and what to do when it is your turn …

  

 "Women belong in all places where decisions are being made. It shouldn't be that women are the exception."

-Justice Ruth Bader Ginsburg

"There's a special place in hell for women who don't help each other!

-Former Secretary of State Madeleine Albright

 

One of my favorite things to do at MCW is study the class pictures lining the hallways of the ground floor of the medical school building. From the earliest days of the 20^th Century, MCW and its predecessor institutions created photographs of graduating classes – not surprisingly, all white men for decades – year after year – generation after generation. Starting about a quarter of the way along the length of the hallway, a few clusters of white women begin to appear, often wearing the habits of religious orders. Further down the hall, the first Black face, a man, in a sea of white male faces with a smattering of white women. Eventually there are Black female faces. And so, it goes, making starkly obvious that acceptance for women and people of color into the ranks of physicians is a very recent, evolving, and slow phenomenon.

I care deeply about our continued progress, which makes me ask: What was it like for those first women pioneers? How much better did they need to be? How fiercely defiant were they of low expectations for academic achievement? How much effort did it take to resist the pressure to conform to gender role expectations – to be considered “good enough”?

 

Being a pioneer

Over the course of my career, I have learned a great deal about being the “only one.” Early on, I ran the gauntlet daily. I regularly dodged being backed up against the wall while on rounds or touched inappropriately in the OR by male residents and attendings – all in “good fun.” I knew I risked being dismissed as the “bitch” when I insisted that junior teammates be accountable to me as they discharged their patient care duties. Being the “only one,” meant remaining appropriately humble as I informed patients, family members, and colleagues that I “was the doctor” and I “was in charge,” not the very tall, much older (he was an MD/PhD) intern standing behind me. To his credit, he regularly reinforced my leadership!

Once patients accepted that I was the doctor they, as often as not, expressed relief and delight. I had many experiences where men from religious traditions with strict rules against being in a room alone with a non-family member woman came to accept and respect me, allowing me special status as a “healer.” It was remarkable how much being a woman in medicine was a “superpower” my male peers didn’t have.  I thrived in the environments where I could work at my full capacity, and benefited from many “affirmative action” programs, aimed at correcting gender inequities,  focused on giving me – based on my gender – a “leg up”; for example, opportunities such as the Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM®) program. I have worked my whole career to be surrounded by respectful, kind, and loving peers and mentors of all gender and racial identities. 

 

Being a pioneer, again

Daily experiences of frank gender-based discrimination and micro- and macro-aggressions faded into the background until I first joined institutional leadership in mid-career.

When I finally had the privilege of being invited into the “C-suite Boardroom” of a private academic health center, it became clear to me who was in charge. The decision-making tables with opportunities for real change were surrounded by men in gray suits and ties. After years of working collaboratively with women and men, I was again the only one. What I was wearing, how my hair looked, and the age of my then young children were considered acceptable small talk at the beginning of each meeting. I was made to feel self-conscious of my gender and relative youth. In the guise of “complements,” I felt “put in my place,” even by those I had considered role models. This could occur immediately before we were to talk about important issues of educational policy and practice in our department or medical school. After the meetings, my assignments might be stereotyped. For example, when a top performing women medical student (whom I did not know personally) had a body piercing that everyone else (not I) agreed could “upset” patients, the task of calling her in for a conversation fell to me.

I recovered my “voice” and, in relatively short order, there were a few other women invited to these tables. And it has made all the difference. As we diversified, discussions were more substantive, less contentious and less autocratic, more pragmatic, and more creative. Not because women uniquely possess different “ways of being” (although some of us do), but purely as an impact of diversity of points of view and life experience. Diverse leadership in institutions is better. Period. Not just right, but good for us all.  

 

How do we make progress?

Progress has been slow in academic medicine. At MCW, as it is at most other medical schools in the US, there is a problem.  While women have been 50+% of the medical students since 2019 and 43% of MCW faculty are women only 29% of full professors and 17% of chairs identify as female.  Of the traditionally impactful leadership positions (chairs, deans, and other executives), the large majority are men.

Nationally, there have been calls to impose medical school department chair term limits to open up leadership roles to more diverse pools of candidates. While the pipeline is hardy and full of talent, we are not, as of yet, experiencing the value of a fully diversified leadership roster.

Having women leaders, is more important now than ever. I am a fan-girl  of the young Prime Ministers Jacinda Ardern of New Zealand and Sanna Marin of Finland, each of whom has demonstrated leadership leading to lower COVID-19 case and death rates in their countries. They are known to encourage and listen to both dissenting and expert voices. Although each situation is unique and complicated, I say having women and other underrepresented groups at the table is a good thing and accelerates transformation.

 

Linking gender and racial equity

White women, as members of a gender minority with life experiences of bias and discrimination, but also as part of the racial/ethnic majority, are finally in the position to exercise some power. As a result, white women are now over-represented in efforts to address injustices, inequities, and the care of the vulnerable. For example, the leadership of a large, multi-institutional, foundation-funded program to mentor women and URiM early career scientists is overwhelmingly white (79%) and female (87%). This is typical of many such activities. I am not naïve; clearly, some white women (like their male counterparts) have demonstrated shameless entitlement, privilege, and racism.  We are not a monolith, but we do have collective power which we can use for good.

Change is coming. Through the efforts of MCW’s Center for the Advancement of Women in Science and Medicine (AWSM) under the leadership of Libby Ellinas, MD and the Council for Women’s Advocacy (CWA), much has been accomplished and much more needs to be done to achieve and cultivate a diverse and vibrant culture at MCW and elsewhere.

As I walk down the hallway of class pictures, I always say out loud to those pioneers “Thanks, sisters!” They helped to change the “face” of the profession. We must reflect on what they did – and what we must do – to continue the progress. We must be at the forefront, increasing the diversity and inclusiveness of our profession and institution. We must enlist everyone to assume responsibility and play a role to ensure continued transformation.

Our work is not yet done.

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin