FemInEM is an open access resource where we discuss, discover, and affect the journey of women working in emergency medicine. Through deliberate conversation and engaging dialogue, members explore a variety of issues that support the development and advancement of all women in medicine. FemInEM aims to address gender disparities in a positive way, empowering physicians of both genders.
Today, we feature with Dr. Tracy Madsen, the President-Elect of AWAEM in 2019-2020 and an Assistant
Professor at Brown. We speak about how she herself as a medical student didn’t
perceive the need for women-focused professional organizations, and how
advancing in her career has demonstrated the critical need for organizations
M Lin: Dr. Madsen, tell me
about where you are currently in your career.
T Madsen: Hi. Thanks for having me.
This is really exciting. I’m an Assistant Professor of Emergency Medicine at
Brown University in Providence. I’ve been there since residency and did my
training and my fellowship there, and I’m now faculty there.
M Lin: Tell me about how you
spend your time at work?
T Madsen: Sure. I’m really enjoying my
current kind of balance of roles and responsibilities. I have my clinical work,
which I love. I’m at Brown in Providence, Rhode Island. But then I also do a
lot of research, which I love, as well. I’m doing mostly sex- and
gender-focused research. I’m part of the Division of Sex and Gender in the
Department of Emergency Medicine at Brown. My particular research focus is on
stroke with a little gender disparity work kind of fit in on the side. But most
of what I’m doing is sex and gender differences in stroke, so we’re looking at
differences in treatment in the emergency department. That’s really where it
all started, because I work in the emergency department. That was the natural
beginning, but now have really expanded to thinking about prevention. How can
we take sex-specific approaches to stroke prevention? How can we take
sex-specific approaches to improving stroke outcomes? It really goes kind of
the whole gamut from prevention to outcomes. That’s what I’m working on right
M Lin: Great. How was it
that you got to where you are right now?
T Madsen: That’s a huge question. I’m
trying to think. There have been so many influences to get me kind of where I
am. I would say mostly mentorship, and colleagues, and really just following
the things that I’m passionate about, which is mostly sex and gender, and
looking at things through a gender lens, which includes thinking about women in
the workforce and women in academic emergency medicine.
M Lin: How did you first
cultivate that interest?
T Madsen: It started a long time ago,
probably all the way back to college. We don’t have time to go all the way back
that far, but I’ve always been very interested in women, and caring for women,
and how I can help improve the health of women. That really drove me to go into
medicine to begin with, but I always thought I think I would end up in a field
that was traditionally women’s health, so thinking about OB/GYN, and thinking
about domestic violence, and all of those traditionally women’s health issues,
but really just fell in love with emergency medicine. Then from there, figured
out how I could incorporate my interest in sex and gender in women’s health
within emergency medicine.
M Lin: That’s terrific. What
motivated your initial involvement with AWAEM?
T Madsen: I would have to say mentors,
again. My mentors have been wonderful and really pulled me into a leadership
position, even before I knew that I was ready. I had mentors like Esther Choo,
and Alyson McGregor, and Basmah Safdar, all of these leaders in AWAEM that kind
of tagged me and said, “You should do the Didactics Committee for AWAEM.
These are great ideas. You’ll get to work with senior people in emergency
medicine and network.” That’s how it started. As a fellow, I joined AWAEM,
and then started as the committee chair for Didactics, and started planning
didactics for SAEM, and just had a great time thinking about didactics that
would help other women advance in emergency medicine, and then, like I said,
meeting people in the field.
M Lin: Tell me about some of
the other projects that AWAEM has gotten you involved in?
T Madsen: Sure. One of the other
committees that I have loved being involved with in AWAEM is the Research
Committee. The Research Committee does great work, puts out a ton of papers,
and really about very interesting and relevant topics. One of the papers that
we put out when I was head of the Research Committee was a paper looking at
gender disparities in salary in academic emergency medicine. That was another
kind of pivotal point for my career that I think really got me engaged and
thinking about how we can help women advance in emergency medicine, and that we
can put information out there, we can start thinking about solutions and
strategies, and that was really all through the AWAEM Research Committee, the
opportunity to use the data, to write the paper, and to network with colleagues
who wanted to think about the same issues.
M Lin: Now you’re
T Madsen: Oh, thank you. I’m excited.
M Lin: What prompted you to
pursue that role?
T Madsen: Again, and this a theme
through my career, is that mentorship with people, senior people, coming and
saying, “You’re ready. Let’s do this,” knowing that this is my area
of interest, and that it fits very well within my career trajectory. I love working
with AWAEM in general, but having mentors say, “Tracy, I think you’re
ready. Let’s do this.” That’s really how it happened. Something I’ve been
thinking about for a few years and looking up to role models and past
presidents, and thinking, “I would love to do that someday, but when will
it be kind of my time? When will I be ready to do that,” and really having
mentors kind of push me in that direction.
M Lin: That’s great, really
important. Tell me about your vision for your upcoming term.
T Madsen: Sure. Really excited to
learn the ropes and to learn from the incoming president, Dr. Agrawal, about
the leadership of the Academy. My vision, really, is move forward from thinking
about all of the disparities in medicine, in academic emergency medicine, that
women face, and all the challenges and thinking about how we form solutions,
because we’re seeing study after study that’s showing gender disparities in
salary, advancement, ability to choose the tract that you want to go on. It’s
issue after issue, but really thinking about how we can fix these solutions. I
think that we’re ready for that. I think the field is really becoming more and
more aware of the disparities and more accepting that these disparities are
real and that they can’t be explained away, so now it’s time to fix them. I
think that’s my vision for AWAEM, to really be the leading organization in
emergency medicine that’s strategizing, and finding solutions to these
disparities, and encouraging women to go into emergency medicine and know that
they’re going to have… or hope that they have… more equality in coming
M Lin: Great. Can you
describe any maybe current or future AWAEM initiatives that you think are going
to support these goals?
T Madsen: That’s a great question. I
think one is collaboration with other academies. Again, really finding
strategies to disparities in emergency medicine. Part of that is based on
getting other people engaged. We can’t do this alone. We have to have our male
colleagues, and our female colleagues, and really everyone on the same page and
understand that these disparities exist, and everyone at the point that we want
to fix it. I think one of the things is collaborating with other groups and
other academies and showing people that this really does affect everyone, not
just AWAEM, and not just women in medicine, and that we need to work together
to find solutions, whether it’s salary transparency, bringing this to light,
talking about this in open forums, coming up with the white papers. Those are
all things that we’re working on currently, I would say.
M Lin: Great. How do you
anticipate the professional needs of women in academic emergency medicine will
change in the next 10 years?
T Madsen: I think we’re going to just
keep asking for closer, and closer, and closer to equality. I think for a long
time women in medicine and women in a lot of professions have settled for less
than equality, and settled for, “Well, I’m a woman. We’re going to have
disparities. It is what it is,” and kind of accepting that. But I think,
as I’m seeing trainees, or as I’m seeing my residents train, and faculty more
junior to myself, just getting really frustrated with these issues, I think
people will not accept it any more. I think the women that are coming up in the
ranks are going to be expecting equal salaries, equal advancement, support for
maternity leave, et cetera. They’re really going to expect equality in all
M Lin: With that lens, how
do you think that leadership roles in women-focused professional organizations
are considered for the purposes of academic advancement?
T Madsen: That’s also a great
question. I think, for me, involvement in women-focused organizations, like
AWAEM, AMWA, other organizations that I’m involved in that have really a gender
focus have been critical to my career in providing the support that I need. As
I mentioned throughout the interview, kind of the mentorship and those senior
leaders in emergency medicine identifying younger women, saying, “You’re
ready. You’re ready for this leadership position,” and really putting you
into roles that maybe you wouldn’t put yourself into. Naturally, those
leadership roles, papers, publications, that people kind of nominate you to do,
all go toward promotion, and go toward career advancement.
M Lin: I’m going to
transition a little bit more to questions about your career in a broader sense.
How do you feel like gender has affected your own career development? I know it
has always been an interest of yours, but has it impacted your career growth in
T Madsen: That’s a great question. I’m
not sure. I mean, I think when you look at your own career and kind of reflect,
the natural thing is to think like, “Oh, I haven’t experienced any issues
or any disparities.” But I think being a woman in emergency medicine, like
all of my colleagues… or many of my colleagues… I know have experienced
being called something other than, doctor, whether it’s nurse, or not being
called, doctor, being called by their first name, where your male colleagues
are being called Dr. So-and-so without any thought can be frustrating and
difficult when you’ve worked so many years to get to where you are. But I think
being part of organizations like AWAEM and the other organizations that I’m in,
speaking with mentors and colleagues about this really just turns those
frustrations into inspiration, and really makes you want to do something about
these issues, and talk about it, and write about it, and change things.
M Lin: How do you feel like
involvement in AWAEM has translated into greater gender equity in your own work
T Madsen: As I was mentioning, when I
was on the Research Committee, was the head of the Research Committee for
AWAEM, and we decided that we were going to write a status update paper on the salary disparities in medicine issue. That really transpired into a lot of changes,
even in my own department, and I’m hoping in other departments, as well. But it
really brought to light that, yes, there is still a salary disparity in
emergency medicine, even after adjusting for all of these factors that people
typically used to kind of explain away any disparity, so maybe women work less
clinical hours, maybe they’re taking longer leaves, maybe they are not as
productive, et cetera, et cetera, which, really, it’s not true. There is a
disparity despite all of these other confounding issues.
T Madsen: After we put out that paper,
I think it really got people talking. Even in my own department about, one, is
there disparity in our department? Do we need to look into this? What can we do
to make things better? What can we do to make sure that we are doing regular
audits of salaries? We’ve had multiple task forces and committees, even within
my own department at Brown, looking into potential issues and making sure that
things are as equal as possible. Really, just opening the conversation has been
the first step, I think, in our own department. I’m asking our leadership to
meet with us and talk about issues that we’re concerned about as women. It’s
gone really well, I think.
M Lin: What career
accomplishment would you say that you’re most proud of?
T Madsen: One of the things that I’m
very proud of is becoming president-elect of AWAEM. It’s an organization that
I’ve really valued for many years and has done amazing things for my career. To
think that I could kind of pay back, and give back, and serve the organization
as a president in a couple of years is really exciting for me, because there
are so many amazing women that are part of the organization. I think our last
count was over 500 people that are on our site. I think that I would be a
leader of all of these amazing women is really just humbling for me. I’m very
M Lin: Great. What piece of
advice would you give a younger version of yourself or an AWAEM member at an
earlier stage of her career?
T Madsen: I think the advice that I am
still giving myself, so I would give to the younger version of myself, as well,
is to put yourself out there, push a little bit, do things that you think you’re
not quite ready for, because you’re probably ready for them. You have the
skills. You have the knowledge. If you don’t have every little piece, you can
learn on the job. I think that’s one thing that I know that I do, and I think
other women probably do, as well, is kind of hold back in taking that next step
in their career until they feel they’re 100% ready. But to really put yourself
a little bit early, before you think you’re totally ready, because you’re
M Lin: Anything else I haven’t
asked you about AWAEM or about yourself that you’d like to share?
T Madsen: When I think about
women-focused organizations, and this is actually something I’ve thought about
for several years, for even through medical school, I was very involved in
gender-focused and women-focused organizations like AMWA. I think there are a
lot of trainees and junior people in medicine that feel like we’re in 2020, we
don’t need this. Everything is fine. I don’t need to be part of women-focused
organizations. But, really, it’s critical. I think as trainees go through the
process, they realize that there are issues with disparity in medicine and that
forming networks and bonds with your women colleagues, and really learning more
about these disparities and how we can fix them is critical. That’s been
something for my career that I’ve really cherished over the years.
M Lin: Great. All right.
Then, okay, last question. Please name three other AWAEM members you think we
should interview, maybe one around your career stage, one slightly more junior,
one more senior.
T Madsen: I would say the one that’s
slightly junior to me that is amazing, and I am amazed the more I get to know
her, Taneisha Wilson. I don’t remember if I recommended her last time, but
she’s at Brown. She was a junior resident to me when I was in residency, and
just to see kind of her career trajectory has been great. She’s working at
Brown still and working on diversity and inclusion in emergency medicine. I
think she’s just amazing and really an up-and-coming star in emergency
medicine. That’s the junior.
T Madsen: Then you said one around the
same stage and one more senior. I don’t recall if you’ve interviewed… have
you interviewed Libby Nestor or Catherine Cummings? They’re both amazing.
They’ve been my kind of women in emergency medicine role models since I started
in emergency medicine. I can remember starting as an intern at Brown and having
these strong female role models clinically that were just like amazing clinicians
and were some of the first women in our group at Brown when there were very few
women in our group in emergency medicine. Just seeing them and learning from
them about clinical care in the E.D. has been spectacular. They’re also great
mentors. They’re sponsors. They’re amazing. I don’t know what I’ll do when they
leave, or if they leave, Brown. I would say those two for more senior people.
T Madsen: Then around the same career
stage, Naz Karim, who is great. She’s part of the leadership of GEMA this year.
She’s great. She’s doing lots of international work. Again, kind of
up-and-coming in leadership in emergency medicine. She would be a great
M Lin: Perfect. Well, thank
you so much, Dr. Madsen.
I am a Critical Care Physician and spend a good amount of time in the Emergency Room, seeing consults. As an Internal Medicine resident, we were often in the ER, admitting new patients. In my three years of residency, we spent only two to four weeks working in the Emergency Room. It was the one time I had an insider’s view to life as an ER physician. And man, was I blown away — by the pace, variety, efficiency and organized chaos that is Emergency Medicine. Many of my classmates and later trainees would find a way to skip or slack on this rotation. My experience with Emergency Medicine has given me valuable perspective which I’d like to share.
The Emergency Room triages, manages, admits and discharges a number of patients. ER physicians are highly versatile, quick on their feet, trained to respond to emergencies and a common cold with equal finesse and ease. They can help a patient with a dislocated shoulder and a heart attack simultaneously. They hold down the fort and are the gatekeepers to hospitals, which are perpetually busy and usually struggling to keep beds open.
Yet, many physicians treat the ER docs with a good dose of disregard, often questioning their decision making, treatment choices and blaming them for the extra work load they apparently thrust upon us. What we look past is the work load they have, going through about 30 patients during a shift, on an average. And that they discharge a lot of patients, the ones we never come across. They shoulder the immense responsibility of sifting through the pile of patients charts in order to triage effectively. ER physicians face the unique job of being the first set of physicians encountering a patient within a hospital system. They have to decide what to focus on if the problem list is huge.
When they discharge a patient, they risk sending home a potentially untreated fatal disease masquerading as a simple headache or cough. When they admit patients, they are met with disdain and skepticism. When attempting to give sign out, they usually have to deal with multiple unanswered phone calls. When they try to justify treatment provided, they are often interrupted by consultants and admitting physicians, while hinting how inadequate their job has been. When they try to be as thorough as possible, their attention is being constantly challenged by beeping alarms, belligerent patients or family members, nurses who need orders entered or a nervous resident trying to get a signature on a consent form.
The Intensive Care Units and the Operating Room can seem similar; however, they receive a filtered kind of patient population. The Emergency Room has to deal with patients that visit the Ambulatory Care or need the Operating room, General Medical Ward or Intensive Care Unit. It is a unique place where all kinds of patients can show up without prior notification in majority of the cases. The rest of us receive our patient seen by at least one other physician.
Let me tell why ER docs are fearless trailblazers, often at the forefront of cool and cutting-edge developments in Medicine. They were amongst the first to embrace bedside Ultrasound, demonstrating the utility, ease and efficacy of using Point of Care Ultrasound or POCUS. Today, bedside Ultrasound is an integral part of Intensive Care Units, Operating Rooms, Inpatient Wards and even Outpatient clinics, when it was previously confined only to Radiology. Emergency Medicine was the first to develop an Ultrasound fellowship for their graduating residents who wanted more time to master this useful technique.
The field of Medical Simulation, adopted initially by Emergency Medicine and Anesthesiology, is now making its way into all aspects of Medicine. In Situ Simulation has become a popular way of teaching in the Emergency Department, given the number of ER doctors now trained in the technique. Again, Emergency Medicine was the first to offer a Medical Simulation fellowship after an ER residency compared to most other specialties.
FemInEM, an online community for women in emergency medicine is the first of its kind. Building a collaborative voice to work for gender equity, outside of any formal medical organization. FIX17, held in NYC, was their first conference idea exchange and brought the online community to life. Very well received, it has now become a yearly conference. Thanks to them, women in other fields of Medicine are beginning to do the same.
SMACC, “Social Media and Critical Care,” the most fun conference I have attended, has mostly ER physicians in their organizing committee. They make it a point to have an equal number of male and female speakers every time. And strive to create a vibe that is informal, attempting to break the silos rampant within traditional Medicine.
Since Emergency Medicine physicians are at a high risk for burnout just as Intensivists are, many ER docs have started a side hustle. They have successfully found ways to merge their creativity and passion with medicine to create lives that are gratifying. Many of the blogs, podcasts I follow are created by ER docs. Personally, I have learnt a lot from these physicians. I have been inspired, motivated and embraced many of these new aspects of Medicine they brought in.
Yes, as doctors, we all work hard. And most of us are overworked, stressed and sleep deprived. This is simply an attempt at providing a tiny bit of perspective to the world that is the Emergency Room by a physician who often visits the place as a consultant. I have learnt far beyond Medicine from them. Many of my close friends work in the ER and are a part of my trusted inner circle.
So, ER docs, we do appreciate what you do, and we thank you sincerely, even if that gratitude isn’t apparent at times.
A version of this piece first appeared on KevinMD.
We’re speaking today with Dr. Kinjal Sethuraman who is Assistant Director of Hyperbaric Medicine at the
University of Maryland and Past President of AWAEM from 2017-2018. She speaks
about how AWAEM has been her “life vest,” and how being a part of AWAEM
has influenced how she writes, negotiates, and how often she thinks about what
other people think of her, which happens to be very little— and also makes
her my hero.
M Lin: Tell us a little bit
about how you spend your time.
K Sethuraman: My job is 75% hyperbaric medicine
and then 25% emergency medicine. I also interview for the med school, I
interview for the MD program, and the rest of my time is surrounded with
anything and everything related to my kids.
M Lin: Great. What initially
motivated your involvement with AWAEM?
K Sethuraman: I know we always remember that
moment when you know that this is something that’s going to be a part of your
life for a really long time. I was in Seoul, South Korea, living there for
about a year and Esther Choo came to visit and she was talking about this “women
in medicine” organization. We had talked about women in medicine issues as
residents together and so she said, “Kinjal this is perfect for you. This
is where you need to be.” So, I came back into academics because I wanted
to be part of a larger community, but then joined AWAEM pretty much in the
first few years, that it started. I became Awards Chair initially, right out of
the gate. I was hooked. I found my people.
M Lin: Why AWAEM as opposed
to any other women focused group?
K Sethuraman: Because it was specifically for
academic women. It also had a lot of very successful women that were starting
it and I thought that was a great place to start. Not just a few friends that
were getting together. Their mission statement and everything that surrounded
it seemed like it was going to be successful because it was started by very
M Lin: And how has AWAEM
affected your career since then?
K Sethuraman: For me it’s really been my life
vest. When I start to get, feel like, you know the clinical work is getting too
stressful or the publications are getting rejected or any low time I just look
to all the great things that AWAEM does and how I can be a part of a much
bigger community. That really keeps me going and keeps me interested.
M Lin: Can you point to any
specific AWAEM initiatives and projects that might have had the greatest impact
on your career?
K Sethuraman: On my career I would say the real
push to publishing. I admittedly am not the best writer and I think because of
AWAEM I’ve gained confidence in my writing skills. A lot of my publications
have come out of collaborations with different members of AWAEM and different
members of our research committees and learning from them and realizing that,
you know what, I’m actually not a bad writer. You see how other people organize
their work, how they organize their writing you see that they fail, and they
figure it out. So, then you can fail, and you can figure it out and it
validates everything that you’re good at and it validates that you can rise above
any setback or failure.
M Lin: So how did you go
from there to being president? What impacted your desire for a leadership role
K Sethuraman: Most of it was I had been a part
of AWAEM for a really long time and I saw it was something I really believed
in. I’m a big proponent of a sense of community, a sense of camaraderie. I just
wanted to keep that momentum going. I started out as Awards Chair; I did that
for a couple of years. Then I mentored other people in the Awards Chair
position. At that time, we had this Member at Large position which was kind of
ill defined. From there I became Secretary or maybe I was Secretary first. I
don’t know what order. At some point I was like you know what I’m just going to
try to be President. It just seemed like the natural next step.
M Lin: You mentioned that
you started out on the Awards Committee. Tell me a little bit about that and
why it’s important for women in Academic Emergency Medicine.
K Sethuraman: It’s no secret that more men get
awards that are impactful for their promotional packages and for their own
validation. When we looked at the data of woman receiving some of the top-notch
awards in Emergency Medicine, whether it’s through SAEM or ACEP, it was almost
all men except maybe for some of the Educational Awards. We wanted to have a
space where we recognized impactful woman. That’s where Awards came in. We
started out with just 3 or maybe 4. From there we moved it and now we have a
lot of awards. It’s this whole beast of its own and the Awards program has
really taken off. This way we can recognize people that would otherwise be over
shadowed by or might be over looked because of unconscious bias in the
selection process of other national awards.
M Lin: When did you first
perceive gender inequality to be a problem in your career?
K Sethuraman: In my career? Gender inequality? I
went to an all-girls high school. I didn’t think of gender as being a thing
because I went to an all-girls high school. It was a really good space for me,
looking back I hated it while I was there, but looking back I thought it was a
really good space for me. It was like being a president of everything and
anything was a girl. It was never a question. I got to college and I found for myself
basically men lead in every leadership position. There was one guy as a
freshman he was like, “I thought you was a senior because you’re so
confident.” I was like I better tone that down. I remember that
conversation I remember exactly where it happened, I remember exactly how it
impacted me in terms of my own confidence and self-worth.
K Sethuraman: As far as medicine as a career, it’s
never not been there. For me in a lot of respects, I just thought that was
normal. I remember times when a surgical chief resident, a female, made a
comment when I was a third-year medical student that all woman should wear
makeup and look their best when they are working. This was a surgical chief
resident female that said that to me! I was like “I don’t even know how to put
on makeup.” I don’t know that stuff. I just thought that was a very sexist bias
thing for a woman to say to another woman and very degrading. I remember other
times when I would use a pen that was a different color. It was pink or
something like that. A male attending would say something like “Oh yeah,
there are only certain types of people that use pink pens.” Things like
that but they were subtle, they have obviously stuck in my mind for a really
long time. A lot of that has been erased because of AWAEM, there was a lot of
reworking of my wiring because of AWAEM.
M Lin: Can you be a little
bit more specific about how AWAEM has helped rewire that for you?
K Sethuraman: Hearing stories of other woman
that had the same exact experiences, but they didn’t take it. They were like,
“Oh yeah, that happened to me and I just stood up for myself. I spoke up
and I talked back, I wasn’t the nice girl. I broke those barriers because I was
willing to take risks.” Taking those risks takes a lot of guts and really
facing those fears of someone saying she’s difficult. Being surrounded by women
that were just like me made it okay to be me. If that makes sense.
M Lin: How has AWAEM
impacted your career perhaps in terms of gender equity and pay or promotions?
K Sethuraman: Now whenever I go in to meet with
my boss, because of the didactics that AWAEM has done at SAEM and negotiation
didactics and talking to woman that are chairs that are willing to share their
secrets, whenever I go into to talk to my chair or any boss, really any
situation where I know I’m going to have to negotiate something, I go in with
data. I learned that because of AWAEM. I learned that because I went to those
sessions and I was really paying attention. I go in with data about how much
I’ve done, what I bring to the table, it’s not like, “Hey, I need to buy a
bigger house. Or, hey, I’m having another kid.” It was like, “No, this is what
I bring to the table, this is my ask. Tell me what I can get to get there to
get that ask.” Having a stronger voice because of bringing into things that the
chair cares about that was a huge lesson that I learned. It’s not just about me—it’s
what I can do for them.
M Lin: Can you describe in
your own experience how leadership in an organization like AWAEM might be
considered for example for academic advancement?
K Sethuraman: It’s a huge national organization
at this point. It’s the largest academy in SAEM. Under my watch we had 250
members give or take. That is not a small number to manage. We have an
organizational structure that is large and complex. Managing all those people
who are effectively, if you were looking at a job in business, they would be
direct reports. Looking at from a point of view of running a company or running
an organization that is a pretty big deal. That skill set of leadership is
something that you don’t have necessarily have the opportunity to get if you
were not part of an organization like AWAEM.
M Lin: How have you
perceived a leadership role in a woman focused professional organization has
been perceived relative to a leadership role in any other type of national
K Sethuraman: By people at work or in general?
M Lin: Anyone.
K Sethuraman: I don’t know. I don’t think about
what other people think as much as I used to. That’s because of AWAEM. I know
that I have a lot of pride in my work through this very large complex and
productive organization and I’m very proud of that. So, if anyone says, “Hey
you know what it’s just a woman’s group or hey what do you do? Do you just go
to dinners or something?” I answer by saying exactly what I’m saying here.
I explain these are our accomplishments. I led an organization that was 250
people, its triple the size of our faculty. I’m very proud of that and it
doesn’t matter that it is a woman’s organization or not. These are woman that,
each one has their light, we try to amplify every single person that’s part of
M Lin: How have you seen
K Sethuraman: Over the years, I have been a part
of it for 8 years now, it was smaller more intimate, when I first got there. At
the organizational structure, it has ballooned, we have multiple Vice
Presidents now that we did not have before. We have the Executive Council
that’s very large all by itself. Then we have lots and lots of people on the
committees. Everyone wants to be involved. I think that because it is such a
huge group you do need that organizational structure and you do need to create
opportunities for people to take on leadership and take on a project. It’s
gotten bigger and better and more complex.
M Lin: How do you anticipate
the needs of woman in Academic Emergency Medicine might befall in the next 10
years? And how AWAEM might meet those needs better.
K Sethuraman: In the next 10 years? I think in
the next 10 years what we are going to find is more and more woman going up. I
think in the next 10 years what we’re going to see is we are at a point where
it is cool to be a woman in medicine. Where its programs are specifically made
for women in medicine and I think that, in itself, speaks volumes about where
we are going to be in 10 years. We are going to continue to take risks, take on
leadership, and tell our stories of how we got there. You are going to see a lot
more woman that are going for traditionally competitive male positions.
K Sethuraman: If you look at papers that have
been published from the mid 90’s to the early 2000’s it’s like “rinse, repeat.”
Some of these papers that were written about gender inequities in medicine,
they are saying the same thing that we are saying. We are just like “rinse,
repeat,” it’s a broken record. I’m really tired of this record, hopefully in
the next 10 years we’ll look back and say, “You know what things have changed.
Things have really changed.” There was a paper that I was reading just the
other day, it was published in 2001, its exactly the same stuff we are talking
about now. Nothing has changed, the needle has not moved and hopefully in 10
years because of organizations like AWAEM, because of things like the
conferences for women, we will not be sitting there rehashing the same research
M Lin: I hope you’re right.
We are going to pivot a little bit more towards you personally. What career
accomplishment would you say you are the most proud of?
K Sethuraman: Career accomplishment that I’m
most proud of? I think just getting through med school and matching in
Emergency Medicine. It’s so basic for me. It’s just being where I am right now.
It’s not after residency, it’s just getting through it.
M Lin: That is an
accomplishment. Absolutely. What piece of advice might you give a younger
version of yourself or an AWAEM member at an earlier stage of her career that
perhaps you didn’t know?
K Sethuraman: Honestly, I would say go to
national meetings and join groups like AWAEM. Find your people, find your raft.
If AWAEM existed when I was a resident, I think my career trajectory would’ve
been a little bit less choppy. I would’ve taken turns at different places and I
would’ve had this network of automatic mentors. Rather than trying to seek out
people, I would just have a network and it would be easy.
M Lin: Please name three
other AWAEM members we should consider interviewing. One perhaps around your
career stage, one whose more junior and one whose more senior.
K Sethuraman: Okay. I’ve been thinking about
this. More junior I would say interview Sarah Gibbs at the University of
Maryland. Can I give you more? Danya Khoujah also at University of Maryland.
Those people are a few years behind me. At my stage, let me think about this
one, I don’t know if they’re AWAEM members. Everyone I know is an AWAEM member.
I’ll come back to that one. More senior would be Tracy Sanson, who’s here by
the way. Tracy Sanson is a good one. Jill Baren is a good one. Angela Mills.
There are many, many people above us. At my level I’m in the same cohort as
Dara and Esther, I would interview Dara. Aisha Liferidge I think she is sort of
at my level. Ava Pierce who’s at UT. She is the immediate past president of ADIEM.
M Lin: Terrific suggestions.
Anything else I didn’t ask about AWAEM or about women in Emergency Medicine
that you would like to share?
K Sethuraman: The one unique thing about women
in Emergency Medicine in particular is that we tend to collaborate. Honestly
the culture of AWAEM is collaborative, people who are in it for themselves
don’t last very long in AWAEM because they are slowed down. A collaborative
process is slower than if you were to just pummel through something by
yourself, depending on what that is. The reason why I have kept on with AWAEM
and probably will for my entire career is the fact that it is so collaborative.
Hopefully no one feels that they’re left out or not invited. I feel like we
make an effort to be inclusive.
Third year of residency, 2013; pre Me Too and Times Up. It had been a tough year for me. I felt like I was coming into my own as a clinician, but I began to recognize that things were different for me as a woman physician. I noticed how often I was assumed to be a nurse, how frequent my orders were questioned compared to my male co-residents, and all of this weighed on me. I was one of two women in my resident class of eight; there were only four female faculty at my program. I felt like I didn’t belong in medicine. Then I read Lean In. It was a watershed moment for me. The book provided the evidence and language for the gender bias I experienced and observed. It also provided a tangible path for gender equity on a personal and societal level. I began to rediscover the hope and optimism that drew me to medicine, and I felt an intense need to share this book with my colleagues.
I discussed the book with Dr. Nicole Hurst, one of my faculty advisors. We decided to host a book club to discuss Lean In. It was a safe space for us to share our struggles and our successes. Part of the power of the group came from having mid-senior level faculty at the meeting, as they provided perspective and practical solutions.
From this book club, Dr. Hurst and I formed San Diego Women in Medicine & Science (WIMS). We have quarterly meetings; every meeting has a theme and we discuss an article, book, podcast or videocast. Each meeting includes some unstructured social time as well. One of my favorite meetings was on the topic of Resilience. We discussed Dr. Gillian Schmitz’s FIX 17 talk on Getting Over It: Rejection to Resiliency. During the meeting, a senior physician shared her experience with a very challenging situation that she had encountered. As I looked around the room, the range of experience spanned from intern to physician in practice for nearly 30 years. I could almost palpate the connection and support in the room. A few years after our group had formed, Dr. Hurst left for the East Coast. She began to form a Women in Medicine group at her new institution. She asked for the list of materials we had used for WIMS meetings, and from there, it became clear that we needed to build a shared and enduring curriculum. We reached out to the FemInEM team and formed a working group to build the curriculum. We are excited to launch it on July 1, 2019, just in time for a new class of interns.
Our working group includes Dr. Francesca Cimino, Assistant Professor in Family Physician at the Uniformed Services University, Dr. Katrina Landa, Navy EM Physician in 29 Palms, CA, Dr. Nicole Hurst, Associate Professor in Emergency Medicine from Uniformed Services University, and Dr. Jenny Beck-Esmay, from FemInEM, along with myself.
Women in Medicine (WIM) and Groups on Women in Medicine (GWIMS) are an important component to promoting gender equity in medicine. These groups serve as a way for medical students, residents and junior staff to access tailored professional development for the challenges that women face. Along with professional development, the groups can also serve as a safe space for sharing struggles and success in a supported environment.
The FemInEM Women in Medicine (WIM) Curriculum is a free, open access curriculum that may be used by individuals and groups to promote understanding of gender bias in medicine and strategies for women to thrive personally and professionally. It can be used asynchronously for self-directed personal development. The curriculum is organized by modules. Resources can be used by the individual or to fuel discussion such as focus groups, local meetings, faculty development, residency or fellowship rotations, etc. Each module contains recommended resources for journal and book clubs as well as focused goals, objectives, and discussion prompts. Content is organized into modules, then organized by objectives and length of time for completion. The first module, Communication, is available now, and new modules will be released on a regular basis. Coming soon are modules on Leadership as well as Mentorship & Sponsorship. Modules in development include those on Gender Bias & Promoting Equity, Career Progression & Negotiation, Resiliency, Finances, Work-Life.
The curriculum will continue to be revised and improved, please send your ideas or suggestions to firstname.lastname@example.org We also want to see your WIM and GWIMS meetings; please post pictures and be sure to tag @feminemtweets and include the hashtag #WIMTime.
We speak with
Dr. Wendy Coates, Professor Emerita at UCLA and a
pioneer in emergency medicine education. She speaks about what it was like
being one of the only women in emergency medicine earlier in her career, and
why mentorship has been the most rewarding aspect of her career.
M Lin: Please tell us where
you are right now in your career.
W Coates: Right now, I am a very
proud member of AWAEM, and just so thrilled to see how it’s taken off over the
last 10 years. I’m at Harbor UCLA Medical Center in Los Angeles, California. My
title there is that I’m a senior faculty and education specialist. I’ve
dedicated my whole career to training the next generation of emergency medicine
educators, and education scholars. I have a chance to focus on that, and try to
advance new talent in scholarship in education.
M Lin: That’s so wonderful
and important. When did you first get involved with AWAEM?
W Coates: Well, I think I first got
involved in AWAEM before AWAEM existed because there was nothing like this, and
as maybe some of your members have already said on their interviews, [that]
they found AWAEM to be a great place to meet other people and to gain
mentorship. There were many, many years where many of us felt isolated, and
needed a place just like this, and there was really no place to turn unless you
just knew people. We basically knew each other, and we formed our own little
groups, but of course that didn’t really address the greater, much broader
needs of all women in emergency medicine. We were just so excited to learn that
AWAEM would be supported, and are thrilled with how it’s really developed into
what it is today.
M Lin: Tell me more about
how AWAEM has changed over its 10-year period.
W Coates: Well, I think in the very
beginning, a lot of visionaries in the leadership of SAEM recognized that women
needed different kinds of support because there was a lack of mentorship for
women in academic medicine in general, not just emergency medicine. As a
specialty, emergency medicine, [which] has AWAEM, has been a leader in
developing things that its members need. SAEM had a great vision, and I think
it was Bob Hockberger, who was instrumental in helping AWAEM get off the
ground. I can say that from my institution’s perspective, he was a very
supportive chair to have as a woman. It’s no surprise to me that he was one of
the ones who was involved in getting this off the ground.
For my career, I would say that
AWAEM has been weighed more heavily on me being a mentor for people who are
coming up behind me, but as we all know, there’s so many different kinds of
mentorship. The most common one is people who are younger or more junior than
you. I have been so impressed and pleased to be part of the career development
of so many younger and more junior [doctors] over many, many years. Also, this
is an amazing group of peers, and people who are pioneers in the specialty, and
people who are accomplished across many, many different areas of emergency
medicine. To just be right in the mix with all those people who are willing to
just sit down, and talk, and give you advice without any expectation of
something in return is a wonderful thing.
M Lin: Definitely. You mentioned
earlier this unmet need that AWAEM is filling. Can you compare and contrast
that potentially to other women-focused organizations?
W Coates: Well, I’m not really an
active member of other women-focused organizations at this point. I’ve mainly
dedicated my efforts toward AWAEM, and follow a lot of the other organizations,
such as FemInEM, and organizations that are really making progress. I think
it’s the same idea. It’s women who are talking up other women, and just making
things so good for each other, and celebrating each other’s accomplishments,
and finding opportunities for mentorship and sponsorship when something comes
your way, and you can’t do it or you have something that comes your way, and
you think a junior person would really benefit from it. I think these are great
forms to get partnerships together, and mentorship dyads, and groups together
to accomplish great things.
M Lin: Can you describe any
potential mentorship or sponsorship relationships you’ve developed in AWAEM that
you may not otherwise have encountered?
W Coates: It’s really hard to
separate AWAEM from just the fantastic friends that I’ve made through AWAEM.
It’s almost impossible to draw the line. Well, did it start with AWAEM and now
we go out every time we ever go to a national meeting together because now
we’re just great friends or is it vice versa? I would say that that’s really
one of the greatest benefits too is that there’s all these dynamic women who
are leaders in such different areas within emergency medicine. You know what?
We’re all just friends because we have so many more things in common. It gives
us a broader view of our specialty, and just being able to sit down with
somebody who invented the such-and-such, whatever that might be. You share the
same issues of work-life balance. It’s nice to just realize that you’re not
M Lin: How do you anticipate
the professional needs of women in academic emergency medicine will change in
the next 10 years?
W Coates: I’m hopeful that the work
that the people of my generation have done, which has I think led to the
ability of women of the up-and-coming generation, to really be out on a
platform that most people listen to, will even grow more. So that we don’t need
to have something that says, “Oh, well, women need to have a boost.”
That we will just be perceived by all people as equal. We will be able to make
the same progress in our academic lives, and in our personal, and other
professional lives because we’re a person who is doing the best job, and we’re
not the woman who comes in to do this job, and we’re not hired because we’re a
woman. We’re hired because we’re the best. We’re chosen because we’re the best.
That’s my hope for the future is that the differentiation is just erased.
M Lin: Yeah, I mean, I
certainly hope so. Can you comment on how perhaps leadership roles in
women-focused professional organizations might be considered for the purposes
of academic advancement, for example promotion?
W Coates: Oh, of course. It’s difficult.
Everyone has heard of the glass ceiling, and that does exist. I think we all
feel it to different degrees, but it’s a moving target that you’re not really
able to put a finger on exactly how that really impacts any individual person.
If you are working with an organization like AWAEM, and just looking at the
people who are in leadership roles now, okay, these people are more junior than
many leaders in very big specialty organizations. The work that comes out of
AWAEM today, academically, with committees, with just productivity in general
is, I think, it’s incredible. These women have had the opportunity to be given
just the chance to show how accomplished they are. They know that they can just
look to their right or left, and there’s someone there to support them, and
they know where to send them. These are opportunities I don’t think would be
available in the general pool of organizations.
M Lin: Can you describe how
gender has affected your career development?
W Coates: Well, there’s a long pause
here because I always start out by saying that when I went on residency interviews,
in general, I was the only female who would be on any interview day. Then we
would go on a tour of the hospital, and back then, frequently there would be a
tour of, let’s say, the OR suite because you had a surgery rotation. They would
lead the tour group to the doctors locker room to change into scrubs. Then they
would look at me and say, “Well, I think the nurses’ locker room is over
there. We don’t really know, but we’ll just see you later.” Then they
would go. I think that from the very beginning, that was a very visible place.
thing is related to family because our culture decides that maybe women have
more responsibilities than men in the traditional family for taking care of the
house and other things that maybe some people around you think that you’re not
as serious about your career. When in fact, you are just as serious, and many
times more serious about your career than anyone around you. I would say that
those are two discrete examples of just how being a woman is different than
maybe just growing up being a man, and falling right in.
Oh, I do
have one other one. On every single medical school rotation, it took about the
first week or two to prove that I was at least equal to the men. The men walk
into the rotation. They’re just assumed to be at some basic level of knowledge.
It would really be about two weeks before the women on the team could be
granted that level of baseline knowledge. Well, and then, it was inevitable
that we just proved that we were just the best. We supported each other back
then too. I think that there was sort of a back door, “Hey, when you get
there, this is what you should do. This is how you can do it.”
Then to just
jump forward to AWAEM, now you guys have something like that that’s available and
M Lin: What career
accomplishment or accomplishments would you say that you’re most proud of?
W Coates: Oh, that’s super easy. I am
the most proud of the accomplishments of my proteges. That goes from medical
students to residents to fellows, junior faculty, and my colleagues in my
specialty. I feel like these people are so brilliant. I mean, I just feel so
energized when I see one of them have some award or they are accomplished, and
they’re published, and all of these things. That’s just so fantastic.
M Lin: What advice might you
give a younger version of yourself or an AWAEM member at an earlier stage in
W Coates: The first thing that I
would say is to believe in yourself, and that if you think that you’re right
about something, you probably are. Don’t be afraid to sit at any table and have
a voice. When you have an opinion, then you should voice your opinion. You
should not be militant about it because that just draws criticism, but you
should be calm, and knowledgeable, and be able to back up what you say with
actual knowledge. Very, very importantly, you should find a team of mentors and
trusted colleagues, both men and women, that you can go to for different pieces
of advice, and people who can just travel the course with you as your buddies.
I’m including men and women in that because it’s really important that we do
this all together if we want to reach our eventual goal.
M Lin: Can you name three
other AWAEM members we should consider interviewing? One who is approximately
at your career stage, one who is more junior, and, well, this one says,
“One who is more senior.” And I don’t know how many AWAEM members are
more accomplished than you are, but if you can think of one, we’d love to hear.
W Coates: Okay. Well, first of all,
there’s a ton of people who are accomplished. All right, well, one of my
all-time mentors for my life is Gloria Kuhn, and I think that no interview
would be complete without talking to Gloria about all of this. She would be the
person who is just a little bit before me that I would name. One of my just
about exact age mates would be maybe Mary Jo Wagner. Just to highlight, okay,
about the fact that this isn’t all about work. Mary Jo and I escaped from a
whole fleet of scorpions when we, let’s say, visited one of the Scottsdale
hotel pools after it closed during an SAEM meeting. Scorpions attacked us, and
we ran through the lobby in our bathing suits. We were really, pretty much too
old to do that. It’s not all about everything being official. Then I would say
another member would be Jamie Jordan. She is one of my fellowship graduates,
and is highly accomplished in her career right now, and publishes things, and
is the most organized person I know, and one of the nicest people ever. She
would be a great person to choose as well.
M Lin: Those sound like
great recommendations. Anything else I haven’t asked about AWAEM or about
yourself that you’d like to share?
W Coates: I think that you’ve done a
fantastic job of hitting highlights. I’m sure I’ll think of something as soon
as I walk out the door.
M Lin: That’s how it always
W Coates: It does. I really commend
you for keeping this ship on course, and having such great leadership of the
organization, and I just feel so lucky to be part of it, and to have all of
these great people surrounding me.
M Lin: Thanks. Well, that’s
how I feel too, which is why I’m doing it. That’s a wrap, and thank you again,
Dr Wendy Coates.
Disclaimer: I have no financial affiliations to disclose. However, I do have a ridiculous amount of expenses to disclose. These include student loans, car insurance, health insurance, credit card payments, rent payments, gas, electricity, groceries, and so on. Also, this post is for informational purposes only. Please do not use this as tax, legal, or investment advice. Prior to making any decisions, please consult a professional.
The Fourth of July is fast approaching and storefronts are already filled with commemorative flags, barbecue gear, and fireworks. But what does The Declaration of Independence have to do with the financial independence of women? Let me explain.
In 1774, John Adams left home to fight in the Revolutionary War. He left his wife, Abigail
Adams, in charge of all household finances while he was away. He asked Abigail to invest in
farmland, find tenants for that land, and then manage those tenants. She refused to carry out
his plan and chose to invest in government war bonds and securities instead. Her financial
acumen paid off (literally). Over the next 10 years, she saw returns of over 400%. She used
those returns to support not only her family, but also fellow women in her community.
As we all know, John Adams went on to sign The Declaration of Independence and later served
as the second President. What most people do not know is that Abigail Adams paved the way
for the financial independence of women as one of the first female investors in America. We
have come a long way since the 1700s and for that I am grateful, but we still have a long way to
In the medical field specifically, financial empowerment is not emphasized as much as it should
be. The majority of medical residents have very high amounts of debt and very low levels of
financial literacy. This is frightening, especially for women. In general, women earn only 89
cents for every dollar men make. And because we shoulder more childcare and eldercare than
our male counterparts, we ultimately spend 11 less years in the workforce. We also live longer.
All of these factors make women 80% more likely to retire in poverty.
Scared yet? No need to be. Together we can tackle the various components of financial literacy.
First, let’s start with the basics of savings:
What is a checking account? Checking accounts are exactly what they sound like. They are accounts used to make payments with personal checks or debit transactions and maybe the occasional cash withdrawal from an ATM. That’s about it. Checking accounts are not a place to save money because their interest rates are absolutely abysmal. Most banks offer interest rates around 0.01%. So if you are interested in saving larger amounts of money, consider opening a savings account instead.
What do you mean by interest rate? Think of an interest rate as the amount the bank pays you
as a reward for storing your money with them. It is usually expressed as an annual percentage
yield. So if you have $1000 in your checking account and your interest rate is 0.01%, you will
earn 0.01% of $1000 (which is $0.10) in interest over 12 months.
So how much should I have in my checking account? Most recommend around one month of
living expenses plus an extra buffer of two to four weeks. The buffer will help you avoid
overdraft fees if you spend a bit more than usual or if you need some cash on hand quickly.
Make sure you are meeting the minimum balance requirements set forth by the bank or you
may face fees. There are ways to avoid minimum balance requirements. For example, many
banks will waive balance requirements if you set up direct deposit.
Why should I open a savings account? Your extra money should not stay in your checking
account. Your checking account is linked to bill payments, debit card transactions, and personal
checks. The account information is therefore visible to numerous third parties. This poses a
major security risk. Moreover, savings accounts usually offer much higher interest rates than
checking accounts. The caveat is that federal regulations limit you to six monthly transactions
per savings account, including transfers.
Do savings accounts have higher interest rates than checking accounts? Usually. Unfortunately,
many make the mistake of opening savings accounts with low interest rates. There are plenty of
banks that offer savings accounts with interest rates of 2.00% or even higher. Ally Bank and
Discover Bank are both popular options on the market currently. Both have no maintenance
fees, no minimum balance requirements, and offer user-friendly online banking. Reminder that
this is not a sponsored post. However, if you are a representative of Ally or Discover and would
like to sponsor me, please contact me. (Just kidding!)
So how much should I have in my savings account? Most say at least six months of living
expenses. For example, let’s say you spend around $3,000 per month. Then, $18,000 is a
reasonable amount to have in your savings account. Ultimately, this number can vary greatly
from person to person. Again, make sure you are meeting the minimum balance requirement for
the account if there is one.
That’s it for now, folks. If you are not sure how to channel your inner Abigail Adams and become
financially empowered, stay tuned. This is the first of a series of posts that will discuss the
basics of savings, retirement, investing, advising, and other topics. We will discuss the 401(k)
and the Roth IRA in our next post: Retirement 101.
I’m thrilled to speak with Dr. Megan Ranney, a leading researcher and advocate on the intersection between
digital health and violence prevention and Associate Professor at Brown
University. We speak about her achievements in research and violence
prevention, and how her gender has affected her career.
M Lin: Tell me a little bit about where
you are currently in your career, and how it was that you came to be here.
M Ranney: I am an associate professor at Brown.
I’ve been at Brown since I was an intern, so for about 15 years. My focus is on
using technology to prevent violence, particularly gun violence, and related
sequela like mental health and substance use.
M Ranney: I made my way to where I am now, other
than the fact that I had stayed at the same physical location for the last 15
years, I’ve had a little bit of a wavy path. I always knew that I wanted to do
public health, but wasn’t sure in what capacity. I actually came to emergency
medicine in order to do global health, because I did Peace Corps before med
school. Very quickly during residency I realized that global health was not
going to work for me and my family, and did this period of a couple of years of
being like, should I do ultrasound, or critical care? Trying to figure out what
the right fit was.
M Ranney: I landed on a fellowship in injury
prevention, given that a third of ED visits are injuries. Huge global burden to
injuries, so I figured that I could someday go back overseas and work globally.
And it’s closely linked to many of the things that I care most about in our
M Ranney: So I chose to stay at Brown for the
injury prevention fellowship, and then from there, have just, sometimes
intentionally, sometimes less so, made my way through various career
development grants, both from SAEM and then from NIH, and have created a career
for myself using research to try to transform the care of our most vulnerable
M Lin: Tell me how you first got
involved with AWAEM.
M Ranney: Gosh, I first got involved with AWAEM,
it had to have been when it first started, 10 years ago. I remember sitting in
a room with it would’ve been Gail D’Onofrio and Michelle Biros and Kathy Clem,
talking about the importance of women supporting each other. And at that point,
I was a brand new mom and so my primary concern was lactation rooms, and how do
I do this whole mom doctor balance thing. I started to learn from the women
ahead of me how they’ve managed their career, some of them took me under their
wing, which was wonderful.
M Ranney: And then as I moved forward, I got to
start to take other folks under my wing, some of whom were only a couple years
behind me, but then obviously as the years have passed, there has been a larger
gap between me and the junior members of AWAEM. So it’s been a nice experience
in transmitting learned wisdom through the generations, and just sharing the
joint experience of being a woman in emergency medicine. It’s also been really
neat over the last few years in particular, to see how far we’ve come, from
where we were in those first meetings, nine and 10 years ago.
M Lin: Tell me a little bit more about
that, how AWAEM has evolved.
M Ranney: Early on, it was almost revolutionary to
just be talking about being a woman in emergency medicine. The mere fact that
we were meeting was crazy, and that we were talking about things that were
women’s issues was kind of crazy, I think, because for the generation ahead of
me, so much of their success was about being seen as being able to keep up with
the guys, being just as good if not better. So to kind of openly acknowledge
that was really a big deal.
M Ranney: And then watching as AWAEM has matured,
not only is it acceptable to talk about women’s issues, but we’ve matured into
a group that talks about a lot of other issues too, that talks about diversity
and inclusion in a thousand ways, and that talks about not just what do we do
to support our young moms, but what do we do to support our senior women, and
our women who are trans, and our women who don’t have kids, and our women with
disabilities, and how do we support our women who are researchers, and our
women who are educators, and as we’ve matured and grown, we’ve been able to
focus in on some of those populations that maybe were ignored, or not purposely
ignored, but just not so much of a focus at first, which is really neat.
M Lin: Yeah. So important. Tell me a
little bit perhaps about specific AWAEM initiatives and projects that may have
impacted your own career development.
M Ranney: Oh gosh, there are so many. I mean,
seriously, just the fact that AWAEM was there was huge. I cannot quantify the
impact of knowing that there’s a community of women who have my back, and who I
can go to with honesty, about whatever challenges I’m facing, and get honest
feedback. I remember having a lunch with Gail D’Onofrio, and talking about
raising kids, and her warning me about what was coming as my kids entered
school, and her telling me very explicitly, sign up to be a room mother, but
never bake the cupcakes yourself. It never would have crossed my mind. She’s
like, that way, your kids get to see you being present, you don’t have to slave
around in the kitchen, you can still go into your awesome career work, and be a
terrific mom, and kind of giving me tips on how to do that. And that, I don’t
know if it would’ve been possible without AWAEM.
M Ranney: So to me, it’s not a specific
initiative, but rather the larger entity of AWAEM that’s been so fruitful.
M Lin: How do you perceive that
leadership in women-focused professional organizations might be considered for
the purposes of academic advancement?
M Ranney: So I think 10 years ago, it was not
perceived as something that would advance your career. I think it was seen as
taking yourself apart as a women’s thing, as a way to advance when you couldn’t
advance along the traditional routes. I think that has changed. I think that
leadership in a woman-focused organization for a woman or a man, is now seen as
a huge strength and demonstration of leadership ability.
M Lin: How do you anticipate the
professional needs of women in academic emergency medicine will change in the
next 10 years?
M Ranney: How do I anticipate the professional
needs of women in academic emergency medicine will change in the next 10 years?
I think that some will be the same. I think with every generation, as you first
get out of residency, first get out of this purely merit-based advancement that
we all kind of thought we were part of, up through med school and residency and
maybe even fellowship, when we first confront the realities of gender inequity,
there will still be an important place for an organization like AWAEM to hold
those people close, and say, it’s okay, it’s not you, it’s the system, and then
to give them tools to combat the system.
M Ranney: I think that hopefully we will see a
rising proportion of emergency physicians who are women, and a rising
proportion of women in leadership positions in emergency medicine, hospitals
and academic medical centers. So I think that AWAEM’s role may not be as much
about showing people that it’s possible to have women in those positions, as
much as helping develop them into those positions in a much less, I don’t know
what the right word is … that it won’t be as unusual for that to happen.
M Ranney: I think that in the next 10 years, AWAEM
will have to continue to expand its focus on diversity and inclusion, and
intersectionality in every way, and I think that’s a really important thing for
the organization to do going forward. We’ve been good, but we can be better, we
all can be better, in recognizing all the ways in which we have implicit
M Ranney: And I think that AWAEM can also play a
big role in advocating for continued research on sex and gender in emergency
medicine, and on biases in every form.
M Lin: I’m going to pivot a little bit
to your career, but when did you first notice gender inequity to be an issue?
M Ranney: In retrospect, it had been there for a
very long time, but it really wasn’t until I was a mom that it became blatantly
apparent to me. There certainly had been sexual harassment in med school and residency,
some of which I called out, but to me, that was just, I didn’t identify that as
a systemic issue. It was really when I was a new mom and couldn’t figure out
how to make it all work together that I first felt the unfairness. That my guy
friends who had new babies were able to go back to working 50 and 60 hour
weeks, and I physically couldn’t.
M Lin: And how has your involvement in
AWAEM perhaps translated into greater gender equity in your own workplace?
M Ranney: I’m very lucky. I’m at Brown and our
chair for over a decade was Brian Zink, and he came in with a mission of
creating better equity. At the point when he came in, we had huge issues in my
residency, and in my department in general, around sexual harassment and gender
inequity. And Brian, the reason he got hired, was with the goal of facilitating
greater equity. I think at that point there were three women, maybe four, now
we’re almost 40% women. He put women in many positions of leadership across the
organization, and had an awareness of the issue.
M Ranney: And AWAEM was part of what helped push
him there. It was also of course the fact that I shared a faculty group with,
at that time, Esther Choo was there with me for eight years, I have Tracy
Madsen, I had Neha Raukar, I had Jess Smith, I had Laura McPeake, I had all
these amazing … Catherine Cummings, Libby Nestor, all of these amazing,
strong women who also helped push, but AWAEM gave us a bit of a framework by
which to do so.
M Lin: Really important. What career
accomplishment are you the most proud of?
M Ranney: Man, that’s really tough. So there are
two things. One is I’m super proud I have an R01. I’m like, really proud of
M Lin: You should be, that’s huge.
M Ranney: Thank you, now I’ve got to get the
second, right? But I’m super proud, I think because especially as a woman, it
allows me to do cool science that I think is going to transform care, but it
allows me to sit at the table with more senior men and feel confident that I
can hold my own.
M Ranney: The other thing that I’m really, really proud of is starting AFFIRM, the American Foundation for Firearm Injury Reduction in Medicine, which is a new 501(c)(3) that is aiming to privately fund firearm injury research. That, to me, I’m incredibly proud of because it has been a chance to overcome partisan divides. My co-founder is a gun owner, and our conversation, I hope, will change the national conversation about what we can do to stop the American epidemic of gun violence.
M Lin: That’s incredible, and definitely
things you should be so proud of.
M Ranney: And then of course, my kids and my
husband. I’m still married, and I still love my kids, so that’s good, too.
M Lin: Also important. What advice would
you give a younger version of yourself, or an AWAEM member at an earlier stage
of her career?
M Ranney: Two things. One is, I think, I was
actually talking about this at dinner last night, I think you should always say
yes, and I do subscribe to Judd Hollander’s view that you need to take things
on, because that’s how you develop skills and prove yourself and get known. But
I think that probably there are times where I could’ve been a little more
focused, and that it would’ve served me better.
M Ranney: I would also say to aim high. To not
say, well, I’m not good enough to do X. Say, I want to do X. The younger women,
there’s one woman who’s like, I want to be a hospital president. And I look at
her and I’m like, you are so cool for labeling that now, when you’re a few
years out of residency, because that means you’re going to get there. If you
wait until someone says, maybe you should be a hospital president someday,
you’re not going to get there. You have to identify that goal yourself, right,
so that’s the other thing I wish I’d earlier, was be much more intentional.
M Lin: Please name three other AWAEM
members we should interview, perhaps one around your career stage, one who’s
more junior, and one who’s more senior.
M Ranney: Okay. So most of the women I would name
around my career stage I imagine you’ve already interviewed, or have … so,
let’s say … Kinjal. She would be … I know you just interviewed Esther, so Kinjal.
Or Basmah, would be my two around my career stage. I also think Liz Samuels.
And then, someone more senior, again, I imagine you’ve interviewed Gail
M Lin: Great, those are wonderful
recommendations. Thank you so, so much for your time, Dr. Megan Ranney.
Emergency Medicine is a tough sport. Whether it’s the torrential numbers of patients we see, or the mismatch between societal expectations and possibility, or simply having to slash through the jungle of bureaucracy, the demands of the profession never let up.
I’ve been a foot-soldier in the gritty,
amazing world of emergency medicine for decades. It doesn’t get all that less
difficult over the years, but the challenges, and the ways we deal with them, evolve.
Which is how we have landed here; me,
talking to you, about why I write.
In its most simple terms, writing is an
act of knowing. Without crafting thoughts into the written word, rarely can I
truly understand things. Without writing I skim. I drift. I find myself, as we
all do during certain epochs in our lives, in survival mode, bumping along in a
half-asleep state of existing, far
from the warm, lusty grip of living. And this is when I am at my most
dissatisfied, my most unhappy. To write, which is little more than thinking
with a bit of poetry thrown in, I have to crack that somnambulism. I must get
down amongst it all – feel things, see things anew, question all of it and find
my own understanding of what it means to be here,
next to a dying body, or teaching a junior about the magnificence of a triple
gas disorder, or tending to the wound of somebody scared, or questioning my own
abilities, but mostly, to be present, as a deeply flawed human full of wonder.
Perhaps it’s simply that writing allows me to outfox reality.
To write means paying attention. To people.
Their words. The way they act. The way I act around them. The way the world
feels on my skin, or how it smells, or when it is unexpected and amusing.
Attention means being all in. I am frequently reminded, as I’m sure you are working
in the land of freakish accidents and life lottery, how fragile and fleeting
our time on this planet is. We get one shot, one blink, bookended by vast
manuscripts of nothing, and paying deep, fascinated attention to both the good
and the bad, and certainly the colourful, is one way to have as much of it as
Novels are only a small, and perhaps anachronistic, aspect of the written word. I have found myself writing novels because it was the reading of novels that let me soar as I grew up, and it is hard to fall out of love with the thing that gave you wings. Long form fiction allows you to explore depths of the human condition you can’t do in any other way. And issues! I wrote my first (not autobiographical, oh no, not at all) novel about medical error and its consequences, which permitted me to say things I couldn’t in a different guise. But writing essays, blogposts, tweets for goodness’ sake, is joyful if you pay even the barest of homage to the English language and its possibilities. A novel takes many years to write. Dustfall took me six. But a post can be written in days and can be just as satisfying.
There is an urgency to making art. Art,
literature, music, poetry, these things are more necessary than ever. We live
in different times now. The online world which, sure, has its benefits, also
has a dark, corrosive element; animalistic and violent. It is full of savage
untruth. It delights in misinformation,
in mob attacks, in ego, in oppression. Often, we humans, when in group-mode, are
not necessarily wise and kind, however engaging with art strips away some of
those layers. Removing the knee-jerk outrage, questioning what’s underneath, coming
to grips with your own sophistication of thought and then going on to craft
those thoughts into considered sentences, is a mighty weapon in the war on
Writing well is more than just having a
barrel full of fancy words. It is the way words are arranged into sentences,
syntax, music and prosody that makes them, as Maya Angelou says, slide straight
through the brain and into the heart. But this skill needs to be learnt. When a
quiet and resolute voice came to me without warning or fanfare, saying, ‘I
shall write a novel,’ I had no idea how much I had to learn (and this voice has
taken some forgiving). But I am nothing special – all it took was years of
being prepared to fail, a passion for great sentences, and some hard love from
friends and mentors.
So, write. See things anew, think of things anew, and say things in new and wonderful ways. Write. That’s all there is to it.
Want more from Michelle? Listen to Resa E. Lewiss talk with Michelle on the FemInEM podcast here.
thrilled to speak with Dr. Basmah Safdar, past president of AWAEM from 2016-17 and Associate Professor at
Yale University. She is an expert in sex and gender-specific research with a
focus on cardiovascular health in emergency care. We talk about her journey in
medicine, and how involvement in AWAEM advanced both her research career and
our understanding of sex and gender in clinical emergency medicine.
Lin: Tell me a little bit about where you are
in your career right now and how it was that you got there.
Safdar: So, I am an associate professor at Yale. I
think I define myself as mid-career at this point. I had a slightly different
start. I grew up in Pakistan and went to medical school there. I started
medical school when I was 16, so kind of had a very different journey. But the
school I went to was one of the most competitive in the region, it prepared me
well for clinical medicine and research. So when I came to Yale, I chose to
pick a research career here and I’ve been here all this time. The only time
I’ve left is to finish my master’s degree at Harvard a few years ago. When I
graduated and became faculty here, I was interested in cardiovascular area, and
I became, I was given the position of Director of Chest Pain Center. So, just
like you, when I started something, then I said, “why not collect
data”? So we created a data base for the chest pain center, and over the
years became a massive data base, but one of the things I learned from the data
base when looking at it, frequently, were just some clinical observations that
chest pain was more common in women, it was unexplained, right around that
time, the NIH was looking at different physiology and progression of
atherosclerosis in women.
Safdar: I became very interested in microvascular
diseases as well as subendocardial disease, which is more common in women. My
research in the last what, 10-15 years has kind of honed in on that. So, I
initially did some physiological studies, I got extra training through both the
master’s, but also through a vascular lab to do physiological work in the chest
center patients and that gave a signal that microvascular dysfunction was
indeed much more common in my emergency department patients. That people hadn’t
looked at before, so we created a phenotype in conjunction with cardiology,
using cardiac PET CT to diagnose it in ED patients. And that has kind of
morphed into more of a multi-system look because as I’ve spent a lot of time
with these patients, I’ve realized these are actually very complex patients,
microvascular disease of one organ doesn’t necessarily mean they don’t have it
of other organs.
Lin: That’s so interesting. So, what you are
saying it sounds like is that, both women and women who present to the
emergency department have more microvascular disease.
Safdar: Correct, so a specific cohort that I did look
into was patients with chest pain and patients with recurring chest pain. And
we find that especially for those who have recurring chest pains, it’s much
higher, up to 40% of those patients have microvascular dysfunction. Chest pain,
or ischemia from microvascular dysfunction was just not detected by our
standard testing tools.
Lin: How does that impact how we should be
treating women with chest pain in the emergency department?
Safdar: I think it has implications that they should at
least be recognized. That it’s not supratentorial. These patients may have
ischemia, which is under recognized with our traditional testing including
conventional troponin, and including regular stress testing and even regular
angiography. And these patients require more sophisticated testing, so if they
are patients that keep coming back, and they have features of microvascular
ischemia, then they should be referred to providers who specifically look at
microvascular dysfunction. Because they just require additional testing. I
think this is all going to change as the high sensitivity troponin enters our
market, because it was just approved last year. My suspicion is the high
sensitivity troponin will pick up some of these patients.
Lin: Fascinating. I’m going to switch tracks a
little bit, and ask how you got involved in AWAEM?
Safdar: I think I got involved in right from the start.
I remember attending that first meeting and then just thought it was something
interesting and just stayed a part of it. And then I had more of a role in the AWAEM
leadership when I became involved with the research, the research committee. I
had continued this work of looking at the sex and gender differences in
recurring chest pain. Through that I got introduced the whole world of, I guess
it started with recurring chest pains from patients who were coming to
emergency department and then became, was introduced to this world of that
disease which may be actually be different between men and women.
Safdar: I became very interested in how that impacts
all the other diseases we took care of. So, it became, almost like a new
science of sex and gender medicine. And so I, and then there was another person
at Brown, Alyson McGregor, who had been interested in that about the same time,
so we had put in a didactic, and I think in 2008, for at ASM, got accepted. But it was like the last didactic of the last
day, and it was not attended. We became perturbed by that, that there is a
whole side of sex and gender medicine and there’s no recognition in emergency medicine,
so we wrote a letter to the editor in chief, and he happen to be somebody in my
department, so they didn’t accept it, and when I talked to him he said,
“what’s the data”?
Safdar: We ended up doing a study, looking at the
status of sex and gender medicine in emergency medicine and we found as
expected that it’s not very high. We were interested in then using that data,
to both create awareness and then create a research agenda for our field and
that’s where AWAEM came in, because if you look at AWAEM’s mission statement,
the third mission is actually looking at sex and gender differences and so we
are light years ahead of other organizations by including it as part of its
agenda. When I became involved with the AWAEM research committee, we wanted to
do a consensus conference on sex and gender. But around that same time, Marna
Greenberg, was also looking at this, so we partnered along with Allison and Esther
Choo, and we formed the core group that put in application for the Consensus
Conference on sex and gender medicine. That got approved and we used the AWAEM
forum to recruit, to make awareness, we put a series of didactics, a series of
lectures, manuscripts, both to inform and then to study. In 2014 that
culminated in the Consensus Conference. And the proceedings that came out of
Lin: That’s incredible.
Safdar: So that’s how it started and then as I became
more involved in AWAEM through that committee experience and as a Chair
experience I realize how what an amazing group of women these are. It was just,
it’s just so different. They are just so passionate and so energetic and they
don’t just talk but they actually do. I became interested to be involved, run
for the President. So that I had the opportunity of working with them.
Lin: Tell me a little bit more specifically
about how the involvement in AWAEM has affected your career directly. It sounds
like some collaborations and leadership opportunities.
Safdar: I think certainly the collaboration and
leadership opportunities. Certainly it actually advanced my research itself. Not
just through identifying people that I can work with but also actual
scholarship. It actually just made the trajectory much more steep in the
material that came out of it. And informing the collaborations of people that I
wanted to work with. For example through this Consensus Conference, I got
connected with other people in the cardiovascular area who are working in this.
And including some leaders in the field that I was able to work very intimately
with. And became part of that group.
Safdar: But also, I think it allowed me to, certainly
as I transitioned into the leadership roles in, it allowed me to really
formulate a second interest and a second career goal for myself, which was
really realizing that systems-based interventions have a much bigger impact.
And so I became very interested in how just restructuring and creating systems
to allow people to grow, for example, for professional development, can
actually have huge impact. And that has now become my second big interest. And
I think it’s kind of growing together. It gave me the forum to do that and also
made me realize how rewarding it was.
Lin: That’s great. And when you talk about
systems change are you talking and thinking again about sex and gender in
emergency medicine? Or in other ways?
Safdar: Yeah. The first glimpse of that was the
Consensus Conference that allowed the sex and gender for patient care. And how
having the Consensus Conference had this ripple effect that is still ongoing.
It translated into an interest group. It translated into this whole
collaborative group of research and didactics and international and national
Safdar: But then the second piece was professional
development and faculty development. How creating opportunities and creating
systems and resources for people can allow them to advance through the career. And
this is not just mentorship, also through AWAEM we created these online
modules. We created these didactics. Scholarship. We collected data to identify
where women in emergency medicine are. And we used that data to actually inform
some of the processes that were put in place including the pre-conference
workshop and the focus of each workshop.
Safdar: A lot of resources that you create that affects
not just one person, one institution, but the whole academic female emergency
physicians as a group. And it was interesting. As President I had reached out
to other societies and other specialties to see what else is out there. To see
if we can incorporate some of the things that people who, specialties that have
been around for much longer have already put in place. And what I realized was
there were some things we learned and we incorporated. Such as having a forum
to collect data all the time. But then what I realized was we are, in many ways
some of the resources that we put together and continue to put together every
year is much more than other societies are putting in. It’s very gratifying to
see that in some ways we were light-years ahead for a new specialty.
Lin: Yeah. That’s definitely a theme that I’ve
heard as well. What would you say is the biggest system change that needs to
occur in order to achieve greater gender equity in our field?
Safdar: It’s an important question that I don’t have the
full answer to. Because we actually collecting data on that right now. We do
have an SAEM equity workforce that was created as a follow-up to the paper that
we published as part of AWAEM. In which we showed that there were basic
inequities. And through this taskforce we actually interviewing Chairs and
Vice-Chairs to figure out what are the barriers at different institutions and
what are the perceived solutions? And I think we’re still learning. I don’t
have all the answers but I’m hoping that we will have answers in the next year
Safdar: I personally think that it actually has to be a
two-prong approach. I think we need to put resources to train the faculty,
right? To make sure that when opportunities come that they are ready. And that’s
exactly the kind of stuff that AWAEM does, which is for professional
development for early and mid-career faculty. To create that pipeline.
Safdar: But I think the second approach, and it has to
be at an institutional level as well. There needs to be systems that have to be
policies put in place. Not just policies but a cadre of resources. We are actually learning through these
interviews that there’s such heterogeneity in what is available at institutions
that we can even put a list of ten or five things that everybody can easily
adopt. I think simple solutions like that can make a big difference.
Safdar: There has to be effort made by institutions to
make sure that there are opportunities that are put in place when people are
ready. And then we also have to create the workforce that they are ready to
embrace those opportunities when the right time comes.
Lin: How do you think these experiences have
translated into greater gender equity in your own workplace?
Safdar: I would say maybe in a couple of ways. I have
been fortunate that I’m under one of the few institutions that has a female
leadership. We already have some things that are given. As one of the things
that I brought back from AWAEM was just a peer support group. Because one of
the things I’ve really enjoyed about AWAEM is you go there, you share
experiences and you realize that many of the hurdles and achievements that you
have are common themes and you can learn from each other. That peer support I really
value at AWAEM.
Safdar: And in our department, what we started doing
was luncheons. For women of different stages. Just an open luncheon that the
department pays for. That we have, it started as monthly and then we moved to do
it every other month. We have one item that we bring up that we usually a talk
about imposter syndrome or promotion guidelines for our institution and things
like that. But then we just chat and we just connect. I thought that was
something that AWAEM helped us create here.
Safdar: The second was just being involved with recognizing
important women in the department. Just how AWAEM recognizes and has created
this cadre of awards to recognize women in our specialty. We thought it was
important to at least recognize your peers who may qualify for those awards.
Making a focused effort on putting them up was a more recent change in our
department. We were just not doing it in general before.
Lin: How would you say that gender has
affected your own career development?
Safdar: I think through life I’ve chosen things that
are not necessarily clear-cut. So choosing, you know, emergency medicine for
where I came from, choosing research in an area which is that is not very
clear-cut. Where the resources are not aligned because it’s not clear-cut, I’ve
learned to navigate and figure out nuanced ways of dealing with things. I think
women in general and women physicians, and particularly academic women
physicians, face that every day. Like where things are not very clear-cut, they
have to create their own opportunities. In
that way, I think gender plays a very clear role because you just have to
figure things out. And talking to other women who have kind of created their
own path in the same way, which are not very clear-cut, and which there is no
clear system of mentorship and sponsorship the way it’s … At least you see in
the literature how people talk about it. I feel like it’s different and I’ve
had to create my own path.
Lin: What career accomplishment would you say
that you’re most proud of?
Safdar: I think, and I don’t know if it is an
accomplishment yet, but I think putting this microvascular dysfunction on the
map for emergency medicine, is something that I’m most proud of. It just came
out. It required many years to even put it into a paper, and I feel like that
was a goal, and I think I have to continue to work on that. So it’s not a
perfect goal there yet, but it’s an intermediate step which I’m very proud of.
Safdar: I think what I had the most fun with was
actually the AWAEM presidency. It was a very diverse and amazing group of women
that I just enjoyed so much. I learned and grew so much in that experience.
Lin: What piece of advice might you give a
younger version of yourself or an AWAEM member at an earlier stage of her
Safdar: I would say don’t wait for your mentor to reach
out to you. And especially when I look back, even though I had mentors, and
some very good mentors, I was kind of sitting there expecting that they will pick
me out from step one to step two. And it took me about five years to realize
that you actually have to create your own agenda and you have to bring it and
you have to kind of push it forward. And when I made that switch, it actually
helped me the most. That’s what I would tell anyone who’s starting. Really,
that when you have a mentor, if you have identified a mentor, or people you are
going to work with, then you need to reach out constantly and keep the new
Lin: Great advice. Please name three other
AWAEM members we should interview, maybe one around your career stage, one
slightly more junior or one slightly more senior, or just three outstanding
Safdar: Libby Nestor, who’s at Brown, I don’t know her
too well, but the reason she came to mind is because I’ve just been impressed
how she advocates and how she has put other people within her department, other
women in the department, up for different awards and different promotions. Somebody
who’s around my stage is Marna Greenberg. I had the opportunity of working with
Marna, you know, through the Consensus Conference, but then, since then, that
part of the second gender medicine interest group. And I just find her one of
those few gems who’s truly invested in students, residents, people who she
oversees. Like she just goes out of her way in cultivating them and genuinely
cares about their growth and is a stickler for details, making sure that she
makes all the resources available for them and continues to hound other people
to make sure that they give her students the attention they deserve. And then somebody who is junior is somebody
in my department, Rachel Liu. She was
president of the Ultrasound group before, but she’s still relatively junior.
You know, I think she’s just in the transition of the early to mid now. But
she’s just fantastic. And what I appreciate about her is that she thinks
outside the box constantly and has really advanced the field of ultrasound in
Lin: Anything else about AWAEM or about yourself
I haven’t asked that you’d like to share?
Safdar: What encourages me is how there is a turnover.
It’s not just led by the three or four people who originally started it.
There’s a succession plan which has helped create, you know, bring in constant
people, new energy and new passion, which is what makes AWAEM so rich.
Each February, we celebrate National Women Physician’s Day (NWPD). Created in 2016 by the Physician Mom Group (PMG) in collaboration with Physicians Working Together (PWT) and Medelita, NWPD honors the first female physician in the US, Dr. Elizabeth Blackwell, and highlights gender inequality in medicine. The day is a social media “holiday” of sorts, with timelines flooded with inspirational posts of women in white coats declaring “#IamBlackwell.” The posts are motivational and create a sense of unity, saying ‘we female physicians are all in this together, doing our individual parts to change the landscape of medicine.’ The posts also remind us how much is yet to be done related to gender disparities within the physician workforce.
There is also another hashtag we should note: “#IamCrumpler”. But who is Crumpler? Dr. Rebecca Lee Crumpler was the first African American female physician in the United States.
Born on February 8, 1831 in Delaware, Dr. Rebecca Lee Crumpler was raised by her aunt who was known as the community nurse, caring for the sick and shut-in of the neighborhood. It is this early exposure to medicine that Dr. Crumpler credited as her inspiration for practicing as a nurse and then entering medical school in 1860. In 1864 Dr. Crumpler graduated from the New England Female Medical College, becoming the first African American woman physician in the US. Ironically, Dr. Crumpler was also the only African American physician to graduate from the medical college because it closed in 1873. Initially, Dr. Crumpler practiced in Boston, MA, however, after the Civil War ended, she relocated to Richmond, Virginia and set up practice caring for newly freed slaves with the Freedmen’s Bureau. Not only was she the first black female physician in the US, she also was one of the first African Americans to publish a medical text. In 1883 she published “A Book of Medical Discourses,” a two-part guide on infant and women’s health. Reports regarding Dr. Crumpler’s later life are sparse, with records showing she later moved back to Massachusetts with her husband and died on March 9, 1895.
To put into perspective Dr. Crumpler’s accomplishments, in 1860, the year in which Dr. Crumpler matriculated into medical school only 300 of the 54, 543 physicians in the US were female. That’s less than 1%. How far have we come since Crumpler? Some would say quite far, others would say not far enough.
Currently, approximately 35% of practicing physicians are female. However, just 2% of practicing physicians are black females. These numbers are substandard considering 51% of the US population identifies as female, and approximately 6.5% of the US population is black and female. The statistics underscore what we already know, the physician workforce does not reflect the diversity of this nation. While the reasons for under-representation of minorities and women in medicine are complex, the solution is even more complex consisting of improved recruitment, retention, and inclusion.
Holidays like NWPD and the ‘#WhataDoctorLooksLike’, a social media campaign in response to biased employees prohibiting black doctors from responding to in-flight emergencies, are important parts of combating the implicitly biased view that physicians are white males. These campaigns aim to increase the visibility of women and minorities in medicine and challenge stereotypes that narrow the perspective of what a doctor looks like, further enhancing diversity and inclusion in medicine.
A version of this piece was originally published on KevinMD in March, 2019.