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We Do Not Need to Fix Women, We Need to Fix the System

Op-Med is a collection of original articles contributed by Doximity members.

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Data show over the past decade that more than 47 percent of medical students are women, yet the number of practicing physicians is around 33 percent. Even with the increasing numbers of women entering the field, the number in leadership positions is discouragingly low, especially in top leadership positions.

The leaky pipeline, or the disappearance of women in medicine from medical school to leadership positions, was the impetus for the inaugural Women in Medicine Symposium at Northwestern University’s Feinberg School of Medicine held on Oct. 25, 2018. The departments of surgery and medicine organized the symposium to promote the advancement of women physicians and scientists at Northwestern Medicine. 

I wanted to provide a forum at Northwestern Medicine, an innovative leader in healthcare systems, to not only identify barriers women physicians face and initiate constructive solutions, but also to facilitate networks amongst women in medicine. I enlisted a passionate surgical colleague who serves as the deputy chair of the Gender Equality in Academic Global Health Working Group for the Consortium of Universities for Global Health: Dr. Mamta Swaroop, an associate professor of surgery in the Division of Trauma and Critical Care. Together, we started on a journey that resulted in a meaningful friendship and partnership and a conference impacting over 200 women physicians in attendance.

Along the way, we were joined by two influential physicians at Northwestern: Dr. Cybele Ghossein, vice chair for academic and faculty affairs and professor of medicine in the Department of Nephrology, and Dr. Amy Halverson, a professor of surgery. We were fortunate to have garnered renowned speakers such as Drs. Caprice Greenberg, Taylor Riall and Tanya Menon, as well as many local influential women physicians to share their expertise and experiences. It was a powerful and inspirational day. The overarching themes that emerged at the symposium were career advancement, overcoming barriers, evidence-based data on gender equity and equality, mentorship, sponsorship and finding fulfillment in life.

To kick off the event, we had an empowering talk focused on fixing the system instead of focusing on fixing women. Evidence-based data show decreased RVU assignment to surgical subspecialties dominated by women, despite the fact these specialties often require more time and effort overall for the actual procedure, clinic time, and emotional support for the patient. The presentation delved into the pervasive and deeply embedded nature of overt and implicit gender bias into our society, and how subtle bias can truly be worse and more damaging than blatant discrimination. In order for these gender inequalities to be remedied, attempts to fix women need to be abandoned and attempts to fix the system will need to be undertaken. To do this, it will be necessary to redesign our mental models and paradigms that are so ingrained in us. It will also be necessary to make a concerted effort to not only recognize these issues, but hold individuals and systems accountable for biases—both overt and implicit. Intentional changes and adjustments will need to be made to both the structure and the process within the system. It was emphasized that this is not just a woman’s issue and will require allies at all levels, and of all genders to result in significant and sustainable change. It is no longer a question of whether gender inequity in medicine exists or not; the question is what will be the solution to fix this documented problem.

After those powerful words, we transitioned to our first panel on mentorship, sponsorship, and coaching. One mentor will not satisfy all of an individual’s academic and personal needs, so by developing a portfolio of a diverse group of mentors, an individual can approach a particular mentor for a particular issue. One of the panelists compared finding a mentor to dating: All relationships may not work out, but you have to keep trying until you find a good fit. The panelists advised attendees to recognize the strengths in each other and help each other accentuate these strengths to succeed. It was noted that some mentors do not feel ready to be in a mentorship role because they themselves suffer from feelings of inadequacy. Imposter syndrome affects women at a disproportionately higher rate than men, and it is important for mentors to acknowledge and address this topic. Many physicians who suffer from imposter syndrome do not take risks or feel they have not accomplished enough to deserve accolades or promotion.

The next speaker compelled the audience to find their voice; energy emanated as an invigorating talk on self-advocacy followed. The importance of avoiding passive responses as they can be detrimental in important meetings and interactions with others were discussed. The importance of lining up allies to support you when you advocate for yourself was stressed. It is essential to get beyond “reflected self-esteem” in order to get ahead in one’s career. She also described ways to handle microaggressions within medicine and use those moments to one’s advantage by handling them in a direct and constructive manner.

A panel on diversity touched on topics ranging from the importance of women championing women to discussing ways in which one could handle an intolerant patient, colleague, or superior. The panel ended with an insightful question from an audience member: How women who were not considered to be minorities could be effective allies for their colleagues when they saw an injustice taking place. The consensus of the panel was, we are all human and we should all advocate for one another. The best way to be an ally is to stand up for what you believe in and stand up for your colleagues.

The title of the last talk speaks for itself: "Wellbeing in Women Physicians; Dancing Backwards in High Heels". It was stressed how important it is to focus on what you want at each stage in your career. The speaker emphasized the need for a major cultural shift in society’s views about pregnancy and childrearing. When the speaker said, “It’s not about healing of the cervix, but the formation of a family!” it was met with applause. When compared to the general population, female physicians are 2.27 times more likely to commit suicide, while male physicians are 1.41 times more likely. These numbers are staggering, and we need to care for ourselves and each other.

The final panel on leadership focused on how an individual should position herself to become a leader, as well advice on how to be a good leader. Attributes common to good leaders were: attention to detail, efficiency, and dependability. Women physicians were encouraged to ask for what they want and not be afraid to fail.

From conception to execution, the symposium was an incredible experience. The ability to meet and bring together influential women in medicine, hear their thoughts on changes in and the future of medicine was brilliant. The journey is arduous to ensure gender equity and equality in medicine, however, with conferences like these, we make strides to narrow the gender gap that remains pervasive throughout the field of medicine. A gap affecting nearly half the population of medical students—with nowhere near adequate representation in leadership. The issues discussed are gender issues that every physician, male or female, should be aware of and be actively working towards mitigating. As the system continues to demand changes, we must remember these words from Dr. Greenberg: “We do not need to fix women, we need to fix the system.”

Dr. Shikha Jain is a board-certified Hematology and Oncology physician on faculty at Northwestern Memorial Hospital. Her research focus includes the impact of social media on medicine, gender equity and career advancement for women in medicine, and GI Oncology. She has been an invited speaker on these topics at conferences. Dr. Jain has written for Doximity, KevinMD, and ASCO Connection. She founded and co-chaired the first CME Women In Medicine Symposium at Northwestern.

Dr. Mamta Swaroop is an associate professor of surgery in the Division of Trauma and Critical Care Surgery and serves as the Global Surgery Program director in the Feinberg School of Medicine. Her research focus is academic global surgery, including trauma education and prevention. She was honored as one of Oprah’s Health Heroes of 2018 and also received the 39th Annual Martin Luther King Humanitarian Award from Northwestern Memorial Hospital. Dr. Swaroop and her lab conduct community directed research and programmatic development in Southeast Asia, South America, and Chicago. In Chicago, she developed the TRUE (Trauma Responders Unify to Empower) Communities Course. She is the co-editor of the book Success in Academic Surgery: Academic Global Surgery.

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