A New Beat » Judy Romero

A New York Times article describes the microaggressions that doctors of color frequently experience in their daily practice. In a field dominated by white males, many minority physicians frequently hear comments from colleagues and patients questioning their credibility and undermining their authority. The article emphasizes the importance of raising awareness about this issue and what steps people can take towards eliminating conscious and unconscious bias. The positive impact of diversity in medicine on patient outcomes is also addressed. NPR recently covered a study from the New England Journal of Medicine which found that female primary care physicians spend more time with their patients but earn less money than their male counterparts. While previous research suggests that the extra time female doctors spend connecting with patients may have a positive impact on health outcomes, study authors believe that the extra time female physicians spend with their patients can have profound implications on the gender pay gap. In the latest episode of Rox Heart Radio, Dr. Roxana Mehran brings Dr. C. Michael Gibson up to speed on Women as One, a campaign to promote talent in medicine by offering professional opportunities to female physicians.

A Medscape article examines the trend of women physicians leaving medicine during the pandemic, highlighting increased caregiving burdens and deep-rooted gender disparities such as lack of fair pay and promotion opportunities. Many experts believe that there will be profound, long-term consequences on the gender landscape of medicine with a major impact on healthcare quality, patient outcomes, and future women leaders in the field.

In the latest episode of Rox Heart Radio from TCTMD, Drs. Roxana Mehran, Wayne Batchelor, and Icilma Fergus discuss the #BlackLivesMatter movement and how to combat racism in cardiology. The American College of Cardiology recently published a statement on compensation and access to opportunity which are critical to the health and future of the CV workforce. The statement was published in the Journal of the American College of Cardiology and serves as an important resource for all clinicians as we aim to advance the profession towards the goals of fairness, minimizing and reducing disparities, and improving patient care. A recent report from JAMA Cardiology found that women remain underrepresented in cardiology despite a growing number of female medical students and internal medicine residents. Researchers found that despite a 42.6% prevalence of female internal medicine resident physicians, women are still underrepresented in adult general cardiology fellowships, comprising just 21.5% of the pool. They’re also underrepresented in procedural subspecialty fellowships, including interventional cardiology (9.8%) and electrophysiology (13.7%). They concluded that more research is needed to help reduce barriers to diversity and improve diversity in the field. Source: Cardiovascular Business The Lancet recently announced that it will no longer sponsor “manels” (all-male panels) and will actively take steps to improve the inclusion of all genders, gender equity, diversity, and inclusion in research and publishing. Several prominent cardiologists provided commentary on this initiative to Cardiology Today. By Gloria Feldt Since Edith Irby Jones MD helped to found the Association of Black Cardiologists in 1974, women in the medical profession and cardiology specifically have come a very long way. And yet, gender-based discrepancies still exist. It will take women’s leadership to make the changes necessary to achieve parity in pay, position, and power. Though we’ve seen a woman first almost everything, these facts tell a disturbing tale: A 2018 report published by the American Association of University Women affirmed that women physicians and surgeons are paid 71% of what their male counterparts are paid. This is even worse for women of color. A 2018 Doximity survey of 65,000 physicians showed that on average, women physicians earned 28% less than men after controlling for the amount of time worked and seniority. “[Female physicians] are less likely to advance to full professorships — even after controlling for productivity — and they account for only one-sixth of medical school deans and department chairs,” according to the New York Times. Active engagement by men and women is necessary to make changes that benefit the medical profession, women leadership and the patients they care for. Physician Leadership Is Learned According to “Physicians as Leaders: What’s Missing?” published by HealthLeaders, “Healthcare leaders who are not physicians have typically been groomed for leadership for many years, but the physician has been groomed to provide quality healthcare. There are often gaps between where the physician is and where he or she needs to be to execute the business of healthcare effectively.” A lack of leadership training in physician’s education is placing them at a disadvantage in achieving this mindset and feat. Strong leadership skills like listening, communication, and delegation are not only important when working with patients, but they are equally as beneficial for the physician leader and should provide physician leaders with the confidence that they can learn the additional skillsets of business. “Effective leadership additionally affects physician well-being, with stronger leadership associated with less physician burnout and higher satisfaction,” reports Harvard Business Review. As Dr. Nisha Jhalani, a cardiologist and Director of Clinical and Educational Services at the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital, says, “Physicians spend a decade learning their trade and at the culmination of training there is an entire world of healthcare industry and business to which we have never been exposed. It is the ultimate hands-on training because physicians must learn to navigate these waters without any formal guidance, unless one is lucky enough to find a strong mentor. “Add to this that most women who are new to their roles as attendings may also have young children at home or are in the process of starting a family, and things get much more complex. It is not an even playing field. Women, and especially women of color, will always need to work harder and be better to get their due. The foundation to success is to have a keen sense of your own limits and priorities and to find mentors who will help you forge your path.” What exactly can female physicians do to bridge this gap? Having transparency about available pay data is important for women to know as they join practices and institutions. Doximity, Medscape and other organizations that prepare this information publicly, serve as a great resource. And according to Medscape’s 2019 report, which found that on average male physicians are making 25% more than their female coworkers, this information can be vital when negotiating salaries. Focusing on the steps necessary for promotion in academic medicine are equally important as the number of patients you see clinically. “Although 45 percent of graduating medical students aspire to work in an academic setting, only about 16 percent will do so. Of those who do work in academic settings, up to 38 percent will leave academia within 10 years,” according to reports by the Association of American Medical Colleges, outlined on KevinMD.com. As a physician, time has to be devoted to participating in research studies even if you are not a full time academic researcher as well as becoming a member of academic societies and presenting your work and clinical interests at society meetings. Dr. Jhalini reflects: “I can personally say that I am known to avoid meetings because I dread leaving my young children for more than a night. I have had to train myself to accept that career development involves being heard and being present for the moments that matter. The key to physician success as a woman really has to do with finding your balance. No one can tell you what that is. But if it makes you uncomfortable or if you feel like a “bad mom” more often than not, then you need to make a change. For me, I have been blessed to have leadership that listens to and can respect both my personal and professional goals. That puts the key to happiness back into my hands….and that is power.” Here are three Leadership Power Tools female physicians should practice to take control of their careers and be happier in them. Women need the intention, skills and opportunity to step into greater leadership roles and embrace their power to lead change in the culture of their professions. Cardiologist and a national spokesperson for American Heart Association’s (AHA) Go Red for Women, Dr. Suzanne Steinbaum, observes, “It’s not all pretty. It’s painful. It’s difficult. It’s not always about immediate success. It’s not about pushing through the pain or ignoring it, but realizing that it can’t last forever. The goal is to be authentic and live your passion.” Take The Lead, a nonprofit organization committed to achieving gender parity in every industry, offers three concrete strategies, or Leadership Power Tools, to take charge of your medical career. The three strategies are:

Leadership Power Tool #2: Define your terms—first—before anyone else does. As writer Nora Ephron said in a graduation speech to Wellesley college class of 1996: “Above all, be the heroine of your life.” Physicians can walk a tough line when it comes to holding power—doctors may ostracize a colleague who has become too “administrative,” while management often doesn’t recognize a physician as a true leader because of lack of training. But if you are clear about what your terms of engagement will be—what matters to you and what your boundaries are—it becomes easier to assert yourself as a leader and influencer.
Leadership Power Tool #8, or Employ Every Medium. Use personal, social, and traditional media every step of the way. This means taking to social media, starting a blog, a website, submitting to Op Eds—choose the authentic ways that you can express your voice. Social networks exclusively for doctors can help facilitate professional connections, while a larger social media platform like Twitter is a good place to share and produce content that people can relate to and find helpful. Being a thought leader and having a strong digital footprint will not only be good for your career, as more and more patients are finding their physicians online, but will also help you network with and find a community with other female physicians facing similar difficulties.
Leadership Power Tool #5, Carpe the Chaos, teaches that moments of rapid change can work to your advantage—for in chaos is opportunity. Those are the times when people are by necessity open to new ways of doing things, and if you can propose an innovation or solution, you are more likely to be able to get people to try it out than when times are in stasis. Let’s face it: the paradigm shift in medicine has been occurring for over two centuries. The days when doctors would go on house-calls and care for a patient from birth to death have replaced by a system where doctors have to cram more work into shorter appointments, and overall want more time with their patients.

To remain resilient and find success in the face of the challenges physicians face, it’s essential to take initiative in developing your leadership skills and to use every Power Tool at your disposal. Dr. Charlene Whitfill, who participated in Take The Lead’s 50 Women Can Change The World Healthcare Leadership Program, says, “It was BETTER than any CME course! This really made me think positively about the future for women in the workplace. I was working with jaw dropping amazing women. And, most important, it was women pulling each other up!” Anyone can be a trailblazer by practicing these leadership skills. They create more time for you to do what you love at work: practicing medicine. Be a mentor and leader to medical assistants. Use techniques like communicating with patients through portals and messaging apps, and practicing empathetic listening to lighten your administrative load and make appointments more meaningful to patients. Couple this with Power Tool #8 and share online the effects you’ve noticed your leadership having on patient satisfaction and your own. Happier patients are not only good for your business and reputation, but empathetic clinical communication has been shown to improve patient health outcomes. Having more women in medical leadership positions improves outcomes. As Cheryl Pegus MD, chair of the board of the Association of Black Cardiologists and Chief Medical Officer of Cambia Health Solutions says about the current trends in health care and what women can do to achieve their fair and equal share of leadership roles: “Today we look at value-based arrangements and taking on provider risk. In the corporate world we look at deliverables and compensation based on results. Both of these trends are good for women overall and female physicians. Women physicians in studies are shown to have better clinical outcomes results than their male counterparts and similarly when women are part of senior management or are on the boards of companies, the companies do better financially. But the data alone won’t make change happen. The real issues going forward are ‘being in the room when it happens’ – to quote Hamilton – and making this seem normal, not the exception.” “Once we redefine power as the power TO accomplish something for others, or for the good of us all,” Feldt writes, “women become much more willing to embrace their power as leaders.” Whether it’s speaking up to get properly fitting gloves in the procedure room, transparently setting your priorities for time with family, or chairing a medical association, seeing yourself as a leader and behaving accordingly is just as important as the work you’re being paid to do. It not only affects you, but other female physicians as well. As Pegus says, “Own it and fund it and then you can do whatever you want.” And the ultimate reward is changing how women in medicine are respected and treated so that patients get the best of care.

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Gloria Feldt is cofounder and president of Take The Lead with the mission of gender parity in all sectors by 2025. Author of four books, she teaches “Women, Power, and Leadership” at Arizona State University and is former president and CEO of Planned Parenthood Federation of America. @GloriaFeldt There are so many ways that women can support each other, especially at work. Lean In provides practical suggestions to encourage and promote the success of other women, whether it’s celebrating their accomplishments or committing the time and energy to be a mentor. Are you being paid less than your male colleagues? If so, this article provides a step-by-step guide to asking for a raise. With these practical suggestions, females in any industry can move forward with confidence and prepared to discuss issues backed by data. A Harvard Business Review piece penned by physicians advocates for leadership training to be formally integrated into medical and residency training curricula. The authors argue that leadership skills and management practices can positively influence both patient and healthcare organization outcomes and that systems should be developed to alleviate biases that disregard the leadership capabilities of women and minorities. This reflective piece written by female CEO Carrie Rich gives tangible advice on how to grow as a leader. Read about her 10 tips to incorporate into your own career and personal leadership journey. Women continue to be underrepresented in leadership positions. In this TED Talk, Sheryl Sandberg looks at why a smaller percentage of women reach the top of their professions and offers three pieces of advice to women aiming for leadership positions. Medical schools are slowly becoming more diverse according to a research letter published in JAMA which examined the changing demographics of medical students from 2002 to 2017. NPR noted that researchers believe that the increase in diversity enrollment may be attributed to a 2009 guideline requiring that all medical schools implement policies that help attract and retain more diverse students. Reuters reports that a study published in JAMA Network Open found that minority resident physicians routinely deal with bias during their training. Although blacks, Hispanics and Native Americans together make up one-third of the nation’s population, these three minorities make up just 9% of physicians. The authors note that addressing these unique challenges related to race/ethnicity is crucial to creating a diverse and inclusive work environment and minimizing potential damage to the minority pipeline. Women admitted to the hospital with heart attacks are more likely to survive if they are treated by female doctors, reported The Atlantic in a piece that also examines the enduring male bias in coronary heart disease research. The study, which was published in the Proceedings of the National Academy of Sciences also found that male doctors were better at treating women with heart attacks when they had more experience treating these patients, and especially when they worked in hospitals with more female doctors. According to a recent letter in the Annals of Internal Medicine, disparities in compensation and career advancement persist for women physicians in the United States. Data from a survey of the American College of Physicians (ACP) internists found that the median annual salary for men is $50,000 higher than that for women.

Coming from a diverse background, Dr. Rachel M. Bond recounts her beginning years as a cardiologist and what she wishes she could say to her younger self. Through this article, she hopes to inspire and encourage women to enter the field of cardiology and advises how to navigate issues such as the wage gap and disparities in cardiovascular care.