Time Stamps

• 2:07 Introduction to one woman’s journey
• 3:00 Stereotype Threat
• 6:15 Not all Anger is Created Equal
• 10:17 Asking and Writing Your Own Job Description
• 13:08 Imposter Syndrome
• 15:50 Breaking Points to Self Care
• 18:50 Work Life Integration
• 21:40 Support Networks

Show Notes

• Stereotype threat – when someone is at risk of conforming to a negative stereotype relating to one or more of their identity groups
  •  This term isn’t just a buzzword, but rather a tangible force that holds material impact 
    • Those who experience stereotype threat tend to do worse on measures of intellectual performance (e.g. standardized test scores or working memory)
    • Beyond the classroom, stereotype threat contributes to workplace burnout
  • Women in medicine can experience stereotype threat in many ways. 
    • Qaali (our main discussant for this week’s episode) comes up against: 
      • Those who doubt she can become a surgeon in the first place due to her identity as a Muslim woman 
      • Others who believe she will be less engaged with her medical learning because she has children
    • Other identities around which one might experience stereotype threat: race, socioeconomic status, achieved level of education
• Stereotype threat is just one of sundry challenges faced by women in medicine. Unsurprisingly, these challenges can engender frustration and even anger in those who come up against them. However, “anger” is an especially loaded emotion for women.

• • Female anger is often stigmatized or made to seem incredibly frightening; women who display anger are frequently cast in a negative light.
  • As fiction author Lauren Groff describes, this societal attitude towards female anger means that women are “unable to access” their fury…in other words, they often hold back anger (alongside other negative emotions) in an effort to avoid conflict or the criticisms of others
• Work/non-work balance was another recurring challenge discussed by our female discussants

• • Our discussants described moments when they’ve (inadvertently) sacrificed their own self care in order to meet the demands of their professional and personal lives
  • Proposed solutions vary depending on the person – there is no one-size-fits-all approach to obtaining a satisfactory work/non-work dynamic
• When our interviewees shared their success stories, we noticed two major themes:

• • They went for the ask
    • When our discussants explicitly asked for a desired opportunity (a new position or a change in their job responsibilities), they found surprising amounts of success
    • However, this is easier said than done. “Going for the ask” can come in direct conflict with one’s feelings of “impostor syndrome” – the sentiment that one doesn’t belong, or doesn’t deserve whatever. Impostor syndrome is particularly common among women.  
  • They didn’t do it alone
    • Whether a spouse, a sibling, or a mentor – many of our interviewees were able to pinpoint an individual (or individuals) who helped them throughout challenging moments during their careers
    • Importantly: not all of us are lucky enough to have built-in, ready-made networks of support in our family or loved ones. For that reason, it’s essential that women buttress one another and produce additional networks of support

Transcript

 S: Hi everyone! This is Shreya – Back in Episode 28, I told you guys about a Women in Medicine conference called GirlMedMedia that I had the pleasure to speak at and interviewed the other women speakers. I asked them first, what would they would tell their younger self, which was episode 28 and second, about their stories. Over the past few months, I worked with a Gaby Mayer, an MS4 at NYU understanding and analyzing the experiences that stuck out most in their mind about being a woman in medicine. Gaby does a lot of behind the scenes work on Core IM Instagram and 12 Lead Thursday graphics. So I am very excited to sponsor her and give her center stage and with that I will leave you in her capable hands  

G: Thank you, Shreya! I am absolutely thrilled to be here to talk about one of my favorite topics – the intersection of gender and medicine. But before I dive in, I do want to take a moment to give a quick preface. We’re going to be discussing the experience of “womanhood” in medicine, predominantly from the perspective of our interviewees – all of whom are practicing physicians, and all of whom self-identify as women. I want to acknowledge that this is a narrow sample group, and is not representative of all women. The experience of being a woman is broad and complex. It encompasses folks who do not identify on a gender binary – those who feel that the designations of “woman” or “man” don’t fully capture who they are as people. So while today’s interviews may not be comprehensive, I do hope this podcast will serve as a starting point for a much larger conversation about how gender relates to our work as clinicians. 

[MUSIC TRANSITION]

Okay – on to the main event. As Shreya mentioned, we’ll be stepping away from clinical medicine for the duration of today’s episode. But since old habits die hard,  we’ll still be using a case-based approach to guide us, taking a deep dive into one woman’s journey through medical training and attendingship to identify larger themes about womanhood.  Who is she? Well, I’ll let her introduce herself:

QH: My name is Qaali Hussein. I’m a trauma surgeon. I also do acute care surgery and critical care.  

G: Qaali’s job title is impressive enough on its own. But then we learn a little bit more about her, and her accomplishments take on a whole new dimension:

QH: I’m originally from Somalia. I was born there. I came to the United States at the age of nine and I’m having to learn a new language, um, you know, navigating through a new culture, being a Muslim woman who’s hijab wearing, um, and the fact that I had a goal of becoming a surgeon was something that was completely contradictory in everybody’s eyes.  …all these negative things just, you know, played with my self confidence. 

G: What Qaali’s describing here – the feeling that her identity of “Muslim woman” makes her, in the eyes of others, an unlikely candidate for a surgeon – has a name: stereotype threat. “Stereotype threat” is sort of a buzzword these days, one with lots of different definitions depending on which source you consult. But here’s how I like to define it: when someone is at risk of conforming to negative stereotypes about one (or more) of their identity groups.

I want to be clear about one thing: stereotype threat isn’t just a buzzword – it’s a powerful force. Ample studies have demonstrated that when people feel stereotype threat – that fear or anxiety that they will fulfill a perceived negative expectation – they do worse on measures of  intellectual performance, such as standardized tests and working memory. Stereotype threat also extends beyond the classroom. The literature suggests that it keeps women out of leadership positions and contributes to workplace burnout. 

In residency, Qaali comes up against stereotype threat again. This time, it bubbles up around a very specific identity – that of “mother”. 

QH: I got myself into a residency program where I was doing well, I started having kids and that became the next thing to say, you can’t do it right. I’ve proven to myself, you know, it wasn’t proof enough for everybody else that I’ve made it into a surgery residency. I was told I couldn’t get into, but now while I was in it, I was being told that no, you can’t do it as a mother. .. no matter how well I performed, it was always, you know, oh, but it’s not gonna matter because you’re a mother, it’s not gonna mean anything you’re going to finish and you’re going to be a stay at home mom and you’re not going to help any patients, you know, it didn’t matter. 

G: To me, what’s most striking is how Qaali responds to all this adversity she’s come up against. She buckles down and – well, for lack of a better phrase – sets out to prove her haters wrong.

QH: I had pdfs of my phone, of my books on my phone and I would be breastfeeding and reading at the same time and when I came back, you know, the expectation was that I would be behind everybody else and I came knowing everything that was in the book.

I think in the end it’s served me very well. All this, all these negative things and all these, um, you know, the fact that people had no confidence in my ability to overcome these obstacles gave me strength to say I can do it…But the fact that all these negative things, I can turn them into a fuel for me to keep going. It made me read more. It made me, you know, work harder to prove others wrong. 

G: Qaali frames the nay-saying she experiences as fodder. She has this natural ability to repurpose negative energy, to allow it to galvanize her ambition.  Now, Qaali is the exemplary way to respond to adversity. When I was listening to her story, I couldn’t help but think of all the times that I didn’t act this way. All the times that when I was faced with a challenge, I felt tears come to my eyes, or I backed down entirely. 

My point is that what we see Qaali accomplish here is much more easily said than done. Sometimes, our responses to difficult situations are much less constructive than hers. Sometimes, for instance, we get angry.  

IB: You’re fearing that your colleagues are going to look down at you. You’re fearing that you could lose your job and all of those fears get bottled up and when you have conflict, boom, now you get angry. 

G: That’s Dr. Ilene Brenner, an emergency medicine physician practicing in upstate New York. She goes on to explain how this anger can work against the women who experience it:

IB: anger is a failure for women….when you don’t keep it inside, people perceive you as a failure.

G: Ilene is suggesting that not all anger is created equal – that the emotion of “anger” has additional negative valence when a woman is the one exhibiting it. This is a phenomenon that is not at all unique to the field of healthcare. One of my favorite authors, Lauren Groff, touches upon the stigmatization of “female anger” quite frequently in her writing. Here she is, discussing it in a recent interview. She says,

LG: We’re told to be nice, sweet, not to be angry, because the anger of a woman is an incredibly frightening thing. It’s not something that we as a society value at all. And there’s nothing more devastating to a woman than to be called a harridan, a hag, whatever a witch is—someone with power who fights against the status quo.

Women are not allowed open access to our fury…If you scream at someone…you get called names. There’s so much shaming for female rage. And we are human beings, like men are. But men can yell at other people, men can get into fights.

G: What Groff is describing – an inability to “access our fury” – leads to a social metaplasia of sorts, one where women choose to hold things in or elect to avoid expressions of conflict so that we remain sufficiently likable or palatable. Now, it’s not always a conscious choice; we may not always be aware we’re holding back in this way. Frequently  “likeability” is just the path of least resistance – the price we pay to ensure that we don’t get written off as “bossy” or “difficult”:

KP:  You know, women can be seen as aggressive if they push themselves forward, or uppity.

G: That’s Dr. Kate Prior, an anesthesiologist (and yes, as her accent gives away – she practices in the UK). Kate goes on to explain how this perception of women impacts our behavior in professional settings:

KP: if you look at sort of the old school language of leadership, the very masculine sort of descriptors, assertiveness, dominance, aggression…if a woman demonstrates some of the masculine traits, it’s seen as a bad thing….You know, women get described as bossy. A man when, well, I say never but probably hardly ever be described as bossy in the workplace. I find that inequality just so disappointing when we live in a world where men can do everything that a woman can do and a woman can do everything a man could do.

G: I really echo Kate’s disappointment here. Her anecdote provides a sobering example of how these conversations about gender – which can often be couched in lofty and theoretical language of “stereotype threat” and “accessing our fury” – infiltrate down to the day to day, playing material roles in our ability to advance ourselves as professionals and leaders.  

I think we’d all love to take a page from Qaal’s book – to develop that skill of buckling down in the face of adversity. But that level of grit is not necessarily something all of us can summon all of the time. And that’s okay. Women aren’t perfect, and the standards to which our behavior is held shouldn’t be, either. Someday, I hope to live and work in a world where there is room for female leaders to be a little more human – a little angrier, or yes…even a little bossier.

[MUSIC TRANSITION]

G: Qaali graduates from residency – juggling motherhood all the while – and starts a new job as an attending. And she finds plenty to keep her busy in her new role:

QH: I came to a small community hospital that has been a level two trauma center for a short period of time. And I came from a level one trauma center that was very academic and the kinds of things that I saw, you know to me were concerning. So I started voicing my opinions and saying, you know, this is not right, this is inappropriate, this is not standard and we should do something about it…I ended up talking to one of my mentors. So the best advice that he gave me was, you know, take on a leadership role, you know? Yes, you’re young. Yes, you just got there, but you can make the change yourself. 

I ended up writing the job description of what we needed in an ICU director and I said,. These are the things that I’m working on right now.  I ended up creating the position in getting hired on to do the job. So when I went to go to talk about this, I said, you need someone hired to do this. I’m here already working on the steps to get there. So, and I’m a, you know, capable and the only person here who is ready and willing to do it. Here’s the position, here are the requirements and I’m here to do the job, to be paid to do it. Um, I did not volunteer. 

G: I want to highlight one key component of Qaali’s: she sits across from her supervisor and she makes an explicit ask. Among those we interviewed, this very act – the act of going for it, of making the ask for what you want or deserve from your career – was at the crux of almost every single success story. Here, for example, is Dr. Jess Willett, an emergency medicine physician, talking about how she landed a spot on the board of directors for a Global Health team: 

JW:  I’ve had to do a lot of learning? as I go and just ask, ask for an opportunity in general, just see how things work out… I approached the board of the organization and I expressed how much I was getting from working with them and how I thought that I could contribute in my own way and really kind of helped to develop things with this vision that I had. And it was only the ask and I got the yes.

G: “Going for the ask” isn’t just something our interviewees did themselves; it’s also something they urged other women to do, too. They gave this advice to one another in varying forms:

CP: Learn to ask for what you need and what you deserve because if you don’t ask, you’ve already told yourself no.

G: But “learning to ask” isn’t as straightforward as it might seem. As Kate Prior (the British anesthesiologist) points out, it’s often more challenging for women to make the ask and seize these opportunities. This is because we often don’t feel we are deserving or qualified:

KP:  Imposter syndrome is very common in high achievers and it is far more common than in women than in men.  Say you were to look at a job description and the person specification wants 10 particular things. A man was saying, oh, well I’ve got six of them, I’m going to go for it. Whereas a woman will think, well, I haven’t got all 10. I can’t possibly apply…and again, that’s the imposter syndrome kicking in, making my holy competent, highly capable female trainee think. Actually I can’t do that where she really can.  

G: The tricky thing about impostor syndrome is that it doesn’t necessarily “disappear” once we learn about its existence. This is something that came up during the creation of this episode. One afternoon, while going through edits, Shreya – who is known for her advocacy work with women in medicine – shared her struggled with impostor syndrome:

S: In my story, I’ve found its not as simple as “just asking.” We talk about going for the ask all the time #womeninmedicine chats or advocating for yourself on the Curbsiders Women in Medicine series but for me there is much more to unravel just to get to the ask. A lot of it comes from been brought up in a way of censoring myself to be less threatening for others or not get hit with a #likeability penalty. So even getting to an ask, I often find myself being conflicted if I’m being too difficult or inconveniencing someone by asking and do lots of internal questioning of what are my values to get to strong conviction. I actually often talk to a few people and have them coach and role-play with me before any negotiation or imp mtg where I have to advocate for myself and not just for others. This where peer-mentorship can be important in combating upbringing.

G:  Here Shreya highlights that the solution isn’t as simple as “if only women asked more, we would achieve gender equity.” The solution isn’t as simple as “let’s fix women — if only they were more confident!” There is so much more to it. There is much more to it, more layers to peel.                                                                                                                                                                                                               

[MUSIC TRANSITION]

G: Now that Qaali has firmly settled into attendingship, time – specifically, time for herself – has become one of her biggest challenges: 

QH: I’ve put everybody, um, my, you know, my family, my career ahead of my self care and I didn’t realize it until I got myself into trouble. I got to a point where I was busy and picking up kids and homework and this and that, and it was time for dinner and I didn’t have time to cook. I went and picked up food for everybody except for myself. I fed everybody and when it, when we sat down, I looked around and I had no food for myself and that’s when I realized, I have to start thinking about me in addition to everybody else that I think about. 

G: This anecdote is striking. But what’s even more striking is that Qaali’s experience is not unique. Here’s Doc Swiner, a family medicine physician describing how she, too, let her self-care take a back seat:

DS: After, you know, becoming an independent entrepreneur, getting married and having two kids…I literally passed out at work because I was doing too much. 

G: So many of the women we interviewed were, like Doc Swiner and Qaali, are able to pinpoint a specific moment where they felt overstretched to a breaking point – where, face to face with their limits, they were prompted to take a hard look at how they were structuring their time. The way Qaali sees it, this is a phenomenon that is tied to the experience of womanhood:

K: I think one of the most important things that we as women do when we want to have a family and we take most of the responsibility for our family and we want to have a career and we want to take leadership roles in our career is we think we can handle it all ourselves.

G: That feeling – of having to “handle it all ourselves,” even if it’s far more than we can manage – is exceedingly common among women. But we’re not masochists – we’re not making a conscious or deliberate choice to spread ourselves too thin.  It happens because we naturally assume responsibility for certain things – like figuring out what’s for dinner, remembering the birthdays of colleagues or family members, being the undesignated agenda keeper for meetings – tasks that fall under the category of “emotional” or “unpaid labor”.

 It’s so ingrained in us to take on these tasks – so culturally encoded, so reinforced by the societal context in which we live – that it can feel instinctual. I once had a mentor – a highly respected female surgeon – describe this phenomenon perfectly. She noticed that when she’s in the middle of a busy day and her mind wanders for a second, it almost invariably goes to one place: her kids. Curious, she asked her husband (also a successful surgeon) what he thinks about when his mind wanders. His response: he thinks about the cadaver study he’s working on. 

G: We don’t know where Qaali’s mind wanders in the middle of a busy work day. But she’s seemingly found a way to get around emotional labor. To juggle her responsibilities as a mother with her responsibilities as a physician, Qaali’s found a solution – she compartmentalizes:

QH:  I put all my shifts together so that when I’m in work mode, I’m in work mode and so all the CMEs that I have to do to keep up with everything, all my readings on my, you know, question banks that I have to do anything work related…And the block time that I have off is when I am a mother, you know, I try and take care of my household, do projects with my kids. 

G:  Qaali’s clearly got a good sense of what work and non-work structure fit her needs. As an aside: I’m using that term “non-work” deliberately, because it isn’t just mothers or wives who struggle with this – it’s all kinds of women, even those who have other priorities.

In Qaali’s case, a segmented approach was the way to go.  For other women physicians, a satisfactory work/non-work dynamic may look decidedly different. Here’s Marguerite Duane talking about her journey in finding what works for her:

MD: I made the radical decision to quit my job and to stay home and be a stay at home mom.I loved being a stay at home mom. But I also knew I missed patient care. I loved taking care of people and really forming that doctor patient relationship. And so I explored ways in which I could combine both, how could I be a mom to my four young children and be a physician. And I found that through direct primary care, which is a house calls only based practice…So I provide care to my patients from cradle to grave and I do it in a time in a manner that’s really convenient for them and convenient for me at different times in my life, I can either expand my practice or limit my practice to make sure I’m getting that appropriate level of balance.

G: Instead of creating a segmented schedule like Qaali’s – one that delineates strict “hospital time” and “home time” – Marguerite actually searches for a way to blur those lines, to bring her personal and work schedules into closer proximity.

The point here isn’t that there’s a right or wrong way to approach this question of what work-life integration looks like. What that looks like is going to be different for every woman, because we’re not all juggling the same things, either professionally or personally.

We may not always feel like we have locked into that elusive perfect “balance” – I know that I rarely feel that way. But talking to women like Qaali is a reminder that it’s important to keep checking in with ourselves – to remain in tune with our priorities and strive to live a life congruent with our values  – otherwise, you may end up sitting at your own dinner table with an empty plate in front of you.

[MUSIC TRANSITION]

G: As Qaali tells her story, she is quick to acknowledge that she was able to navigate these women-specific challenges because of the support of those around her.

QH: One of the things I learned is to create your network to help you do all the things that you want to do. I, you know, I had the support of my family and that was the most amazing thing that could’ve happened. 

G: For Qaali, this support comes in the form of family and relatives. And this was certainly true for many of the other women we spoke to, who cited brothers, aunts, and family friends who helped sustain them through challenging moments in their careers. But it’s key to acknowledge that these familial or spousal networks are a form of privilege – not everyone is lucky enough to have this natural, built-in avenue of support. Which is why it’s so critical that we create networks of solidarity, as electrophysiologist Dr. Susie Figofski points out: 

SF: I think other women truly understand your struggles and conflicts and the complexities of being a wife, a mother and a physician.  I think it’s very important to have your tribe of support. We crave connectedness. We need to feel as though we’re not alone in our struggles.

 G: But again – theme of this podcast – it’s so much easier said than done. Devoting time to connectedness can be particularly hard to do when you work in healthcare. As medical professionals, we train within a larger system that incentivizes the next career milestone, the next abstract submission, the next discharge. With such a never-ending checklist of professional to-dos,  it’s no wonder we feel difficulty investing in our relationships with others – it’s relegated to the bottom of our priority list. 

We’ve spent a lot of time thinking about the challenges that women physicians face – and all the structural and societal changes that will be necessary before we can arrive at true gender equity. I’ll admit, at times, this feel discouraging. But I was heartened by the way that one of our interviewees, Clinical Pearl framed it:

CP: We talked so much about how the medical system is broken and it is, it really is, but the people in it are not. The people in it are kind and compassionate and committed to making the next generation better. And that restores my faith in humanity.

G: Thank you for being one of those kind and compassionate people – thank you for listening. I also want to take a moment to thank my own support network of women who provided insightful feedback on this episode. Working on this podcast has been a timely reminder of just how important you all are. A very special shout out to Shreya Trivedi, who has served as a model of female mentorship throughout this whole experience.

Should you be interested in continuing this discussion, I invite you to join me on Twitter or instagram at @gabmayer/@coreimpodcast. We’d love to hear the ways that this podcast resonated or jived with your story – times that you came up against stereotype threat; what support looks like for you; or anything else that wasn’t mentioned in this episode. 

We will continue the conversation on the Women in Medicine twitter chat this Sunday Aug 25 at 9pm EST. Log on to twitter, go to the handle @womeninmedchat. Feel free to reach out + ask for help if you don’t know how the twitter chat works. I was once that person. We also invite our male allies to join in on the discussion. Because regardless of gender identity,  one may still identify with some of the things that came up in this episode but I hope these stories can make us more introspective and open minded on how these concepts can affect us all differently. So thank you for joining us, share this episode with colleagues and I look forward to hearing you from you on twitter!

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