Pathology Grand Rounds: March 23, 2023 – Jennifer Grandis, MD
March 23, 2023Information
Building and Sustaining Careers in Academic Medicine: A Gender Equity Lens – by Jennifer Grandis, MD
ID9727
To CiteDCA Citation Guide
- 00:00So on behalf of the pathology department,
- 00:03Grand Rounds Committee and also the swim
- 00:06liaison to status of women in medicine
- 00:09liaisons including Joanna Gibson,
- 00:11Rita Aviraj and myself,
- 00:13it's really my honor to introduce
- 00:16Doctor Jennifer Grandes. Dr.
- 00:18Grandis is the Robert K whereby
- 00:21we're forby distinguished professor
- 00:23and head and neck cancer and the
- 00:26Department of Otolaryngology and had
- 00:28neck surgery at UCSF she's received.
- 00:31Um numerous awards for her mentoring
- 00:33and teaching as well as her research
- 00:36into basic and basic and translational
- 00:39research into the genomics of
- 00:41squamous cell and other head,
- 00:42neck cancers and also the role
- 00:44of stat mediated EGFR signaling
- 00:46and head and neck cancers.
- 00:48And for her research,
- 00:49she's received the prestigious
- 00:51R35 Outstanding Investigator award
- 00:53from National Cancer Institute.
- 00:56She currently actually serves on the
- 00:59Board of Scientific Advisors for NCI.
- 01:01And she's also been an editor of The Who
- 01:04Blue Book for head and neck cancers.
- 01:07And in addition to all of that
- 01:09amazing work and all of those
- 01:12contributions as position scientists,
- 01:13throughout her career,
- 01:15Doctor Grandis has also been
- 01:16an advocate for diversity,
- 01:18equity and inclusion.
- 01:19And in her role as the director
- 01:22of the Clinical and Translational
- 01:24Science Institute at UCSF,
- 01:26she developed and implemented programs
- 01:29to enhance professional development.
- 01:31Training and mentorship of women
- 01:33and junior faculty,
- 01:34as well as trainees from underrepresented
- 01:37backgrounds in medicine and research.
- 01:40And she's also published on on that work.
- 01:43And so today we're really extremely
- 01:45lucky to have Doctor Grandis
- 01:47as our grand round speaker.
- 01:49So please join me in welcoming her.
- 01:57So much it is so wonderful to be
- 02:00here with the connections from
- 02:02college and from my prior work in
- 02:05Pittsburgh and old friends and new.
- 02:07And this is a topic that is
- 02:10especially dear to my heart.
- 02:11I've done a lot of work and had neck
- 02:14cancer when a very dear friend of
- 02:16mine developed HPV positive head
- 02:18neck cancer about a decade ago.
- 02:19I understood the difference between
- 02:22research and me search because it
- 02:24suddenly became really important for
- 02:26me to save the life of my friend.
- 02:29And my work on gender equity has really
- 02:31evolved from research to research,
- 02:34and I'm happy to share that
- 02:35story with you today.
- 02:37So we all are little CEO's.
- 02:40At least it used to feel like
- 02:42we were little mini CEO's when
- 02:44we began our academic career,
- 02:46and it was almost passed on to us
- 02:48without explicit instructions.
- 02:50But I understood early on that the
- 02:53way to be successful that was to be
- 02:56promoted to secure tenure, was to.
- 02:59Respect and adhere to the meritocracy,
- 03:03whether it be grant funding or peer
- 03:06reviewed publications or service
- 03:07or invitations to speak.
- 03:09I understood what was expected
- 03:10of me and I did it.
- 03:12And in 2004 I I climbed to the top
- 03:15of the mountain and I thought,
- 03:17oh what do I see from here?
- 03:21And what I saw is I was done with me.
- 03:23I was so uninterested in in building
- 03:24me up as a business anymore.
- 03:26I had no interest in in franchising.
- 03:29But I really felt like I learned a
- 03:31lot and it was my opportunity to
- 03:33really give back in a fully authentic way.
- 03:36And so at around this time,
- 03:37I was given a lot of opportunities
- 03:39to learn about leadership in science
- 03:41and medicine at the University of Pittsburgh,
- 03:44whereas Dr. Dasik and I were reminiscing.
- 03:47It was really an extraordinary time
- 03:49to be there because we went from
- 03:52really an average medical school
- 03:53to a top tier research institution
- 03:55and we came along for the ride and
- 03:58we really believed in the mission.
- 04:00Which was discovery brings patients
- 04:02and if the patient mission is efficient,
- 04:05it will then be reinforced into
- 04:07the discovery mission,
- 04:08which was absolutely true.
- 04:09And so I had had leadership roles
- 04:12in the Cancer Center where I ran
- 04:14a program back when we had Oregon
- 04:16site programs.
- 04:16I became the vice chair for
- 04:18research and my department,
- 04:19which is otolaryngology and then
- 04:21Art Levine who came from NIH is our
- 04:24Dean and Senior Vice Chancellor,
- 04:26Health Sciences.
- 04:27Kind of plucked me out and said,
- 04:30let me teach you what it's like to
- 04:32be a leader in academic medicine.
- 04:33And it was really an effort to retain me.
- 04:35But I really appreciated the effort
- 04:37because it wasn't the right time
- 04:38for me and my family to move.
- 04:40And so for about five years,
- 04:42I went to every Dean meeting,
- 04:43every chancellor meeting,
- 04:45every chair meeting,
- 04:47and I watched and I listened and I learned,
- 04:50and I worked on some projects
- 04:52that were potentially important
- 04:53to me that helped the university.
- 04:55And I also, you know,
- 04:56was elected to all the societies
- 04:58we're supposed to get.
- 04:59Elected to but one thing I became
- 05:00aware of after so many years
- 05:02of being one of the very few,
- 05:04if not the only women in the room
- 05:06is I couldn't really rely on my
- 05:09experiences alone to guide others.
- 05:11This is particularly true in my clinical
- 05:14field of head neck surgery where
- 05:16when I started I I was only woman.
- 05:20It was me and 18 men in internship,
- 05:23and then I was the only woman resident.
- 05:25And now I'm very happy to say that half
- 05:27of our trainees are women, half of our.
- 05:29Junior faculty or women.
- 05:30But it was a very different
- 05:32experience back then.
- 05:33And as more medical students were
- 05:35interested in going into ENT and
- 05:37they would come to me for mentorship
- 05:39because I had a successful career.
- 05:41I was a mother, I had a happy marriage.
- 05:43I I did.
- 05:44I was concerned that my experience
- 05:46couldn't be replicated because I
- 05:48was so research focused and like
- 05:50we could talk about why I decided
- 05:52to spend so much time on research,
- 05:54but I decided that I really needed
- 05:56to understand what the women in ENT.
- 05:59What the world looked like to them.
- 06:01And so I took a validated statistical
- 06:04survey developed by Susan McKinnon,
- 06:06who is a plastic surgeon at Washu,
- 06:09and I modified it for otolaryngology.
- 06:13And I sent it to all the women
- 06:16otolaryngologist in the country,
- 06:17which was 504.
- 06:19And I matched each woman with two
- 06:22men who were practicing ENT in the
- 06:24same region of the country who
- 06:25were the same age because all the
- 06:28surveys previously in other fields.
- 06:29Medicine had concluded that women
- 06:31were underpaid compared to men,
- 06:33but people minimized those findings
- 06:35because it was like they were
- 06:37comparing older men and younger women.
- 06:39And of course those weren't comparable.
- 06:41And I decided I would try to eliminate
- 06:44that bias by doing it this way.
- 06:46And it was very eye opening to me.
- 06:48This is before we had, you know,
- 06:50electronic surveys of the 121 questions,
- 06:53like almost 70% of the people
- 06:56returned the questionnaire,
- 06:57which was exceptionally rewarding.
- 06:59But I learned that women were less
- 07:04successful and less satisfied.
- 07:06And this is despite having tried
- 07:08to put in controls for all these
- 07:11different variables personally.
- 07:12They were more likely to be diverse,
- 07:14divorced or childless,
- 07:15and regret their choice of career
- 07:18and experience higher instance
- 07:20of discrimination and harassment
- 07:22on the basis of gender and.
- 07:25I felt like in my naive and we can talk
- 07:28about my awakening as I've gotten older.
- 07:32I thought,
- 07:33OK now this is information.
- 07:34Two things.
- 07:35I'll publish this because we also earned
- 07:3720% less money for doing the same work.
- 07:39I'll publish this and that
- 07:41will change everything right.
- 07:42Because we're we're data-driven
- 07:43and here's the data and people
- 07:45are going to change their habits
- 07:47and everybody wake up
- 07:48and and and and be mindful of
- 07:49your own career development.
- 07:50And these are the pitfalls.
- 07:52And lo and behold,
- 07:54it was so disappointing.
- 07:562019 where and when Aaron O'Brien from
- 07:58Mayo Clinic wrote this piece and she said,
- 08:00you know, Jennifer Grant has published
- 08:02this I'll really long time ago
- 08:04and newsflash nothing's changed.
- 08:05And in 2020 the DOXIMITY
- 08:08data to look at a pay,
- 08:10a compensation and medicine across all
- 08:14fields found that older Laryngology had
- 08:17the highest degree of gender pay inequity.
- 08:20So here I am.
- 08:22We're still here and so the question is why?
- 08:26And that's going to be a theme
- 08:27for the rest of the talk.
- 08:28Why? When we know a problem,
- 08:31and we all overtly admit that it's a problem,
- 08:34why doesn't it get better?
- 08:38So it's called and NIH.
- 08:40So this is a work by Tim Lay at Washu,
- 08:43wonderful Guy, also an R35 ALDI.
- 08:46And what Tim did he he directed the MD,
- 08:49PhD program. Maybe still does at Washu.
- 08:51He asked.
- 08:52The really important question
- 08:53is is there any evidence that
- 08:55women are discriminated against
- 08:56at the time of peer review?
- 08:58And the answer is no.
- 09:00But here's the bottom line is that.
- 09:03Women stop applying for grants.
- 09:06They're equal numbers of women and men
- 09:09at the F level and at the K level.
- 09:11By the time you get to the ER level and
- 09:14beyond the the gap starts widening,
- 09:17but the gap is in
- 09:19proportionate to application.
- 09:20It's not proportionate,
- 09:21it has nothing it,
- 09:22it seems to be independent of peer review.
- 09:24And so for the last couple of years
- 09:26I was working as a consultant for
- 09:28the intramural program at NIH and
- 09:29some extramural stuff as well.
- 09:31And I said, wait, you guys have data.
- 09:33You know, let's say from Yale,
- 09:36you know how many of the applications
- 09:38to the NIH come from women and
- 09:41other individuals who are
- 09:43underrepresented in medicine?
- 09:45Yes, you do. Does Yale know?
- 09:48And they're like,
- 09:48we don't know.
- 09:49I said I'll bet you they don't
- 09:51because I went to UCSF and I said,
- 09:52do you have,
- 09:53does anybody here have any
- 09:55idea how well represented are
- 09:57women and minority populations
- 09:59are in the application pool?
- 10:02And the answer was nobody knew because.
- 10:04And and so I am really pushing
- 10:05hard at the NIH to give us our
- 10:08scorecards even if they give it
- 10:10to us privately because they're I
- 10:11I've seen the data and there are
- 10:14institutions where close to half of
- 10:15the applications come from women.
- 10:17And the only reason I'm using
- 10:19women as a proxy because we make
- 10:22up enough of the pool of potential
- 10:24applicants that it's actually the
- 10:26numbers are worth looking at it's.
- 10:29Dismal when it comes to other
- 10:30groups who are underrepresented
- 10:32in medicine with no evidence of
- 10:34any improvement overtime.
- 10:35So I'm I'm hopeful that we can
- 10:37get that information back to
- 10:39institution so that the Deans and
- 10:41the chairs know who is putting
- 10:43in grants and and those and
- 10:45I would say that the application.
- 10:49Discordance is reflective of a lot of things,
- 10:53but most importantly,
- 10:54resource allocation, discordance and
- 10:55we'll get to a little bit of that.
- 10:57So this is back in 2810.
- 11:00Years later, Tim looked at the data
- 11:02again and it was exactly the same.
- 11:04So once again, you know,
- 11:05science publication, here we have an issue.
- 11:0810 years later, nothing's changed.
- 11:11Now, what we've all held on to sort of
- 11:14as a beacon of hope is when, let's say,
- 11:17a woman gets a leadership position like
- 11:19you're Dean of the School of Medicine.
- 11:21The rest of us are like,
- 11:22you go girl and ohh progress.
- 11:24Things are changing,
- 11:26but the challenges is that the
- 11:28denominator has not been considered.
- 11:30So what I want to share with you,
- 11:33if you saw this,
- 11:34is that a few years ago they
- 11:36did a very smart thing.
- 11:38They they instead of looking
- 11:40at the numbers of women.
- 11:42Who were advancing along
- 11:44the academic trajectory.
- 11:46They took into consideration the denominator,
- 11:49how many women proportionally
- 11:51were eligible for advancement?
- 11:53And the sad news is that over 35 years,
- 11:59there's no evidence that
- 12:01the slopes are changing.
- 12:03There's no evidence that there's any
- 12:05significant change in advancement
- 12:07or narrowing of the gap over time.
- 12:09So that's the background to
- 12:10what I want to talk about.
- 12:12Today.
- 12:13Now, I mentioned to you that gender
- 12:16in my own career was an awakening.
- 12:19So when doctor Mcniff and I were
- 12:21students at Swarthmore College,
- 12:23it was Coed.
- 12:24It had been co-ed since its inception,
- 12:26and I never once Jen got
- 12:28the feeling that I was.
- 12:30Inhibited from doing anything I wanted
- 12:32to in life because I was a woman.
- 12:34It it was not part of the vocabulary,
- 12:36although I did learn later
- 12:38on this Jenny may recall,
- 12:39I got an award when we graduated and
- 12:41there was a comparable war to a man and
- 12:43we called them best girl and Best Boy.
- 12:45And I found out later on that the best
- 12:47boy got more money than the best girl.
- 12:50So even good old Quaker Swarthmore
- 12:53College has an opportunity for growth.
- 12:55Trust me,
- 12:56when when the Provost discovered
- 12:57that there was more money being
- 12:58given to the male who won the prize
- 13:00and the female won the prize,
- 13:01they changed the rules.
- 13:02But it's just endemic, you know,
- 13:04that's my feeling is I don't want,
- 13:05I don't think I want to.
- 13:06I want to.
- 13:07It probably are our villains
- 13:08and there probably are heroes,
- 13:10but most of us are just people,
- 13:11and most of us just come to work
- 13:13with the same sort of assumptions
- 13:15about ourselves and other human
- 13:17beings that we live in the
- 13:18life outside of work and it.
- 13:20Ends up contributing to this intractability.
- 13:23So I realized when I became a surgical
- 13:25intern that being a woman was
- 13:27different because I was the only one.
- 13:29And there's no doubt that I was treated
- 13:33differently from everybody else.
- 13:34But whether it was grit or
- 13:36resilience or my personality
- 13:38type or the simple awareness that there was
- 13:40no one to complain to, I mean, you know,
- 13:43my daughter's now an intern in Pediatrics.
- 13:45They're much nicer than surgeons.
- 13:46But the truth is,
- 13:47is that there's mechanisms now.
- 13:49So if, if, if.
- 13:50What had happened to me was happening today.
- 13:52There would have been an
- 13:54institutional mechanism or or Ave.
- 13:56for it to be reported it.
- 13:58It didn't exist.
- 13:58And I realized I had to learn
- 14:00how to be a surgeon.
- 14:01I had to learn the trade.
- 14:03So I just dealt with it.
- 14:05And I think one of the reasons
- 14:08that I became so connected to
- 14:10research is that it was,
- 14:13it seemed, less.
- 14:17Vulnerable to these biases.
- 14:19I felt like I understood the metrics.
- 14:21I understood how to write
- 14:23grants and get grants.
- 14:23Swarthmore taught us how to write,
- 14:25and I could publish papers and and it
- 14:28felt somehow protected from the swirl
- 14:31of is she a good surgeon kind of thing,
- 14:34you know, or or or something like that.
- 14:36On the other hand, there's lots of other
- 14:38reasons why I became a researcher,
- 14:39mostly because it was a way to help
- 14:41a whole lot more people beyond my
- 14:43own clinical practice.
- 14:44I got kind of.
- 14:45Used to being the only woman in the room.
- 14:48And I want to say this now because
- 14:50at the time I wasn't aware that
- 14:52it kind of felt good. Sometimes.
- 14:54I didn't process that at first.
- 14:56It was deeply uncomfortable and then
- 14:58I quote UN quote, got used to it.
- 15:00And, and I'll never forget,
- 15:02I was at a meeting in Europe and
- 15:04I was the only woman speaker.
- 15:06And I actually found the words
- 15:07to say to the meeting organizer,
- 15:09I can't believe that there aren't
- 15:11any other women in the world,
- 15:13you know, who would be able to
- 15:15speak on the topic of this meeting.
- 15:17And that he said something
- 15:18along the lines of, well,
- 15:19you, you know,
- 15:20you are at the same caliber as
- 15:22all of the other speakers here
- 15:24and you wouldn't want us to,
- 15:26you know,
- 15:26have to go down into like the
- 15:28second rank and and party was
- 15:30deeply offended by what he said.
- 15:31But I was also a little flattered.
- 15:34So what I would have liked to
- 15:35say is that what happens to you,
- 15:37it's kind of like Stockholm syndrome.
- 15:38You become used to feeling exceptional.
- 15:41You know,
- 15:42Doctor **** and I were talking about that.
- 15:43So in Pittsburgh, you know,
- 15:44by the time I was on like the 20th.
- 15:47You know a chair search committee
- 15:48is the only woman.
- 15:49I finally went to the Dean and
- 15:50said you gotta find another woman.
- 15:51Like there has to be more than
- 15:53me but but you need that.
- 15:54They're interesting.
- 15:55It's interesting, it's fun work.
- 15:56You get to meet people.
- 15:57So but it's a double edged sword
- 15:58and and it's something that I'm.
- 16:00I'm.
- 16:00I'm pleased I realized now.
- 16:02But I wasn't always a realized in
- 16:04that and I had this belief and I
- 16:06think it was naive that if I was
- 16:09great at what I did I would pave
- 16:11the way for others and I would
- 16:12make the world a better place.
- 16:14And then I kept looking behind
- 16:15me and like they weren't.
- 16:17Air like where where was the
- 16:19second string coming from where.
- 16:21And so it was a it was it was
- 16:24not necessarily a good solution.
- 16:27Now I was vulnerable to powerful
- 16:32men who for reasons that we can only
- 16:35speculate about wanted to harm me.
- 16:37And but by training and staying at
- 16:39the same institution for a long
- 16:41time I had even more powerful
- 16:43men who protected me.
- 16:44So when my postdoc mentor you know,
- 16:47stole my. Stuff and applied.
- 16:49And for an NIH grant with my
- 16:52data that didn't belong to him.
- 16:53The Cancer Center director
- 16:55fought that battle.
- 16:56I had to meet with the committee,
- 16:58but I didn't have to take it on myself.
- 17:00And I won't go through all the details,
- 17:02but I had other experiences where the
- 17:04CEO of the health system protected me,
- 17:06or my team protected me,
- 17:08or my chair protected me.
- 17:10And at the time, I didn't understand
- 17:12how important their protection was.
- 17:14It just felt like this was
- 17:16this was what mentors did.
- 17:18This is part of, you know.
- 17:19Living in a full throated world.
- 17:20And so I moved to a new institution in 2015,
- 17:23to a very top leadership position.
- 17:26I was and and I couldn't
- 17:29be protected anymore.
- 17:30There was no one there to protect me.
- 17:31So when the person who was became
- 17:34my boss started harassing me,
- 17:37I couldn't solve it, I couldn't fix it.
- 17:40And that was really the
- 17:42motivation to take on this work.
- 17:44And I realized with my accomplishments,
- 17:46if it could happen to me, it could happen.
- 17:50Absolutely anyone.
- 17:50And at this point,
- 17:52my daughter was about to start medical
- 17:54school and I just felt this powerful need,
- 17:57one,
- 17:57to heal and two,
- 17:58to use whatever voice I
- 18:00had to make a difference.
- 18:02But now it's a really important time for
- 18:04me to acknowledge that I am privileged.
- 18:07I am a cisgender,
- 18:09white rich woman,
- 18:11and even though bad things
- 18:13happen to me and I see bad things
- 18:16happening to people like me.
- 18:18I I need to acknowledge that
- 18:21the experiences of people who
- 18:23are even more different from
- 18:24the status quo than I am can be
- 18:27really amplified in this context.
- 18:29And I learned a lot in the study
- 18:31that I'll tell you about by
- 18:33interviewing people from really
- 18:34underrepresented backgrounds,
- 18:35people who are not necessarily cisgendered.
- 18:38And I understand that
- 18:39intersectionality is powerful,
- 18:41and we won't really understand each other's
- 18:44experiences until we ask and we listen.
- 18:47So right around the time
- 18:49that I was struggling,
- 18:50this report came out from the
- 18:52National Academies of Medicine.
- 18:54Well, it was medicine,
- 18:56sciences, and engineering was
- 18:57all the national academies.
- 18:59And surprise,
- 19:01surprise,
- 19:01the most pervasive harassment and
- 19:04discrimination on the basis of
- 19:06gender took place in medicine,
- 19:08even though the others had
- 19:10their challenges as well.
- 19:11There were five factors that
- 19:13they concluded in the report
- 19:15that created the conditions for.
- 19:17Harassment and discrimination
- 19:18in science and medicine,
- 19:20a perceived tolerance in the workplace.
- 19:23Male dominated work settings
- 19:25with men in positions of power.
- 19:28Hierarchical power structure.
- 19:29So there really is a chain of
- 19:32command and no real way to
- 19:34escape that chain of command,
- 19:36particularly if the perpetrator
- 19:37is in that chain of command.
- 19:40Title 7 and Title 9,
- 19:41but only symbolic compliance with it.
- 19:43We could talk a little bit more about
- 19:45that and maybe what's most important
- 19:47since the messages come from the
- 19:49top, if leadership doesn't get it,
- 19:52doesn't understand what's happening,
- 19:53it just has a trickle down impact.
- 19:56There may be very enlightened individuals and
- 19:58we can talk about the heroes and heroines,
- 20:00and I met many of them and I know
- 20:02many of them. But if we don't
- 20:05have systemic factors in place,
- 20:08we will continue to be vulnerable.
- 20:10To people who happen to be wonderful and then
- 20:13people who happen to be not so wonderful.
- 20:15What happens to women is that they are less
- 20:18satisfied with their job and their career,
- 20:20and they tend to withdraw.
- 20:22Maybe part of the dropping out from
- 20:25the NIH application workforce.
- 20:28And what I also encountered in my study
- 20:30that I'll share with you is when women
- 20:33report that they're being harassed,
- 20:34people either minimize the experience.
- 20:36My favorite response always was him.
- 20:40He seems so nice.
- 20:41And what are you supposed to do with that?
- 20:45Um, you know, because we're all complicated.
- 20:48And of course the people who harm
- 20:50us are loved by other people.
- 20:52They have families,
- 20:53they are decent people in some
- 20:55realms of their life.
- 20:56It doesn't mean,
- 20:56though,
- 20:57that what they're doing to you or
- 20:58what's happening to you doesn't count.
- 21:02I want to make sure that we all remember
- 21:05that women are just as biased as men.
- 21:09This was a brilliant study from Yale,
- 21:12and for those of you who don't remember it,
- 21:13I love this study was so eye opening.
- 21:16There was a CV and the CV was identical
- 21:19and the CD was either Jennifer or John.
- 21:22And they sent the CV to science professors
- 21:25at Ivy League institutions and they
- 21:28asked the professors, men and women,
- 21:31would you be more likely to hire?
- 21:33John or Jennifer and what
- 21:35would you likely pay them?
- 21:37And women and men,
- 21:38science professors in the Ivy League
- 21:41were more likely to want to hire
- 21:43John and to pay him more money.
- 21:45So all this means is we bring our
- 21:49sense of self, our impostor phenomenon,
- 21:51whatever we want to call it,
- 21:53to the workplace and we are all biased.
- 21:56It's just a matter of being human
- 21:58and it's something we just need to
- 22:00talk about a little bit more often,
- 22:01especially when it's gets gets
- 22:03manifested has.
- 22:04Consequences for other people.
- 22:05So my study that I'm going to
- 22:07tell you about is really trying to
- 22:10understand how gender shapes career
- 22:12paths in science and medicine.
- 22:14I hope I've now convinced you that
- 22:15the problem is that women physicians
- 22:18and scientists are underrepresented
- 22:20in leadership position,
- 22:21particularly in proportion to
- 22:22our presence in the field.
- 22:24We experience more discrimination
- 22:26and harassment,
- 22:27and we're paid less than
- 22:28our male counterparts.
- 22:29By the way,
- 22:30the doximity data that I told
- 22:32you about where my field is,
- 22:33like the worst offender, there was no field.
- 22:36In medicine,
- 22:37where women made as much as men zero.
- 22:40So every single there were
- 22:41better and they were worse,
- 22:42but there was no one where it was equal.
- 22:45So the reality is,
- 22:46I think I've said already is we
- 22:49recognize as this is not news.
- 22:51What's news is that it isn't changing.
- 22:54And So what I realized is that I
- 22:56needed to develop the research skills
- 22:59to understand why it wasn't changing.
- 23:01So I learned how to be a
- 23:04qualitative researcher,
- 23:05which is really different from doing.
- 23:07You know,
- 23:07high touch clinical investigation and
- 23:09cancer or molecular biology and cancer.
- 23:11But I was mentored by some
- 23:14wonderful sociologists at UCSF,
- 23:15and then Arlie Russell Hackshield,
- 23:17who's one of my heroes,
- 23:18also went to Swarthmore.
- 23:19But she's a sociologist at Berkeley and
- 23:22had written a lot about women's experiences.
- 23:23And I went out there a few times and
- 23:26really got some very good advice from her.
- 23:28So my objective and I was,
- 23:30I got IRB approval,
- 23:31I used my endowed chair to pay for it,
- 23:33and I wanted to listen and.
- 23:37Understand lots of voices in the in
- 23:40the all across the United States,
- 23:44men and women.
- 23:45Really importantly men too,
- 23:47to understand where we were.
- 23:49And I've always thought this,
- 23:51but I think Albert Einstein said it best.
- 23:53If I had an hour to solve a problem,
- 23:55I'd spend 55 minutes thinking
- 23:57about the problem in 5
- 23:58minutes about the solutions.
- 24:00We don't do that.
- 24:02We especially don't do it when
- 24:04it comes to these really thorny,
- 24:06complicated social problems.
- 24:07We immediately come up with solutions,
- 24:10and we don't fully understand the problem.
- 24:13So we're all surprised when
- 24:14the solutions don't work.
- 24:15So here's an example.
- 24:1720 years ago or so it became.
- 24:20Popular to often offer women an
- 24:22opportunity to lengthen the 10
- 24:24year clock so they could have
- 24:26children and they could get tenure
- 24:28and they wouldn't be punished.
- 24:30But because we are equitable institutions,
- 24:33anyone who was having a child had the
- 24:36opportunity to use the 10 year clock
- 24:39lengthening process 20 years later.
- 24:41When we look back at the data,
- 24:43men were advantaged,
- 24:44women were not,
- 24:46and the same thing seems to be
- 24:48likely to have happened with COVID.
- 24:49You know, because in most families,
- 24:52women are the primary
- 24:53caretakers of the children.
- 24:55Men took advantage of the COVID policies,
- 24:58dug deep, wrote more grants,
- 25:00wrote more papers,
- 25:01and my guess is this is going to be a
- 25:05space where we see an amplification of
- 25:07whatever inequities existed before.
- 25:10So I in 2019,
- 25:11it's important because I did
- 25:12this all before the pandemic.
- 25:14I traveled around the country and
- 25:17I and I sat down with 52 men and
- 25:2152 women at 16 different academic
- 25:23medical centers and I got their
- 25:27IRB approved consent and I recorded
- 25:29the interviews.
- 25:30I tried very hard to have a
- 25:32real diversity of institutions,
- 25:34both geographic location and you know
- 25:37top tier versus middle tier versus.
- 25:39Not so middle tier using NIH
- 25:42and use news rankings.
- 25:43The question was,
- 25:45was it any evidence that it
- 25:46was better at one than another?
- 25:47Newsflash?
- 25:48No.
- 25:48It's the same everywhere,
- 25:49but it's just,
- 25:50you know,
- 25:50different versions of social language.
- 25:53But it's really the same everywhere.
- 25:54Half by population.
- 25:55We're full professors or leaders.
- 25:57Because I really wanted people
- 25:59who had a Longview,
- 26:00and I also kind of wanted people who
- 26:01are in positions of accountability.
- 26:03I wanted to hear from their point of view,
- 26:04what they thought about it.
- 26:06All the interviews lasted about 60
- 26:08minutes and they were transcribed.
- 26:10And and and then coded and so
- 26:13this was new for me,
- 26:14but this is how we developed the code.
- 26:16So I had a team of sociologists
- 26:18and we developed our codes for the
- 26:21interviews based on the literature
- 26:22and also the salient features the 1st
- 26:2510 interviews trying to right size it.
- 26:27So we had two sets of codes.
- 26:29The first set of codes was all
- 26:30the features of academic medicine
- 26:32ecosystem and you can read them
- 26:33here and all this information is
- 26:35in the papers that we published,
- 26:37but they're pretty standard
- 26:39mentorship recruitment negotiations.
- 26:40Resources, etcetera.
- 26:41The second set of codes was So what
- 26:44we call gender related bad stuff.
- 26:46And it was really what are your experiences,
- 26:48what is your awareness,
- 26:50what is your observations,
- 26:51what is your perceived lack of awareness,
- 26:53et cetera.
- 26:53And then we analyze the data
- 26:55by looking
- 26:56for the intersections between gender
- 26:58related bad stuff and the features
- 27:01of the academic medicine ecosystem.
- 27:04So here are the interviewees.
- 27:06It was 52 men and 52
- 27:09women about the same age.
- 27:11The men were more likely to be MD's,
- 27:15the women more likely to be PHD's.
- 27:16And this is because I really tried
- 27:18to enrich for senior people,
- 27:19and there are very few women
- 27:21MD's who who were leaders.
- 27:23There were more likely to be women
- 27:25who were chairs of basic science
- 27:26departments than there were MD's who
- 27:28are chairs of clinical departments, 25%,
- 27:31assistant professors 25%, associate 50%.
- 27:34Um of full for the women,
- 27:37even more for the men.
- 27:38Men were more likely to
- 27:40have leadership positions.
- 27:41I tried very hard to find women
- 27:43with leadership positions,
- 27:44and men were significantly more
- 27:45likely to hold endowed chairs.
- 27:47And I think that's pretty
- 27:48much true everywhere.
- 27:50So we have published 3 papers to
- 27:52date in the peer reviewed literature
- 27:54and I'll tell you a little bit
- 27:56about each of those papers now.
- 27:59So the 1st paper we published
- 28:01had to do with mentorship now.
- 28:04Only the women reported to me that they
- 28:07had been sexually harassed by their mentor.
- 28:11Now,
- 28:11I'm sure that there are men in this world who
- 28:14have been sexually harassed by their mentor,
- 28:17but I didn't meet them,
- 28:18so I can only conclude that
- 28:20it's probably less common.
- 28:21But imagine that when this happens,
- 28:24mentorship is such a private place,
- 28:26it's so difficult to know what to do.
- 28:29The one woman who I met who had a
- 28:32postdoc mentor who sexually harassed.
- 28:35Who was encouraged to go to the
- 28:38Title 9 Office and report it,
- 28:41went through a formal adjudication
- 28:45process where his he he basically
- 28:48just had his hand slapped.
- 28:50She had to stay in his lab and she
- 28:53was geographically constrained
- 28:55by her family situation.
- 28:57And his argument was she misinterpreted
- 29:00my embrace and I'm thinking the
- 29:03word embrace is the problematic.
- 29:05Were there, however,
- 29:06she did what we think people should do,
- 29:10and it didn't help her at all.
- 29:12In fact, I would say from my point of view,
- 29:15it probably hurt her career because
- 29:17now she's officially labeled as a
- 29:19troublemaker and she wasn't able to
- 29:21get herself out of that situation.
- 29:23So that's what happens when a
- 29:26mentor harasses a mentee.
- 29:27The good news, though,
- 29:29about mentorship is both women
- 29:31and men became aware of gender
- 29:34inequities in academia.
- 29:36Because of their relationships with
- 29:38women mentors and women mentees.
- 29:40I heard from men who happened to train
- 29:43with women that their their mentors
- 29:45taught them about the world that
- 29:48existed for them as opposed to these men.
- 29:50And you know I can tell you I'm
- 29:52married to a man who's 6 foot four.
- 29:54And what he has learned probably
- 29:57by being married to little old me,
- 29:59is that by being a man who's tall,
- 30:02he is awarded so much respect and and.
- 30:06And um.
- 30:09Accolades simply by walking into a room.
- 30:12And I can tell you the number of times I
- 30:14walked into a room with my male resident
- 30:16where everybody assumed that I was the
- 30:18nurse and that male resident was the doctor.
- 30:20It's too numerous to count.
- 30:21It was just standard and it's kind
- 30:23of funny and we would joke about it,
- 30:25but it's not so funny after a while,
- 30:27you know. So, but so the point is,
- 30:29is that my husband has become
- 30:31aware of these inequities.
- 30:32But through through being married to me now,
- 30:34our daughter who's a physician and and
- 30:36it's just an awareness problem, both women.
- 30:39And men mentors recognize challenges
- 30:41that they're women mentees faced,
- 30:43and they really went out of their
- 30:44way to try to help them. Now,
- 30:46I would say sometimes they felt powerless.
- 30:49So I'm recalling an interview with
- 30:51a man who ran a graduate program.
- 30:53And one of the graduate students,
- 30:55a woman in the graduate program,
- 30:56was being harassed by a senior
- 30:58faculty member,
- 30:59and he saw it.
- 31:00But because the senior faculty member
- 31:02had so much power in the institution,
- 31:04and this man was more junior,
- 31:06he didn't know what to do except
- 31:08help her move her desk.
- 31:09So he made an effort to help her.
- 31:12But I would call that a hero action
- 31:14and not a systemic action.
- 31:16And what we need are systemic actions with
- 31:20systemic recognition that these things are,
- 31:22are really odious and they
- 31:24really bring all of us down.
- 31:26And both women and men modeled
- 31:28family work balance and tried to
- 31:31create family-friendly environments,
- 31:33but sometimes it backfired.
- 31:34So I heard from women who were Graduate
- 31:36School or medical school or training,
- 31:39and they saw that.
- 31:40And their, their male mentor took off
- 31:42in the middle of the day, you know,
- 31:44to go to their sons baseball game.
- 31:46That really inspired them that
- 31:47they could do the same thing,
- 31:49but the price that they paid
- 31:51for taking advantage of the same
- 31:54flexibility was so different.
- 31:56And so again,
- 31:57it helps to have your mentor
- 31:59understand you and respect you,
- 32:01but if your mentor can't address the
- 32:03challenges in the room, it's difficult.
- 32:06But let me now point out the real.
- 32:10Issue.
- 32:13In 2018, at the end of the annual
- 32:16INSERVICE exam for surgery,
- 32:18so every surgical resident in
- 32:20the country takes this exam,
- 32:22they had the opportunity to participate
- 32:24in a survey to assess discrimination,
- 32:28abuse, harassment and burnout.
- 32:3197% took part.
- 32:32And what this article found was that
- 32:36the attending surgeons the mentors.
- 32:39They were the most frequent sources
- 32:42of sexual harassment and abuse.
- 32:44The next month I'm sitting in a chair
- 32:46of surgery's office and he is agreed
- 32:48to be part of my study, and I asked
- 32:50him what he thought about this paper.
- 32:52Oh, that was awful.
- 32:54I cannot believe that's still happening.
- 32:57I said I agree with you,
- 32:59So what are you doing about it here?
- 33:01And he looked at me and I said,
- 33:03you realize your residents
- 33:05were part of this study.
- 33:08And it was.
- 33:09The ability to connect those
- 33:11dots is not trivial.
- 33:13It's really,
- 33:14really hard when people are in positions
- 33:17of accountability and leadership.
- 33:19To not be frightened to learn about
- 33:21what might be happening because
- 33:23it means they'll be responsible,
- 33:25then they'll have to do something about it.
- 33:27So it's just so much easier to believe
- 33:29that the people who took part of this
- 33:31study are training somewhere else,
- 33:33and that your faculty members aren't the
- 33:35ones doing the abuse or the harassment.
- 33:38So I mostly had wonderful
- 33:40mentoring experiences.
- 33:41They almost were always men by definition.
- 33:44And I mentioned that my postdoc
- 33:46mentor did something awful to me,
- 33:47but all I had to do was discover it,
- 33:50report it to the Cancer Center director,
- 33:52and then he took care of it.
- 33:54I've now been a mentor for longer than I
- 33:58have been a mentee and it is hard work.
- 34:01Frequent communication is key.
- 34:02And being able to admit when you're wrong,
- 34:05I can tell you a story.
- 34:07I had a woman graduate student,
- 34:09and this was about 15 years ago when there
- 34:11was a lot of cell line misidentification.
- 34:13And she came to me and she said,
- 34:15you know, we published this
- 34:16paper and it wasn't her paper.
- 34:17She was a middle author.
- 34:18And she said we used these cell lines,
- 34:20but we didn't, you know, a genotype
- 34:22because we weren't genotyping back then.
- 34:25I'm worried that they might
- 34:26have been misidentified.
- 34:27And I said, well,
- 34:29I guess that's theoretically possible,
- 34:30but, you know, the results were.
- 34:32Producible and like,
- 34:32you know, 5 or 10 cell lines.
- 34:34I don't know how we would ever find those
- 34:36cell lines and go back in genotyping now.
- 34:37And I think that's something
- 34:39we need to do going forward.
- 34:40Basically, I dismissed her.
- 34:42She wasn't happy with my answer.
- 34:44So she went to the chair of her department,
- 34:45which is pharmacology,
- 34:46and he reached out to me.
- 34:48My first reaction was I was mortified.
- 34:50I was so embarrassed.
- 34:52And then I realized she was right
- 34:54and I didn't realize that she was.
- 34:58My answer was inadequate.
- 34:59And so we went back and we repeated
- 35:01all the experiments and genotype.
- 35:02The lines and the results were validated.
- 35:05And today she and I have
- 35:06a wonderful relationship.
- 35:07She's now chair of her department.
- 35:08I'm really proud of her,
- 35:10but all I can say is none
- 35:11of us are perfect mentors.
- 35:12None of us are perfect parents.
- 35:13We make mistakes, and recognizing those
- 35:15mistakes is really an important thing.
- 35:18Choosing mentors and mentees is
- 35:20both strategic but also organic,
- 35:22and we are all people.
- 35:24We're both exceptional and we're complicated.
- 35:27The next paper was on promotion and tenure,
- 35:31and I wanted to analyze the data from
- 35:34the women and the data from the men,
- 35:36but I couldn't because only two men
- 35:39reported any problems with promotion
- 35:42and tenure and they were both gay.
- 35:45Could have been a coincidence,
- 35:47but I realized I just didn't
- 35:49have that data in my study,
- 35:51so it was only about the
- 35:53experiences of women.
- 35:53So take it for what it's worth
- 35:55and what the women reported to me.
- 35:58Even if they had sailed through,
- 36:00the process was that they spelled
- 36:02that the the criteria for promotion
- 36:04and tenure were either ambiguous or
- 36:07seem to be inconsistently applied.
- 36:10The most common story I heard was I
- 36:12went to my chair or my division chief.
- 36:14I said I was ready and he said no, no,
- 36:16you're not. You need another year.
- 36:18And then I saw this guy over
- 36:19there who was hired after me,
- 36:21who doesn't have many publications
- 36:22and grants. He was put forward.
- 36:24So it was basically trying to
- 36:26reconcile their own experience.
- 36:28With the experience of a colleague
- 36:30and trying to make sense of
- 36:32that in their own institution,
- 36:34there appeared to be a lack of
- 36:36standard processes for reviewing the
- 36:37applications and making decisions.
- 36:39I could tell you one of my own stories,
- 36:40and at UCSF throughout the
- 36:43University of California,
- 36:45we have an opportunity
- 36:46for accelerated promotion.
- 36:47We have these very Byzantine step levels,
- 36:49but the more the higher you are,
- 36:51the more you make in retirement.
- 36:52So it's not trivial.
- 36:53So if you have some big accomplishment,
- 36:55you can apply to jump a step level.
- 36:58So something big had happened
- 36:59to me and I went to my chair,
- 37:00who is wonderful, who supports me?
- 37:03And I said, you know,
- 37:04do you think this year I can go
- 37:06for an accelerated promotion?
- 37:08He said, oh, Jennifer,
- 37:09you're already ahead of me.
- 37:11And this would make it even more ahead of me.
- 37:13And that would be really
- 37:15uncomfortable for me.
- 37:15And in the moment, I thought,
- 37:18thank you for being honest,
- 37:19but what a wacky thing to think, right?
- 37:21But this is what people think.
- 37:23I was just grateful that
- 37:24he was so honest with me.
- 37:26So this is what I mean.
- 37:28But it's it's seemingly ambiguous now.
- 37:31Some women were so vulnerable to
- 37:34malicious behavior of senior faculty,
- 37:36division chiefs and department chairs.
- 37:38The most awful story was a person who
- 37:41was hired, basic scientist, you know,
- 37:43moved her family, all her children.
- 37:45The chair discovered the
- 37:46resources that he'd
- 37:48counted on to support her
- 37:49were not his to give out.
- 37:50And he essentially,
- 37:52from that day forward,
- 37:54tried to destroy her.
- 37:56And it was extraordinary that.
- 37:58She was able to survive and
- 38:00go to another institution,
- 38:02but listening to her experiences
- 38:03was harrowing and when she went to
- 38:05the Provost office to complain,
- 38:07she was told to suck it up.
- 38:08This guy and the Provost were really good
- 38:10friends and nothing was going to happen.
- 38:12And as I said, women see the men having
- 38:14a different experiences of advancement.
- 38:16So I sailed through,
- 38:17and part of it is I was really good.
- 38:20But I also had a friend on the
- 38:22promotion and tenure committee,
- 38:24and she came to me when I
- 38:25was going up for promotion.
- 38:26And she said, OK, here's the truth.
- 38:29The truth is you're going to be asked to give
- 38:31us a list of people to write you letters,
- 38:33and then we're going to come
- 38:34up with a list on our own.
- 38:35And the letters from our list are going
- 38:37to matter more than the letters on your list.
- 38:39And so why don't you let me know
- 38:42who should be on our list and.
- 38:45I don't know that this was right or wrong,
- 38:48but all I can say is that it was
- 38:50standard knowledge in circles,
- 38:53but not usually circles of women.
- 38:55So I would just want to say that
- 38:56if we're going to play a game,
- 38:58we all need to play by the same rules.
- 39:00If we're not going to play a game,
- 39:01let's not play a game.
- 39:02But I was really Privy.
- 39:04I I thought,
- 39:05to some inside baseball knowledge
- 39:06that I would have been otherwise.
- 39:08So I was hired right after residency.
- 39:10I just had a baby.
- 39:12I got my key award when I was a resident,
- 39:14and I had no startup package.
- 39:16I was just, I was like so grateful
- 39:18that they hired me again,
- 39:20something more to talk about.
- 39:21But I realized after a time
- 39:23that I needed startup package,
- 39:25even though I had my key award,
- 39:26and then we got an R1.
- 39:27I still need some resources
- 39:29to really take risks.
- 39:30My chairman bless his heart.
- 39:33Raised money to recruit his son.
- 39:38His son wisely chose not to come.
- 39:40But I knew my chairman had this money,
- 39:41so I don't know how I had the
- 39:43courage to do this, but I walked
- 39:44into his office and said, you know,
- 39:46that money that you raised to support,
- 39:48blah, blah, blah, can I have it?
- 39:50I could really use it and that's
- 39:51that's how I got my start up package.
- 39:53It's like three years later.
- 39:55But it was only because his son had the
- 39:57decency not to come and work for his dad.
- 40:00Every time I've learned that I was underpaid,
- 40:02it was an accident the first time and
- 40:04now is working for a chair who I adored,
- 40:07who adored me.
- 40:07And he was trying to retain
- 40:09a junior faculty member.
- 40:10And I was his key award mentor.
- 40:12That's how much older I am.
- 40:14And he told me the salary
- 40:16that he offered him to stay.
- 40:17And I went speechless,
- 40:19which is really an unusual thing.
- 40:21And he said. I don't pay you that much.
- 40:23Do I like?
- 40:24No, you don't.
- 40:27And he corrected it.
- 40:28But it was, it was just accidental.
- 40:31Now, one of the things that I appreciate
- 40:33is I now work at a public institution
- 40:35and all of our salaries are public.
- 40:37And it has really made this
- 40:40conversation so much easier.
- 40:41And I see no good reason for
- 40:45compensation not to be public.
- 40:47You know, I grew up in an
- 40:48era where it was unseemly.
- 40:49We didn't talk about it.
- 40:50But if we have a problem called pay equity,
- 40:54which we do in science and medicine.
- 40:56And I don't know how we're going to get
- 40:58better if we don't actually look at the data.
- 41:01I was lucky too, in that I received
- 41:03endowed chairs without asking for them.
- 41:05You know, my chair at UCSF.
- 41:07My chair and ENT wanted to retain me.
- 41:10But my message to all of us is be mindful of
- 41:13the advancement criteria and ask for help.
- 41:17There are people to help.
- 41:18I can't tell you how many women I
- 41:20interviewed when they were being
- 41:21recruited someplace got like a
- 41:22super secret private phone call
- 41:24from another woman there say,
- 41:26OK, here's how it works.
- 41:27This is what you need to ask for.
- 41:28I mean, and this is not written down and.
- 41:31We have to be mindful that what
- 41:34is secretive is not going to
- 41:36get to the people who need it.
- 41:38But maybe the most important paper
- 41:40that we wrote was about networking
- 41:43and professional relationships.
- 41:47The conclusions were that women are
- 41:50routinely excluded from networking
- 41:52activities dominated by men.
- 41:54Almost everybody I interviewed
- 41:55talked about the boys club,
- 41:57whether it be the Medicine Boys
- 41:59Club or the Science Boys Club,
- 42:01and they understood that being in
- 42:03this club was really beneficial.
- 42:06And if you were not in the club,
- 42:08you did not have those benefits.
- 42:10One of my favorite stories was a
- 42:11guy whose wife is also in medicine.
- 42:13He golfed, and so he got to meet
- 42:15all these really powerful men
- 42:16who golfed at these meetings.
- 42:18And when it came time for him to be
- 42:20nominated for a prize or go promotion,
- 42:22he just reached out to his golf
- 42:24buddies and they all wrote letters.
- 42:25And he knew that his wife did
- 42:28not have the same opportunity
- 42:30to find people like this.
- 42:33Women make efforts to counteract exclusion,
- 42:37but I have to say that the
- 42:40limitations are real, that until,
- 42:43you know, women have.
- 42:45Equal power, equal accountability.
- 42:47These were much more like support groups.
- 42:52So women getting together and
- 42:54and talking about childcare or
- 42:56how to navigate this environment,
- 42:58then there's there's nothing wrong
- 43:00with it but it's not the same as the
- 43:03mail networks and one thing I want
- 43:05to say is and and then there were
- 43:08other patterns of gender related
- 43:09exclusion that were unrelated
- 43:11to the boys Club and maybe the
- 43:13most common one was alcohol.
- 43:16So alcohol shows up in professional
- 43:19environments and people become disinhibited
- 43:22when they drink alcohol and when the.
- 43:28Senior. People present are men
- 43:31and they're just inhibiting the
- 43:33younger people present are women.
- 43:34It becomes a fairly challenging
- 43:37environment to navigate. This is true.
- 43:40And I could say it happened at UCSF.
- 43:42I'm, I'm able to disclose this,
- 43:43my institution,
- 43:44I was interviewing someone for the book,
- 43:47another institution, and she said to me,
- 43:49oh, you've heard about the Wilbur
- 43:51Hot Springs resorts, haven't you?
- 43:53I'm like, no, what's that?
- 43:55Just Oh my God.
- 43:56So not that long ago,
- 43:58let's say 15 years ago.
- 44:00The basic science departments would
- 44:03have their departmental retreat
- 44:05at this venue in the Bay Area.
- 44:07And this woman and the only graduate
- 44:10students at the time were women,
- 44:12and they show up.
- 44:13They're so excited to present
- 44:14their research to these,
- 44:15you know, famous senior people.
- 44:17And the talks go well during the day.
- 44:19And then they're supposed to
- 44:20all go into the Hot Springs,
- 44:22and she describes going down to the
- 44:25water and seeing all of her male
- 44:28professors naked and realizes that
- 44:30she's expected to take off her clothes.
- 44:33And so she did.
- 44:35And she's describing this is 15 years later,
- 44:37she's now married with three children.
- 44:39She's describing what it
- 44:40felt like to have to do that.
- 44:43And I said. How did the,
- 44:45how did you experience that with your cohort?
- 44:47Because the other PhD students for women,
- 44:50she said we couldn't talk about it.
- 44:52We were so ashamed,
- 44:53you know, that we did this,
- 44:55that it took us years before we
- 44:57were actually able to talk about it.
- 44:59So I'm thinking, this is crazy, right?
- 45:01This can't happen.
- 45:02So I go back to UCSF and I find some
- 45:04senior faculty and I go to them.
- 45:06I said, tell me about the Wilbur Hot Springs.
- 45:08Oh man, that was awful.
- 45:09Yeah.
- 45:10And, and, and I said to the men,
- 45:12because the men were telling me this.
- 45:13I said, why didn't you do anything?
- 45:15I mean, why didn't you?
- 45:16I mean, even 15 years ago,
- 45:18it was not cool to get naked
- 45:20with your trainees.
- 45:21I mean,
- 45:21I can't imagine a time in this country
- 45:23where we thought that was good,
- 45:25a good mentoring policy,
- 45:26and they felt powerless.
- 45:27So they knew it was bad.
- 45:29They stopped showing up.
- 45:31They didn't feel like their voice was
- 45:33powerful enough to challenge the status quo.
- 45:36So.
- 45:37That's my appalling story.
- 45:40So my network experience is surprise,
- 45:42surprise.
- 45:42I'm an extrovert and I can say
- 45:44that it's helpful.
- 45:45So I'm married to an introvert.
- 45:47I have a child who's an introvert,
- 45:49and I really appreciate half
- 45:51of us are introverts.
- 45:52It can be really hard when you're
- 45:54the only one who looks like you
- 45:55in a room and you don't feel like
- 45:57you have a voice that you can use.
- 45:59It's hard to network in venues.
- 46:00As I just illustrated.
- 46:02We are not comfortable.
- 46:04Most power networks in science and
- 46:06medicine are still male dominated.
- 46:08But I can tell you that if you
- 46:10can show
- 46:10up and you can speak up,
- 46:11you can make a real difference.
- 46:13I think that in this era of at
- 46:15least an awareness of diversity,
- 46:17equity, inclusion, we are beginning
- 46:19to have a language that we can use.
- 46:22And I want to say I was wrong about Elam.
- 46:25So I don't know if anyone here has done Elam
- 46:27executive leadership in academic medicine.
- 46:29Every year my Dean, my chair would say,
- 46:31oh, do you want to go do this?
- 46:33And I thought it sounded like a really good.
- 46:35Idea. But my kids were young.
- 46:37I always already felt stretched
- 46:39going to science meetings,
- 46:40doing my surgical work and my research.
- 46:42And I just didn't see how spending,
- 46:44you know, a month away was going to help me.
- 46:47And I naively thought and by the
- 46:50way everybody empowers a man.
- 46:51How would a bunch of women getting together
- 46:53and training each other how to do leadership.
- 46:55How would this help?
- 46:56But I think I was wrong because many,
- 46:58many women including your Dean
- 47:00went through in the Elam program.
- 47:02And I think it,
- 47:03at least my understanding is giving them an.
- 47:06Network to support them.
- 47:07People that can go to for advice
- 47:09outside their institution,
- 47:11and I wish that I had taken advantage
- 47:13of it back then, but I'm way too old.
- 47:16So what keeps me here?
- 47:18Well, I get to come here and talk with you,
- 47:20which is really a joy.
- 47:21But I love discovering things in our
- 47:24research that can really change the world,
- 47:27that can help so many people
- 47:30beyond our clinical practice.
- 47:31I love interacting with
- 47:33colleagues and trainees,
- 47:35and I keep hoping that I
- 47:37can make a difference.
- 47:38So what am I take home points?
- 47:41Consolidation of power in places
- 47:43otherwise known as people without
- 47:46transparency or accountability,
- 47:49facilitates and perpetuates the
- 47:51inequities that we all realize exist.
- 47:55After admissions to medical
- 47:57school and Graduate School.
- 47:59The deal is off.
- 48:01We are persistently disadvantaged.
- 48:03Women are and individuals who
- 48:05are underrepresented after
- 48:06the admissions process.
- 48:08Policies are necessary,
- 48:10but they're not sufficient,
- 48:12as illustrated by the
- 48:1410 year clock extension.
- 48:16When something bad happens to you,
- 48:19please know that you're not alone.
- 48:21Find somebody you can talk to.
- 48:24And when you see something bad
- 48:26happening to someone else,
- 48:28if you can find your voice,
- 48:30say something, do something.
- 48:32At the very least,
- 48:34let that person know that you
- 48:37saw what was happening to them.
- 48:39A few years ago,
- 48:40I was still in my leadership position.
- 48:42We were.
- 48:43We were brainstorming about
- 48:45the capital campaign themes,
- 48:47and a woman offered a theme radio silence.
- 48:50About 5 minutes later, a man spoke up.
- 48:54And essentially said the same thing.
- 48:56Ohh, that's a wonderful idea.
- 48:59And I'm looking at them and I'm
- 49:00looking at her and she's looking at me.
- 49:02I didn't have the courage then to say,
- 49:05you know,
- 49:05so and so just said that and that
- 49:07is great that you both have the
- 49:08same idea and it's a good idea.
- 49:09I think I would do that now.
- 49:11But afterwards I went up to her and
- 49:12said I am so sorry that happened to you.
- 49:14I saw that you know what happened?
- 49:16And and so we see it. We feel it.
- 49:18And and at least if you can't speak
- 49:20out in the moment to give her the
- 49:21credit that she needs or them the
- 49:23credit that they need at least.
- 49:25That's something, no about it afterwards.
- 49:27But at the end of the day,
- 49:29there's no quick fixes.
- 49:31This is hard stuff.
- 49:34Just like a great marriage is hard stuff.
- 49:37Being a great parent is hard stuff.
- 49:39Being a lifelong friend is hard stuff.
- 49:41We need a language and a culture free from
- 49:44retaliation to talk about what we experience.
- 49:47We need to get comfortable
- 49:49feeling uncomfortable.
- 49:50These are hard things to talk about,
- 49:52but we have to do it because
- 49:54at the end of the day.
- 49:55Right now what we have is a
- 49:57winner takes all mentality.
- 49:58Someone's either a villain or they're a hero.
- 50:00What about their a good person who stumble,
- 50:02who made a mistake,
- 50:04who said something disrespectful,
- 50:05who it doesn't mean that they go to jail,
- 50:07it just means there's an opportunity
- 50:09to educate each other in the world that
- 50:11we spend an enormous amount of time.
- 50:13And so I'd really like to take
- 50:15ratchet the stakes down,
- 50:16ratchet the noise down and just create
- 50:19communities where we work so that we
- 50:22can really be our best selves. So.
- 50:25Advice to my younger self and to you,
- 50:28of course.
- 50:28I wish I'd written down my experiences
- 50:30and how they made me feel before
- 50:32I got to such a crisis mode.
- 50:34One of my really wise mentors,
- 50:36when he saw me going into surgery,
- 50:37he said,
- 50:38oh,
- 50:38you should really keep a journal
- 50:39because what you're going to go through,
- 50:41other people going to want to know about.
- 50:42I was too overwhelmed and I don't
- 50:44think I could have handled being
- 50:47honest about what was happening.
- 50:49I really dismissed and minimized what was
- 50:52happening because it was too hard to manage.
- 50:56Your bosses, our bosses,
- 50:58are not our parents.
- 50:59We don't have to spend so much
- 51:01time trying to please them.
- 51:03Embrace Team science and hold on to
- 51:06your true research partners and friends.
- 51:08They will be with you forever.
- 51:10And find communities places to work where
- 51:13you can bring your full self and be accepted.
- 51:16If someone is uncomfortable with you,
- 51:19it's their problem,
- 51:20not yours.
- 51:21Family and friends are everything.
- 51:24Your children will love you for who
- 51:25you are and forgive your missteps.
- 51:27I can't tell you how many times
- 51:29I threatened to quit and stay
- 51:30home with my children.
- 51:31Luckily,
- 51:31they had the good sense to talk me out of it.
- 51:34Take the bad stuff seriously,
- 51:36but not personally.
- 51:36If you can realize it's bad
- 51:38but it's not your fault,
- 51:39there's nothing wrong with you.
- 51:41And if you can find a way,
- 51:42we were talking this point,
- 51:43if you can lean into those hard times,
- 51:45you will grow. So when I think back
- 51:47about what happened to me, I say,
- 51:49I used to say, well, if I'd known it,
- 51:51I'm not sure I would have moved,
- 51:53but now I know I would have,
- 51:55because I wouldn't be here today and I
- 51:56wouldn't be talking to you about this.
- 51:58And as much as it was hard at the time,
- 52:02I'm fine.
- 52:02And now I can actually help the world.
- 52:06And this is just to acknowledge,
- 52:07no, I'm not standing in a hole.
- 52:09I'm just that much shorter than
- 52:10everybody else in my family.
- 52:12Thank you very much and good luck.
- 52:21We have time for questions.
- 52:23Yes. That was amazing.
- 52:30You've done so much.
- 52:36Now that the new way is. Awareness.
- 52:43Hmm. How do you think this
- 52:46is this affecting all?
- 52:49This is it, you know,
- 52:52doesn't have any effect yet.
- 52:53I think the jury's still out,
- 52:55but I think it's a double edged sword.
- 52:56I wrote a piece in stat news
- 52:58about a month ago to another piece
- 52:59coming out in the conversation.
- 53:01I think the good news is we now
- 53:02have a vocabulary and I don't think
- 53:05there's a single institutional
- 53:07leader who is against it.
- 53:08It would be they would be unable to continue.
- 53:11There's nobody who's in a position.
- 53:13Um, of leadership in science and medicine?
- 53:16Who who doesn't overtly embrace DEI?
- 53:20So that's the good news.
- 53:21The bad news is they don't
- 53:23understand it or mean it.
- 53:25And.
- 53:28And that's where the hard
- 53:30conversations come in.
- 53:31And we also run the risk of assuming that
- 53:34the policies are going to change everything.
- 53:37So let me give you an example.
- 53:38We now, anytime you're part of
- 53:40a important search committee,
- 53:41you have to get training on unconscious bias.
- 53:44And someone from HR comes to talk
- 53:45to you're like, OK, game on,
- 53:47we're on the same page.
- 53:49I can't tell you how many times in a
- 53:51search committee setting I have heard
- 53:53and other save reported to me that
- 53:56women candidates are judged by gendered.
- 53:58Language for example.
- 53:59Ohh, she's just not warm and fuzzy enough.
- 54:02And the woman sitting there saying thanks.
- 54:06I just she.
- 54:09Yeah, have to be more of a department,
- 54:11and we certainly didn't talk about that.
- 54:13Male candidates, warmth and fuzziness.
- 54:16So, you know, things still happen.
- 54:20And,
- 54:21and but I'm hoping that rather than
- 54:23us believing that the policies and
- 54:26the mission are limitations that their
- 54:28opportunities and what it's going to
- 54:31take is we all have to find her voice.
- 54:33And I promise you that when
- 54:36you say something respectfully
- 54:38the backlash is so minimal.
- 54:40I'll give you an example.
- 54:41I was at a meeting we were trying to
- 54:43identify people for an individual role
- 54:45was an opportunity woman's name came
- 54:47up and the chair of the department
- 54:49and man said, oh, no, no, no, no.
- 54:51She can't do it.
- 54:51She has three young children.
- 54:53And I don't know how I found the words.
- 54:54I said so and so I'm so grateful
- 54:56that you want to protect her.
- 54:58But I was a woman with young children once,
- 55:01too. And I would have wanted the opportunity.
- 55:03I would have wanted to be my
- 55:05decision whether I took it or not.
- 55:07I wouldn't have wanted my
- 55:08chair to protect me from it.
- 55:10You can always be there as a resource
- 55:11if she wants to talk to you about.
- 55:13I saw the women, all the women there.
- 55:14But, but, but, but, you know,
- 55:18it's a chance that we can speak out.
- 55:19You have to find the voice
- 55:20that has to be respected.
- 55:22And it's hard.
- 55:22I was telling,
- 55:23you know,
- 55:24the folks at dinner last night,
- 55:25I was on a I won't board the details,
- 55:27but an investor call, so trying to
- 55:29raise millions of dollars to get a
- 55:31drug that I invented into the clinic.
- 55:33And umm, a woman asked another
- 55:36woman a question before she
- 55:37had a chance to answer it.
- 55:39A senior man said,
- 55:40I'll answer that and he just shuts her down.
- 55:42And I saw the women recoil and immediately,
- 55:48you know, I called the man and said.
- 55:51Didn't know yet we're doing this but
- 55:53this is what's happening and and it
- 55:55was OK and then I reached out to her
- 55:57and said I saw that and I'm so sorry
- 55:59and and it meant so much to her.
- 56:01It took her a while to come back.
- 56:02She's you know in her late 50s early 60s
- 56:04and it just we call these microaggressions.
- 56:07So I would like to say they're neither
- 56:08micro nor necessarily aggressive.
- 56:10I don't like the term because it
- 56:12kind of makes it sound like it's
- 56:15trivial but repeatedly you know
- 56:16your your voice isn't heard one
- 56:18of the IT can really destroy you.
- 56:21And one of the my male interviews,
- 56:23he's told me about a culture in in where
- 56:27he trained and this was in cardiology and
- 56:30he described it as a really sexist culture.
- 56:32I said what do you mean?
- 56:33He said, Oh yeah, in the Cath lab, you know,
- 56:36they wouldn't even talk to the women fellows,
- 56:40so.
- 56:42What does that mean?
- 56:43If you're in a fellowship and you
- 56:44want to learn how to do something,
- 56:46but your your professors choose
- 56:48to pretend you don't exist,
- 56:50that's a pretty big problem.
- 56:51Hard to call it out.
- 56:53He was a trainee as well.
- 56:54There was nothing he can say.
- 56:55But I'd like to say that you accumulate
- 56:57this over a lifetime and you hang in there.
- 56:59I'm not even thinking about
- 57:00the people who leave,
- 57:01and it's really gut wrenching.
- 57:03And we're a field dedicated to healing,
- 57:06and I'd like us to remember that,
- 57:08you know, when we think about the
- 57:10impact we have on each other and.
- 57:12If you're talking about a
- 57:14person who's an investigator,
- 57:15you don't know if they're going to cure.
- 57:18The disease that's going
- 57:19to kill your loved one.
- 57:20And then when we force people out,
- 57:21he'll have the same amount of talent.
- 57:23You know we were just talking last night.
- 57:25I'm doing a study now on MD PHD's and.
- 57:2930 years, MD, PhD, trainees, women and men.
- 57:33Equal number of F awards equal
- 57:35number of K awards at the ER level.
- 57:37It starts going like this.
- 57:38Today there are 100 program project
- 57:40grants in the country led by an MD, PhD.
- 57:43Three are women.
- 57:45So what you see is that this.
- 57:48Silencing now,
- 57:49maybe all these women chose to be clinician.
- 57:52Educators chose going to private practice,
- 57:53but the point is they started in the
- 57:56same place with the same ambitions.
- 57:58And I would argue there were myriad
- 58:00of things that happened to them.
- 58:01What I heard most often from the men
- 58:04is that the reason the women
- 58:06dropped out is they had families.
- 58:08Not a single woman told me that
- 58:10the reason that she was held
- 58:12back was because of her family.
- 58:14So there are people who choose to pull
- 58:16back and go part time, and that's fine.
- 58:19But there's this perception disconnect.
- 58:21I would say the one last
- 58:22answer to your question,
- 58:23I'm sorry I've gone on so long,
- 58:25is I think when you're working in an
- 58:28environment that is overtly committed to
- 58:30DIY and you're not feeling very included
- 58:33or that you're treated equitably,
- 58:36it can be very painful because it feels
- 58:38like maybe there's something wrong with you.
- 58:40Maybe you're misinterpreting,
- 58:41maybe you're not getting it,
- 58:43maybe you don't belong there.
- 58:44So I think it's a double edged sword.
- 58:45I'd like to see it as an opportunity,
- 58:47but I'd love to hear you know,
- 58:48what other people think. Yes.
- 58:52Thank you so much. Bing.
- 58:54Stop. So my question.
- 59:01This problem. This.
- 59:05Questions. Otherwise, yeah.
- 59:15How do we encourage open discussion?
- 59:21Yeah. Something, yeah.
- 59:26Become a problem with safety.
- 59:28And it's not like people know
- 59:31because they don't pop over, right?
- 59:34Right. Right. Right. Yeah.
- 59:44Some, some. Yeah, yeah, yeah.
- 59:46Oh, that's such a thank you
- 59:49so much for for asking that.
- 59:51Which means you're, you're,
- 59:52you're a wonderful chair.
- 59:54So I would start with you.
- 59:56I would start by saying I'm new here.
- 59:59I wasn't born in this country.
- 01:00:02I need to understand.
- 01:00:04Where I'm missing things and so I'm human.
- 01:00:09I bring unconscious bias
- 01:00:10every day to my world,
- 01:00:12and I'm unconscious.
- 01:00:13I don't even know it.
- 01:00:14So I would really like to invite you
- 01:00:17all to give me feedback when I misstep,
- 01:00:20when I misstate, when I stumble.
- 01:00:22I would really like to learn from all of you,
- 01:00:25and if you can create an environment where
- 01:00:28they can give you feedback and you can
- 01:00:30listen and not be destroyed by that feedback,
- 01:00:34it will be such a wonderful.
- 01:00:36Model for everybody else.
- 01:00:38So first be willing to listen.
- 01:00:41The other thing is listening really,
- 01:00:43really matters that so many of
- 01:00:44the men that I interviewed,
- 01:00:46you know,
- 01:00:46at the end of the interview is like
- 01:00:48all these light bulbs had gone off
- 01:00:49in their head and they'd say to me,
- 01:00:51what can I do?
- 01:00:52And I said, well,
- 01:00:53when was the last time you reached
- 01:00:56out to a woman colleague or woman
- 01:00:58trainee and asked her about her
- 01:01:01experiences and they had never done it.
- 01:01:03It's so simple and what
- 01:01:05you can do as a leader.
- 01:01:07You can invite small groups.
- 01:01:10It's probably too hard in in large groups.
- 01:01:12Small groups of people have a monthly lunch,
- 01:01:14and the monthly lunch is just let's
- 01:01:16talk about how did we get here?
- 01:01:17What are our joint values,
- 01:01:19what do we want to accomplish?
- 01:01:20What's holding you back?
- 01:01:21What can I do to eliminate those barriers
- 01:01:23to holding you back? And listen.
- 01:01:26So one of my favorite interviews.
- 01:01:29I love this guy.
- 01:01:30He's so the men.
- 01:01:32And Peter,
- 01:01:32you'll appreciate this.
- 01:01:33The men who are most clued in were
- 01:01:35the men who are married to women.
- 01:01:38Who are also in the field
- 01:01:39because they'd heard it,
- 01:01:40you know, like my husband,
- 01:01:41they'd come home every day and they'd
- 01:01:42heard their wife talk about what their
- 01:01:44experiences were in the workplace.
- 01:01:46And so he's describing in the beginning of
- 01:01:48you how his wife is Mansplain Mantera opted,
- 01:01:51you know, frustrated all these meetings.
- 01:01:53And I said to him so, and he ran a center.
- 01:01:56How do you mitigate against that
- 01:01:58happening in the meetings that you run?
- 01:02:00He said.
- 01:02:02I don't think it's ever happened.
- 01:02:05Oh, it must have happened.
- 01:02:07Oh, I just didn't see it.
- 01:02:09So, but, but it but that's it.
- 01:02:12I mean I I honestly, when I you know,
- 01:02:14the man who who you know Mantra
- 01:02:15opted the woman last week,
- 01:02:17he didn't realize he was doing it.
- 01:02:18I mean, when it was pointed out he did.
- 01:02:21But we have to find ways to give
- 01:02:24feedback without it feeling crushing,
- 01:02:26without it feeling like career.
- 01:02:27And we have to be able to judge high crimes
- 01:02:31and misdemeanors from
- 01:02:32day-to-day human foibles.
- 01:02:34But I would say that the
- 01:02:36cumulation of the day-to-day human
- 01:02:37foibles is so powerfully toxic.
- 01:02:39So create an environment,
- 01:02:41be open to feedback,
- 01:02:43and walk the walk.
- 01:02:47Thank you, Peter.
- 01:02:51Salary. You know, there's been a
- 01:02:54lot of pressure around here, but.
- 01:03:00Business basic type, yeah.
- 01:03:05Yeah. But one of the biggest
- 01:03:09challenge. Hmm, huge problem.
- 01:03:14Prosperity.
- 01:03:17Absolutely. OK.
- 01:03:18So this is the Wild West.
- 01:03:21So what I and I hope that we're moving.
- 01:03:23So bottom line, thank you for recognizing
- 01:03:26because here's the typical scenario.
- 01:03:28It costs a lot more to hire a new
- 01:03:29person than their retainer person.
- 01:03:31That's the bottom line.
- 01:03:32So it's really economically to
- 01:03:33everybody's advantage to retain
- 01:03:34the person who's already there.
- 01:03:36Women tend not to job search so much,
- 01:03:40and whether it's because we don't
- 01:03:42think we're worthy or whether
- 01:03:43because we have a partners who are
- 01:03:46geographically constrained or whatnot,
- 01:03:47that's a different conversation.
- 01:03:48But it's far more common for a man
- 01:03:51to come in and say I've got this
- 01:03:53other offer and to be retained.
- 01:03:54And when they're retained
- 01:03:56they get more resources.
- 01:03:57So every time they interviewed
- 01:03:58a chair I said,
- 01:03:59So what do you do under those circumstances?
- 01:04:02Only two chairs recognized it and solved it.
- 01:04:06Well, recognized it to solve it.
- 01:04:08And one of them was happened to be an
- 01:04:10institution where the Dean had been
- 01:04:12publicly humiliated for salary and equity.
- 01:04:14So every time that a man was retained,
- 01:04:17this guy went to the Dean and said, OK,
- 01:04:18we need to raise everybody's salary.
- 01:04:20You know,
- 01:04:20this is what I'm giving him.
- 01:04:21And the guy did it because his job
- 01:04:23was on the line and I'm trying to
- 01:04:25remember the other institution.
- 01:04:27There was more of a mechanism there to do it.
- 01:04:29But most people just throw up their
- 01:04:30hands and say I I can't afford it,
- 01:04:32I just can't do it.
- 01:04:33And it's huge and and and guess what?
- 01:04:36There's no institutional records.
- 01:04:38So here's what we and also it's kind of like,
- 01:04:42you know, Woody Allen, you know,
- 01:04:44how many times a week do you have sex?
- 01:04:45Ohh, we have it all the time.
- 01:04:46Three times a week. We never have.
- 01:04:48We have a three times a week.
- 01:04:49So someone's impression of retaining some
- 01:04:51like thinking of our conversation, really.
- 01:04:54You didn't feel retained.
- 01:04:56Right.
- 01:04:57You know,
- 01:04:57because it was too little,
- 01:04:58too late.
- 01:04:59But I promise the people who sat her
- 01:05:01down and tried to keep her thought
- 01:05:03they were trying to retain her,
- 01:05:04but they had missed the boat,
- 01:05:06you know, so many years before.
- 01:05:08So what I think we need to do
- 01:05:09as an institution,
- 01:05:10I'd love CEO ahead of the curve on this.
- 01:05:13Let's collect the data.
- 01:05:14You know we can't.
- 01:05:16Again, you can't solve a problem you
- 01:05:18don't understand. We need metrics.
- 01:05:20These are emotional things.
- 01:05:21So bottom line is when someone leaves,
- 01:05:25there needs to be a rigorous.
- 01:05:27Exit interview and it can't be by the person.
- 01:05:30They're leaving.
- 01:05:31And we need to deeply understand
- 01:05:33what didn't they get?
- 01:05:34Why couldn't they stay?
- 01:05:36Yes, maybe it was. So shiny out there.
- 01:05:39There was no way they're going to stay.
- 01:05:41But maybe there's a lot
- 01:05:42to be learned from that.
- 01:05:42And the question is,
- 01:05:43did did you feel like there was
- 01:05:45a sincere retention effort?
- 01:05:47I think we'd be stunned at what we hear.
- 01:05:50And the other thing is,
- 01:05:51when someone retains someone,
- 01:05:52they have to look at the big picture.
- 01:05:55Even if you don't know how to fix it,
- 01:05:56you have to say, OK, now I've given
- 01:05:59him these additional resources.
- 01:06:01So we looked at the you have to say,
- 01:06:03this has happened.
- 01:06:04I have a problem.
- 01:06:06What are we gonna do about this is
- 01:06:07something probably exists everywhere,
- 01:06:08but at least you can collect the
- 01:06:10data and know what to do about it.
- 01:06:12So I'm thank you for turning on the lights,
- 01:06:14but I think retention is the Wild
- 01:06:16West and I'm hopeful that UCSF
- 01:06:19neck right now because they're
- 01:06:21really tired of me nagging.
- 01:06:23But I think we're going to start collecting
- 01:06:24the data because it's important.
- 01:06:28Yes. You mentioned the beginning
- 01:06:30that there is a dramatic NIH
- 01:06:33transfer submitted by women.
- 01:06:37Spitting ohh let me start the ways OK.
- 01:06:44I think I I call it the protege phenomenon,
- 01:06:47and I've seen it up close too
- 01:06:50many times to be able to recount.
- 01:06:53If they're being hired by a man.
- 01:06:55They see in a young man a younger
- 01:06:58version of themselves and they
- 01:07:00want to invest in that protege and
- 01:07:03whether that be discretionary funds,
- 01:07:05space, administrative support,
- 01:07:07we'll call it the startup package.
- 01:07:11When a woman comes along with the same
- 01:07:13ambitions, if they're not so inclined,
- 01:07:17they may not see her the same way.
- 01:07:19They may have a very different impression,
- 01:07:21you know, if she comes in
- 01:07:22with the same qualifications,
- 01:07:22with the same ambition.
- 01:07:24And so I think that.
- 01:07:27It starts early on with differential
- 01:07:31support and resource allocation
- 01:07:33and mentorship rich funding.
- 01:07:36I mean, there's, I mean.
- 01:07:38So many women I interviewed who dropped
- 01:07:40out of the investigator track and gone
- 01:07:43into the mostly the educator track
- 01:07:46talked about not having the resources
- 01:07:48that they needed in order to stay
- 01:07:52competitive and submit the grants.
- 01:07:54Now, sometimes it's probably a genuine
- 01:07:56interest in doing something else,
- 01:07:57but I don't see any gender biological
- 01:08:00basis for why a woman would choose
- 01:08:03a different track than a man,
- 01:08:05and especially the MD PHD's.
- 01:08:06To me, that's.
- 01:08:08So blatantly a cohort of
- 01:08:11homogeneous individuals, you know,
- 01:08:13most people go into MDP's.
- 01:08:14Don't do it to be clinician educators.
- 01:08:16You know,
- 01:08:17there's a much quicker route to become
- 01:08:19a clinician educator than to get a PhD.
- 01:08:21So I think it's an accumulation
- 01:08:23of a lot of different facts,
- 01:08:26not the least of which is sometimes
- 01:08:28not seeing anybody who looks
- 01:08:29like you in that track.
- 01:08:30I'll tell you a story.
- 01:08:32We had in our department a woman
- 01:08:35who came mostly do clinical work,
- 01:08:38but she had research.
- 01:08:39Training.
- 01:08:39And she had researched ambitions
- 01:08:41and she got research grants.
- 01:08:42And every time she asked the chair
- 01:08:45to give her some protected time
- 01:08:47so she could do the research,
- 01:08:48the answer was no, no, no.
- 01:08:49You were hired to do this,
- 01:08:51OK.
- 01:08:52At the same time,
- 01:08:54the chair is recruiting a former
- 01:08:55male resident back to the program who
- 01:08:57hasn't done a lick of research than
- 01:08:59has since his PhD, like 10 years ago.
- 01:09:01And it's throwing the moon at
- 01:09:03him in terms of a package.
- 01:09:05And I'm like, there's a real disconnect here,
- 01:09:08but it really has to do with, you know,
- 01:09:10probably gendered assumptions,
- 01:09:12impressions of who people are
- 01:09:13and what they're meant to be.
- 01:09:14We are terrible at picking winners.
- 01:09:16I would just like us all to acknowledge
- 01:09:18that we think we can pick the winners,
- 01:09:20but we really can't because
- 01:09:21at the end of the day.
- 01:09:23What matters most is the
- 01:09:25individuals commitment and passion.
- 01:09:28And,
- 01:09:28and I can tell you lots of stories offline,
- 01:09:31but if you have a person who's
- 01:09:33equally committed and passionate,
- 01:09:34but they happen to look a certain way,
- 01:09:36they may not get what they
- 01:09:37need in order to
- 01:09:38be successful. But it's it's
- 01:09:39a profoundly big difference.
- 01:09:41And I think such a waste of talent.
- 01:09:43Not that the women physician educators
- 01:09:46aren't doing wonderful work,
- 01:09:48but that's not why they
- 01:09:50became physician scientists.
- 01:09:54I have a question.
- 01:09:57Well, First off, I'm a winner.
- 01:09:58Thank you so much Doctor
- 01:10:01Granese for your talk.
- 01:10:03So first just to illustrate how how?
- 01:10:07You know, maybe innocuous.
- 01:10:08Some of these examples are like for
- 01:10:11example when I was doing sign out with.
- 01:10:13An attending, a male attending,
- 01:10:15and I had a male senior resident with him.
- 01:10:18With me, I was a, I think a PG Y two.
- 01:10:22They would talk about fishing and
- 01:10:24golf and these are activities that
- 01:10:26I personally have not engaged in.
- 01:10:28So being the extrovert that I am,
- 01:10:32I felt like, you know,
- 01:10:34there wasn't really like much
- 01:10:36of an impression that they could
- 01:10:38make of me because I could not
- 01:10:39participate in that discussion.
- 01:10:41So actually my my question
- 01:10:43is how do we safeguard?
- 01:10:44Um, from repeating exhibiting traits
- 01:10:47and behaviors that are stereotypically,
- 01:10:49say, sexist, racist, ableist.
- 01:10:51All that is because even within
- 01:10:53women organizations and groups
- 01:10:55or even other minority groups,
- 01:10:57there are still implicit biases
- 01:11:00and behaviors that we have sort of
- 01:11:03been ingrained and umm, you know,
- 01:11:05we, we're pretty much,
- 01:11:06we're nurtured with it, right?
- 01:11:08In surgery, we have, you know,
- 01:11:11women or residents who would be very,
- 01:11:13you know, brash and cussing.
- 01:11:15Just like our male attendings,
- 01:11:16you know, like, you know,
- 01:11:18copying these behaviors,
- 01:11:20these gendered behaviors to sort of
- 01:11:23elevate themselves or that perception of,
- 01:11:26OK, I'm,
- 01:11:26I want to be just like them so
- 01:11:28that they can see themselves in me.
- 01:11:31But they may be detrimental to,
- 01:11:34you know,
- 01:11:35people who are not going to try
- 01:11:37to do those types of behaviors
- 01:11:39because they're honestly not savory.
- 01:11:42You said thank you so much for.
- 01:11:46Your observations, they're spot on.
- 01:11:49I call it the aggressive, assertive dilemma.
- 01:11:52You know,
- 01:11:53somebody wants in Pittsburgh said to me,
- 01:11:55you know, you're a little aggressive.
- 01:11:57And I said, well, tell me what you mean.
- 01:11:58And they describe the behavior.
- 01:11:59I said that sounds assertive.
- 01:12:01And if I was a man,
- 01:12:02you'd probably compliment me.
- 01:12:03And they're like, oh, yeah.
- 01:12:05So,
- 01:12:05but it took me a long time to
- 01:12:07be able to say that.
- 01:12:08So what I would suggest is that
- 01:12:11we all decide we're going to
- 01:12:14talk about these things.
- 01:12:16And we're going to give each other feedback.
- 01:12:18And we're going to acknowledge
- 01:12:19that we're going to bring our own,
- 01:12:22you know,
- 01:12:23biases and ableist and gendered
- 01:12:25expectations into the workplace
- 01:12:26through no fault of her own.
- 01:12:29But we work hard, we work evenings,
- 01:12:31we work weekends,
- 01:12:32and give permission to the people that
- 01:12:34we work with to give us feedback.
- 01:12:37So start by asking for feedback and
- 01:12:39then asking permission to give them feedback,
- 01:12:41too.
- 01:12:42It's interesting.
- 01:12:42I wrote a piece that got that went viral.
- 01:12:46On I think it was like fishing,
- 01:12:49hunting and strip clubs because
- 01:12:50those were the places that,
- 01:12:52you know,
- 01:12:52that the men went to hang out and
- 01:12:54I had a woman reach out to me from
- 01:12:56the business world, she says.
- 01:12:57You know,
- 01:12:58my daughter's in medicine and I
- 01:12:59wish she had learned how to
- 01:13:00golf because I think golfing is
- 01:13:02so important for the career.
- 01:13:03And I'm thinking, well, that is one solution.
- 01:13:07But it doesn't really address
- 01:13:08the nugget of the problem.
- 01:13:10And so you're right, when you were PG Y2,
- 01:13:12you probably had no ability to say,
- 01:13:15I'm so glad you guys liked to hunt and fish,
- 01:13:17but how about did you see this movie?
- 01:13:20I mean, I'm not a hunter Fisher,
- 01:13:22but it's hard because when you're
- 01:13:24in that position of vulnerability,
- 01:13:26it's really hard to find the language.
- 01:13:27But that's where going to your chair,
- 01:13:29your program director, and say,
- 01:13:31how do I navigate this?
- 01:13:32And then maybe in a different environment
- 01:13:34where it's safe for them to get feedback.
- 01:13:37They can get feedback.
- 01:13:38There is no easy answer except to
- 01:13:41recognize how pervasive these issues
- 01:13:44are and to find a creative environment
- 01:13:47and a climate at work where we can be
- 01:13:51ourselves and talk about these things.
- 01:13:53But it's hard.
- 01:13:54Thank you.
- 01:14:07Thank you so much. Ohh. Ohh my pleasure.