Coming clean…

Obvious confession:

The blog has been a bit of a ghost town for the last few months.  You’re aware, I’m aware. Twitter hasn’t been an echo chamber, but I’ve not been as present there either.

Not-so-obvious confession to most:

Professional life has been messy and hard, and I’ve struggled with how to process that. Heart and Brain provide a near-perfect summary of what it’s been like (though I’m not sure the brown stuff would have been quicksand had I drawn them).

Personal life has been fine, great even. I have professional friends whom I’ve entrusted with what has been going on and who have been amazing advocates and supporters. I have other professional friends who haven’t been in the loop on things but who have consistently reached out with a kind word when I’ve needed it most (serendipity, FTW!). I have running  friends who have stuck with me when I’ve stopped for an ugly cry in the middle of a 10K. I have friends who have been around seemingly forever who are simply there and constant and kind. While you might not think that in your late 40s your sorority sisters would provide a life raft for you, they have done precisely that. As I told one of them a few weeks ago, “ADPi has saved my sanity the last 18 months.” Mom is great and healthy.  Dad is navigating the indignities of Parkinson’s with grace. Other than Belle!’s anxiety (maybe she’s channeling for me?), the animal support team is awesome. If you look at the ledger strictly from this side, I’m incredibly fortunate, and I won’t deny that. I am grateful for all of these things every day.

Then there’s the professional side.  Lots of things on the “good” side of the ledger there too. I work with the best team that anyone could ask for.  I take care of the most remarkable and resilient people that I could ask to be entrusted to care for. It’s a rare day for me to walk through clinic or the burn unit without getting a hug from a patient, family member, or both. Outside of my clinical work, I’ve been entrusted with leadership roles that I consider both a privilege and an honor. Again, these are the things that keep me going and for which I am grateful.

And yet…there’s this body of literature (which I am in the process of contributing to) that describes why women leave academic surgery and academic medicine. That literature has become intensely personal over the last 6-9 months for me. I’ve found incredible irony that the system that I’m trying to help fix, to make more equitable, has nearly chewed me up and spit me out. While I always found it tragic that many talented women were exiting academic surgery, even 10 years or more into what should have been remarkable careers, I now “get” how this happens. I would be a liar if I didn’t say I’ve thought about walking off. I don’t do disappointment and disillusionment well.

So what?

I’m still working on the answer to this question. What I do know is that I’ve moved past taking it all personally and simply being hurt. If anything, I’m realizing how important some of the intellectual work that I started out to do a few years ago truly is and that it’s time for me to double down on those efforts. I’m focusing more on my core mission(s) and doing the things that are the most meaningful to me. And I’m reminding myself at the close of every single day of those things I am grateful for; there are plenty of them, and they help maintain that sense of purpose that I need.

If you’ll excuse me now, I’m off to tilt at some windmills.  Thanks for joining me.

What if it’s not our fault?

“If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place.” – Margaret Mead

In the last week I have found myself in the midst of two interesting Twitter conversations, both with a similar underlying theme regarding the impact of culture and how we seem to underestimate its impact on the individual.

Here’s conversation #1 (remember to start reading at the bottom):

I particularly loved the empathy behind the idea that the term burnout implies that it’s a personal choice. While we’re getting smarter about identifying organizational factors that drive burnout (ahem…my group’s call schedule), there still seems to be this idea that if you’re struggling with burnout, you’re simply not resilient enough. Reality check: I’ve witnessed some people who are remarkably resilient struggle with burnout, and without exception they have been in a work environment in which they had little to no control. Yes, I understand that individual characteristics may predispose people to burnout or may limit the impact of a dysfunctional system upon the individual…but at the end of the day, victim blaming and pretending it’s ALL about resilience?  That’s simply feeding the dragon.  It’s not helpful.

On to Twitter conversation #2:

(The link that you can’t see from here is this recent piece in the Atlantic.)

So, maybe it’s not about biological clocks or because we’re not ambitious enough.  Maybe, just maybe that ambition is situational…and that if we’re in an environment where we see other women hitting their heads repeatedly against the glass ceiling,  or we experience that ourselves, we adjust our expectations accordingly. Or we leave when we realize that we shouldn’t have to adjust those expectations because there isn’t anything wrong with them.

It’s time to stop telling us to try harder, or telling us that we can’t be mothers and academic surgeons, or telling us that we don’t measure up because we don’t know the 100 extra double-secret and unwritten criteria that you’re using to evaluate us. Most importantly, it’s time to create a culture in which we feel valued and supported, not because you tell us that we should, but because we actually are.

What if it’s really not our fault?

Ladies, get yourself a Girl Gang

I admit that I usually try to give you food for thought then let you draw you own conclusions and applications.

Tonight, on the eve of International Women’s Day, I’m making an exception.  I’m dispensing some invaluable career advice for my women readers, particularly those in surgery:

Get yourself a “Girl Gang.” If you are somewhere where one is already in place, find out how to become a contributing member. At all costs, though, find yourself a group of women who share your commitment to excellence.

This article examining mentor-mentee sponsorship and gender came to my attention over the weekend (HT: Susan Pitt).  She astutely pointed out that this gives us an “action item” for women in surgery- to do a better job with sponsorship as more of us move into leadership roles.

This came on the heels of my friend Harriet Hopf mentioning during a breakout session last Friday that she appreciated being asked to join a “girl gang” that we already had in place at Utah with the expressed goal of promoting one another for leadership opportunities and awards. She came here from an institution with plenty of women in her department and in leadership roles, so this wasn’t something instinctive for them to do. For those of us in departments and places with a paucity of women leaders, it’s critical.

How does our Girl Gang work?  It’s remarkably easy.  We watch out for leadership positions or awards (both within and outside of our institution) that align with one other’s skills and accomplishments, and we nominate each another. Also, if there is a recognition that one of us really wants, we have an understanding that self-nomination to another group member is encouraged, and they’ll take care of the actual nomination.

Certainly our effort focuses on a group of women who are at a certain stage of their career, and those people definitely comprise the active members of our Girl Gang. However, once you start doing these things for your peers, you realize that it’s easy enough to extend your influence beyond that core group. I suspect I’m becoming a bit notorious with some of our female faculty in particular for my “nudge” emails (“You are incredibly qualified for this…you should apply…how can I help?”). My basis for doing this is two-fold, and both are factual.  First, as women we tend not to apply for things until we’re overqualified.  Sometimes we just need someone to tell us that yes, we really are worthy.  Second, it helps take the stigma away of tooting your own horn– again, something that women are penalized far more heavily for than are men.

(Closing note: While our Girl Gang has focused heavily on promoting the careers of women, we are not exclusionary and we welcome allies. I solemnly promise that I’ve put men forward for awards, leadership roles, opportunities, etc…I just focus on it less because we’re nowhere near having a critical mass of prominent women in academic surgery.  Yet.)

I was a stranger and you invited me in

Although I usually don’t go clearly political around here, it’s happening today; since it’s time-sensitive, I interrupt your regularly schedule programming. Your February Reading Round Up will happen over the weekend, I solemnly promise.

I’ve spent almost a week now pondering the Executive Order issued last week that limits entry to the US by residents of seven Muslim-predominant nations. When I first read about it on Friday, I immediately thought of two former medical students I mentored whose parents immigrated to the US from Iran in the late 1970s under terribly unfavorable conditions. I thought about a young Iraqi who we cared for during my time at Shriners as a fellow. And, of course, I started thinking about many, many immigrant stories of friends, colleagues, and my own family and the impact that blanket policies could have had on many of us.

Of course, over the last week many stories have come to light.  The first one I saw was on Facebook– an Iranian woman with a PhD from Clemson who went home to visit family, then couldn’t get back to her home in South Carolina.  She astutely asked what happens to her car at the airport, to her house filled with her belongings, to her dog? That brought the immediate human cost home to me.

Then there’s the story of this Sudanese physician, training at the Cleveland Clinic, who was in Saudi Arabia on vacation with her family when the Executive Order dropped. She is now suing. She is not alone in this.

For those who don’t know, many foreign medical graduates come from the targeted countries, and many of them are delivering healthcare in areas where we simply can’t get American physicians to work.  Not only does this affect that pipeline, it also may impact their willingness to come here in the future if it becomes easier again.

Most importantly, it appears that the foreign docs we are attracting are the best and the brightest since Medicare patients cared for by IMGs have a better in-hopsital survival rate.

The AAMC and the ACGME have generated thoughtful statements on the impact of this Executive Order on medical education and healthcare delivery. I particularly appreciate the ACGME for acknowledging the associated moral distress around the order; this has been an almost taboo subject, but it really shouldn’t be. This order has real human consequences on scientists, students, and residents; on patients; on families; and on the American healthcare system as it currently functions.

What’s my point here? Simply that this Executive Order appears to have had plenty of unintended consequences.  It wasn’t ready for prime time, and it became clear over the weekend that ICE and DHS weren’t ready for implementation.

And my other point is simply that it’s easy for us not to know all of someone’s story and how they can be impacted by decisions that seem less-than-strategic when you look at all sides. I’m not going to make an argument for wide-open borders, but for us to be able to help people who are trying to help people…well, that seems like the right thing to do.  It also seems, to me, to be relatively apolitical.

 

 

 

One…more…thing!

This past week I attended the Society for Critical Care Medicine Critical Care Congress.  Sure, the venue was a draw (Honolulu), as was the opportunity to spend time hanging out with my favorite pharmacist (Ann Marie is a rockstar and wonderful human). More importantly, I always leave this meeting feeling like it was time and money well spent.  This year was absolutely no exception (and yes, Burn Unit colleagues…be afraid.  I have at least 5 new and improved ideas for us!).

One of the standout sessions was a 2 hour discussion of burnout in ICU providers.  The session focused on physicians and nurses, and I’ll grant I would have liked more inclusion of information for our APCs, our PTs/OTs, and our pharmacists.  In spite of that, there was a lot of great discussion around the topic; if you want to see what it looked like on social media, check out the #StopICUBurnout hashtag on Twitter. It’s clear that we need to take a team-based approach to burnout because of the impact on team dynamics (it’s contagious) and patient outcomes (it’s negative).  Oh, and it also negatively effects our learners.

Here’s the conundrum around burnout.  A certain amount of stress can be positive and constructive under appropriate circumstances.  Plenty of  literature demonstrates that we adapt, both individually and collectively, with a certain amount of stress and that these changes can be for the better.  The issue becomes when the amount of stress is simply too much and we can’t manage another thing.

Like this:

Just right 👌

Posted by The Awkward Yeti on Wednesday, January 18, 2017

I’ve been there, and if you’re honest with yourself you’ve probably been there too. That’s when stress can become negative and maladaptive and push us into that “burnout” space.

What if going for a run or going to yoga or doing whatever your “thing” is- what if that were actually helpful even when you’re heading into what I’ve referred to more than once as “the land of overwhelm”?  Or…to ask it another way, how many times have you not done something that you know is good for your mind, soul, and body because you simply have too many other things to do?

Again, yes, count me amongst the guilty. But what if that “one more thing” is actually something that really is regenerative for you?  It might actually help you to become more productive and more focused.  And if you’re a leader in your environment, by being authentic and engaged (and less stressed), you’re setting the best tone for your team to thrive as well.

Try it.  Let me know how it goes.  I promise I’ll work on doing better with this as well.

Gratitude: It’s good for your team AND it’s good for you

Let’s start with a question.

How did you feel the last time someone provided you with a sincere thank you or kudos for something you did?

If I’m a good judge of human nature , I suspect it made you feel pretty good.  Perhaps your body generated a nice surge of dopamine. I would also suspect that it generated some good will towards the person who said the nice thing about you. You felt seen, and valued- two of the things that we know are so important to developing a sense of empowerment and belonging. And, of course, empowerment and belonging result in loyalty.

Gratitude is an important, and sometimes underestimated, leadership skill. Let me be clear about one thing before you decide to just go around saying, “Thank you” to everyone in sight.  That won’t get it.  Appreciation needs to be personalized, and if you can be creative in how you show appreciation, all the better. Personally, one of the best acknowledgements I’ve received recently was from a friend and sorority sister whom I work closely with. Last weekend I couldn’t run my planned half marathon because of illness.  And the text I got from her….well, it knocked my socks off.  It was a well-timed reminder that I can do hard things, I just couldn’t do them last Sunday morning.  And that’s okay.  She is someone with an incredible gift of gratitude and appreciation, and it makes her FUN to work on big projects with.  It also makes her a wonderful friend.

Appreciative Leadership has a summary table of 7 reasons to be generous with appreciation. Taken from Table 6-1  in the book, the list is as follows:

  1. Recognition lets people know they are on the right track
  2. Appreciation communicates and reinforces your values
  3. Compliments foster a positive emotional environment
  4. Gratitude is a verbal immune boost; it is good for your health (we’ll come back to this one shortly)
  5. Praise is good for the health of those you honor
  6. Acknowledgement creates a sense of safety (SO important in teaching and learning environments!)
  7. Gratitude encourages risk-taking and experimentation

The reality is that a culture of gratitude helps to promote high performance by teams.

Here’s the thing: While appreciation is the right thing to do for your team, it’s also the right thing to do for yourself. Many individual-level benefits of practicing gratitude are becoming increasingly clear: it improves both physical and psychological health, enhances empathy, improves sleep, enhances resiliency…the list goes on. If you look at that list closely and if you follow the literature on burnout, you immediately recognize that gratitude might just be one of the cornerstones in combating burnout.  Again, from personal experience I know that on days when I am feeling particularly frustrated and as if I’m tilting at windmills, the best thing I can do is pause and think about something I’m grateful for.  On bad days, it might be that I’m only on call for 4 more hours.  On less bad days, the list is typically much more robust.

Weekend homework, friends. Before you go to bed tonight, tomorrow, and Sunday night, write down (yes, write it down with pen or pencil on paper- it does imprint better that way!) three things you are grateful for.  I’m helping you to kickstart your personal gratitude practice.  Next week see if you can extend sincere appreciation to people you work with.  I’m willing to bet you’ll make someone’s day and make them want to do an even better job the next time you work on something together.

…and doggone it, people like me

Many of us remember laughing at Al Franken’s Stuart Smalley character on Saturday Night Live; for those who don’t remember the skit, the character is focused on repeating positive affirmations (and it’s still worth a watch).

I’m currently reading Appreciative Leadership, which I’ve am convinced may be the best leadership book I’ve read ever. The authors provide a framework for using appreciative inquiry as an approach to leadership.  The framework uses five “Is” for appreciative leadership: inquiry, illumination, inclusion, inspiration, and integrity. As I read the chapter on Illumination, I’ll admit I giggled thinking about a Stuart Smalley skit for a moment, then realized the actual value of positive self talk for generating what the authors call “positive power.”

If you think about when you’re at your absolute best, what thoughts are you having about yourself? Chances are that this is not when the word “loser” comes through your mind repeatedly, or when you’re wrestling with a case of impostor syndrome. Now, if you extend this to your team, what thoughts do you have when your team is performing at a crazy-amazing level? Again, I doubt that you’re thinking about how tired you are of Bob and Betty fighting, or what a poor lead nurse Billie Jo is.

Admit it- when you recall situations in which there was great success, you tend to go positive with the things you think about.  It immediately tells you what your and your team’s strengths are, and it gives you confidence to perform at a high level.

Time for a confessional: As I thought about using strengths and success oriented self-talk, I had a moment of self-illumination.  I realized that during the times when I have not been a good leader, when I’ve been petty and difficult, it has uniformly come from a place of insecurity. And what’s put me there? That little voice telling me that I’m not enough, that I don’t belong there, that I really can’t do this.

Additional confession, or wisdom grown from my own lack of it: If I’ve learned any lessons in the last decade, one of the biggest ones is that people “feel” that insecurity and that sort of inner monologue.  They know you’ve got doubts, and if you’re supposed to be leading them they’ll start to doubt themselves and the team too.  It becomes a vicious cycle.

That leader stands in stark contrast to the “I’ve got this, and we’ve got this” leader who instills confidence in the team, makes them more capable, and helps them to achieve at a higher level.

Which leader do you want to be? And what are you telling yourself about your ability to be that leader?

 

Leadership and the ambition gap

The McKinsey 2016 Women in the Workplace report was recently released; it’s taken me a bit of time to process the information in it. It’s complicated, and in the throes of a Presidential campaign that is rife with misogyny, it might even be a bit discouraging. We know in professional America, and in academic surgery, that a significant fall-off occurs in the number of women as leadership roles become more powerful. In academic surgery, we see it with the drop from 16% of Associate Professors to 9% of full Professors; we see it with the paucity of women in leadership roles in major organizations; we see it with the number of women who are department chairs (recognizing this number has improved dramatically even in the last year).

We know that women often simply don’t seek promotion to the highest levels, perhaps because work-life integration is more acutely present for women in our society. Perhaps its because we have an unconscious bias against ourselves that only allows us to take a chance on that “big” job once we’re 100% qualified (or, perhaps, more than 100% qualified).

Or maybe, just maybe, it’s because we’re programmed to think of “power” and “ambition” as dirty concepts.  They’re not ladylike, and therefore we don’t want to be in that top role because that would require us to be ambitious and it would require us to use our power.

Gap in Leadership Ambition

Gap in Leadership Ambition

This week I saw an interesting complement to the idea of the the ambition gap, in which Anne-Marie Slaughter hypothesizes that women perceive ourselves as able to have a greater impact at the center of a “web” than at the top of a hierarchy. While her idea that women don’t understand the impact we can have at the top, it’s also plausible that we are so much more comfortable working collaboratively that the idea of having diffused impact through a network is what makes the most sense to us. What we may be overlooking is that we can use the same high-touch, collaborative skills when we’re in that “big” leader position, and use it to our advantage.

Maybe it’s time for us to change our thinking and stop being one of our obstacles (because heaven knows there are plenty without self-sabotage). Maybe we need to realize that it’s okay to dream big, and that it’s okay to start looking even when we don’t think we’re quite ready.  Maybe, ladies, it’s time to leap- and our nets really will appear.  It’s a win for each of us who is ready to do so, and it’s a bigger win for those coming after us as they see our courage, our commitment, and our strength.

 

 

Being and belonging

Earlier this week, I got into this Twitter-sation with my friend Arghavan Salles:

Belonging and academia

Belonging and academia

As you can tell, I moved the needle a bit in this discussion, doing so based both on data I have (I’m working on the manuscript, I promise!) and anecdotes from talking to surgeons who are struggling with career advancement.

When I talk to friends who are struggling in their career, be it in academic surgery or another profession, I consistently hear two integrally related ideas from them.  One is that they truly don’t feel like the belong where they are; they aren’t aligned with their company or institution for some reason, be it an issue of core values or goals. And as part of not belonging, I find that many of them try desperately to fit in and often feeling like a round peg in a square hole.  Those attempts at conformity are, if nothing, destructive to both their satisfaction and their achievement.

We see this sense of exclusion, of not fitting in around gender in male-dominated fields like engineering (full disclosure- my best friend is a woman engineer, and she may have more awful gender bias stories than I do, though she has also stuck it out and is incredibly successful). We see it in policing around organizational culture and institutional racism.  Ironically, we could use social accountability, in this instance playing on leader’s interests in fitting in, as a way to improve diversity and inclusion.

As leaders, we have to embrace that it’s not fair of us to try to fit round pegs into square holes; when we’re recruiting, we need to have the courage to tell someone that their interests or ethos may not be a good fit for our organization so that we don’t set them up for failure. As leaders, we also have a responsibility to create a culture that is inclusive and that can accept differences. I understand that resource limitations mean that every department cannot have expertise and resources in every area that might be relevant for a junior faculty member’s career development.  The time to think about that is during recruitment-do we have it or can we build it for them- rather than once the new faculty member shows up only to realize they won’t be able to do what they view as meaningful work.  They’ll be forced to try to fit in, rather than to belong, because they’re always going to have a sense that what they do doesn’t have value where they are.

I want to also be clear that I don’t expect every single academic department to be a cookie cutter of other departments.  That would be boring, and wouldn’t be good for our patients or our profession.  We should institutionally embrace our strengths and capitalize on those and recruit appropriately. If someone wants to be a public health researcher and trauma surgeon, we should support that person going to the best place to fulfill both of those professional goals. If someone wants to be a surgical educator and a vascular surgeon, we should do the same. What matters is that there is a “home” for everyone who wants to be here within the house of academic surgery (yes, we need to redefine what being an academic surgeon means!), and that we find them that place where they can thrive and belong.  It’s time to move past fitting in.  Our profession deserves that, and so do our junior colleagues who have plenty of amazing ideas.

Rule Number 5: Everyone’s an equal fighter

PSA: It’s Women in Medicine month.  I would be completely remiss if I didn’t have at least one feminist post this month.

And a warning: Have you heard of Feminist Fight Club (FFC)? No? I’ll warn you that there’s some salty language over there, so if you’re easily offended it may not be for you. That said, it’s a how to guide for fighting sexism with plenty of data.  It’s my current read, and I’m loving it. It’s also providing me with some inspiration.

Before you question if there’s a need in surgery and in medicine for something like FFC, I assure you that there still is. Although women have been half of all medical students for a decade or more, our gains in academia and leadership simply aren’t matching the numbers there- and it’s not simply a time decay phenomenon.  Women enter academics at a lower rate, and our attrition rates are higher.  Even with our equivalent levels of training, we are paid less. These are all simple facts. So, yes, while FFC isn’t written about careers in medicine, it’s no less applicable in our professional world.

Bennett divides her stories and facts into a few key areas:

  • Know the enemy (for the record, it’s patriarchy, not men in general)
  • Know yourself
  • Booby traps (a/k/a “office hospital politics”)
  • Get your speak on
  • F you, Pay me
  • WWJD- What would Josh (a really average white guy) do?

Interestingly, several of these concepts, particularly those around effective communications,  align with key features of Executive Presence, which were published in a more “formal”/ professional  manner.

One of the bits in Feminist Fight Club that resonated the most with me was one of the ground rules for Bennett’s group- no mean girls. We are all in this together, and if we’re busy fighting with you, we can’t get the work done.  You’re a distraction. If you’re a mean girl, we’re still fighting the patriarchy on your behalf.  We’re just not including you in our meetings about how we’re getting it done. Work this important requires a drama-free zone.

I’m going to borrow Bennett’s questions that she includes as discussion topics for a Feminist Fight Club meeting, and I’m going to encourage you (reader) to think about them, to develop your own set of responses.  Note: Men and Women both welcome to play!

  1. Where do you want to be in 5 years?
  2. What’s your biggest pet peeve at work?
  3. What career goals do you have, and who can help you to achieve them (include yourself on the list!)?
  4. When is the last time you were proud at work? Why?
  5. (For those who read the book) Try out a FFC ninja move, keep notes on how it worked, and report back to some like-minded friends.  Guys, you also have FFC ninja moves that start on Page 239. We’re all in this together.

You’re not crazy.  It is real. And being aware of it is the first step to solving the problem.

Apropos of nothing at all: The best piece of advice appears on page 103- Take the nap.