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.




Mind the (author credit) gap?

HT to my Dad, who is a more reliable NPR listener than I am (it’s an advantage of retirement, I’m told). Yesterday he shared a short segment from All Things Considered that discusses the gap in women as first and senior authors in medical publishing.

I have two key concerns looking at the article they discuss and after digging a bit more deeply into the literature in this area.  One is the evidence of a plateau in women as first or senior authors in the last 7 years.  Is this because we’ve hit a glass ceiling in science? Is it because we’re not trying? Is it because of implicit bias? Or is it some combination of the three?  Those concept are all subtle enough that it’s almost impossible to determine the role that each plays without employing qualitative methods. Of course, the beauty of qualitative methods is that more reasons we aren’t even thinking of might be playing a role and this would help to identify them.

My second concern is the one alluded to in the conversation with the female cardiologist in the NPR piece. We know from many areas of the business and academic literature that as women we tend to advocate poorly for ourselves; most of us culturally can’t get comfortable with the probability of being viewed as pushy, which is a documented consequence of aggressive negotiation tactics. Is our absence as first or senior authors a result of us failing to negotiate and advocate effectively for ourselves in yet another realm? Is this another manifestation of “Women don’t ask” in a way that is perhaps even more insidious than failing to negotiate salary?

And, of course, I can’t help but wonder if this isn’t generally representative of our global shortcomings in attracting and retaining women into careers in academic medicine.  Until we have a system that provides the professional development opportunities, the hard resources, and the work-life integration capabilities that are expected in the modern world, there may be little additional room for change.

Not so graceful, but giving myself grace

It’s a week for self-disclosure, mostly to let you know why my recent posting has been so irregular.  Don’t brace yourself for something really exciting or you’ll be terribly disappointed.

A week ago I was meeting with one of my colleagues in my office, who commented on my Personal Kanban board in my office, which is covered with bright Post-Its (surprise!).  I told him it’s really the only way I feel like I can begin to keep all of the plates in the air.

Until I can’t keep them in the air, that is.  This week has definitely required lots of latitude from others, and has made me grateful that apparently none of the plates I was juggling were particularly fragile.

Here’s the truth: While the amount of time we all have in a given day or week is fixed, our energy is variable from one of us to another, and even for each of us as individuals at different times. I am generally a high-energy person, though I am also well aware of the things that are more likely to drain my energy. A series of days with early meetings drains me, and that’s been the case for my schedule this week. Not getting my workouts in or getting to yoga = draining (as counterintuitive as that may seem). Falling behind on my email = tiring. Not writing or creating = complete energy paralysis.  You get the idea.

And, as luck had it this week, I did manage to run on Wednesday and Thursday and I am mostly caught up on responding to email (though not meeting all of the scheduling requests/ demands contained therein).  It was a week when I had little control over most of my schedule because, as I often say, “We just take care of the people.” Blissfully, I did have little night call with our crazy days, which made the clinical demands generally achieveable.  However…I was late to a session with the students on Tuesday, I missed a Tuesday night conference call, and I didn’t make it to conference on Wednesday morning.  By Wednesday afternoon I had it all down to a dull roar and was able to not feel like I wasn’t struggling at every turn.

Why am I rambling about this?

Mostly to help people understand that sometimes even those of us who you often think do it all “effortlessly” aren’t effortless at all.  We mess it up.  We miss obligations. We get tired. We are human.  I don’t try to be anything but that, and on Tuesday afternoon I apologized profusely and made sure that I was 100% present once I made it to class.  Tuesday night I apologized via email for the whims of my schedule and was given a gracious, “It’s okay. We understand and we love it when you can be here.”

The best part of that response? It reminded me that I’m not failing dismally, and that I’m not even failing. I’m just managing more-than-a-few-things right now.

And that maybe, just maybe, I need to give myself a little grace when it’s like this.


Many pathways, similar goals?

Yesterday I received the monthly newsletter from our Women in Medicine and Science (WiMS) Office.  It has 10 bullet items in it, 5 of which relate to the Mom community, parental leave, child care, etc. This was notable to me primarily because I can’t say that I have a positive history with our WiMS group.  About 3 years ago our Dean hosted a series of dinners for women faculty with the leadership from WiMS and Academic Affairs serving as the co-hosts; I found myself at a table that spent the entire evening discussing marriage and children.  I have nothing against people being married and having children (more power to you, particularly in dual career families!).  What I do have an issue with is having a conversation in a place with people who are your professional peers that entirely excludes others at the table; there was one other unmarried woman without children at our table, and unfortunately she and I were seated directly across from one another, preventing us from being able to start our own conversation.  After the dinner I told my friend who is the Associate Dean for Academic Affairs what happened, and also told her the probability of me attending another WiMS event is near zero.  Yesterday’s newsletter heavy focus on issues relevant to that same subgroup who excluded me reinforces my belief that at our institution we probably should rename the WiMS office for what it really is- a Families in Medicine Office.

I want to be clear that I acknowledge the tension present for those who have the competing pressures of a young family- or aging parents- and a vibrant academic career.  I hope that my friends who are dual career with children and making their way in academic medicine understand how much I respect them; it’s all I can do to keep my own house running and I have a dog and two cats (and a wonderful mother who lives 1.5 miles away from me).  However, based upon conversations with male colleagues of my own generation, this family-work tension (or work-life integration as I also refer to it) is no longer the exclusive domain of women.  And based upon my own research about barriers to careers in academic surgery, while women surgeons do perceive that tension as a barrier, it was one of MANY barriers- and it wasn’t the first thing that came up in most of my interviews.  Resources, mentorship, having your work valued- all of these things were raised as much or more in terms of things that are critical to success in academic surgery.  More to come on all of that, I promise, as the stories crystallize into their themes.

I’m always happy to hear my friends’ tales of trying to juggle two careers, soccer practice, dance lessons, and getting dinner on the table.  I’m also happy to hear these friends’ tales of their latest research idea or commiserate over a terrible clinical story.  I need both of those things as a peer and a colleague- I need to know that they are multidimensional, that they are passionate about all of the things in their lives.  I want them to love their kids and spouses.  I want them to love their profession.  And I want them to strive for better in both of those spaces.

I still believe there is a need in medicine, and surgery in particular, for us to have organizations responsible for helping women to break down the structural barriers to our success in academia and in leadership roles. I do believe some of those barriers are still real and relevant.  I also believe that we must be thoughtful and non-exclusionary in our approach to these things because we are each traveling our own challenging path.  And more importantly, we need to include those who are different, be it in gender or family model, who are willing to embrace the concerns and to help us find ways to make all of these challenges just a bit easier.  Our loved ones and our profession- both at the individual and the collective level- deserve that.


It’s implicit

I recently found myself involved in an interesting (and insightful) conversation with one of my residents and one of my practice partners about sexism and racism.  The short version of how we got there is that the resident noticed that a discussion of two trainees with identical professional development issues but of different (race/ethnicity/ I’m not going to tell you distinguishing characteristic so we’ll go with “blue” and “orange”) appeared to be VERY different in content and tone, particularly from one person.  Our discussion quickly moved from the particulars of this situation to the bigger picture- bias and prejudice, and the impact that they have on us and our trainees.  Specifically, our discussion moved to our perceptions that most prejudice that we experience, particularly as women, is no longer overt.  More importantly, most of the people we tend to identify as the biggest offenders don’t even realize their own bias.  In other words, the faculty member described apparently has no knowledge of that tendency to describe blue people and orange people in a dramatically different manner.

For those not familiar with this concept, it’s described widely in the social psychology literature as “implicit bias.”  Project Implicit, originally based at Harvard and now with an international infrastructure, is the most robust general research for information on implicit bias.  Housed within their website is the Implicit Association Test (IAT), which now addresses myriad potential angles of bias.  I first took a version of the IAT probably 8 years ago and I’ll admit- for someone who tends to think of themselves as a modern, liberal, open-minded, generally unprejudiced person it was eye-opening.  In spite of being a woman in a very male-dominated field, I found that I still had some biases about women and science (is THAT why I was a liberal arts major?!?), as well as women and command leadership.  Who knew?

What we know is that implicit bias is real.  We also know that it has a very real basis in both family and social experience imprinting; our biases are formed at a very early age. We know that those biases have a tremendous impact, and can certainly have an impact on women in academic medicine for a variety of reasons.  We know that even though those biases are imprinted early that they can be “managed”; simply being aware of our biases makes us more likely to be able to limit their influence on our behaviors and actions.  Many institutions now have in place implicit bias training as part of faculty recruitment as a starting place to address this issue.  I would be curious to hear from colleagues (yes, dear reader, that’s you) what, if anything, your institution is doing on this front.  And, of course, I would encourage you to take the IAT.  It’s eye-opening about those biases you might have about blue people versus orange people.

Mid-Career: Stagnation, Generation, or a new path forward?

It’s been almost 6 months since I headed to Austin for the 2013 AAMC Mid-Career Women Faculty Professional Development Seminar.  Parts of the three days were tremendously helpful to me- in particular, sessions on interpersonal communication, conflict resolution, and the importance of sponsorship (as opposed to mentorship) for career progression.  The networking was tremendous, both in terms of some relationships it built with other women surgeons at a similar career stage and a few new folks I met who aren’t surgeons but who are inspirational. Some parts weren’t terribly helpful to me at all; I’ve long been aware that my temperament is one that is driven by creativity and possibility and thrives on relationships- no surprise to anyone who knows me or works with me.  And yes, I understand the ramifications for that in group settings since I become absolutely non-functional when thrown into a dysfunctional group.

The six-month mark seems a good time point to take inventory and consider what my best take-home messages were from the meeting.  Fortunately, I was easily able to find my concept map that I drew on the last day:

Mid-WIMS Concept Map

What does this photo tell me without me having to go back and read pages and pages of notes?  I definitely left Austin better prepared to lead than when I got there.  Why?

  • The seminar was an opportunity for me to refine skills that are crucial to being a good leader.
  • I gathered some new ideas from the seminar (all of which I need to try, though I did write something that approximates a PAR/ CAR statement recently).
  • Participation helped me to clarify my vision of what I am doing and where I would like to head professionally.

The greatest reminder was that I haven’t explicitly tried any of the new ideas that I left with, all of which have some merit for career development and organizational growth.  While it will require some thought, applying a mission/ value grid- or the related idea of a mission- core competence (MCC) decision matrix– to some of my administrative activities may help me to be more strategic in how I am running my portion of our department’s education enterprise.  I can and should write a PAR statement for each dimension of the work that I do- clinical, education, research, and administrative.  The hidden benefit of generating PAR statements is that they allow us to look at obstacles that have been overcome and skills/ traits employed in so doing; looking at those skills and traits will allow me to insure that I’m really using my “best” skills in the roles I’m playing.  Finally, I know I could use a personal consulting team on a few career progression issues, and perhaps it’s time to formally convene one for some wisdom (and for me to listen to the feedback they provide, which can be the hard part).

Hopefully in six more months I can come back to my concept map to let you all know that I did try out these new ideas- and to recount their successful implementation.