I am thankful for the opportunity and platform to write about my personal experience on “lessons learned” as a female electrophysiologist. The fact that there is a “Women in EP” series in EP Lab Digest speaks volumes — not only to the growing recognition of women in the field, but also to the collaboration amongst us. While I am still learning many “lessons” on a regular basis, I chose to highlight the following three scenarios to best illustrate what I have learned. In turn, I hope to pass on that gained perspective to others who may be faced with similar encounters.
Lesson #1: “Help me, Rhonda…or Ron.”
The importance of mentorship in medicine cannot be overstated; it is associated with a higher level of job satisfaction and career advancement opportunities.1-4 Hence, the first lesson is to seek and accept mentorship.
As a second-year medical resident, I was fortunate enough to work with Dr. Martha Gulati, who was relatable and encouraging. While the lure of the electrophysiology lab ultimately prevailed over my initial intent to pursue a career in preventive cardiology, that early mentorship provided the essential spark to propel my career development forward. Later, as an EP fellow, I would reflect upon that early mentorship when I often felt I was the “odd woman out” in a male-dominated field. Ten years later, I imagine that current trainees still feel the same, since females still comprise only 9% of first-year EP fellows.5
As fellowship moved into early career, the lack of belonging to a “wolf pack” often led to frustration on my part which, in turn, limited my ability to recognize the value of mentorship from my male colleagues. I still believe that our male colleagues may never truly appreciate the particular nuances of being a female EP, such as ablating while eight months pregnant or experiencing discrimination based solely on our gender. Fortunately, I do have one female partner, Dr. L. Lee Eckhardt, who also happens to be a leader in inherited arrhythmias research, so it was helpful to seek advice from her. Additionally, I began to part ways with the notion of mentorship requiring a gender “match.” Dr. Michael Field, the former section head at UW Health, encouraged me to pursue academic endeavors both within our institution and nationally. While Dr. Field has since moved on to MUSC Health, his mentorship (and at times, sponsorship) was a key component to my career advancement in the past couple of years. Importantly, the fact that he is a male did not impair the quality of his advice and encouragement, but only added to the breadth of knowledge shared by others. In fact, data show the positive impact of mentorship regardless of gender matching between mentor and mentee.6 Thus, I encourage you to seek mentorship from all of those who may offer career guidance, keeping in mind that everyone has a niche, and therefore, ability to guide in those areas. There are also ways to connect with women in EP beyond your local institution, including in-person events such as the Women in EP Luncheon at the Heart Rhythm Society’s Annual Scientific Sessions, as well as via media such as email list serves or by connecting with the authors of the Women in EP section in EP Lab Digest.
Lesson #2: “You are looking at the old guard.”
Unfortunately, many women have experienced bias and/or discrimination based on gender. The association of gender with a particular “norm” is not simply limited to our practice in medicine, but stems from a much larger societal level that creeps through the walls into our institutions. Within cardiology, the American College of Cardiology (ACC) reviewed female practice experiences over the past 20 years and found that women cardiologists still report significantly more discrimination (65%) than their male counterparts (23%), with discrimination based on gender experienced by 96% females vs 8% of males.7 As females, we are already aware this is occurring, but I wonder how we all manage bias when it actually happens to us. This brings me to the second lesson on gender bias and how to manage it.
I have completed my fair share of bias training and understand the role of the unconscious bias in how people make judgements. We all have biases; it is the recognition and insight on how to alter those biases that help us to make better choices. When we become the targets of bias, it ignites a variety of feelings including anger, frustration, helplessness, etc., regardless of whether or not the origin of that bias was intentional or unconscious.
Earlier in my career, I would try to ignore or simply move on when I heard these “little” discriminatory comments, for fear of offending the offender. This was particularly tough with supervisors or patients. However, I realize now that I am not doing myself or any future female professional a service when I do not address those comments. Therefore, I now try to view these experiences as an opportunity to educate the offender. I am also more vocal to my colleagues, particularly my male colleagues, each time that an offense of bias occurs. Although well intended, my male colleagues are usually unaware how often we experience bias as females. Recently, a male fellow introduced me as his boss; the patient responded with surprise, remarking that I was young and female, so it was unexpected that I would be his boss. I informed the patient that female physicians are more of the norm than the exception nowadays, including that approximately one-half of all medical students are female. He seemed interested and was apologetic, and said he hadn’t meant to be offensive.
Just prior to that, I experienced bias following a discussion with a patient regarding an upcoming procedure. When I asked if any questions remained, he asked me if the “old guard” would be there. When I tried to clarify what was meant by this question, it became clear that the patient wondered if I would be supervised by two of my male colleagues, whom he knew by reputation. I smiled at the patient and said, “well then, you are looking at the old guard.” I followed by stating that these particular colleagues typically are the ones referring these cases to me. He was apparently satisfied with the answer, since he did show up for his procedure. Notably, two male trainees were with me during that incident — one remarked to me that it was sad to witness such an overtly biased comment. I am glad he was there to see it, as it exemplifies how often bias events are underreported, and as a result, creates a mirage of equality that has yet to be obtained. Lack of awareness that such biases exist only perpetuates these very issues. Additionally, it is also up to us to address bias when we may be playing more of a bystander role in certain occasions. Admittingly, in prior years, I was guilty of brushing comments aside or underreporting events when the need was there. However, if we continue to maintain the status quo in our institutions, how will we ever seek equality on a more global level?
Lesson #3: “Thanks, but no thanks.”
Besides our numerous clinical responsibilities, physicians are offered a myriad of additional roles, including administration, teaching, research, community outreach, and more. While some of these activities are built into our job description as well as our compensation plans, others are not remunerated. For those uncompensated activities, we must be able to discern amongst those that are: (1) beneficial for our careers, (2) something we love, or, (3) none of the above. That brings us to the final lesson: learn to say no and be your own advocate.
When I first joined the group at the University of Wisconsin, I was excited and wanted to do it all. I volunteered for medical student teaching, joined the medical school admissions committee, became the associate program director for the EP fellowship, advised an undergraduate medical interest group, and the list goes on and on. I was happy to help, and really enjoyed these activities. However, as time went on and my practice developed, the additional duties began to creep into my clinical time and then spill over into my home life. It was not until the past couple of years that I took a lesson from my toddlers and learned to appreciate the use of the word “no.”
As tough as it is to say this to your colleagues, directors, or students, it is of the upmost importance to place our efforts towards things that we either really love or that will help to advance our career. The latter reason may seem self-serving, and it is. While we are by nature those who enjoy serving others, we also need to tend to ourselves and become our own advocates in order to ensure that we get the most out of our career. What defines career satisfaction is unique to every one of us — this may equate to attaining promotions or leadership positions, becoming funded for our research, or being the best clinicians that we can.
While research is not my primary career focus, I find this topic to be a great example of how we compare with our male colleagues, as data show that females are more apt to spend time with direct patient care and teaching duties, and less time participating in research.8 The resulting downstream effect is fewer publications, with possible implications limiting promotion or attaining full professorship.9 While higher levels of research accomplishment may lead to higher likelihood for promotion, not all of us thrive on research. Even so, when publication activity is accounted for, females still have an overall lower likelihood of achieving a leadership position.10 Moreover, fewer full-time women (32%) obtain associate or full professorships compared to their male colleagues (52%) per an AAMC survey in 2014.11 While I am not an expert on the etiology of promotion disparities in medicine, I do wonder if a theme is developing.
When we consent our patients for procedures, we discuss the risk vs reward of whether or not to undergo a procedure. Similarly, we must evaluate the investment vs reward when selecting opportunities above and beyond our clinical duties. Your career goals (and hence, determinants of career satisfaction) will help you select the most beneficial activities.
I previously feared missing opportunities or disappointing others; however, this was at the expense of feeling less satisfied both in my career and at home. Thus, I needed to change my approach. I found ways to tailor my extra clinical activities to those that I either truly enjoy or that will help my career to grow. This has also led to either declining or placing stipulations on my level of involvement with activities in order to strike more of a balance between my career and my life. After recently declining a leadership position that I would have grabbed at years ago, I did not feel guilty or unsure — I simply felt really good. In the end, it is true that time is an extremely precious commodity and we must use it wisely. Therefore, be picky, be choosy, and be your own advocate in the process.
- Palepu A, Friedman RH, Barnett RC, et al. Junior faculty members' mentoring relationships and their professional development in U.S. medical schools. Acad Med. 1998;73(3):318-323.
- Varkey P, Jatoi A, Williams A, et al. The positive impact of a facilitated peer mentoring program on academic skills of women faculty. BMC Med Educ. 2012;12:14.
- Welch JL, Jimenez HL, Walthall J, Allen SE. The women in emergency medicine mentoring program: an innovative approach to mentoring. J Grad Med Educ. 2012;4(3):362-366.
- Beasley BW, Simon SD, Wright SM. A time to be promoted. The Prospective Study of Promotion in Academia (Prospective Study of Promotion in Academia). J Gen Intern Med. 2006;21(2):123-129.
- American Board of Internal Medicine (ABIM). Resident and Fellow Workforce Data. Available at https://www.abim.org/about/statistics-data/resident-fellow-workforce-data.aspx. Accessed May 29, 2019.
- Butkus R, Serchen J, Moyer DV, et al. Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians. Ann Intern Med. 2018;168(10):721-723.
- Lewis SJ, Mehta LS, Douglas PS, et al. Changes in the Professional Lives of Cardiologists Over 2 Decades. J Am Coll Cardiol. 2017;69(4):452-462.
- Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement. Results of a national study of pediatricians. N Engl J Med. 1996;335(17):1282-1289.
- Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender Differences in Academic Medicine: Retention, Rank, and Leadership Comparisons From the National Faculty Survey. Acad Med. 2018;93(11):1694-1699.
- Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA. 2015;314(11):1149-1158.
- The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership 2013-2014. Association of American Medical Colleges (AAMC). Available at https://store.aamc.org/the-state-of-women-in-academic-medicine-the-pipeline-and-pathways-to-leadership-2013-2014.html. Accessed May 29, 2019.