Saturday, February 3, 2018

An Impromptu Group Conversation With Women in Hospice and Palliative Medicine

Collectively written by Allison Jordan, Katie Harmoney, SarahScott Dietz, Jeanette Ross, Emily Hahn, Meredith MacMartin, Christian Sinclair, Rachel Thienprayoon

Waking up today February 3rd, I (Christian) saw a discussion on our Facebook private messages for the Pallimed page about what we should post for National Women Physician Day (which is held on February 3rd the birthday of Elizabeth Blackwell, the birthday of the first US woman physician.) Jeanette had found the 2016 Pallimed post written by Meredith MacMartin and we posted that, but then I thought it would be great to write some fresh content on this new celebration. So I jumped over to Twitter and reached out to a handful of female colleagues on a direct group message and asked my co-authors above:

My first thought was, “let’s use the reach of Pallimed and social media to amplify women’s voices on this commemorative day!” As soon as I sent the DM I realized, maybe this wasn’t the wonderful idea I initially thought.

Oh my gosh…
the horrible realization hit me…
I was asking women peers to do work…
on a weekend…
with no notice…
on a day focused on the challenges and accomplishments of being a woman in medicine…
challenges often from the results of a historical and current male-dominated workplace...
and I am a man.

Thankfully they didn’t point this out to me, but what followed was a really fantastic conversation that Katie noted: “We could publish this thread!” So we organized and streamlined some of the discussion would love to share some of our observations to broaden the conversation.

The Initial Ask

Sinclair: Sorry for the group DM, if some of you don't know each other. But I was wondering if any of you would be interested in writing a piece on National Women Physician Day for Pallimed. Meredith (@GraniteDoc) wrote one in 2016. We didn't have one in 2017, and this one just snuck up on me and I didn't think to get one drafted before this year's day. You can email me with a submission. Will get it published today or tomorrow if I get it today. And if you want to enjoy your weekend, not writing, that is perfectly acceptable! No pressure, honest.
Harmoney: I'd love to, but am actually volunteering at a cancer fundraiser.
Jordan: Is there a specific topic that you would like the writers to discuss? LOL otherwise I’ll just send you “being a woman in medicine is hard. We are still working in a system that was designed by men ages ago. Women need to be at the table to redesign the system so that it works for everyone.”
Dietz: May be able to, subject to the whim of a 16 day old. Right now I would probably rant in a sleep-deprived manner about parental leave. 😆 But yes, what Allison said, LOL.
Ross: Sarah, congratulations on the new baby! I was thinking something about women in #hpm but I don’t think I know all relevant info. Could go:
First hospice and palliative medicine (HPM) Physician: Dr. Cicely Saunders
First USA HPM Physician: Dr. Elizabeth Kubler-Ross?
Like first AAHPM woman president ....
Dietz: I would love to work on a post about women leadership in early HPM but I don't think it's going to come together this weekend. Next year's women's day?

On Mentors

Ross: Did you have a woman mentor play an important role in HPM for you. I would say that is why I’m grateful to mentors who help me think about how to balance life and work.
Jordan: Mentorship is HUGE.I could not have done this without male and female mentors
Dietz: I haven't had a female mentor. I can only imagine that would be a very helpful experience! Jordan: Sarah, I would strongly advocate for a mentor. And peer mentors too. Sometimes your girlfriends will be great cheerleaders to give you the courage to ask for what you need/want. I have different mentors for different reasons. I have a mentor for work/life balance. I have a mentor to help me with leadership skills, and I have a mentor to help connect me with people. I have the mentor for when I need a kick in the pants to push me to not settle.
Harmoney: Yeah. It's so important to pick mentors for each thing.
Jordan: LOL! I need a lot of help. It takes a village! But I can’t do this alone and there are women and men out there who have AMAZING knowledge.
Harmoney: My HPM mentor is a lady. She's very helpful and open about her own struggles. Helps that she’s late/mid-career.
Jordan: So the mentorship is great, but it still doesn’t fix systemic problems with the way our jobs are designed.
Harmoney: We need a fundamental culture change.
Jordan: I agree Katie. if we all work together and advocate for what we need, with the support of mentors, change can happen. We need people in leadership and positions of influence to help change the culture. Otherwise we will continue to have burnout, physician shortages, and people choosing to not go into HPM or medicine.
Harmoney: We have this in peds oncology too. So much pressure, jobs are super competitive, funding is scarce.

The Future of Medicine

Dietz: Baby woke up, reading back. (She’s amazing. I have two boys but today I’m really reflecting on what I want medicine to look like, if she decides to be a doctor like her parents. I really want to not have to worry that it’ll be different for her than it would be for her brothers.)
Jordan: I worry about my goddaughters and they see me and their mom in medicine... I want it to be different for them. Right now they don’t understand what we do (they are 2 and 4) but they clearly get we are not like other women in their lives.
Harmoney: Medicine also has a culture of us doing everything: patient care, research, grants, writing. It’s unsustainable.
Jordan: “Medicine is a very jealous lover. It will take as much time as you give it.”
Dietz: There’s an enormous pressure to be perfect or super-human in Medicine, because of the part where we have people’s lives in our hands. It makes it really hard to admit there’s a problem. Any problem, from “my car wouldn’t start this morning” to “I am so depressed I can’t get out of bed.”
Harmoney: Gifted physicians are being forced to choose family versus career because it's a system not designed to accommodate both.
Dietz: True for both male and female! The system is damaging for both genders but it exists in part because the structure is built on one parent at home full time to enable crazy work hours and expectations.
Harmoney: Agreed.
Jordan: There is talent literally walking away from medicine because of poor design. I bet burnout would decrease and we could retain talent if we had a part in the design.
Thienprayoon: My husband had a job gave him 6 weeks paid paternity leave. which was AWESOME. he felt guilty for taking it, since no one else does, because that is the culture of the company. Looking to the future, leave is not something he'll likely get again, which impacts us and our whole family SO much.
Dietz: My husband had to spend 2 weeks of sick/regular leave for his "paternity" leave, since FMLA would have been unpaid and we can't afford that. His group worked with him but it shouldn’t be this complicated. It's ridiculous. There is such a backlash for physicians in general against taking time for family, things as simple as looking for positions that don't require call, or even that do have call but on a predictable schedule instead of random assignments. Pumping at work, heaven forbid. I’m grateful my current workplace is supportive but I know many who are not as lucky.

Let’s Publish This!

Ross: I like this thread Esther Choo (@choo_ek) has going showing all the disparities in medicine.
Harmoney: We could publish this thread.
Dietz: Christian didn't know what a bag of worms he was opening in his DM. 😆
Jordan: LOL Christian got awfully quiet…
Ross: Christian, the post could be about how you tried to get HPM women to write a post and you got an earful about why we couldn’t.
Dietz: LOL
Sinclair: I just went to make lunch for my kids and came back to all this! I learned a lot and see a lot of some of the issues Kelly and I face together and as individuals. I like Katie and Jeanette’s idea.

The Hard Work of Hospice and Palliative Medicine

Jordan: There needs to be more flexibility. This job and especially Palliative Medicine is HARD. You can’t expect me to see a high number of consults, make people sad all day, and then get upset when I want to not take call on weekends and nights.
Harmoney: But the issue is that we are hard on each other. We’re part of the problem.
Jordan: We have to speak up and say NO to some of the foolishness.
Harmoney: And also support one another. We've got to advocate for our colleagues, male or female. It's really the only way to fix this. I do think that medicine has worn down my resilience. People in medicine need to advocate for our health.
Jordan: We need to not suffer in silence. Women physicians and especially us doing HPM should not work alone. We need each other!
Dietz: We do!!
Harmoney: We need to hold each other up!
Jordan: I’m thankful that during my med/psych training they paid for us to go to therapy.
Harmoney: I think of therapy as a requirement in medicine.
Jordan: I worried about my non-psych colleagues. They didn’t get help and their department would NOT cover therapy. Therapy should be part of the redesign of medicine.
Okay. We need:
1: women at the table for leadership
2: women included in the redesign of medicine
3: mentorship
4: no stigma with seeking mental health services
5: health systems that support people with families or who just want to have a life outside of the hospital
6. Support for those in academics to advance their careers and STAY in medicine
Dietz: Recognition that men suffer under the current system as well. (Toxic masculinity, anyone?)
Jordan: YAS Sarah!
Dietz: Just a second, I have a mac and cheese situation.😆
Sinclair: Sounds delicious!
Hahn: I want mac and cheese.
Harmoney: Me too!
Dietz: 3 yo NEEDS mac and cheese y'all. It's dire.
Harmoney: It's a serious need.

Women Leadership in Hospice and Palliative Medicine

Ross: I wonder if there any stats about how women are represented in HPM, like how many are in leadership positions like regional hospice medical directors, division chief, etc?
Jordan: Good question. How is the Academy (AAHPM) doing? How is HPM doing?
Ross: My gist is that we may be better than other specialties. HPM being founded by a woman and I think a good group of women started AAHPM. For example, Chest (the pulmonary society) just now has a woman president-elect. That doesn’t mean we still have room to grow.
Sinclair: I count 15 men and 12 women as Presidents of AAHPM since founding in 1989.
Jordan: Plenty of room to grow. I think women would be more inclined to take leadership positions if they knew they would have adequate support at work AND at home.
Sinclair: I recall being surprised in 2008 or 2009 a session at the Annual Assembly of HPM focused on “Women and Leadership in HPM.” My career had essentially been working only with women physicians as colleagues and supervisors. I was wishing for more male physicians honestly. Only recently did I realize what the need for that session was. Currently, our HPM physician group is 3 men, 8 women led by a woman.
Ross: In my department, we are like 8 women to 2 men HPM specialists.
Harmoney: HPM seems much more balanced than oncology. HPM is a field where we have this discussion.
Jordan: True Katie. We actually have a better shot at changing the culture. Because we are new, we have a unique opportunity to negotiate and define our role as we become part of the fabric of healthcare. We might be a beacon of hope that can become a model for other outdated specialties.
Harmoney: I was floored during interviews because I was asked about self-care.
Jordan: The other specialties may look to HPM to figure out how to do self-care right. So we have to get it right and set the tone. And with a woman at the lead, it can happen. It could happen with a guy too, don’t get me wrong.
Harmoney: The right guy.

Future Collaboration

Ross: I see an AAHPM 2019 submission in our future.
Dietz: Love it!
Harmoney: As a group? I’m down. I'm interested to see what this looks like.
Jordan: It’s going to be epic
Hahn: Oh my just read through this whole thing! It really could just be published!

You can find all of the authors on Twitter: Allison Jordan (@doctorjordan) , Katie Harmoney, SarahScott Dietz (@SDiezMD), Jeanette Ross (@RossJeanette), Emily Hahn (@TexasKidDoc), Meredith MacMartin (@GraniteDoc), Christian Sinclair (@ctsinclair), Rachel Thienprayoon (@RThienprayoon). They often tweet about #hpm.

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