BY JENNIFER VILLWOCK, MD
What unique challenges do women face in residency?
We all face challenges in residency. There is little in your training up to that point that adequately prepares you for the immersive and intense experience that residency is. I do think that women, and anyone in underrepresented groups in medicine, persevere through some extra nonsense at times. Much of this bias is unconscious, which can make it even harder to address. However, the dialogue is expanding and faculty and other key leaders are open to these conversations. This is a critical step in the right direction.
There are little things we can all do to proactively address bias. Unconscious bias trainings are routinely offered. Make it a point to, at least in front of patients and care teams, refer to trainees as “Dr. so-and-so” if they are a resident and “Student Doctor so-and-so” if they are a student. This minimizes the possibility of the patient or team mistaking their role if they don’t fit the doctor stereotype.
There is also the challenge that is unique to women regarding, if the desire is present, when is the “best” time to conceive and carry a child. For many, residency occurs during prime child-bearing years. From what I have heard, some programs are supportive, some are not. Regardless, there is no “right” time. Whenever it happens, you will adjust to the new normal. Know your rights, what is safe, and what is not. Planning ahead is critical – both for your own sanity and to avoid resentment. I felt very strongly, given that surgical residents have worse pregnancy outcomes than smokers, that I would not take 24+ hour in-house calls in my third trimester. This meant I had to talk with my co-resident cohort very early in my pregnancy to front load my call schedule so as to not over burden them and come to consensus on other potential logistical issues.
I also try to keep in mind how I would respond if a colleague asked me to cover their call or help because of something going on in their life. Of course! I view pregnancy and motherhood in the same light. If you try and minimize disruptions, plan as well as you can, and your colleagues are unwilling to help, that’s a reflection of them. Not you.
Have you experienced gender bias and if so, how have you handled it? Can you offer any strategies and tips?
I don’t think it’s possible to have not experienced any form of gender bias in our society. This is not unique to medicine. I try to be proactive in avoiding the impacts of bias. For example, I use my title and last name when I introduce myself. As a woman, I typically don’t have the “professional currency” to do otherwise as I am often assumed to have a role on the care team other than doctor…even when I introduce myself by my title. Once, in residency, we had a post-operative patient who was in the hospital for over a week. He was a VIP and complained to the hospital administration that it had been over a week since any doctor had seen him. The head and neck team had been rounding on him daily. It’s just that our team of four physicians was all female.
The good news is that society is evolving. Another patient encounter I still remember was one that concluded with the patient saying something to the effect of “You know quite a bit for a little lady.” The patient’s adult daughter was in the room. She immediately turned to him and said, “Dad, she is the doctor and your surgeon. You will address her with the respect she deserves.” That’s not a battle I would have picked, but I was heartened to know that these conversations and corrections are occurring all around us.
Just as important as picking your battles is building your support community. It can be hard to relay the meaning of certain experiences to those who have not had them. Finding “safe people” you can commiserate with is critical. It’s also a good opportunity to learn from them how to handle sticky situations. I also recommend keeping in mind that, while complaining and commiserating can be cathartic, wallowing in the negativity without charting a course can quickly become toxic.
What are the most challenging issues to balancing work and family?
For me, the most challenging part of work life “balance” or “integration” is managing expectations and realizing that I can’t do everything and be everywhere at once. I am not, and have no desire to be, a stay at home parent. But I feel like I should. A large part of the work I have to do on myself is to reconcile this. I constantly remind myself that “different” from the “norm” isn’t wrong. I also remind myself that working moms aren’t unusual. I also like to believe that I’m modeling for my daughter that we should all follow our dreams and passions, even if that looks different from what we are conditioned to expect. She recently had one of her friends over, and I overheard her proudly explaining, “My mom is a doctor. That means she helps people when they need help.” She at least partially gets it.
What can women do to mitigate the issues between the demands of family obligations and work demands?
I am extremely lucky in that I have a supportive stay-at-home partner! This helps immeasurably. I can focus, without guilt, on my professional endeavors when needed and not worry about the state of family life. I do also try to be present in whatever I’m engaged in. I remember an evening in residency when I came home and could not stop perseverating about work. My husband turned to me and said, “If you’re just going to be at work in your mind, you might as well go back to work.” Duly noted. When you’re at work, be in a place mentally where you can focus on work. When you’re at home, let go of the work nonsense and really be at home.
I do also recommend putting family, or wellness, activities that occur during the week on your work schedule. This prevents professional activities from being inadvertently double booked and reinforces that family life and wellness should be a priority too.
How do you approach wellness issues? Do men and women face the same issues?
Having struggled with, and recovered from, depression prior to medical school, I believe that wellness is the most important issue facing today’s physicians. This is true for both men and women. More honest dialogue about our struggles, and how we’ve managed with them, is needed. It normalizes the fact that perfection is not the norm, that our needs are not weaknesses. Therapy, coaching, medication, leaves of absence. Let’s talk about what these experiences are like and how to thrive after the storm.
Do you find there are still barriers to women advancing in leadership positions? With over 50 percent women now in medical school, do you think this will improve for future residents and physicians?
The evidence from other fields shows that sponsorship is the most important factor for advancement and leadership. Mentorship is great too, but if the mentee never receives opportunities, they are not able to showcase their skills. Intentional sponsorship is critical. We also know that diversity is key to fruitful collaborations and novel ideas. I had the opportunity to listen to Scott Page talk about “Leveraging the Diversity Bonus” at the AAMC Continuum Connections. He makes a compelling, evidence-based, argument for diversity of thought and experience in the teams we create, the research collaborations we engage in, and the leadership around us. Gender is just one component of diversity.
Did you have a female mentor? If so, how did you find her, and did you feel she was helpful in navigating some of these issues?
Valerie Opipari, MD, at the University of Michigan was one of my first mentors. At this point, I’ve known her for over half of my life! I started in her neuroblastoma research lab as a 17-year old undergraduate. Under her guidance (and that of the entire lab family), I learned to generate hypothesis driven research ideas and really think. She showed me by her example that a woman can be a NIH funded investigator, successful clinician, chairperson of a large department, and a mom. And that all of these things can be done on your own terms. I remain close to her to this day.
It is important to remember that women don’t need just women mentors. My residency, and fellowship, faculty were predominantly male. They have been some of my most steadfast supporters and advocates. While the nuances of the relationships are sometimes different (I am unable to engage in meaningful conversations about golf, cars, or whiskey), the substance is the same.
Dr. Jennifer Villwock, MD, is an Otolaryngologist practicing in Kansas City, Kansas. She graduated from Michigan State University College of Human Medicine and completed her residency SUNY Upstate Medical University, Syracuse, NY and Fellowship in Rhinology and Skull Base Surgery, University of Kansas Medical Center.