About the Author: Michael A. Gisondi, MD is Associate Professor and Vice Chair of Education, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA. Twitter: @MikeGisondi
Dr. Dara Kass is Associate Professor of Emergency Medicine at New York University School of Medicine (New York, New York) and Editor-in-Chief of the blog, FemInEM: Females Working in Emergency Medicine. Twitter: @darakass
About the blog, FemInEM: FemInEM is “an open access resource where we discuss, discover, and affect the journey of women working in emergency medicine. Through deliberate conversation and engaging dialogue, members explore a variety of issues that support the development and advancement of all women in medicine. FemInEM aims to address gender disparities in a positive way, empowering physicians of both genders.” Twitter: @feminemtweets
Dr. Kass presented, “Gender Equity in Emergency Medicine”, at Grand Rounds in the Department of Emergency Medicine at Stanford University in July 2017. The following is a brief Q & A with Dr. Kass following her lecture.
MG: All of your work with FemInEM is simply amazing – congrats! But to grow FemInEM, you stepped down as the medical student clerkship director in your department and reduced your effort to part-time clinical hours. That must have been a difficult decision to ‘quit your day job’ and forge ahead into an unfamiliar world of online education and activism. Why?
DK: Following a non-traditional academic path is definitely nerve wracking. I was the kind of kid who went straight from college to med school and never looked back. This is the first time in my life I have diverged from the typical and direct path in any academic pursuit.
The truth is, I ‘quit my day job’ to make a real difference. I am someone who is driven by impact. In order for FemInEM to be most impactful, I had to dedicate significant time and effort to the project. I couldn’t expect my chair to support that time and effort, so I needed to do it for myself. This meant leaving my traditional academic position, maintaining my clinical presence, and hoping for the best. In a worst-case scenario, I return to academics in a year or two with an abundance of entrepreneurial experience behind me.
MG: FemInEM is sponsoring its first conference, FIX: The FemInEM Idea Exchange, in early October 2017. Ok, sell me on FIX. Why is your blog hosting a live conference?
DK: FIX is going to give participants what FemInEM gives me every day: an incredible jolt of energy and excitement about being successful in medicine, while still being true to yourself. I can guarantee that FIX participants will leave the conference feeling inspired and rejuvenated in ways they may not have realized they were missing. Oh yeah, and we are going to talk a lot about gender equity in medicine.
MG: Here’s a hypothetical: You are a female physician getting passed over for promotions and you’re suspicious your salary is less than what the men in your department receive. What do you do?
DK: I AM a female physician who gets passed over for promotions and I do make less than the boys. This isn’t a hypothetical, it’s the truth, because it’s all of our collective truth. On the micro-level, many of us try to explain away our personal circumstances, making excuses that our situations are ‘better than average’ or are ‘the exception’ for one reason or another. But they aren’t.
The first thing we should be asking for is salary transparency and regular audits for discrepancies in gender and race. We just proved (yet again) that women physicians and physicians of color make significantly less than white male physicians in emergency medicine, at every level. Women physicians need to empower themselves through data. It is very difficult (nearly impossible) to effect change like this for just a few individuals, as impact rarely results in sustained equity. We need to change the system.
MG: Another hypothetical: You are now a chair of an academic department. Tell me the first five things you do to ensure equity.
DK: If I was a chair, I would:
- conduct a salary audit for race and gender in my department
- distribute an anonymous survey to my faculty on bias and their perception of bias
- provide implicit bias training for me and my leadership team
- update my departmental policies on parental leave and other change-of-life events, then pro-actively distribute them to my faculty members
- create schedule variability for various faculty needs, as well as support those faculty members who expressed those needs to me.
MG: “Dear Chairs, please…”
DK: Just do any one of the things I outlined above…
Ok, my turn. You are a guy. You probably will never get pregnant. Why would you support a fellow doc getting any paid maternity leave?
MG: I support paid maternity leave and paternity leave. I also support extended leave programs for other major life events, such as protracted personal or family illness, deaths of family members, divorce, mental illness, and others. You want your colleagues to be their best selves when caring for patients and advancing your group practice. Parental leave programs allow employers to respect their employees in a deeply personal manner, thereby promoting well-being, engagement, and employee retention.
DK: If you were a member of an accreditation committee for trainees, what policy would you put in place to support gender equity?
MG: In addition to mandated parental leave policies for women and men, I would endorse a return to work policy that allowed new parents to be home with their children at night: a short-term clinical schedule with no night shifts, no night call, no sick call, etc.
DK: If you knew that a salary audit in your department for inequity based on gender and race would result in a delay of any raise you could get, to make up for any gender differences found, would you support it?
MG: Yes. 100%. Not hyperbole.
DK: What’s the change you most want to see happen to support women in emergency medicine?
MG: Well, there are many issues to address. I would like to see the emergency medicine workforce mirror the diverse patient population that it cares for, in gender, race, and many other ways. Issues of pay equity and advancement for women remain documented, but largely unaddressed. And importantly, there is new evidence that female residents in emergency medicine receive lower training evaluations than their male counterparts. There is much work to do.
Dr. Kass’ Favorites
What is your favorite medical education article from the past year?
Dayal A, O’Connor DM, Qadri U, Arora VM. Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Intern Med. 2017;177(5):651–657.
Recommend a book to read?
Life’s Work by Dr. Willie Parker (2017)
What is your favorite charity?
American Civil Liberties Union https://www.aclu.org/