Tackling gender disparities from the ground up

Some gender disparities in medicine are obvious, such as lower pay and fewer leadership opportunities. But disparities by gender can be more subtle, too, such as introducing women physicians by their first names rather than as “Doctor” before a grand rounds presentation, or excluding them from decisions about practice management. The WEL (Women's Wellness Through Equity and Leadership) Program, which was launched last year, aims to address both categories of problems.

WEL is funded by a grant from The Physicians Foundation, a nonprofit organization that works to support physicians in a changing health care system. The program is aimed at early- to mid-career female physicians and health care leaders, with the goals of providing networking and education regarding leadership skills, developing principles about healthy work environments for female physicians, and helping create a better infrastructure. ACP, the American Academy of Pediatrics, the American Psychiatric Association, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Hospital Association are the six organizations participating in the project.

During the project's first phase, a steering committee made up of leaders from all six organizations created an 18-month-long curriculum focusing on equity and leadership among female physicians and drafted principles regarding a healthy work environment. Susan Thompson Hingle, MD, MACP, professor of medicine at SIU School of Medicine in Springfield, Ill., served as ACP's representative. After the curriculum was developed, 18 early- to mid-career female physicians, three from each participating organization, were chosen to participate. ACP's representatives are Adebisi (Bisi) Alli, DO, MS, FACP; Tammy Lin, MD, MPH, FACP; and ACP Member LCDR Karen G. (Mayr) Zeman, MD.

The program is uniquely collaborative, said Dr. Alli, who is a senior associate consultant at Mayo Clinic Arizona in the Division of Community Internal Medicine in Phoenix. “I don't think I've ever seen anything like it,” she said. “The idea is really to normalize leadership amongst women, and there's a lot of mentorship, a lot of sharing of experiences, and with an interest in our feedback.”

Dr. Lin, who is in private practice in San Diego and is an ACP Well-being Champion, said that the 17 strangers she was introduced to at the first in-person WEL meeting quickly became just the opposite. “It seemed like after even just a couple of hours, everybody had just checked their egos at the door,” she said. “We didn't belong to an organization, or a specialty. After a while, we simply knew that we were taking part in something special and that we would become champions for each other.”

At that first meeting, which took place almost a year ago, each of the 18 members were given the opportunity to talk about what was most important to them and were encouraged to create a related “indelible mark” project that could be implemented in their institutions or communities.

“All of these resources and information may have been available to us through other venues or sources, but there was something really exceptional about bringing them together for us and then making us feel that this program was going to really invest in us, not just as future leaders but also as people too,” Dr. Lin said.

Participants also heard from an expert speaker about ways to empower themselves through language and how they see themselves. “It's very easy to be socialized to be someone who sits in the back of the room or someone who doesn't raise her hand when she has a great idea,” Dr. Alli said. “That's an unfortunate social construct. As women, as a physician group, we're redefining that and emphasizing our roles as leaders.”

Dr. Alli developed an interest in quality improvement during her chief residency at the Phoenix VA Healthcare System and later earned a Lean Six Sigma Black Belt. Her indelible mark project centers around promoting outpatient safety and goals-of-care initiatives at Mayo. Dr. Lin's project, titled “Med Mindset,” involves improving the pipeline for underrepresented groups to enter the medical field. Other colleagues, meanwhile, are focusing on promoting diversity at their institutions or improving access to mental health in the community, among other issues.

“Every individual has a specific goal to realize, and that's the purpose of the indelible mark,” Dr. Alli said.

Program participants are scheduled to meet four times in person—three meetings have taken place so far—and via webinar during the other months, said Dr. Lin. The webinars include regular updates on the indelible mark projects, where each participant shares her progress.

“We are honest in those discussions: what's worked, what hasn't worked, the twists and turns that may not have been expected, the pivots that needed to be made, and we learn from that,” Dr. Lin said. “It's given us a new set of tools to collaborate with those around us, and also just a feeling of being better prepared to step into leadership roles and accept opportunities when they get presented to us.”

The most recent in-person meeting of WEL participants took place in August, and the final session, which will include presentations on the indelible mark projects, is slated for January 2020. After that, the participants will continue with their projects and take what they've learned with them into their practices and institutions.

Dr. Alli said that one of the goals of WEL is helping to change the status quo for good. “We aren't leaving any alternative to continuing movements like this. … We're trying to create more platforms to make it easier to find mentors, use uplifting language to define ourselves, or launch our important endeavors every single time,” she said. “We want to promote opportunities like this for everyone.”

Dr. Lin agreed that the potential “ripple effect” of the WEL curriculum is one of its most important benefits.

“It's wonderful to have the opportunity to learn, but a big part of this for me is to also help figure out how we can extend this for more women and more members of ACP, because it's desperately needed,” she said. “There's a leadership gap, a gender pay gap, an epidemic of burnout, and so the more that we can translate our learnings from WEL for maximal impact, the better.”