How to pay for women in medicine programs [PODCAST]

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“‘That’s great. You want to start a women in medicine program! How are you going to pay for it?’

This is the most common question and potential barrier from colleagues, leaders, and those who understand the value of these programs. We found that our two-year Women Leaders in Medicine program improved burnout, retention, and engagement of the over 400 women physicians who participated. However, funding remained the chronic barrier to sustainability.

I will introduce you to ten possible funding strategies to get your creative strategy-building blood pumping.”

Dawn Sears is a gastroenterologist and can be reached on Twitter @GutGirlMD, YouTube, and at GutGirlMD Consulting.

She shares her story and discusses her KevinMD article, “10 ways to pay for women in medicine programs.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Dawn Sears. She is a gastroenterologist, and she wrote the KevinMD article “10 ways to pay for women in medicine programs.” Dawn, welcome to the show.

Dawn Sears: Thank you so much for having me, Kevin. Thank you for allowing us to discuss this. It’s a hot topic right now, so this is a great venue.

Kevin Pho: Fantastic. Thank you for writing and for being on the show. We’ll get into that article in a little bit, but first off, can you share your story and journey to where you are today?

Dawn Sears: So I’m a gastroenterologist, which is not real common. Women don’t usually go into gastroenterology. At the time that I went in, only 8 percent of gastroenterologists were women, and now it’s up to 13 percent. As an intern, I needed to know what was happening behind that curtain at three in the morning that stabilized the blood pressure, that stabilized the patient, so that they no longer needed blood transfusions. It was exciting to me. I felt like the Wizard of Oz was happening behind there, and I wanted a part of it. So I went into gastroenterology.

But I also knew I wanted to have a family, and knowing that the gastroenterologists were there at three in the morning, I wasn’t sure I could do that. But I learned that gastroenterologists work really hard into the night for that one week they’re on call, but the other weeks they’re doing regular doctor hours, 7:30 to 6:30, whatever. So that was a lot of fun. And then I found out that gastroenterology allows me to have long-term relationships: curing hep C, getting patients through death and dying, as well as preventing cancer and taking care of the acute bleeds. I just love the dabbling and tinkering, and the teaching and education of the public. Everybody has GI problems. It doesn’t care if you’re homeless or the president of the bank. So it’s been a very gratifying career.

Meanwhile, I was able to be successful at ultimately leading my division, which also is not very common. There was a publication that came out in February from Digestive Diseases and Sciences, and it said that of gastroenterology leaders, the chiefs, only 20 percent are women. But if you have a chief, you’re more likely to have female program directors, associate program directors, and fellows. Overall, fellows are 33 percent, but at my program, because I was the associate program director, then the program director, then the chief, 50 percent of our fellows are female. So it shows that women in leadership can move the needle.

As a result, I was asked to mentor a lot of women coming out of health care or coming out of medical school. They said, “You’re successful in leadership. Teach me the ropes.” Well, there are no ropes. We all just make it up as we go. So I got together a group of women leaders, and we put together a Women Leaders in Medicine program. From there, it just happened to be October of 2018, when the Me Too movement was happening. So we put together a group. We were ready to talk about leadership, we were ready to talk about life-work balance, and we were ready to empower women.

I thought maybe 20 or 30 women would show up. Well, the first week, 35 people signed up, and my assistant said, “Where do we block it?” “Block it? What are you talking about?” She said, “Well, we’re already at 35.” So we blocked it at 100, and we ended up with a waiting list of 20. So 120 women physicians took time out of their busy schedules to get together and empower each other. It was incredibly successful. We had leaders there. We invited the C-suite and all the division directors. We asked the board of directors to provide wine, and they wanted to make sure it was put to good use, so they all showed up. At the end, they said, “When are you going to do it again?” I was like, “Wait, what about the thank you?” But no, it was, “When are you going to do it again?”

We needed to empower this generation of women physicians who were already out there, to show them that they were leaders and that they were capable of mentoring the next generation, even though they didn’t feel like they had the self-confidence to do that yet. Now they saw that they could. At the time, the Physicians Foundation put out a grant request to change burnout in women physicians. As you know, women don’t commit suicide, especially moms, unless they’re doctors or dentists, so the burnout rate and the suicide rate for women is disproportionate. We knew we already had the program, so we went ahead and wrote our proposal: Let’s continue this for the next two years, and let’s look at burnout, engagement, and retention. We got fully funded, the $150,000. We had planned on 25 percent participation, but instead we ended up with 30 percent participation, and we moved the needle for engagement, burnout, and retention. So now that’s my focus. It’s not what I planned to do, but it’s what I ended up doing.

Kevin Pho: Now, from all your experience in running the conference and mentorship, and being in a leadership position yourself, what would you say are the biggest obstacles that prevent more women physicians from taking on leadership roles?

Dawn Sears: Self-confidence is huge. There’s so much imposter syndrome, feeling like, “Well, I don’t have the credentials. I don’t have the MBA.” I said, “Well, do you have two initials after your name? You have DO or MD. You are a leader already.” So it’s the self-confidence and the imposter syndrome, and feeling like, “I don’t have enough training. I don’t have that extra certificate.” Just giving the women the permission was huge.

Among the women who participated in our program, who came to one of the eight sessions, most of them came to two or four sessions. But if they came to at least one, we measured their self-fulfillment of “I’m a leader,” and they gave themselves a 10, 20 percent of the time, at the very beginning. Then at the end, we did our last survey in January 2020, before COVID hit the United States, and it went up to 40 percent of those who participated. But for women who didn’t participate, it went down even lower, to 18 percent, because they’re just overwhelmed. Being mothers, 85 percent are mothers with children at home, as well as leading a division, taking care of patients, and having all the high expectations, the perfectionism that women put as our own internal voices, as well as what the world tells them.

We know that patients have higher expectations. We know that the support staff has higher expectations. But we’re letting women know good enough is good enough. You don’t have to be perfect anymore. Just show up, do your best, and amazing things will happen.

Kevin Pho: All right, so let’s talk about your KevinMD article, written back in April. It’s titled “10 ways to pay for women in medicine programs.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Dawn Sears: Absolutely. We know that we need women leaders in medicine programs to help women know that they have leadership skills, or need to develop leadership skills. But the question always is: Who’s going to pay for it? Is it valuable? This is the most common question I get. Everybody knows they need it, but is HR going to pay for it? Are you going to pay for it? Or you can charge for it. What are you going to do? So I wanted to write the article to answer that question and to let people know all things are possible. There is no road map for this. This isn’t standard. So let’s just throw out 10 creative strategies. Not any of them is perfect, and I’m sure that about 50 other women could come up with 50 other lists of who should do this.

As I went through them, I said, “OK, we’ve got well-being initiatives.” This is a burnout initiative. This is 50 percent of the population, this is 30 percent of physicians, and this is 50 percent of new graduates that you want to recruit and retain. So how could we do that? So, using well-being things, using lectureship series. This is an easy no-brainer. Every academic institution has them. Whether you’re talking about pediatrics, which has a large number of women, 71 percent, or orthopedics, which only has 3 to 6 percent and maybe needs to increase that, we can get creative that way.

And then there’s some of the stuff that we did: asking for internal sponsorship, asking the board of directors to pay for the wine, and asking the surgeons to pay for the leadership books. In our evaluation of moving the needle for engagement, retention, and burnout, we found that just giving leadership books to people increased their own satisfaction and autonomy, decreased burnout, and increased their engagement with the institution and their likelihood to be a leader. Just that power of having a book. In our case, the department of surgery bought everyone Brené Brown’s “Dare to Lead” and put a little sticker in there. So you don’t have to come up with all the money.

And then there are other ideas, kind of like the bake sale thing, of having a silent auction and utilizing the talents within your department. You probably already have some coaches in training. You probably have somebody who has a VRBO, et cetera. So as you can see, there are 10, just a variety of options. There’s no one way to do this. Just giving people the freedom to get creative is why I wrote the article, and it’s gotten some really good feedback and some great results, internally and externally.

Kevin Pho: Now, tell me a little bit about the structure of your program in particular. Did you have any experience in putting together anything like this? As a physician, did you have experience putting together courses or lecture series, or is this something that you just learned on your own?

Dawn Sears: Yeah, being a program director of a fellowship, of course you’re going to be putting together educational series. I had the opportunity to put together some national meetings in liver disease, where I was one of the co-hosts for many years, and I put together other wellness groups, things like that. I had done some smaller groups. My original first thing that got me into leadership was a thing I called the MBA program: Mind, Body, Activity. I got 10 executives to work out with me at 4:30 in the morning. I said, “You don’t have a meeting at 4:30 in the morning. You’re mine. We’re going to get together and train for a half marathon.” So I’ve done some creative stuff that I didn’t ask permission for. I just kind of put it together and made it happen. I didn’t have formal training in this, other than being an associate program director and then just taking opportunities to lead people to well-being and growth. So that was part of it.

The way we structured it is, I said, “Let’s just get together.” So I got a group of 10 women physicians together. I got the grumpy surgeon, I got the sweet pediatrician, and I got the quiet pathologist. We just sat around the table, picked a date, picked a venue, and made it happen. Going forward, we knew we needed to have more touch points. We covered a huge geographic area in central Texas, so we also had regional dinner clubs that would occur, and then we had an online presence. We created our own Facebook group. We called it the Potter Society, not after Harry, but after Claudia, who was our first female physician, who helped Dr. Scott and Dr. White operate. She was the anesthesiologist.

Anyway, we got a lot of data. Before every event, after every event, and during every event, we constantly surveyed. We constantly tweaked it to deliver what the women wanted, and we always had our date on the calendar for the next event, because that was very important when we’re planning for busy women physicians. As a result of that, we were able to tweak it in real time to exactly what the needs were at the time, and with COVID hitting, that became particularly relevant.

Kevin Pho: Now, take us inside the exam room when you were making that first pitch to administration that you wanted to start a women in medicine program. What was their initial response, and tell me about how their thoughts about it evolved over time.

Dawn Sears: Yeah, so it was interesting. We had a wonderful support group of key leaders, because they saw that those of us who were elevating ourselves through leadership were doing it in a servant leadership way, in a collaborative way, because that’s how women physicians lead. So they saw that we weren’t doing it for our egos. We weren’t doing it to climb a ladder. We were doing it because we truly wanted to serve each other and serve our patients. My drive was to stop the hemorrhaging of women physicians. If you just look at the data from the AMA, replacement of a physician costs 150 to $200,000. This is an economic no-brainer. And look at litigation, when you’re talking about sexual harassment, and making it so we can normalize the conversation: What is sexually discriminatory behavior? How can we call it out? How can we stop it? How can we improve the climate? The administration leadership were easily bought in.

And then when I invited them to the event, literally those who weren’t awake yet stood up at the end and said, “Oh my goodness, this is our future of leaders, and I didn’t even see it before, because I just assumed all of you were too busy raising babies and taking care of all the things at home. I did not give you the opportunity, and that was my bad. And now I’m ready to.” So we really awoke a lot of eyes by inviting the male leaders to the event, and it changed everything. Thereafter, there was the expectation: “Hey, Dawn, when’s your next event? I haven’t gotten my invitation yet. I’m looking forward to it.” So it was just wildfire, the spread of how powerful this movement could be.

Kevin Pho: We’re talking to Dawn Sears. She is a gastroenterologist, and she wrote the KevinMD article “10 ways to pay for women in medicine programs.” Dawn, for those listeners who are interested in starting a similar program from scratch at their own institution, what are some actionable tips that they could do to get started?

Dawn Sears: A great question. Actual tips that they can do today: Come up with your list of five or six women physicians in different walks of life, different careers, and different specialties that you want to be involved. You’re going to want the brand-new graduate, you’re going to want the one who’s been around forever, and you’re going to want some in the middle. And you’re going to want to be sure that you’re talking about specialties that you may not normally bring to the table, like radiology, pathology, palliative, things like that.

And then you’re going to want to come up with your list of five allies, five people who are in power positions, whom you definitely want in line with you now. You want to give them a reason to make this a win for them. Make them want to partner with you, and engage with them. You’re going to want to go to them for their advice on what’s been successful in the past, and get them to put skin in the game, to want to own it too. When you do that, you also give a menu of all the different ways that we can pay for it. Don’t just say, “It’s this way, or we’re not going to do it,” or, “It’s this way or that way,” but instead say, “These are eight options. These are 10 options.” Then everyone loves to feel a little part of problem solving and coming up with a great program.

Kevin Pho: Now, what would you say was your biggest challenge in creating a women in medicine program, and how did you overcome it?

Dawn Sears: The biggest challenge was the expectation of ourselves. We’re perfectionists. We’re planners. We like to go boom, boom, boom. We like to know exactly how many people are coming. We like to have the name tags already put out, everything. And then we realized, when you’re dealing with this group of women physicians, the dog is going to vomit, somebody’s going to take somebody to the ED, and somebody’s going to think they signed up, but then they didn’t.

So I encouraged my other women who were part of the directorship and kind of leading the program, because we’d always have a small committee of five to 10 of us who were responsible, and then we recreated it in Dallas as well. I let them know: Give yourself 20 percent flex. Understand that this isn’t like your patient schedule or other things where it’s very stringent. These women need flexibility on either side. And it was so funny, because every time, 10 percent would no-show, and then 10 percent would just show up at the door and go, “Oh my gosh, my bad. I forgot to register.” And you’re like, “It’s great. We’re so glad you’re here.” Just making them feel welcome. That was a learning point that you don’t usually get at other conferences, but it was so valuable to just let them breathe and let them know it’s OK, and there’s no judgment here. We need that. We need these safe spaces more than ever.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Dawn Sears: Yeah, my take-home message is going to be: Just do it. Just get out there, just show up, and just make something happen. It’s not going to be perfect. It doesn’t need to be perfect. The people will tell you what they need, and it will evolve into a beautiful thing. Every institution is different, and every climate is different, but we need each other. We are the cure to burnout. We are the cure to this drainage of women physicians out of health care, and we can stop this now, together.

At the end of every conference, there were two or three women weeping in the back of the room, saying, “I was ready to quit, but now I’m not. Now I feel like I’ve been seen. I’ve been heard. There’s a sisterhood.” So overall, this is needed, and I encourage every leader to find a way to create that safe space at their institution. They won’t regret it.

Kevin Pho: And how could people reach you?

Dawn Sears: They can reach me multiple ways. I’m learning a lot about LinkedIn and YouTube and Facebook, so I’m on all those areas. You can find my website, gutgirlmdconsulting.com. You can also find me at doctordawnsears.com. You can find me on the KevinMD author page, and you can also find me as GutGirlMD on Facebook, Twitter, or YouTube.

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Dawn Sears: Thanks so much, Kevin, for highlighting this and all of the other amazing projects that all the doctors are doing. Appreciate you.

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