In Her Own Words: Women in Internal Medicine

This week’s Views from the Chair falls on the last Friday of September, which is Women in Medicine month. Instead of writing his own column, Dr. Abel asked a number of women faculty members for their thoughts on the subject without any other prompt or guidance. We are grateful for these contributions.

Isabella Grumbach, MD, PhD
Professor of Internal Medicine and Radiation Oncology
Vice Chair for Research

When I was in medical school, my PhD supervisor told me on my last day in his lab that women should not be in a MD/PhD program.

A few years later in residency, when I told a well-meaning male mentor that I wanted to become a physician/scientist in academic medicine, he replied that women are unlikely to succeed in this pathway.

This was 25 years ago. So, whatever the current obstacles are, women in medicine have come a long way and will go further.

Jeydith Gutierrez Perez, MD
Clinical Assistant Professor of Internal Medicine

When I entered medical school, I was not aware of any gender inequalities in the medical field. I particularly never felt them as a student. In my class, there were more women than men. I was convinced that I and all my female colleagues were just as willing and competent to go into any specialty field as our male colleagues. There were female attendings that were role models in most specialties and we could look up to them. As a resident, my program director was an amazing woman, who is now the CEO of the American College of Physicians (Darilyn Moyer, MD). Later I learned that this was more of the exception than the rule with only about 20% of Internal Medicine program directors around the country being women. How fortunate I was to have so many good mentors and women that lifted me up and pushed me higher! I certainly remained oblivious to some of the challenges that women in medicine face until my early years as an attending. It was then when I realized the implicit biases that are still present in our profession and how as a woman one had to work harder to earn the same respect and treatment as our male colleagues. I learned the importance of mentorship, sponsorship, and collegiality among female staff and among those colleagues and supervisors that are truly a #HeforShe and help to promote women.

The work of many ahead of us has paved the road for a smoother ride in our careers, a workplace that is more equitable and fairer. Margaret Cleaves, who was the first woman doctor in Iowa (1873), quickly recognized the challenges of being a woman in a male-dominated field and she was an activist for the advancement of women. We have come a long way since, but there is still a long ways to go. Even though the number of female trainees is similar to male trainees now in the US, only about 15% of full Professors around the country are women. That speaks volumes to challenges advancing women’s careers. Through my time at the University of Iowa, I have felt well-supported and empowered to advance my career. I’m grateful to be in a place that is part of the change and working actively to lift some of the limitations to women’s career advancement. But we should be aware of the barriers including challenges and stigma around childbearing, increased difficulties achieving work-life balance due to higher childcare burden—which has certainly being exacerbated during the COVID-19 pandemic—and the existence of implicit biases around women’s roles, some of which are self-imposed. I learned in leadership training at the University of Iowa that women tend to apply for promotion and for leadership positions less than men because they might feel that they are not qualified enough, while our male colleagues with same credentials will often apply for those positions. Although clearly this is not the only factor affecting career advancement, it is one area where we can have a tremendous impact. With appropriate mentorship and sponsorship, we might encourage and nominate other female colleagues for timely promotion and leadership roles and help advance their careers. We must lift each other up.

Loreen Herwaldt, MD
Professor of Internal Medicine and Epidemiology

When I was in medical school women made up 25% of the class but there were only two women on the faculty and neither of them were great role models. I didn’t encounter overt bias but some of the academic and clinical faculty treated me differently than they did the men in my class. My research mentor once commented that women often had “expensive private practices,” indicating that they did not continue in medicine once they had children. My residency class at Washington University had only four women and in my second year, the department chair put his arm around my waist and asked me my name so he could introduce me to his wife.

Fast-forward through two years at CDC and five years at Washington University for my ID fellowship. When I arrived at Iowa, there were some women in the Department but most were not in leadership roles. Few people did clinical or epidemiological research and the clinical track did not exist. Once again, I did not have women as mentors and role models. But over time I was able to attend national meetings for women in academic medicine and I was in one of the early [Executive Leadership in Academic Medicine] classes, which helped me grow. The men who mentored me were very helpful and they enabled me to develop my epidemiological research skills and to make national and international connections. The Department and College also granted me a sabbatical in 2000 that led to the publication of my book Patient Listening: A Doctor’s Guide, which was based on interviews I did with people who had written about their illnesses, injuries, or disabilities. My sabbatical transformed my clinical work and my clinical teaching as did the Teaching Scholar program. As you can see, the Department and the College have given me many opportunities to grow and many resources. I am grateful and have tried to pay it forward by being a good colleague, mentor, role model, clinician, and researcher.

The Department has grown and changed during my 33 years on the faculty. Now many women hold faculty and leadership positions. We have a robust clinical track and clinical and epidemiological research is thriving. I am grateful to the College, the Department, and to the department and division chairs for giving me the opportunity to have a fulfilling academic career. During my recruitment trips, I stayed at Iowa House where I saw a poster that said, “Iowa: a Place to Grow.” Indeed, Iowa has been a great place for me to grow and to put down roots.

Diana Jalal, MD
Associate Professor of Internal Medicine
Deputy Chief of Subspecialty Medicine, VAMC

It is true that women have made many strides in medicine over the last few decades. It is also true, however, that women continue to face many barriers in medicine that limit our growth and impair our ability to realize our God-given potential. Women continue to encounter bias in medicine, be it in the clinical setting, in medical education, or in leadership positions. Most pertinent to academic medicine, this bias does impair our ability to build our careers as physician scientists and is an important factor that contributes to the lower numbers of tenured female professors across institutions in the US. To the women in medicine this bias is palpable, frustrating, and clearly evident. Yet, all too often, the discussion around this bias is framed as a perception rather than a true barrier to overcome. The fact is that this bias against women in medicine is well-documented in the scientific literature. Numerous studies have shown that identical scientific works and biographies are graded of lesser value if the name of the author is female versus male. It is easy to see then how this bias would result in women being offered less protected time to focus on their research, smaller start-up packages to invest in their research operations, and lower pay to support their families compared to their similarly or even lesser qualified male colleagues. Simply put, the size of the investment in talented and promising female physician scientists is not equitable. As such, it is no surprise that the majority of academic medical institutions in the US suffer from a paucity of women in the senior ranks despite the large numbers of women in the junior ranks. As we have seen, from our own data that Dr. Abel boldly shared, we fare no better. The first step to solving a problem is to acknowledge that one exists. Now, we must make a commitment to do better and we must recognize that the women cannot do it alone. Our male colleagues and leaders in the department must lead to deliver tangible and lasting change.

Krista Johnson, MD, MME
Clinical Professor of Internal Medicine
Educational Director – Safety and Quality

My thoughts:

Rich Hoffman, Division Director of GIM, has been very supportive of women faculty. One of his first initiatives was to fix salary inequities for our entire group and make women’s pay equivalent to men’s.
Dale Abel: very supportive of women and has many women in key leadership positions
Appreciate the formation of the Women in Medicine meetings
Opportunity to address gender disparities while we address racial disparities will be important for University of Iowa. I think we can be leaders in this area.
Still a need for mentors to help prepare and encourage women to go up for promotion as still a relatively low number of female professors and women are promoted more slowly than men in medicine. (My impression is based on personal experience and friends’ experiences; I do not know data, but can’t imagine it is not there.)
Also a need to recognize and support female physicians’ need clinically (We see more women who have more complex psychosocial issues often and take longer to see and are still the main family caregivers; need to recognize this, allow for it, reimburse.), research mentorship, and scholarship mentoring
Need to continue to address unique challenges for women physicians (men, too, but still falls more to women in our society) regarding childcare, caring for elderly parents, more roles and work at home even when we have awesome partners.
Work with amazing women at UIHC!

Lama Noureddine, MD
Clinical Assistant (soon to be Associate) Professor of Internal Medicine

Promote women. (On their deserved time).
Pay women. (What they deserve).
Hire women. (Into Chief positions).
Respect women. (On rounds, during teaching, and their opinions, when consulted).
Men are fathers too.
Welcome to the 21st century.

Heather Schacht Reisinger, PhD
Associate Professor of Internal Medicine
Associate Director, Institute for Clinical and Translational Science

I was attending a mixed gender workshop on work-life balance—or work-life integration as we are supposed to say now—and a male faculty member asked with real pain in his voice, “What are we supposed to do? My wife and I have too much to do. We literally sit down with index cards and prioritize our household responsibilities to figure out what we can get done that week and who will take care of what.”

I had two thoughts run through my head at once:

Brilliant! Why haven’t my spouse and I thought of this?
Deep satisfaction. I’d never experienced talking about the struggles of managing daily household tasks with a male who wasn’t my family member or a dear, dear friend.

A couple of things are important to note in this story.

First, I was very intentional in mentioning this was a mixed gender workshop. Many of the professional development workshops I’ve been to, including the annual women’s faculty development symposium Lois Geist started 12 years ago, are for women only. I say this unapologetically because women need a safe space to talk about the many slights we encounter living in societies where male bodies are the assumed norm. Where my female clinical colleagues talk about very intentionally wearing white coats as they walk into patients’ rooms so they can move straight into the medical exam rather than being asked to get more ice chips. Or ask why the Hardin Library doors are so heavy and difficult to open. Or why the woman in front of her in the ED has suffered more extensive injuries than her husband after a car accident because the safety features were designed to protect an average sized man. (If you’d like to peruse a volume of data on the pervasiveness of this assumption, I would suggest picking up Invisible Women by Caroline Criado Perez.)

Talking about these things in a room of women feels safe because it can feel ridiculous to get frustrated by these everyday slights. It is demeaning when male colleagues dismiss your frustration. And it is incredibly tiring to constantly examine society’s assumptions about you.

The second thing to pay attention to in the story is the deep satisfaction I felt having a male colleague talk about the challenges of managing a household. He either didn’t realize this was a rare confession from a male—and that it is not socially acceptable in many circles—or he felt confident enough in himself and his relationship with his wife to share his frustration in a half-full Seebohm conference room.

You know, on that day I don’t think any of us talked about the break in gender norms that we all just witnessed. I wish we had. It may have been more productive than the empathetic conversation we had about getting one kid in the bath while trying to get the other to finish her peas and washing dishes knowing your fantasy of one of the two adults in the household actually getting to the PTA meeting is going down the drain with the cold dishwater.

For some, gender equality is about proving you are just as good as a man and taking on “male traits.” Others argue “female traits” are just as good as (if not better than) “male traits” and we need to fight for “female traits” to be more valued by society. However, what that argument has often led to is women taking on “male traits” and “female traits,” trying to be all things to all people. Exhausting.

And this is where I get stuck. My body is female and I identify as a woman. I delivered my first baby as a post-doc and was shamed for staying home for 12 weeks (despite taking an online class and continuing to work on my research), while my husband was praised for taking six weeks of paternity leave. I then returned to work in a shared office space where (luckily?) my officemate was female and didn’t object to me pumping in our office. Male and female bodies are different. That cannot be erased, nor do I want it to be. I would like policies to start with that assumption, but this is where my imagination fails. I retreat to my safe space of women-only professional faculty development conferences. They are cathartic and help me keep going.

It is cliché to say there are no easy answers. I do appreciate when my male colleagues recognize the impact society’s gender assumptions have on their female colleagues—and I still feel deep satisfaction when they admit they are overwhelmed by household responsibilities. However, while these are necessary steps toward a society where women—and men—feel unencumbered by gender norms, it does not solve the very real inequities women face. These take structural changes. Taking big risks on yet-to-be-imagined policies where different bodies get different treatment. Where the focus is on equity and justice—not the equality we all thought was the answer.