The group of clinicians who support critical care medicine are as diverse as the specialties that make up the field. With a growing awareness of the role of diversity in the workplace, it is important to have conversations about diversity and to take steps to create inclusive environments.
The Society’s 48th Critical Care Congress highlighted diversity and inclusion during the Women in Critical Care Roundtable Discussions. These discussions were led by Roshni Sreedharan, MD, and Marie R. Baldisseri, MD, MPH, FCCM, and covered a variety of topics related to advancing women in critical care.
“Women have achieved so much in the past few decades—some of which has come to the forefront. Unfortunately, a large part of it goes unrecognized due to the roles assigned to them,” shared Dr. Sreedharan. “My experience overall has made me realize what unconscious bias is and why directed efforts need to be put into the advancement of women in medicine,” she said, speaking firsthand to the challenges women face in critical care.
As recognition grows about the disparities that exist for women in the workplace, it creates an opportunity to discuss ways to advance and support women in critical care. In this article, Dr. Sreedharan, Dr. Baldisseri, and Schirin Tang, MD, share their advice:
Top Five Things Today’s Women in Critical Care Need to Know
Roshni Sreedharan, MD; Schirin Tang, MD; Marie R. Baldisseri, MD, MPH, FCCM
1. The Reality of Gender Disparity
These days, we expect and assume gender parity. Unfortunately, it still remains an ambitious goal. It is important for women in critical care to recognize the gravity and impact of this issue to be able to make consistent efforts to address it. Several studies have looked at gender disparity from various dimensions: remuneration, academic advancement, presence on editorial boards, presence on guideline authorship, and leadership roles. For instance, women make up only 15% of department chairs and 16% of medical school deans in U.S. medical schools.1 Despite adjusting for specialty, age, experience, and research productivity, women are much less likely than men to become full professors.2 Of 60 highly ranked medical journals, only about 16% of the editors-in-chief and 17% of all editorial board members are women.3 Additionally, an analysis of genderbased differences in remuneration of American academic physicians showed that women earn significantly less than men after adjusting for age, experience, research, scientific authorship, National Institutes of Health funding, and Medicare reimbursements.4 There is no doubt that gender parity is a requirement in all dimensions for the well-being of our patients and community. Although important work has begun toward this goal, clearly a lot of work remains. For the first time since 2004, more women than men applied to medical schools and women made up the majority of matriculants to medical schools two years in a row.5 More than ever, there is acknowledgement and recognition that gender disparity is a problem. It is important for us to address and educate people on the unconscious biases that lead to these gender-based differences. We should speak up when we witness unfair disparities by amplifying the voices of people who raise these concerns. Most of all, we should rally around, uplift, and recognize the women who are putting in the effort in order to propel them forward.
2. Finding a Niche
As you launch your professional career, you will have the opportunity to implement your ideas and develop yourself. Most of the faculty members you have admired were not just good clinicians but also clinicianresearchers, clinician-educators, or clinician-administrators, or had some other supplementary professional role. But how should you develop your niche? Begin by identifying your interests. Certainly this is easier said than done. There are so many tracks available that this can be overwhelming at first. Maybe you were lucky enough to find a clear path early on. For others, just transitioning from training to a faculty position is enough to consume their mental energy. However, once you settle in, you may start to notice certain interactions and instances that keep you interested even when you have had a rough day. These are the clues to finding your niche. Everyone you admire found a niche through their interests. If you develop your work within the domain of your interests, you will find yourself happier and more productive.
3. Balancing Work and Life in Critical Care
Speaking of being happy and productive, women in critical care can have an especially difficult time balancing the demands of work (high morbidity and mortality, chaotic and stressful encounters) and personal life (cultivating healthy relationships with a spouse or children and maintaining self-care). Author Amy Westervelt remarked that the expectations of modern society imply that “women should parent like they don’t work and work like they don’t parent.”6 Early on in one’s career, there is a desire to say “yes” in hopes of finding fruitful endeavors. This leads to overextension, which, for many young women in critical care, decreases the likelihood of job satisfaction, which is one of the strongest predictors of burnout. While finding your niche requires investing in professional opportunities, finding balance requires investing in yourself. This balance will be different for each woman, so it is important to reflect on your priorities and adjust the structure of your life accordingly.
4. Connecting and Networking Through Professional Societies
Professional societies play an important role in bringing people with similar interests together. Engagement in these societies provides an opportunity to network, advance, and learn. They also provide avenues to identify mentors and sponsors by providing the opportunity to connect and work together. It is important for us to be engaged as well to inspire our trainees, who are the future of our specialties, to help them find their path.
5. Finding a Career Coach, Mentor, and Sponsor
Coaches, mentors, and sponsors—each of them plays a significant role in developing a clinician’s career. A coach helps with personal development and plays an integral role in driving the coaching relationship. A mentor helps the mentee navigate the career map, providing guidance and support. We sometimes underestimate the role a sponsor plays in shaping our career. Sponsors play an important role, helping us move up the career ladder. Usually someone in a position of influence in an institution, a sponsor can speak on our behalf at the decision-making table. A quote that resonates with me and helps me understand the differences in these roles is: “A coach talks to you, a mentor talks with you, and a sponsor talks about you.”7 It is important to identify individuals who will fill these roles in your career and utilize the opportunities you have with them.
Finding a Mentor: My Journey
Marie R. Baldisseri, MD, MPH, FCCM
The path we travel as clinicians, teachers, researchers, and academics is not clearly delineated for us, whether in medical school or during our clinical training. It is assumed that when we finally complete our training, we will know exactly what we want to do and also be capable of taking the necessary steps to achieve success. However, this is rarely true. We are often so grateful to have finished training relatively unscathed and sane that thinking about the future takes a backseat.
However, as we finish training, we need to recognize that we often do not know what the next steps are. Getting a job is important, but what happens after that? As a senior intensivist in my department, I am often asked many final questions by my residents and critical care fellows before they graduate from training, such as: How do I navigate the system? How do I advance in the department? How can I advance in my professional society? How do I make a difference—clinically, educationally, in research, or administratively?
My first answer is that our choices are not easy or intuitive. You simply cannot guess what you should do to advance your professional career. So then, how do we move along the path to success? For me, I had my greatest success with the perfect trifecta: a fabulous and dedicated assistant, dear friends and family, and a professional mentor. How do you identify a potential mentor? Ask yourself: Who do you know who reflects the values and practices that you would like most to achieve? Who do you admire and respect and consider a role model? For me, it was a senior intensivist in my department. I would sit and talk to him about my career decisions. Even after I finished training, he was the one I would call on the phone and text to ask for advice. I trusted him implicitly. He gave me advice but never in a manner that was domineering or condescending. He asked me to make my own choices, but it helped to hear about the choices he had made. He also introduced me to other senior clinicians and researchers in our relatively small world of critical care medicine and advocated that I become involved with our professional society, the Society of Critical Care Medicine. His direction, guidance, leadership, and friendship were invaluable to me. My only regret is that I did not tell him often enough how much of a difference he made to my professional career.
- Lautenberger DM, Dandar VM, Raezer CL, Sloane RA. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership. Washington, DC: Association of American Medical Colleges; 2014.
- Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex differences in academic rank in US medical schools in 2014. JAMA. 2015 Sep 15;314(11):1149-1158.
- Amrein K, Langmann A, Fahrleitner-Pammer A, Pieber TR, Zollner-Schwetz I. Women underrepresented on editorial boards of 60 major medical journals. Gend Med. 2011 Dec;8(6):378-387.
- Jena AB, Olenski AR, Blumenthal DM. Sex differences in physician salary in US public medical schools. JAMA Intern Med. 2016 Sep 1;176(9):1294-1304.
- AAMC News. Women were majority of the medical school applicants in 2018 [press release]. Washington, DC: Association of American Medical Colleges; December 4, 2018. https://news.aamc.org/press-releases/article/applicant-data-2018/. Accessed April 11, 2019.
- Hu E. American motherhood is ‘messed up,’ author says. Here’s how she wants to fix it. Here and Now. National Public Radio. November 13, 2018.
- Catalyst. Ask Catalyst Express: Sponsorship and Mentoring. New York, NY: Catalyst; July 26, 2018. https://www.catalyst.org/research/ask-catalyst-express-sponsorship-and-mentoring/. Accessed April 12, 2019.