October 24, 2023
If you have not yet, check out Part 1 of Gender Equity in the Emergency Department with Dr. Kimon Ioannides where we talked about the role men play in moving toward gender equality in the ED.
Today, we are joined by Megan Healy, an emergency medicine physician, who is the current Program Director at Temple University Emergency Medicine Residency program. Not only is she the Co-chair of the Women Faculty Committee at the medical school, but she has also done work at the national level within AAEM and the Women in Emergency Medicine (WiEM) Committee. In our talk, we discuss the discomfort that can come from being in a position of privilege and having that privilege in the spotlight, our unknown unknowns which can include biases and how to overcome them, resources for those looking to get involved in the conversation and change culture, and the future of gender dynamics in the ED.
Emergency Medicine Mansplaining – Gender Equality & How We Can Move Toward It Part 2 with Dr. Megan Healy – The SimKit Podcast
Jason Hine: Hello everyone and welcome back to our second, actually, talk on Emergency Medicine, mansplaining and gender equality or inequality in the emergency department. This is a follow up to our conversation with Kimon Ioannides where we talked about the role men play in moving toward gender equity in the ED. If you have not heard that podcast, go back, have a listen, it is definitely worth it. But we mentioned really early on in that chat, there’s a pretty palpable issue. You know, myself and Kimon, we are two cis white men talking about gender. So we recognize that that is not a very diverse representation of the people involved in the conversation. So I am happy to say that we are now joined by Dr. Megan Healy, an emergency medicine physician who helped train and raise me. Meg, thanks for joining us today and tell the listeners a little bit about yourself.
Megan Healy: Thanks so much for having me. So I’m the program director here at Temple Emergency Medicine. I’ve served the past two years as Co-chair of our status of Women Faculty Committee at the medical school. And so I’ve also done work at the national level within AAEM. And the Women in Emergency Medicine Committee, which has now grown to be a section of that organization.
Jason Hine: Fantastic and congratulations for moving to a section and just thank you again for the work that you’re doing in this area of bringing attention to inequity and moving toward equality.
Megan Healy: Thank you.
Jason Hine: So Meg, I’d actually like to kind of start this chat with a little bit of a a confession, I guess. This topic makes me uncomfortable. You know, I’ve kind of been in a position of privilege for a long time and it’s a privilege that often doesn’t really even get discussed or recognized. So when that privilege is kind of so strongly highlighted, it’s a little bit unnerving. I guess I’d ask, what do you think about that? Should gender disparities in medicine make men uncomfortable? If so, what do we do as a gender or specialty to mitigate that? Or actually probably most importantly, should it be mitigated? Is the discomfort that we feel something that’s valuable for the conversation?
Megan Healy: I think it’s unavoidable to have discomfort and that discomfort can be leveraged into productive and meaningful work. I I definitely empathize with that experience of feeling uncomfortable. I think these important conversations do bring that out in us as a reflection of kind of the vulnerability and humility that’s required to engage in a meaningful way. I think a lot about this, as a white CIS woman who’s interested in Health Equity. There’s a lot to learn and unpack, and I think it’s important to do the work as an individual first to be really introspective and reflective about how you contribute to oppressive systems, and interact with those systems benefit from those systems, and how you can do better on the individual level and then it can help inform the kind of work that you do on a broader you know more systems level to you know, insight change that can benefit others.
Jason Hine: That makes sense and within that you you sort of said that you leverage it so you, you aren’t specifically targeting it, but having that discomfort one, you know a point of privilege, discomfort you know people are probably like well who? Who? Who really cares? And you’re talking about a group of of people on the other side that have dealt with such more severe discomfort for a such a long time that it’s a very disparate area to discuss, but you’re saying that bringing that discomfort to the table actually has some value potentially.
Megan Healy: Yeah, it’s sort of a badge of honor of some of the solidarity…
Jason Hine: Sure
Megan Healy: that’s required, just like a little piece of that discomfort, as you said, is only kind of a drop in the bucket of what’s experienced by other groups and it shows that you’re doing something meaningful that other people would rather avoid. And I think that’s always a reflection of of growth and something positive.
Jason Hine: That makes sense. I like the way that you stated that. Now, in my conversation with Kimon we talked a little bit about sort of the unknown/unknowns. Those issues are kind of knowledge gaps that we just don’t even know that we have. I think biases and inappropriate conduct may fall into that category for many men. How would one approach sort of recognizing these unknown/unknowns in gender inequity?
Megan Healy: Sure. I think when we stumble into these situations a lot of people’s first natural move is to get defensive and speak a lot to explain their point of view or their perspective, or to kind of dismiss or minimize. So I think the guiding rule is ask questions and listen to understand, giving appropriate kind of time and space for different perspectives to be heard. I remember this experience I had as part of the board for a National Org, I was one of only two women at that time who were within that group and we were talking about planning for a national meeting. I brought up the suggestion of having a space for lactation, and I was already, like, very hyper aware of, you know, the differences between, like, myself and the other people who were at the table at this meeting. And, you know, one of the first people jumped in who grew up in another area and said, well at meetings in this place, you know women will just pump in the lecture and, you know, went into a long explanation of that. And I think lead by asking questions and understanding more and giving space for especially a a perspective that is a lone perspective or one of few to be heard and expressed what’s important. Be very aware of who’s in the room at various like meetings and spaces that you find yourself in and who isn’t think one of the really important things that men can do is advocate to get those other perspectives in the room.
Jason Hine: I like that I I gleaned sort of three, uh, three take-homes there. So asking questions, right, you know, recognizing your unknowns. First you need to even contemplate the idea that there are things that you don’t know that you don’t know you don’t know and then listen to understand. And within that listen to understand element, bringing in voices into the room that you know, if you’re, if your medical directorship is 95% men, then maybe you’re not really listening to understand your entire workforce or your entire group and it’s also, bringing in voices from other areas listening to understand and simply asking questions. Great.
Megan Healy: Yeah, and one of the most memorable parts of that specific experience was actually a more senior physician who came to me after the fact in a one-on-one setting and was and said, I really appreciated that you brought that up, I’ve just never thought of that before. Like, that’s why you’re here. And it meant so much to me that someone recognized it that was hard to do in that room and also reinforced how important it was so I really appreciate the folks who do those sorts of things they go a long way.
Jason Hine: And then imagine in a lot of the work that you do, some of the most rewarding experiences are in that sort of, you know, side table coffee hour conversations after a really challenging interaction like the one that you described. But it’s not always in the forefront, but people sort of bending your ear and saying I agree, this was my experience, or thank you for saying that I’ve had this problem, how would you manage that? I would imagine a lot of those types of interactions kind of come across the table for you.
Megan Healy: Certainly. And I think that’s where we can move the needle by by having those discussions and supporting others, so those are some of my favorite parts of this work.
Jason Hine: You know, as you were giving that description of the rapid and sort of probably long response that you got about the area of lactation, I find that sometimes when people get into these realms or start, you know, being questioned about how they land or feel about gender equity or support of women, they rather than listening right, you said listen to understand and ask questions. They just start on a tirade. They just sort of start talking in a rapid, somewhat nervous way that usually just leaves them so much further underground than they would have been if they sat and listened. Do you find that that’s true? Or have you had shared experiences like that?
Megan Healy: I think that’s true, and I think that’s another place of like a call to action for for the men that would have been the perfect example where if another guy had approached him after the fact and said hey, I think if maybe we had asked some more questions that might have gone a little bit differently. I think those kind of interventions are really are really important.
Jason Hine: That makes sense that that’s a thank you for highlighting that as well. If you see someone putting their shoe in their mouth or digging themselves a hole through rapid pressured speech, nervous conversation and lack of insight, taking them aside and saying this seems like an opportunity to listen rather than speak, and getting more perspective, that’s a great tool to use with our colleagues. And now a little bit of a transition in sort of topic matter. But one thing that I find challenging in this realm is our ability as men to discuss sort of this conversation and obviously this topic matter with coworkers without putting anyone else into an uncomfortable position. Right to ask a female colleague to point out when I’m being sexist is inappropriate. It puts the illness on the female and it’s just incredibly awkward, so that’s not a viable option. So how can men start to approach gender inequity issues with colleagues without sort of falling into that trap?
Megan Healy: So I think you could start by having that conversation among a close group of people that you know who are you know, in your in your peer group you already have established relationships. I think it would be hard to put a woman on the spot that you don’t know well, especially if you perceive that there was some sort of misunderstanding. I think you always have to be careful not to put the burden on women or other gender minorities or folks of other marginalized identities to do the work to teach you in real time. I think we can certainly create spaces where you can have these conversations, I’ll say as someone who’s planned a lot of programming around gender equity, there don’t tend to be a lot of men in those rooms. And I think when there is a set space where our conversation is going to be had, it can be helpful to go and just listen and again ask questions and take advantage of those spaces that that are built. I think it’s also important to be aware of other kinds of power dynamics, such as those that you find in a training environment. I feel that or say a a faculty member in a residency program to be to be asking a woman resident about their specific behavior would be kind of an unsafe setting for that conversation to be really productive. I’d say if you do some introspection about an interaction and you feel a little icky about it, there’s probably something there and start with those close people that you know to try and unpack it.
Jason Hine: And I’d love to sort of peel back some of the layers there of when you’ve created sort of curriculum or even just opportunities for discussion in this area. You mentioned that there you know whether it be women in emergency medicine or, you know, a sexual orientation related or whatever the demographic that’s being discussed or addressed. There’s low attendance probably from that sort of CIS white male. Is that correct?
Megan Healy: Yes, and there are spaces that are, you know, for community building amongst a particular group and that isn’t a space where, but I think that folks who are in this work are good about communicating, when that’s the case and when it’s the more general education for a larger group and I I just appreciate the few, there’s always a few, you know, men who do show up and ask questions and learn because there are opportunities for that. I just feel that not many people take advantage of those.
Jason Hine: Yeah, that’s perfect, because that kind of leads to my next question of if groups like this exist in your hospital system and you’re sort of, you know, listening to us now and recognize your desire to address some of those unknown unknowns and you say, maybe I’d like to attend one of these meetings, would it be off putting to have that sort of CIS white male presence in a group that’s largely lacked that demographic before, obviously, I suppose it’s going to depend on how you present yourself, but how would you know if this is closed off to you or not, I suppose.
Megan Healy: I think you can always ask the organizers if it’s unclear, I know that we’re very explicit when we send out, you know, conferences and education and workshops like all faculty are invited. But if it is unclear, you can always ask the organizers. I feel like that’s a smart move. There are also some interesting groups that are coming up more commonly now, like you know, a white affinity group for people to have some conversations within that group in order to explore kind of their own biases and do so in a way that’s not you know, harmful to others. So, you know, explore the opportunities that are available within your own institution within your hospital, within your medical school. Because I think the forums are out there. It’s just, you know, everyone prioritizes different things. I think if you care about this, this is, you know, something to make it a goal to sometime in the next year into setting like this to get some more education and engage in that kind of discussion.
Jason Hine: That’s perfect advice. I was wondering if you might end, this might be putting you on the spot a little bit, but I was wondering if you might have any resources if someone is really sort of for the first time kind of having the wool pulled off the eyes and recognize they have no real knowledge in this, they actually need to be brought up to speed in terms of language so that they can attend these types of settings and not offend people and feel as though they’re, you know, speaking intelligently, are there any asynchronous or other resources if someone wanted to just learn on the topic matter of podcast or blog that you would recommend?
Megan Healy: Sure, so I think I know that SAEM and AAEM in particular, have great resources out of their committees that are focused on women in emergency medicine. There’s also some really good material in the general press. HBR has a couple of great article series around workplaces and and toxic workplaces, issues around gender and like diversity, inclusion, more broadly. There’s a great piece called stop telling women they have imposter syndrome that I think is great, that talks about the experience that many women have, navigating medicine, of feeling like an impostor, and how actually that phenomenon is a reflection of our of our culture and broken systems and people being made to feel excluded. And they did a great follow up piece about what you can do within your own institution. I think that was one of my favorite pieces in recent years around this topic.
Jason Hine: Excellent. Yeah, I’m definitely, we’ll grab that from you and put a link to that in the show notes and thank you also, you have some articles there for people to review. I was amazed in that article that you sent me about that sort of 12 year difference in attrition rate between male and female practitioners of emergency medicine. So, clearly there’s a lot of work to do.
Megan Healy: Yeah, there was a, that great piece that looked at attrition. That really identified how the pandemic exacerbated the preexisting kind of disparities around gender in emergency medicine. They really break that down well, and I really think that should be a call to everyone in emergency medicine that we, we need to do differently and take a hard look at this because we’re losing really talented people from the workforce.
Jason Hine: Oh absolutely and the other article about the 11% of department chairs are female, that is a that’s a pretty puny number. That’s an embarrassingly low number as well. And so yes, definitely put these references into the show notes for you guys to sort of see where we are and then also very importantly, so the, HBR, the stop telling woman they have imposter syndrome, SAEM and AAEM as resources. If you yourself, this is more individual level stuff, if you yourself kind of want to get brought up to speed as you start to sort of put your toes in the water of your local group’s assessments of DEI diversity, equity, inclusion these resources can help you sort of speak the language which I think is it’s pretty important. You know, I’m not very good at it but there’s definitely a specific sort of non-biased and neutral language that you want to bring coming into these and it’s a little different than other ways of speaking and addressing people and so, getting that sort of up to speed and knowing the background information before joining a group I think can be really helpful for you to engage yourself into that conversation in a meaningful way. But if you are, you know, the CIS white man or, if anyone if you are not ready to go sit down for the you know the coffee break with the DEI group in your hospital, but you still do want to be engaged in this and sort of like an everyday way, I was wondering if Meg, might have any recommendations for how people can make changes and be supportive within their department itself.
Megan Healy: Sure, there’s great ways that you can be you know a sponsor for, for women or those with marginalized identities, you know, don’t accept an invitation to be on a mantle. I’m sure we’ve all heard that term. You know when you get an invitation to something happening at the national level, look at who else is participating. Are there perspectives that are missing? Is there someone that you can recommend that you know, who you’ve worked with, especially someone junior. I think within your own group or within your own department you know, take a look at who’s doing what kind of labor and think about maybe how you might disrupt that? Often women are disproportionately doing uncompensated work like that around mentoring, education, wellness roles, thinking about that, and how it’s reflected, where you are working, thinking about how much transparency there is in things like pay or promotion and advocating for more transparency there, those are all really important things that we can advocate for to, to move the needle.
Jason Hine: Fantastic. Those are those are great recommendations and we’ll sort of itemize all those up and put them in the show notes for you to have on hand for your next shift to be a proponent ,to be a supporter of this movement toward gender equity. So, Meg, what do you see as the future of gender equity in medicine as a whole? Certainly, very interested in emergency medicine… And then how most importantly, how do we get there?
Megan Healy: Sure, I think for a long time, much of the advice that’s been given to women in particular is how to play the game. Like, what do you need to do to survive, to succeed within the current systems? And I am an optimist and want to think of a future in which we can all contribute to changing the game. I don’t want to have to play the game, I want to change the game. And doing that with an eye to especially intersectionality like women, any work within committees for women in emergency medicine or within your medical school or within your department. You have to be really explicit to how connecting the ideas of equity for women connects with broader equity work and other peoples experiences, and there’s real power in that kind of solidarity. I think we have to work to detoxify the current systems to have accountability, especially for things like unprofessional behavior, discriminatory behavior so we can no longer have tolerance for work environments where people are made to feel unsafe. I think that’s really important focus.
Jason Hine: Sure.
Megan Healy: And I think we also have to reflect on how the culture we have that’s very much in support of the gender binary has shaped our expectations of one another in the workplace. And all the different relationships, especially in emergency medicine, you know where the ultimate team sport we are interacting with many other folks to do the important work of caring for patients and there’s, you know, gendered expectation, like Kimon was talking about, his examples about how we navigate that work and what the consequences are for particular leadership styles or particular communication styles. And that’s something that women and others are, you know, navigating on the daily basis and the more kind of awareness and appreciation we have for that, we can all learn to to be stronger teams.
Jason Hine: I like that. I think, I mean with your opener, yeah, we it’s kind of BS thing to say. Just play that game, you know, play the hierarchical patriarchical game that that medicine has been. So I do love the idea of changing the game and how it’s going to be small efforts is kind of what I gathered from what you’re describing, is, yeah, you can’t have a a workplace that that is tolerant of certainly, you know, sexism or statements that make someone either feel uncomfortable or unsafe. That is a, you know, that should be a no strike policy, right. You are sort of out of the environment in that and so the role that men have to play in in this area include supporting, mentoring, increasing visibility about opportunities for promotion, for the type of work done, male versus female. There’s a lot of air, small, simple little things that we do, but it seems like each of these little pieces might add up to the whole picture. In that every sort of step that you take toward showing an understanding showing either an intolerance to sexism or gender inequity, or your willingness to understand more is a step in the right direction. It’s going to take hundreds of thousands of these small steps for us to get to where we want to go.
Megan Healy: For sure. And there are we’re gaining more and more tools and data to understand this better. You know an area, a whole separate conversation could be around, you know, assessment and feedback. How do we, how do we give feedback, how the issues of gender like affect that, because that comes up in so many ways for promotion and leadership opportunity’s, I think that’s a really important area and we’re seeing new tools, even with AI and more objective data to understand the insidious ways that some of our some of our language and just our learned experience over time gets into letters of recommendation, gets into assessments, and evaluations of other people and might be hindering progress in this area.
Jason Hine: Yeah, I think that’s a great area to focus, is sort of the, you know, the younger learner or the someone that’s earlier in their career because there’s certainly more room for molding their understanding, experience and existence within the healthcare field. It’s going to be harder to change unfortunately, practices of the seasoned clinician that’s been out for some time. Both are incredibly important, obviously to still address, but you know to recognize how we affect a, you know, a medical student or a resident through our evaluations, our letters of recommendation, and what that does to their career trajectory is very important and it’s the first domino in, you know, one or the other direction. So how you and your gender biases and the way you evaluate them, the feedback that you give them, how that is crafting and shaping their career, we need to be conscious of that. And I appreciated that article that you sent me and I’m sure we can grab some more for the references, about being super conscious of how our biases play into evaluation, promotion and the path for our young learners. All right, so as we wrap up Doctor Healy, do you have any closing thoughts or words of wisdom to impart upon our listeners?
Megan Healy: I think the most important thing to keep front of mind is, get curious, ask questions and be on the lookout to make sure our diverse perspectives are at the table when you’re having important conversations. And there’s a lot that we, and I, continue to learn from trainees and medical students and residents, and the coming generations, the future of emergency medicine. So pulling those folks into these conversations, I always I always learn and am, you know, buoyed by the interest and the expertise of those trainees as well. So that’s another resource that we can, that we can use to push this conversation forward.
Jason Hine: That’s a great concluding point and they are more cognizant aware and have a better understanding of the sort of social factors at play probably than as we mentioned some of our older folk. But so bringing those people into the conversations a fantastic idea. Well, there’s so much to learn, so much to do. Thank you, Doctor Healy, for your perspective, the work that you do for gender and other equity building in our field in emergency medicine/ medicine as a whole and I learned a lot. Thanks again for being on the podcast.
Megan Healy: Thanks for having me and thanks for creating a space to have this conversation.
Jason Hine: Happy to.
Discomfort Coming from a Position of Privilege
To start, it is important to confess that this topic can be uncomfortable coming from a position of privilege, as a white male. This privilege doesn’t often get discussed or even recognized.
Should gender disparities in medicine make men uncomfortable? If so, what do we do as a gender or specialty to mitigate that? Or most importantly, should it be mitigated? Is the discomfort that we feel something that’s valuable for the conversation?
It is unavoidable to have discomfort, however, that discomfort can be leveraged into productive and meaningful work. A couple ways to do this are:
- Working as an individual first is essential to be introspective and reflective about how you contribute to oppressive systems, interact with those systems, and benefit from those systems.
- Learn from your individual reflection so that you can impact others for the better on a broader scale.
This discomfort shows that you’re doing something meaningful that other people would rather avoid.
The “unknown unknowns” are the knowledge gaps that you may be unaware that you have. For many, these may include biases and inappropriate conduct.
How would one approach recognizing these unknown unknowns in gender inequity?
First, take a step back to avoid getting defensive, as many may speak a lot to explain their point of view or perspective, or to kind of dismiss or minimize. This can often lead to digging a deeper hole.
Second, ask questions and listen to understand, giving appropriate time and space for different perspectives to be heard.
How can men start to approach gender inequity issues with colleagues?
First, start by having conversations among close groups of people that know who you are, with already established stable relationships.
Second, it is important to be careful not to put the burden on women, other gender minorities, or folks of other marginalized identities to do the work to teach you in real time.
Third, it is important to be aware of other kinds of power dynamics, such as those that you find in a training environment. Explore the opportunities that are available within your own institution within your hospital, within your medical school.
Resources for All Levels of Engagement
If you are interested in gender dynamics and creating a culture of equity in your department, but don’t know where to start, some of these resources can be a great place to start.
- SAEM and AAEM: Each have great resources out of their committees that are focused on women in emergency medicine.
- Harvard Business Review: Great article series around toxic workplaces, issues around gender, and diversity, inclusion, more broadly.
- Emergency medicine physician workforce attrition differences by age and gender
- Gender Differences in Emergency Medicine Attending Physician Comments to Residents: A Qualitative Analysis
- January / February 2023 Common Sense
These resources are great if you want to get brought up to speed as you begin to look into your local group’s assessments of DEI: diversity, equity, and inclusion.
If you are not ready to go sit down for a coffee break with the DEI group in your hospital, but you still want to be engaged in creating an inclusive space at the workplace…
What resources are there for people who want to make changes and be supportive within their department?
- Be a sponsor for women or those with marginalized identities. When you get an invitation to something happening at the national level, look at who else is participating. Ask yourself:
Are there perspectives that are missing?
- Often women are disproportionately doing uncompensated work, for example, mentoring, education, wellness roles. Think about this, and how it’s reflected where you are working.
- Consider how much transparency there is in pay or promotion and how you may be able to advocate for more transparency in your department!
The Future of Gender Equity in Medicine
We want to think of a future in which we can all contribute to changing the game.
I don’t want to have to play the game, I want to change the game!
Hold those accountable for unprofessional or discriminatory behavior in your department so that we no longer have tolerance for work environments where people are made to feel unsafe.
Reflect on how the culture we have supports the gender binary and how it has shaped our expectations of one another in the workplace.
Get curious and ask questions! Be on the lookout to make sure diverse perspectives are at the table when you’re having important conversations.
Learn from trainees, medical students, residents, and the coming generations, they are the future of emergency medicine.
Every step that you take towards understanding gender dynamics or the role you play in creating gender equity, or your willingness to understand more, is a step in the right direction.
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