Cultivating a Culture of HeForShe within the Field of Radiation Oncology

 

The United Nations jump-started its HeForShe campaign in 2014 with a powerful

speech from its ambassador Emma Watson. In it she recognizes the lifelong

advantages she has enjoyed from inadvertent feminists: “My parents didn’t love me less

because I was a daughter. My school did not limit me because I was a girl. My mentors

did not assume that I would go less far because I might give birth to a child one day.” In

considering how to most effectively globalize such basic gender equality, she poses the

poignant question: How can we affect change in the world when only half of it feels

welcome to participate in the conversation? SWRO’s response is to formally welcome two of ASTRO's male leaders, Paul Harari, MD and Brian Kavanagh, MD, to our conversation on effective strategies to diminish gender disparities in the field of radiation oncology.

 

Dr. Harari is the current Chair of ASTRO and chair of radiation oncology at the

University of Wisconsin, and Dr. Kavanagh is Immediate Past-Chair of ASTRO and

chair of radiation oncology at the University of Colorado. Both have been strong early

supporters of SWRO and have used their leadership roles to champion the role of

women in our field.

 

 

 

 

PART 1 - Since the recent media reports of sexual harassment surrounding the

#metoo movement, almost half of male leaders in the workplace now say they are

uncomfortable participating with a woman in a common work activity (mentoring,

working alone, or socializing together). This is clearly a concern within the field of

radiation oncology, where women currently comprise roughly a quarter of the

physician workforce and only a handful of academic chairs. [1]

 

1. As an ASTRO leader and department chair, do you feel there are practical (i.e.,

self-serving) reasons a radiation oncology practice should strive both to hire

women and to foster their trajectories toward leadership positions? Are there

similar reasons for the field at large to attract more women?

 

BK: Absolutely there is a way to consider the issue with local advantages in mind. First,

half the population is female, as are about half of all cancer patients. Although a doctor

does not have to share all demographic characteristics with a patient to provide high

quality care, it is simply the case that some patients—male and female—would prefer to

see a physician of the same gender if possible because they are more comfortable

sharing intimate health details with someone of the same sex. Of course, we can’t

always match up everyone perfectly on an individual, “micro” scale given that many

smaller sites of practice are staffed by only one or two individual physicians. But I think

there is also a larger, “macro” benefit to the field when there is better gender balance

across the specialty. Patient-reported outcomes of health-related quality of life are

extremely valuable to record and understand, and I think that by having a larger

percentage of women working as radiation oncologists at community and academic

centers, we are as a group in a better position to interpret findings in context and

prioritize opportunities for improvement than we would be if we have only male doctor

perspectives.

 

PH: The cancer patients we serve are highly diverse and I strongly support efforts to

increase the diversity among the medical care providers who serve these patients.

Hiring female faculty members in my department has been a joy and among the most

valuable and important changes to transpire in my department over the last decade. Not

only are women particularly well suited to care for female patients who express their

desire for a female physician, but women play critically important roles in leadership,

education, research, and mentorship that broadens the overall perspective of the

department. We have women in key leadership roles in the department that adds an

incredibly important dimension and breadth to our program.

 

2. How has the #metoo movement colored or informed your views on mentoring,

collaborating and socializing with female colleagues?

 

PH: The #metoo movement raises awareness of a very significant and longstanding

worldwide problem. Demonstrating by example a highly inclusive and collaborative spirit

across a department means consistently showcasing the highest level of respect for all

members unaffected by gender, race, rank, height, weight, native language, etc. Care

and thoughtfulness in handling one-on-one interactions are, of course, important but

need not inhibit high quality mentorship, collaboration and socializing.

 

BK: I have been married to a female physician for over twenty-five years so, long before

#metoo emerged as a rallying cry for awareness and action, I had become mindful of

the reprehensible behaviors of some male physicians toward female colleagues from

stories my wife shared about her own observations and the experiences of other female

physicians. I suspect the problem is of a similar magnitude as in other occupations, but

that doesn’t make it any less disappointing. Anyway, like most if not all male physicians,

I think the #metoo movement has been a good start toward improving the culture. I

personally now think much more carefully about remarks I might be tempted to say that

could be interpreted as insensitive in some way. It can be tricky at times. If I bump into a

female colleague outside of work somewhere and my instinct is to give her a

compliment about a dress she is wearing or a new hairstyle, I mentally process the

words several times in my head to be sure the tone is OK. For what it is worth, I am

probably just as likely to tell one of my male colleagues that I like his pocket square or

well-trimmed beard because I think some guys also like to be given a friendly boost of

this sort once in a while.

 

3. How should a leader ensure male faculty feel safe (i.e., free from potential

appearances of impropriety) when working closely with female colleagues?

 

BK: I haven’t seen this situation occur locally, where a male faculty member feels

uncomfortable in that regard. However, I would think that the priority should be to

sustain transparency and accountability around the goals of the relationship. A male

faculty member supervising a female medical student on a research project, for

example, is in a situation with an intrinsic power imbalance. He has to recognize that he

must treat the student with respect at all times. Periodic work-in-progress discussions of

the project by the faculty-student team in an open forum with peers present, e.g. a

department research conference, can focus the collaboration on the work itself above all

and should help get past other potential pitfalls.

 

4. How should a senior male physician address a situation in which they overhear

male colleagues, staff, or patients using demeaning or objectifying language

about a female member of his team?

 

PH: My wife worked for years as a Pediatric ICU nurse. She overheard many comments

that reflect various degrees of gender and other bias. I have heard such comments as

well over the years. What could a senior male physician do if they overhear such

comments? Act! Diplomatically and constructively, take the opportunity to speak directly

to the individuals about the issue. Let them know you do not agree with the style or the

content of comments that are demeaning to others. Convey clearly that these

comments can be hurtful to individual, and compromising to the ultimate clinical,

research, and teaching missions of the deptartment.

 

BK: I think the proper course of action is different if the overheard remarks come from a

co-worker as opposed to a patient. If it is a first-time occurrence for a co-worker, the

senior male physician should probably approach the other individual with a comment

such as, “You might not realize it, but the way you just said that could be interpreted as

biased or as creating a hostile work environment,” or something to that effect. The

desired outcome would be a conversation and self-reflection on the part of the person

who made the remark—and for a lot of people, that can go a long way towards

eliminating future transgressions. If the senior physician is uncomfortable with this plan

or if individual is a known repeat offender, then somehow the office of professionalism

and/or human resources section should be engaged. The rules for a male patient who

behaves in a sexist manner toward a female staff member are not so straightforward, in

my opinion, though I am aware that this type of problem can occur. The first step is

probably to alert the physician most directly managing the patient’s care, since he or

she is in the best position to know if the patient has dementia or another medical

explanation for the behavior. If there are no medical explanations for the behavior, then

the physician of record needs to communicate directly with the patient to explain why

the behavior is unacceptable. Sometimes a social worker or even a hospital chaplain

will have valuable insights and skills that can be enlisted to help out in this type of

situation.

 

5. In your experience, have you noticed women failing to negotiate and/or

advocate for themselves as strongly as their male counterparts?

 

PH: Some women (and some men) do not advocate as well as others for themselves.

Leaders can help these individuals to gradually gain confidence to better express

themselves. Encouraging them to begin stating their views on certain issues, and

echoing support for their comments immediately thereafter in a public setting can be

very helpful in this regard.

 

6. Do you have suggestions on implementing standardized mechanisms to

ensure gender equity in regards to pay and benefits?

 

BK: Our institutional policy is that salaries are set at levels consistent with AAMC or

similar survey data in accordance with rank and experience.

 

7. In meetings where one or a handful of people are most vocal, are there

techniques you utilize to convey that each person’s voice is valued? How can the

leader in the room speak up if someone is interrupted or overshadowed?

 

BK: This situation is not uncommon. It is best to anticipate the problem and script the

framework of the discussion in a way that identifies the first person or two who will

comment on a given topic. If someone tries to hijack the conversation beyond that, I

generally let that individual have the floor for a specified length of time with the

understanding that other people will thereafter be allowed to speak uninterrupted.

 

PH: Leaders can thoughtfully encourage and stimulate the inclusion of more voices in

the room when there is a pattern for a few voices to dominate the discussion. Gentle but

direct phrases such as, “let’s hear some other voices and perspectives”, “thanks for

those comments, who might see some other perspectives or options”, or “thanks for

those comments, I sense there may be other viewpoints we could consider, does

anyone else have some distinct perspectives we might consider?” This is a perfect

opportunity to hear feedback from our junior faculty who may bring their valuable

experience and perspectives to the topic.

 

PART 2 - Motherhood often triggers assumptions that a woman is less committed

to her career. This is inexorably linked to the fact that many men have partners to

handle the majority of parental and domestic obligations outside of work while

women generally, at best, split such responsibilities 50/50. While this

phenomenon is not specific to radiation oncology, it no doubt pervades it. [2]

 

1. How can constituents encourage academic and/or private workplaces to adopt

progressive parental leave policies? What are some practical reasons a

workplace should offer appropriate benefits surrounding parental leave, including

for a woman who gives birth, for her partner, or for adoptive couples?

 

BK: The most practical reason that I might suggest as an argument for good and fair

parental leave policies is that while a three month or so shortage in the workforce is

always somewhat challenging, the process of starting from scratch to advertise for a

new worker, interview candidates, and train a new employee is almost always in my

experience harder and longer.

 

2. What strategies would you recommend to proactively safeguard against peer

pressure on women—and especially men—to forgo utilizing appropriate parental

leave (e.g., comments from co-workers or superiors about being “stretched thin”

or “making-do” in someone’s absence)?

 

PH: Leaders can provide enormous support regarding progressive leave policies.

Specific actions and words demonstrated in a public setting (faculty meetings for

example) are very powerful to effect change. Stimulating a collective esprit de corps

where faculty/staff help one another whether for paternity, illness, stressful events, etc

can be infectious once a pattern is established within a group.

 

BK: This issue is more acutely uncomfortable in smaller organizations, but even large

departments will feel temporary personnel shortages to some extent. I don’t know of a

one-size-fits-all solution, but, for the sake of a harmonious group dynamic, it seems

reasonable to offer some form of appreciation pro-actively to the physicians who

perform extra clinic coverage if there is going to be a substantial differential in workload

in a given year as a result of a parental leave. Lots of places have an established

incentive distribution plan that is linked to a measure of productivity in a given year

(typically RVUs), so there might already be an existing means of mitigation. I have

usually seen individuals returning from a parental leave offering to do favors here and

there for the colleagues who covered for them, maybe take on some extra new patient

consults or other tasks that allow their colleagues to leave early or have an extra day or

two off. It is a great team strengthener when these transactions occur spontaneously.

 

3. How do you initiate transparent discussions with both female and male

prospective hires on your workplace’s resources for new parents so they do not

feel uncomfortable broaching the subject? Do you think this works to effectively

remove stigma surrounding using such resources if/when the time comes where

they are needed?

 

BK: That’s a tough question. We are generally advised against mentioning the issue of

an interviewee’s potential family expansion plans unless something is volunteered by

the interviewee. The reason for advising against the questions is to avoid even the

perception that there would be bias in a hiring decision against someone who hopes to

take a parental leave in the future.

 

4. How do you encourage senior faculty to be cognizant of setting important

meeting times to accommodate the schedules of co-workers who have family

obligations? E.g., Do you utilize polls for meeting times with the option for

feedback with anticipated conflicts?

 

BK: It is always hard to find good ad hoc meeting times outside of regularly scheduled

times since everyone is so busy with patient appointments, multi-disciplinary clinics, and

all sorts of other commitments. We really can’t schedule meetings at extreme early

times because of these constraints, and end-of-the day meetings are always tough

because clinic schedules can run late. Add in the fact that we often have personnel

covering at centers away from the main campus, and what we wind up with is a solution

that usually involves a combination of face-to-face engagement and remote electronic

participation by Zoom or Skype or similar software.

 

5. In closing, do you believe there is a unique influence male radiation

oncologists exert when supporting their female counterparts within our field?

 

PH: Male radiation oncologists demonstrating their strong support for female

counterparts sends a powerful and valuable message to others. Providing the highest

quality care to our cancer patients means recognizing and highlighting the critical roles

that female faculty and staff play in this effort. To reduce and hopefully eliminate hidden

(and overt) gender bias that may exist, conscious and consistent commitment to

supporting female counterparts is critical to maximizing the very best cancer care for our

patients.

 

BK: I believe that the vast majority of male radiation oncologists are strongly supportive

of their female colleagues. I am hopeful that within the next decade or so we can reach

a point where we achieve more equal gender representation among radiation

oncologists, and I think that our patients will be well served at that time.

 

 

 

REFERENCES

1. Jagsi R. Sexual Harassment in Medicine — #MeToo. N Engl J Med. 2018 Jan 18;

378:209-211. doi: 10.1056/NEJMp1715962.

 

2. Holliday E, Ahmed A, Jagsi R, Stentz N, Woodward W, Fuller C, Thomas C.

Pregnancy and Parenthood in Radiation Oncology, Views and Experiences Survey

(PROVES): Results of a Blinded Prospective Trainee Parenting and Career

Development Assessment. Int J Radiat Oncol Biol Phys. 2015 Jul 1;92(3):516-24. doi:

10.1016/j.ijrobp.2015.02.024.

 

 

By Dr. Laura Dover, radiation oncology resident at the University of Alabama

 

 

 

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