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. 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
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
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.