Personal journal entry, September 11, 2017:

Sometimes we wear womanhood like a yoke — burdensome on our shoulders, as we carry the torch for younger women coming behind. Sometimes, we swing womanhood as a sword, slicing, and jousting for survival in a world that started without us, and in some cases, would be more than happy to continue that way. Sometimes, womanhood surrounds us thick as a fog, wrapping us in expectations that are ungrounded or paralyzing. Sometimes, we don womanhood like a dull pair of work boots, knowing we will often be asked to do more than our male colleagues and be given less in return.

And sometimes, womanhood comes with a roar.

In late July, the Medical Women’s International Association Centennial Congress was hosted by the American Medical Women’s Association (AMWA) in New York City. This was a large convention, attendees numbering in the thousands, but the Twitterverse sparkled with clusters of “powerhouse docs” that I will call The Circle: founders of the #TimesUp health care movement, luminaries of gender-focused scholarship and allies whose “amplified” actions and words reverberate across global venues. Attendee images featured assembled women presidents of global medical societies — exuberant smiles, T-shirts and lapel pins shared atop a platform formidably staged with flags of the world — Gloria Steinem herself was the keynote speaker.

And then, there were the rest of us.

That same weekend, you may have been working, rounding with a consult team, finessing a critical experiment, revising a manuscript, writing overdue EPIC notes, or reviewing a grant application. Perhaps you were making sense of fellowship interview offers. A patient’s family may have needed extra time with you at the bedside as they grappled with bad news. You may have been at home, nursing a newborn. Maybe your tomatoes (like mine) badly needed watering, or your dog needed a long walk. Your body, rest.

Perhaps you (like me) looked from images of the gathering in New York City to your rounding list/data/ manuscript/EMR/grant/tomatoes and questioned your place in the larger revolution. Perhaps you too felt from your city or town the nagging sting of irrelevance — Gloria Steinem nowhere in sight.

The gender equity movement in medicine and academia is gaining both visibility and ferocity, and rightly so. It is a bold and beautiful spectacle with unparalleled potential for the improvement of worldwide health. Time is indeed up. The redemption of decades of postponed justice will require a massive collective movement of earth, and each of us must expect to do our share of heavy lifting. We will need our champions.

But when I speak with women physicians who exist in a sphere just beyond the lights — the torch-bearing of social media, the driving productivity of academia and the fevered angst of urban centers — I have heard, in response, a direct and fiercely independent message that offers a different viewpoint. That message is this:

“I don’t really need other women to save me.”

In my own work, I play at the outer fringes of The Circle. I respect its leaders as brilliant and visionary. Based on my personal observations, I do not believe that a “savior complex” fundamentally drives current large-scale movements to advance gender equity in medicine.

I would offer, however, that this reaction should broaden our perspective. Many women physicians I know do not routinely invoke the word “patriarchy” and may not consider their daily work a “rallying cry,” but they lead the way locally, regionally, and nationally. They achieve C-level positions in their hospitals. They assume seats at oversized conference tables unapologetically, and certain of their right to be present. They own and manage thriving practices. They bring younger colleagues alongside. They would hope to see their professional reality reflected in the public square, but absent that, nothing will change about how they do work on a Wednesday in the pediatric ICU.

Wednesday will be “business as usual” — not because these women are unequipped to navigate gender bias and entrenched barriers to advancement, but because they have already found a way to swim strongly against the tide. Without followers. Without amplification.
Quietly— with a whisper.

As all women physicians must find a voice in this work, I think it is wise to consider whether there may be moments in which The Circle can appear rather like an echo chamber, maybe too small for everyone. If the end game is inclusion, such optics serve no purpose. As there must be powerful declarations and influential hearers, then we must find as much space for intent listening and jubilant celebration of smaller, everyday acts of defiance.

To the Circle – our activists and influencers: Bless your upturned faces and raised fists. Bless your fierce support of one another. Curse your incessant trolls. You speak the truth with great bravery. If others are anything like me, perhaps we had slipped a bit in recalling how stunning it can be to be a woman, born for this time that will shape the future. Thank you for reminding us what righteous anger looks like.

To the rest of us: All successful social justice movements require a “diversity of tactics.” Seize and relish the unique influence you harbor at this moment. If as a woman, you have assumed personal risk to take your place as a medical student, you join a hungry majority. If you are in the running for a departmental leadership position, you have braved the proverbial “sticky door.” If you head a quality improvement committee in your clinic, you have already said a firm “no” to the status quo. If you consistently offer technically excellent and compassionate care to patients, you are everything that generations of young girls once thought to be impossible. If today you remind your woman resident to use not her first name, but her well-earned title of “doctor,” stand tall. Take a picture in your mind — right now. Tag it to the feed no one but you and her will see.

Sometimes, womanhood comes with a roar. But sometimes, it comes with a whisper.

Do you hear it?

Jennifer A. Best is an internal medicine physician.

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