Women physicians and pivoting from medicine [PODCAST]

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“We must continue to work to create gender equity as here is where we stand today: A significant gender pay gap still exists in medicine where women doctors earn up to 33% less than their male counterparts. Even though women make up 36% of practicing doctors in the country, only 15% of women doctors are department chairs. Among women doctors who are also mothers, 78% felt discrimination. All of this is leading to 48% of women doctors reporting burnout, and 22% of female physicians admitted thoughts of suicide this year right before the pandemic hit our shores.

As a nation, we cannot afford to lose doctors to professional burnout and suicide, especially in the midst of a global pandemic worsening and hitting record numbers throughout our country in recent weeks.”

Archana Reddy Shrestha is a physician life coach, author, and co-founder, Women in White Coats. She can be reached on Instagram @womeninwhitecoatsblog.

She shares her story and discusses her KevinMD article, “What Kamala Harris means for women doctors.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Archana Shrestha. She is an emergency physician and physician life coach. She is co-founder of Women in White Coats, and she wrote the KevinMD article “What Kamala Harris means for women doctors.” Archana, welcome to the show.

Archana Reddy Shrestha: Thanks so much, Kevin, for having me. I’m really, really excited to be here and sharing with your audience.

Kevin Pho: So we’ll get into your article in a little bit, but first off, if you could share your story and your journey today, that’d be great.

Archana Reddy Shrestha: Yeah, Kevin, so I’m happy to share. Women in White Coats really started with an idea that began after we published our book, our best-selling book, The Chronicles of Women in White Coats, back in 2018. What that book was, was the real-life stories of women doctors, 20 women doctors. We shared the struggles that we went through being women in a heavily male-dominated field of medicine, which it still is today, and we shared the ups and downs, the different things we went through, the obstacles, the people who didn’t believe that we had what it took to become doctors, and what it was like to be a mom in medicine. I wrote about what it was like to be pregnant working in the ER. We also talked about things like sexual harassment, burnout, and physician suicide in that book. We really touched on a lot of real topics that were happening.

When we were at our book launch, what we realized is that this was more than just a moment in time in writing this book; it was really the beginning of a movement of women doctors coming together to empower one another and to share their stories that needed to be shared. People out there, especially the young women out there considering a career in medicine, needed to know what the struggles were, what the real deal was, and not just the Grey’s Anatomy version of it. So we wanted to share that real deal.

What also happened, Kevin, was that so many other women doctors started to come out and say, “I want to share my story too. I’ve gone through some different things through my career, some ups and downs, some struggles. I want to share those stories too.” And so we created the blog, and on there we’ve shared so many different perspectives on so many different things that women are going through: trying to juggle career and life, the second shift that happens when we come home and have all the family responsibilities, dealing with imposter syndrome, gender pay inequity, all of the things that are really going on.

And so, you know, when we’re training, we realize this old boys’ club of medicine is really alive and well, and what we needed to do with Women in White Coats was really create a sisterhood within medicine and really be there for one another, uplift and empower one another. So that’s exactly what we did. Through Women in White Coats, we’ve really been able to build an amazing community of women that get together and support and uplift one another, and we do that through our CME courses, through our events, and now coaching. It’s just been incredibly rewarding to be in the space right now.

Kevin Pho: Wonderful. And especially during the pandemic, over the last few months, what are you seeing? What are some of the major themes that women physicians are facing?

Archana Reddy Shrestha: You know, I’m sure you’ve seen some of the statistics on the number of women who are leaving the workforce right now, and that is actually happening too for women doctors, having to figure out ways to make this work, right? So many of us are mothers as well, and we have kids in school, and we’re trying to figure out child care, where maybe we were able to have a lot more help before between daycare or nannies and other things like that. And school, of course: kids going to school and that being a way to make being a career woman work. When your kids are at school, if you’re working, then that kind of allows things to work and flow better.

But right now women doctors are really struggling with trying to find that balance. Not only are they worried for their own safety, of getting COVID, for example, and bringing that home to their family, but also trying to juggle when they are home. Maybe they are working remotely or doing some telemedicine and trying to see patients and be professional online while also having to meet the needs of their children, who are doing remote learning.

I’ve also been seeing a lot of women doctors wanting to pivot right now in their career and do something a little bit different, something that can allow them a little bit more flexibility in their schedule and a little bit more freedom. So people are switching to non-clinical careers, switching to telemedicine, some people are leaving medicine altogether, and maybe starting online businesses as well. So there’s definitely been a lot of change this year for women and a lot of different things that they’re having to juggle right now. It was already hard before the pandemic, but I feel like it’s even harder now.

Kevin Pho: Yeah, and on my podcast I talk to a lot of physicians, and this is both women and men as well. They’re pivoting, they’re taking less time in clinic, starting businesses, coaching, and just taking a step out of clinical medicine. Now, what are some other ways that women physicians can perhaps pivot out of medicine if the clinical situation isn’t ideal for them?

Archana Reddy Shrestha: Yeah, there are so many different ways, and I’m actually really passionate about that right now. At Women in White Coats we had an entire summit called Women Docs Thinking Outside the Box, and we shared a whole bunch of different ways that women doctors are thinking outside the box, doing maybe some non-clinical work or practicing clinically in different ways: things like direct primary care, telemedicine, and locums. There are different ways that you can try to take back control a little bit more of your schedule and also maybe even the financial side of things. With direct primary care, a lot of people are not taking insurance; they’re having a more direct-to-consumer, a direct patient financial arrangement.

But aside from that, there are a lot of different non-clinical careers that we talked about in the summit, things from utilization review to doing R&D or working for pharma. There are so many different options there. There are a lot of people getting certified as coaches too right now.

One of the cool things that we are doing at Women in White Coats is, because we saw the need in our community, so many women wanting to think outside the box and so many women wanting to actually start their own businesses, online businesses. As I’m sure you’ve seen, Kevin, I’m hearing so many success stories of people who’ve had amazing growth with their online business this year, and that’s sort of been the silver lining, I think, of this pandemic: Online businesses have grown tremendously. So we’re hearing from women doctors who have seen huge success online, and we too have grown with Women in White Coats this year. We weren’t sure how things would go, but we actually grew tremendously and doubled our revenue in 2020.

And so I’m really passionate about helping other women doctors who want to make that transition to start creating some other source of revenue besides their clinical income, because as we’ve all seen, I think this pandemic has really shown us that medicine isn’t quite as stable as we thought it was. We were kind of all sold on that idea that it was, and I used to, in fact, tell people, “Oh, yeah, medicine is recession-proof. People will always need doctors.” And while that’s true, they do need doctors, this pandemic left, I think the statistic I saw was one in four of us either furloughed or with pay cuts. We’re sitting on the sidelines of a pandemic happening, a global pandemic, and you’ve got these doctors who are highly trained not being able to find work.

So I’m really passionate about women doctors out there who have an idea, something else that they have wanted to do. So many of us are multi-passionate, and I’m definitely one of those people who has been multi-passionate. But I decided to take, you know, taking an idea and turning it into a business is such a great idea right now, and that’s one of the things that I’m coaching women on. We actually just launched our Women in White Coats Business Academy to give women doctors all the information and know-how that they need, because so much of the time we think we can’t do it because we don’t have the MBA or we don’t have the experience. But you can totally do it, and that’s why we created the business academy: to help women doctors create that other source of income and turn their passion into a profit, even during this pandemic.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote, “What Kamala Harris means for women doctors.” Now, for those who haven’t read the article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Archana Reddy Shrestha: Yeah, absolutely, Kevin. When Joe Biden won the election and Kamala Harris became the first-ever woman elected, you know, VP-elect, so many women on social media were really excited, and they were talking about how the glass ceiling had been shattered. I was completely excited as well that finally we were going to have a woman in the vice presidential office of the United States of America. And for it to be a woman of color, of a multiethnic background, achieving such heights just felt really, really amazing.

As I was reading some of the stories about her, I came across this one quote she often says about her mother, which is that her mother told her, “Kamala, you may be the first to do many things, but make sure you’re not the last.” That really resonated with me, because so often we think, you know, this whole concept of unicorns at the top, which is that it’s easy to think that just because we have a few women in high-level positions, women have arrived, right? Just because there are a few women as CEOs of Fortune 500 companies, or a few women who are CMOs, right, chief medical officers, out there, or we have the president of the AMA who is a woman, or a few women in male-dominated specialties such as neurosurgery or orthopedics, that we have arrived at gender equality. And yes, that’s a step forward, and yes, that is the beginning, but it can’t be the end of where we need to go. So much more needs to be done.

And the truth is, within medicine, this is definitely the case. We do see some of those unicorns who have broken that glass ceiling, but that is not what the rest of us women doctors are feeling and going through. So just to share, in the article I share some statistics, and I can share them with the audience, which is that there’s still a significant pay gap in medicine, and women doctors earn up to 33 percent less than their male counterparts for the same work. And even though women are 36 percent of practicing physicians out there, they only make up 15 percent of department chairs. There was also a study published that showed that 78 percent of women doctors who are mothers felt discrimination in the workplace. And then in 2020, Medscape, before the pandemic, released statistics about burnout rates, and 48 percent of women doctors said they felt burned out, and that was before the pandemic. So I can only imagine how much higher it is right now.

So I think that we just need to keep pushing forward for more equality in medicine. The thing is, though, that we can’t do this alone. We women can’t do this alone, and we really need our male allies. There’s the hashtag #HeForShe, and I really, really love that hashtag, because I’ve actually had a lot of men in my life who’ve supported me, starting with my father and now my husband, who’s really supported me in my career. And even at work, I’ve had men support me as well, my physician colleagues, especially when I was pregnant or had family issues come up. They were there to support me.

I think that we just need more of that. Women really need more of that, and especially men who are in positions of power reaching out to women who are interested in taking on leadership roles, who have the qualifications, and really trying to bring them up, because I really believe that women can make amazing leaders as well. So just like Joe Biden did in selecting Kamala Harris as his running mate, we really need men to be our allies. And so I think if we have that, we can really push forward, and that’s what my article was about.

Kevin Pho: What’s the role of communities? You know, I have a community on KevinMD; of course, you have a very strong community as well. Just give us some examples of the power of sharing their story. How could that make a difference?

Archana Reddy Shrestha: Yeah, it’s so incredibly powerful. I think, you know, sharing stories is vulnerable, right? And there’s so much power in just opening up and sharing those vulnerable things. On our blog and in our books, people have shared a lot of vulnerable things, things from miscarriages to sexual harassment to imposter syndrome to failing, right, failing certain tests in med school or having to take the boards again. Those things were really difficult to talk about, but the thing is, every time someone shares about something vulnerable like that, they realize that there are so many other people who’ve gone through the same thing and that they’re not alone. That’s the big thing that we love about what we’re doing at Women in White Coats.

My big take-home message is that I don’t want women to feel alone in this. It is a struggle; it is a difficult field. I mean, for all of us, men and women alike, getting through med school and getting through residency, the training is difficult. And even once you’re out there as an attending, it isn’t like life is easy all of a sudden, especially right now in this pandemic. It is a really difficult profession that takes a lot of sacrifice. But if you’re also sitting there feeling alone and in the struggle, like you’re the only one going through this alone, then that makes it even more difficult.

When we have our events, whether they’re virtual or in-person events, the biggest thing that women say when they’re part of our events is, “Wow, I don’t feel alone anymore. I was feeling so alone. I was feeling like I was the only one feeling like an imposter, the only one feeling burned out or wanting to pivot, but you know what? So many other people are going through that too.” And that’s what we want. They kind of breathe this sigh of relief and feel like, “These are my people. This is my tribe. Now I feel like there are other people there who get me.” And just that, in and of itself, knowing that you’re not alone, is so huge.

Kevin Pho: We’re talking to Archana Shrestha. She is an emergency physician and a life coach. She is the founder of Women in White Coats, and she wrote the KevinMD article “What Kamala Harris means for women doctors.” Archana, if there’s something that you know now that you wish you knew back before you started, any piece of advice that you could share with those female medical students, the women in residency, the young physicians, what kind of advice can you give them as they navigate the medical world as it is today?

Archana Reddy Shrestha: Yeah, for me, I guess what I wished I knew back then was that it’s OK to be multi-passionate, to have interests outside of medicine. Because the thing is, medicine can be so all-consuming, right? I do remember this entire decade of my life that I dedicated to the study of medicine, to taking care of patients, to just really burying my head in the books and studying for exams and learning everything I could, because I took it really seriously. I wanted to be the best doctor I could be. I always describe med school as sort of like drinking from a fire hydrant. It’s so much information coming at you, and it does require that for a period of time, I think.

And so many of us are already very talented people before we even get into med school, where many people, you know, whether they’re artists or singers or musicians or writers or whatever else it was, so many of us were really well-rounded people. But we kind of throw all that out the window. We put that on the back burner for some time, and it’s OK to do that, but what I love is to tell people to come back to those things when the time is right. Make sure you come back to it, or maybe even just keep it going a little bit in the background and keep those things there. And it’s OK to maybe come back to them at another time and to bring that passion back, to reconnect with certain things.

For me, that was reconnecting with writing. And for me also, this entrepreneurial spirit grew in me when I became a mom. I guess it was my form of nesting. I started having all these ideas for businesses. And so I think what I’d like to share with people is to just give them permission to have those passions, to pursue them, and not feel like your whole life has to be medicine only, that you can’t do other things, because you have so much to offer beyond the exam room, beyond the hospital, to the world. And so just go out there, share that with people, and don’t be afraid to do that.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Archana Reddy Shrestha: Yeah, I guess my take-home message, especially right now, is: As people are pivoting, I think there’s so much guilt around that, around pivoting and leaving medicine, as if the only way to do it, and the only way to be considered successful in a career in medicine, is to, you know, last until you’re 65 and practicing full time, that there’s only one way to do it. So my big takeaway, I guess, is: It’s your degree. Do whatever you want with it, and do so unapologetically. You do not owe anybody an explanation, whether you are working full time, part time, switching to locums, doing telemedicine, doing something non-clinical, or starting some other business. It’s your degree, and you can do with it what you want.

And there are so many ways to help people, like I said, beyond the exam room, beyond the hospital, beyond the office. You can help people in so many different ways. And I encourage you just to own it. You know, own it, and do so unapologetically.

Kevin Pho: Archana, thank you for sharing your time and insight, and thanks again for being on the show.

Archana Reddy Shrestha: It’s been awesome. Kevin, thank you so much for having me on.

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