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In this episode, we celebrate Women in Medicine Month with guest Janet A. Jokela, an internal medicine and infectious disease physician. We dive into the experiences and challenges women have faced across generations in medicine, from pioneers like Elizabeth Blackwell to today’s leaders. Janet shares personal stories of confronting gender bias, discusses the persistent gender pay gap, and explores strategies for achieving true equity in the medical profession.

Janet A. Jokela is an internal medicine and infectious disease physician.

She discusses the KevinMD article, “Celebrating women physicians: Keeping our foot on the gas.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Janet A. Jokela. She is the treasurer of the American College of Physicians, also an internal medicine physician and infectious disease physician. Today’s KevinMD article is “Celebrating women physicians: Keeping our foot on the gas.” Janet, welcome back to the show. How are you?

Janet A. Jokela: Oh, great, Kevin. Thank you so much. Delighted to be here with you.

Kevin Pho: All right, today’s KevinMD article is “Celebrating women physicians,” very relevant because this is women in medicine month. Tell us about what led up to this article, why you decided to write it, and then the article itself for those of you who didn’t get a chance to read it.

Janet A. Jokela: Thank you so much, we will do. As I was thinking about this topic, and knowing that it’s women in medicine month, the story came to mind from an experience I had as a third-year medical student, and it stayed with me all these years. And so that’s what I decided to write about, to start out.

So this was a situation where I was a little medical student, if you will, on the surgery clerkship, rounding with our team and rounding with our attending. And our attending was a woman physician, and she was the head of the department at that time, which I didn’t know was a really unusual and kind of a special thing.

At any rate, there were a few students, some residents, a fellow, and we were following behind her into this big open ward area. It was a bright sunny room, big place, multiple beds filled with patients. And then this patient finally hollers out and says, nurse, can you help me. And I don’t remember exactly what he was asking for, but my goodness, it certainly caught her attention.

And Kevin, it was really interesting. She just marched right over to him, to his bedside, and in a very loud voice, an emphatic voice, she said, I am not your nurse, I am your doctor. And I think all of us were just stunned into silence, and we just stood there. And then a nurse magically appeared and took care of the patient, and then we went on with our rounds as if nothing had happened. I tell you, that memory was seared in my mind for all these years, and it just really stayed with me.

Kevin Pho: So like you said, this is women in medicine month. Tell us about the accomplishments and how far women in medicine have come. You’ve obviously been observing the world of medicine for a bit now, so tell me about that evolution.

Janet A. Jokela: Right, that’s a really important question. I tell you, with medical schools these days, about half the classes are comprised of women, so men and women comprise about 50 percent each of medical school classes coming in now.

That said, in terms of leadership positions and also the gender pay gap, which I touch on later in the article, there are still things to be addressed. Women do not achieve the same levels of authority or positions of leadership that men do, whether it’s in practices, in hospital systems, other health systems, or in the medical schools. So there are still issues there. But we certainly are seeing a lot more women in medicine today, which is a really positive thing. There’s still more work to do, and that’s why we keep the foot on the gas.

Kevin Pho: So tell us about your own leadership experiences. You’re treasurer at the American College of Physicians, and you obviously are involved with organized medicine. So tell us about some of the challenges and obstacles that you yourself have had to overcome as a woman leader in medicine.

Janet A. Jokela: Thinking about it, going through medical school and all that, I remember at the time thinking, oh, I’m not experiencing any problems or any types of bias or those kinds of things at that time, and it just seemed very normal to me.

That said, going on throughout my career and being a witness to things that had happened, whether it was to me or to other people, biases still exist. The gender pay gap still exists, and it’s critical, absolutely critical, for women to negotiate, well, for all of us, but in this case especially for women, to negotiate for the appropriate salary, especially as they’re starting out.

Because if women don’t start out at an equitable playing field as far as the salary goes early on, then that just gets amplified over time, and men in general would end up making a lot more money, say, than women would over time. And it’s, I know, approximately a $2 million difference over a 40-year career is what it’s estimated to be. So it’s nontrivial, and that’s problematic when you think of wanting to really optimize and maximize the potential of women in the workforce.

Kevin Pho: So have there been other instances, when I’ve seen female attendings being, not directed, or comments from patients not directed to them but rather directed to the male medical student or the male resident?

Janet A. Jokela: Yes. Have I seen other women physicians being, say, referred to as nurse in various settings? Yes. So those things happen. We’re in a much better place today, but there’s still work to be done.

Kevin Pho: Well, let’s talk more about the gender pay gap, because that’s come up several times. What are some of the primary factors today that are still contributing to the persistent gender pay gap in medicine?

Janet A. Jokela: Good question. And if you do a quick Google search on this, there’s been a lot of publications on this, so it’s well known and well established that this gender pay gap exists.

It’s been attributed to things like women may go into lower paying specialties, women may take off more time than men may, in particular say especially at the beginning of the career when it’s prime, you know, establishing a family and child rearing time. Those kinds of things end up playing a role.

But even accounting for a number of those differences, the gender pay gap still persists, and it can grow. And so the thinking is it’s partly due to the pay structures in the various organizations where we all work, and also perhaps a lack of transparency in terms of how salaries are established. So there’s a number of different factors that play into it that require kind of ongoing vigilance and dedication to really continue to address it.

Kevin Pho: And you mentioned one of the possible solutions is that women physicians, and or all physicians as you say, should negotiate to help narrow this pay gap. So go into more detail. For women physicians in particular, when you say they should negotiate better, what exactly does that mean?

Janet A. Jokela: Easier said than done, right? Much easier said than done. Negotiation is a skill. We can all learn it, and I’m convinced that we can all continue to learn and improve as far as our negotiation skills go. There’s wonderful courses that can be taken, and even online modules and things, lots of tips out there in terms of the specific skills required to negotiate better.

And I think it’s, again, to avoid emotion as one goes into this, but sticking to the facts, sticking to the conviction of what one is worth and what our time is worth, is really important. And I think especially for people who may not be used to doing that kind of thing, it can be uncomfortable at first. Could be helpful to practice with someone else before going into a big salary negotiation conversation. Those kinds of things can be helpful.

But there’s a lot of resources out there that can help women and others negotiate from more of a position of strength. That’s one thing you want to do, you want to negotiate from a position of strength, not from a position of weakness. So that’s one place to start.

Kevin Pho: It’s been said that the culture of medicine adheres to the status quo. It’s sometimes very difficult to change that culture of medicine. Right, you’re in academic medicine, you’re also in organized medicine. Tell us some of the successes over the years that you’ve seen where there’s been a relatively significant shift in the culture of medicine to better support women in medicine.

Janet A. Jokela: One obvious shift, if you will, is the leadership at the American College of Physicians. We have a woman physician CEO of the organization, the first in its history, and that’s been transformative in many ways. There are issues that are coming to the forefront which perhaps in the past may not have received the same spotlight or the same attention that they might have before.

For what it’s worth, I’m the first woman treasurer in the ACP. You know, who knew. But there are things that we can see happening in leadership roles that I think are really critical. There’s many more women in leadership positions too around the country, whether it’s in departments of medicine or medical schools, that it’s encouraging to see.

And we know that the individuals in those positions have a different perspective and a different viewpoint, if you will, on the course of careers, and also an important viewpoint on how to support young trainees coming up and junior faculty coming up. So we can all do better together.

Kevin Pho: And for those women physicians who are listening to you and are inspired by you and they want to be more involved in leadership positions, whether in organized medicine or in academic medicine, what are some first steps that they should do to try to attain some of those leadership positions?

Janet A. Jokela: That’s so important. It’s so important for these early career physicians and, say, junior faculty in these various organizations. One is to get involved, and just to get involved, participate, lean in, as Sheryl Sandberg has said many times. Just to lean in, be visible, be present.

For all of our early career physicians and junior faculty, their inherent worth is priceless, and it’s really critical for the organizations to hear those voices. So by all means, to lean in, get involved, participate, find and identify like-minded colleagues, which you will when people lean in in that way. And that’s so important, to build a supportive community around you and to find that supportive community. And again, I can’t stress enough the importance of negotiating early on for the right salary. All of that, it’s critical.

Kevin Pho: And when you say get involved and lean in, what are some examples where women physicians have done that that you’ve seen in a typical medical setting? It doesn’t have to be organized medicine. What are some easy ways that they can get involved?

Janet A. Jokela: Yeah, one, it would be volunteering for committees that interest them, committees that they think are important to them or that may address important issues. And when someone reaches out to them and says something like, look, I think you would be fantastic on this committee, or you would be fantastic in this role, you really should consider applying for it, those are the kinds of things that I think are really important for an individual to listen to.

I tell you, I’ve known of other women in, say, academic medicine who may have young families, and people have reached out to them and said, look, I think you would be great at XYZ position, please apply, you would be phenomenal.

And I think lots of times, especially with young families at home, there’s a balance or an integration, if you will, a work life integration that needs to be certainly recognized and respected. So these are very personal decisions. We just want to do all that we can to ensure that women and early career physicians are involved and engaged in a way where they could have some meaningful impact. And leaning in, volunteering, seeking out like-minded colleagues is critical.

Kevin Pho: So when it comes to seeking out like-minded colleagues, that brings me to the topic of mentorship. And I’m sure that you yourself have mentored a lot of women physicians as they progress. So tell us the importance of mentorship, and how physicians can find the appropriate role models and mentors if they’re interested in achieving some of those leadership positions.

Janet A. Jokela: Right. I think one thing that’s useful is for people to look around and look and see, you know, do I want what they have? OK, so in terms of how perhaps someone is practicing, or how someone conducts themselves in committees or in other leadership positions that those individuals may be in. And then those people potentially could serve as good mentors, coaches, role models for these up-and-coming women in early career positions. So that would be one way to do that.

And I think in addition, it’s important for not only the mentor to be thinking about what they can do and how they can best support and encourage their mentees, but also for the mentees to be open-minded, if you will, to suggestions, and to be available to be mentored, if you will. It’s a give and take relationship. It’s not necessarily unidirectional, but it’s a bidirectional thing, and it’s critical to keep that in mind, I think, for both parties as they enter into such a relationship, such a situation.

Kevin Pho: So we’ve touched upon the gender pay gap and we’ve touched upon leadership and women physicians going forward. Where do you see the areas where we can do the most work when it comes to decreasing some of the disparities surrounding women in medicine?

Janet A. Jokela: I think it’s critical to keep our eyes open and our ears to the ground. So when we hear of things, of any bias perhaps oriented comments, or structural issues that require attention, it’s important to be aware. And then once we’re aware, we can begin to address it. I mean, if we don’t look, and if we don’t have our ears open, we’re not going to see these things.

And I think it’s critical to be aware and to be open to hearing and observing what may be going on. And then it’s critical then to work with others and allies to do this. Women cannot do this alone. I mean, we need male allies, we need everybody to kind of raise all boats together. It’s critically important.

Kevin Pho: We’re talking to Janet A. Jokela. She’s the treasurer of the American College of Physicians, also an internal medicine and infectious disease physician. Today’s KevinMD article is “Celebrating women physicians: Keeping our foot on the gas.” Janet, as always, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Janet A. Jokela: Sure. Our inherent worth is priceless. And our worth is not dependent upon other people’s opinions of us or what they may think of us, any of that. And in fact, our salary and our positions and our titles, those don’t define our worth. Our inherent worth is priceless.

And when we have the opportunity to rise to the occasion and affect change, we have to step in and do that. So we really have to seize the moment when the opportunity presents itself.

Kevin Pho: Janet, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Janet A. Jokela: Thank you so much, Kevin. Thank you.