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Women physicians are walking away from practice in their forties, and not because they stopped loving the work. Dawn Sears is a gastroenterologist of 25 years and the founder of GutGirlMD Consulting, where she coaches physicians and runs Women in Medicine groups. This episode is based on her article “10 ways to keep women physicians from leaving,” published on KevinMD. You will hear why the job asks women to carry patient care, child rearing, and elder care at the same time, how the patient portal routes them 25 percent more messages than male physicians in the same practice, and what has genuinely improved over the last decade. Dawn walks through fixes she has watched work, from half call and half weekends for the first six months after a baby to a handful of extra days off for screenings and staff support to triage the inbox. She also shows you how to ask, using a hostage negotiator’s playbook and the reframe that brings a skeptical colleague back to the table.
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Transcript
Kevin Pho: Hi and welcome to the show. Subscribe at kevinmd.com/podcast. Today we welcome back Dawn Sears. She’s a gastroenterologist and founder of GutGirlMD Consulting. Today’s KevinMD article is “10 ways to keep women physicians from leaving.” Dawn, it’s great to talk to you again.
Dawn Sears: It’s great to see you again, and thank you for all your hard work, Kevin, and having a place for us to express our opinions and our thoughts and our reality when the rest of the world is telling us to be quiet. You let us speak up. Thank you for what you’re doing.
Kevin Pho: All right. Well, thanks for coming back on. I know it’s been a few years since we last chatted. For those who don’t remember who you are, just give us a brief synopsis of your story, and then we’ll jump right into why you decided to share this article on KevinMD.
Dawn Sears: Yeah. So I’m a gastroenterologist, and in the ’90s that wasn’t very common. As soon as I walked in the room, they wanted to know, “Where’s the old man with white hair who will be taking care of me?” And I said, “Sorry, would you like your colonoscopy anyway?”
And so through that, I went through the old school: no duty hours, no maternity leave, all those things. Climbed uphill both ways in the snow, and still managed to have three kids, be a gastroenterologist, be a program director, be the chief, and started women in medicine groups 10 years ago, so 2017, because everybody who was hiring a new woman wanted me to mentor them, sponsor them and career coach them. And I said, “No, no, no. I cannot do this by myself.” And we got together a group and started doing that.
So I’ve been a gastroenterologist for 25 years now, and I’m also a coach, and I love to stop the hemorrhaging of women physicians from health care.
Kevin Pho: All right. And you of course wrote this article, “10 ways to keep women physicians from leaving.” So tell us about this article for those who didn’t get a chance to read it yet.
Dawn Sears: Well, it came out because of an article that we all saw on May 7th saying that women physicians are leaving health care at age 45. I said, “Oh my goodness, it’s worse than I even suspected.” They were saying that the average age of the newest generation, because we know that the newest generation is just not going to tolerate what we tolerated, is leaving at 48, and women specifically at 45.
And so I had written articles for KevinMD in the past about why women are leaving, gaslighting, and that we do more work without compensation, etc., all the things we’re talking about these days. And I said, “You know what? I need to write an article about solutions, for leaders and for the physicians that are suffering, or the physicians that want their colleagues to not quit.”
Kevin Pho: All right, so give us some context before we get into solutions. What are some common reasons why women physicians specifically are leaving?
Dawn Sears: Yeah, the very most common reason is the hassle of trying to navigate two worlds. We’re supposed to be the caregiver. We’re supposed to do everything for everyone. We’re told to also give self-care to ourselves and produce more RVUs and see three more patients. That’s just not humanly possible. So we are so frustrated that women say, “Never mind. This is not worth the hassle.” And then of course there are all the expenses of keeping our license, keeping all these things that we have to do in order to have the privilege of practicing medicine, when in reality we don’t necessarily want to practice medicine 12 hours a day, five days a week.
Seventy to 85 percent of us are moms, and the primary responsibility of child rearing and birthing tends to fall with the women. So, the reality that we’re being pulled to provide all the health care for our families as well as the elder care. When you look at people that are coming into the hospital or clinic, the elderly population or those with special needs, 85 percent of the time it’s a woman that’s with them. So we’re asked to care for our communities, our nuclear families, our extended communities, and have a full-time job. And it’s just not tangible anymore.
And the women are saying, “Nope, I’m not going to be able to do this anymore,” because the system was designed for someone who is a male, who is married to a female, who is at home taking care of everything. So we just need to get more creative, and we can do that.
Kevin Pho: So I see some responses that are less than sympathetic to articles like these. They say that if someone is going into medicine and they’re planning on leaving early, maybe they shouldn’t apply to become a doctor in the first place. So what’s your reaction to comments like these?
Dawn Sears: Yeah, it’s true. I feel the same way, and I had a couple of people in my class who literally never practiced, and it was hard for me to swallow, knowing that I worked so hard to get in. So the reality is, we thought we could do it all, and we were sold a pile of lies. You cannot do it all. And the system was designed one way. So if we want to be realistic, to have the best physicians who really love what they do and are full humans, it’s OK to look at redesigning the system.
And I point to COVID. I point to April of 2020. Everything changed within four weeks. We went from almost 100 percent in-person visits to 80 percent virtual visits. We have shown that health care moves slowly in general, but when it has to, it will pivot.
And the reality of 50 percent of medical students being women, the reality of the outcomes of women physicians: providing higher quality care, more adherence to the guidelines, fewer readmissions, fewer surgical complications. You want a woman taking care of you. And of course, the ER data is my favorite. Looking at 10 years of all heart attacks coming into Florida, 50 percent survival if a female patient with a heart attack was treated by a female ER doctor, 25 percent higher survival if she was cared for by a male who was on service with a female. So we make health care better. We’re contagious in that way.
So yeah, it’s not fair. It’s not equal. But it’s also not fair that I had a miscarriage at work. It’s not fair that my husband didn’t feel any cramps that day, but we both lost a baby. But we have to deal with it. So it’s OK to pivot as a group and as a whole and as all of society. We deserve that, and we’re going to be fine.
Believe me, I’ve never practiced 1.0. I’ve been 0.8, and I was still chief. I was still on the board of directors. I was still program director. I still had research published. It can be done. It’s just mind-blowing that we can do things.
Kevin Pho: Now, you’ve been involved in this space, you said, for 10 years. You’ve been doing these women in medicine groups. Have things been moving in the right direction? I certainly know that we do have room to move, but how far have we progressed since you first started?
Dawn Sears: Oh, absolutely. And I’m so grateful for that. I do not hear of people being fondled on the elevator anymore. I do not hear of incredible gross disparities of pay. There is absolutely still 97 percent of the time we are paid less, but it’s no longer by $100,000. It’s usually by 10 or 30, which adds up to a million. Don’t get me wrong. But we’re just not getting away with that kind of behavior anymore.
And when Frank over-speaks Susan at a conference, somebody else usually goes, “Oh, Frank, thank you for noticing Susan’s comment.” So we’re having bystanders be able to stand up with us and no longer feel like they’re losing their man card if they dare stand up for a woman who is being disrespected. So that’s amazing.
And I’m so grateful for all the HeForShe conversations, and of course, having Melinda French Gates donate $2.5 million to menopausal research this month. That would have never happened 10 years ago. We couldn’t even say the word menopause. We couldn’t even say the word tampon unless it was in a joke. And so now the reality of what women’s bodies go through is going mainstream. And the economists are talking about it. The economists are talking about the incredible loss of so much talent, all the CEOs in the corporate world leaving because of menopausal symptoms. So now we’re actually talking about it. So I think we’ve made huge strides.
Kevin Pho: So let’s talk about paths going forward. In your article you did mention a few, and I think it’s also a reflection of some of the advancements. You mentioned things like patient portals and the biases when it comes to patient portal messages. So talk more about that and some of the solutions that we’re talking about.
Dawn Sears: Yeah. Interestingly, with the internet boom and with social media, everyone feels like they have to say their opinion, and they have to say it right now, regardless of their credentials. So unfortunately, we’ve lost all filters, and the social interactions have gotten very bizarre as we’ve gotten very frustrated with health care. So the amount that is spewed at women physicians is disproportionately more than at male physicians. And so we’re being screamed at not only by the patients in the room, but also on the portal.
And I may have mentioned in this article too that many times we’re being called by our first name in the portal, where they’re not doing that to Bob or to Scott or to Stan. And we’re like, “Ooh, one more microaggression. Remind me I’m a woman one more time, because I almost forgot.” And I’m like, “Really? Why do you call me Dawn? I’m Dr. Sears. I’ve been your doctor for five years, and today I’m Dawn.”
So having some help with that, so that we’re insulated a little bit against the rage that everyone’s feeling against the insurance industry, against their bills, against their choice between food and health care, would be really helpful. We need a little bit more armor and protection, because we get the onslaught worse as women physicians. We get 25 percent more messages from our patients versus males in the exact same practice, and 26 percent more messages from our own support staff. So give us 25 percent more people, more MAs, to help us so we don’t have to deal with it all, to sift through it all and find out: Where’s the real medical question where we absolutely need a physician, and where’s the venting? Let somebody else deal with that.
Kevin Pho: What other solutions do you propose? I think in your article you talked about medical time off, working less than full-time. I’m working less than full-time like you as well. So talk to us about some of those potential solutions.
Dawn Sears: Yeah, I think the flexible work schedule is huge, and that will change everything for retention, and you will have your women that will be loyal to you. And so I give the proposal: When you’re doing a re-entry after you deliver a baby, if you let that woman work 70 percent for the first six months or even the first year, but she stays with the company until 58, that is very different than losing her, because we know that when you lose her, that is half a million dollars to a million dollars. Is that how much time she’s asking off? No, that is not how much time she’s asking off.
And then the reality that we’re just different, different bodies. We’ve talked to that a little bit, and business structure has sometimes allowed for that. We know as parents, if we have a teenage driver who’s a boy, we’re going to pay higher premiums. And we don’t question that. We don’t push back. We don’t say, “How unfair and unjust that is. How do you discriminate against my boy?” We just go, “Oh yeah, boys have more accidents. OK, well, they should pay a higher premium.”
Same thing. Women need more time off. We have more parts that need more screening. Men just simply don’t have menstrual cramps every month. They simply don’t have to have these invasive tests regularly every one to three years on their parts, depending on what’s going on with their risk factors, during their 30s and 40s. They just don’t.
And so if you give us an extra five days, then it’s not a disruption to take your child for those well visits and to take ourselves for our screenings. Well, I can’t say colon screen, because I’m a gastroenterologist. For our breast screenings, for our cervical screenings, all the things that we have to do. So I think that we can do this. I know we can do this. It just takes brave, creative and unpopular new strategies.
Kevin Pho: So you mentioned unpopular new strategies. What are some of the reactions from hospital administration? Just tell us some stories, and I guess also some success stories as well, in terms of headway that you’ve seen made regarding some of these issues.
Dawn Sears: Yeah. So often the men that read these articles are shocked and a little bit embarrassed. They say, “I never thought of it that way.” And then you reframe it. You say, “What kind of medical system would you want your daughter to function in, or your wife or your sister?” And they go, “Oh my goodness, you are so right.” And when you bring the humanity back to them, then they step back, and they see that they don’t have to worry about just angry Bob lashing out at them, but that the whole system wins.
And when angry Bob comes at me and says, “That’s not fair. Why do we have to give her more time off?” I say, “Well, do you like your call schedule being what it is? Because when she quits in two months because you don’t give her her maternity leave, your call is going to double.” “Oh, I didn’t think about it that way.” I was like, “Yeah, you’re going to have to pick up her call. And if that’s what you want, that’s great. But if you want to ease her back in, to know that she just has to do half the call for the first six months, and so she stays your partner for much longer, you actually win, too. And your patients win. And then she can continue to take care of the patients you don’t want to see.”
And so you’ve got to give them some skin in the game of why they want to do this. And then they often soften, and then they come back and say, “I’m ready to talk about those solutions now. How do we really work this out when I have two women that are pregnant?” It’s like, “Glad you asked. Let’s look at the schedule. What can we do?” And then we work together to come up with a solution. And it’s a win-win.
Kevin Pho: Now, are there any systems or stories that you could share where women got more of those ancillary resources, a little bit more time off, some more of the solutions? Have they been successfully implemented elsewhere? Have you heard stories?
Dawn Sears: Yes, I have heard stories from my colleagues. I’ve had three of them in the last month that have all asked for re-entry to be 50 percent of call and 50 percent of weekends for the first six months, and they saw the value, and they saw the need, and they were able to give that. So that was different systems all over the United States, which was so good. And they often said, “Well, we’ve never done that before.” And so through my coaching, I do a lot of, “Yeah, we’ve never done that before. And won’t it be exciting to be the first? And won’t you be a trailblazer, and let them see that now you’re going to recruit more women that are dedicated to your practice?” So again, you’ve got to find the reason why.
And for me, when I went to 0.8, I did all my time off during summer, and I worked full-time during the year. So I worked for a creative boss who saw my value and was able to work with me. So again, we don’t just come in there demanding, “We need special treatment, we need this, we need that.” No, we let the system see what they’re going to gain by flexing with us. And you’re not asking to get away with anything. You’re just asking for a shift in how you do it, which is not a problem. But it takes creative leaders that are ready to listen and engage and see the long game, and not just the short game of the quarter right before us.
Kevin Pho: Now, do you have any advice for individual women physicians who are listening to you now? What are some approaches that they could bring to their leaders to ease re-entry, to alleviate some of these biases?
Dawn Sears: Yeah. The first step I tell them to do is read the book “Never Split the Difference” to learn how to negotiate. He’s a hostage negotiator, as you know, and you can’t split a hostage in half. So he says no deal is better than a bad deal.
And so the first thing we need to do as women is realize that we scan the environment constantly to make everyone else comfortable. So when you start bringing up an uncomfortable conversation, we immediately throw out the baby with the bathwater. We’re like, “Oh, well, if I can’t have that time off, I’ll work every Christmas for the rest of eternity.” You’re like, “Wait, what did I just say?” And so we need to be quiet.
As we go into negotiations, it’s all about listening. Whoever listens the most wins the negotiation, not whoever talks the most. So you’re going in to interact with your boss to find out: Is it access? Is it reputation? Is it RVUs? Is it some other thing that they’re trying to accomplish? Learn what they want, and then craft your solution so that you are the solution, and they want you to take the maternity leave. They want you to go to the part-time schedule, because ultimately you’re helping them accomplish their goal.
But you can’t do that if you come in guns blazing and feeling entitled to all these things. You come in there with, “How can I help, and how can I be their hidden weapon? How can I be their best resource, so they are going to be so glad they did this?” And then everything you do with that leader and for that leader, you want to make them look good. You never want to make them look bad. And so I work with a lot of physicians having this conversation, on how to change our mindset around it and how to be quiet and not give everything away.
Kevin Pho: So, a wonderful book, “Never Split the Difference” by Chris Voss, former FBI hostage negotiator. And I think what you’re describing is Chris’s term, tactical empathy, right? You have to not go in guns blazing, of course, but you have to understand the situation from their point of view, and you have to institute some empathy. And like you said, you have to frame your wishes in their terms, in terms of their understanding, how they can benefit from it. So, wonderful advice. Highly recommend that book.
Dawn Sears: Yes, I read it probably every other year.
Kevin Pho: We’re talking to Dawn Sears, gastroenterologist and founder of GutGirlMD Consulting. Today’s KevinMD article is “10 ways to keep women physicians from leaving.” Dawn, as always, let’s end with your take-home messages to the KevinMD audience.
Dawn Sears: You’re doing nothing wrong. If you’re a leader, you may want to reevaluate what you’re doing, as if you were caring for your daughter in your own group. And if you are a woman physician, find your group. You’re not alone, and you’re doing nothing wrong. So again, find your group that’s going to encourage you, and reach out if I can help, and read all of Kevin’s stuff. He’s got lots of resources for you.
Kevin Pho: Dawn, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Dawn Sears: Thank you, Kevin. Appreciate you so much.
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