12. Giselle Aerni, MD - Part I of II: Gender Disparities in Sports and Medicine

Hello, everyone. I'm Dr. Darsha Shah, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined, a podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. What is going on, guys? Welcome back to another episode. Today, we have an extremely special guest, and I cannot wait to share this conversation with you. But before we get into the show, here's a quick message from MR Insurance, a small business that helps physicians with their disability insurance needs. Michael Elravas is a CFP professional and insurance agent committed to helping physicians nationwide with their term life and disability insurance needs. He provides an objective, transparent, and education-focused process that aims to help physicians make prudent decisions and avoid over-complicating things. He exclusively offers own occupation disability insurance policies for residents, fellows, and attending physicians. We know he'd be happy to help you with whatever your needs are. You can find Michael at Dr. podcastnetwork.com slash MR insurance or contact him at 800-817-4522. Our guest today is Dr. Giselle Arney. Dr. Arney is a sports medicine physician who has covered everything from high school sports to the WNBA. Along the way, she's even racked up a couple of national championships at both the NCAA Division I and Division III level. She previously served as a sports medicine fellowship program director and has mentored countless residents and fellows throughout their medical journey. On a personal level, she was a collegial lacrosse player, as well as an elite martial artist who I believe competed or at the very least qualified for the junior Olympics. In this episode, we cover her journey into and out of academic medicine. We talk about a critical issue that does not get nearly the attention or deserves, and that's the issue of gender disparities in medicine and in sports. We talk about the history, how we got here, but more importantly, how we can move forward and make the system better. We'll learn much more about her and how she decided to take matter into her own hands by stepping away to step forward, which I found particularly fascinating and inspiring. Even though she's no longer an academic medicine in the traditional sense, she remains passionate about mentorship and coaching young female physicians on how to navigate through challenges they might face in this field. Lucky for you guys, she's launching a brand new course that covers all this and more, so I would highly recommend that you check that out, and if you're interested, you'll be able to find all that information in her website that's linked in our show notes. We had an incredible conversation with Dr. Arnie and realized about halfway through that there was no way we'd be able to cover all the things we wanted to, so we decided to split this up into two parts with some different but related topics. I think it's safe to say that the more important part of the conversation is where we started, but you'll want to tune next week's episode to get more of the science and actionable tips for women's health and gender-specific training. So without further delay, please enjoy part one of our discussion with Dr. Arnie. All right guys, welcome back to another episode. Today, we have Dr. Chiselle Arnie with us. Dr. Arnie, how are you? I'm doing great. Thanks. It's so good to see you, to talk to you again. It's definitely been a couple of years since we last chatted and definitely in different circumstances. I'm so excited for this conversation. We've been listening to everything that you have been doing, and it's funny, one of my mentors, Dr. Du, Dr. Raj, he recently pointed me back in your direction. I think you guys recently had a conversation and we were just talking about the fellow's conference coming up, and I guess you guys were talking about that, and so he mentioned your new project that you're doing, so we're definitely excited to talk more about that. But before we dive into all that, why don't you tell us a little bit about yourself, your journey, and what inspired you to be where you are today? Yeah, great. Dr. Du is wonderful, so I'm excited that you're getting to work with him. So I'm a sports medicine physician. I'm family medicine trained, sports medicine fellowship trained. I got into sports medicine, not knowing what I wanted to do. I was one of the med students who kind of liked everything. But I always had this idea of working with college student athletes that I just felt like that was a fun population. I would have a chance to make a difference because they were sort of kind of figuring out their independence, like starting to get independent, but not really. And that would be where I could kind of get in and make a difference. And so as I went along, it really just became a natural fit, a primary care sports medicine. And I've been very lucky. I've been able to be team physician for D1 universities, Yukon, Yale. I've been team physician for D3 universities, Gettysburg College, one national championship in women's across while I was there. I have three national championship rings. It's insane. It's such a wonderful perk sometimes in our in our life. And one of the things that I sort of realized along the way was that aside from being the team physician, I'm working with the college student athletes, I really enjoyed teaching. I've always been a faculty member. I've been program director at two different programs and the mentorship. And particularly of my female fellows, female residents, female med students, in kind of navigating this world, Udo sports medicine is particularly male dominated. A lot of medicine is male dominated. And navigating that world. And I really enjoyed the mentorship of their career of their life beyond just teaching them the sports medicine musculoskeletal knowledge. So as I've been going through this career, getting interested in podcasts, listening to people sort of branch out, listening to physicians who've taken their work beyond clinical, beyond just seeing patients. I was really eye opening for me. And so I had this idea to start the podcast. So my podcast is called Madame Athlete. Come check it out. It's fantastic. But I interview women who work in sports and athletics. So I have sports medicine physicians, athletic trainers, strengthening conditioning coaches, sport nutritionists. And I'm really trying to talk to them about their career journey to find out what challenges if they had, what triumphs have they had, what advice do they have for other women who are looking to go into this space. And it's really been incredible. I've met so many amazing women. And I think as a woman in a male dominated field, having a network of other women, whether they're your exact career or not, but getting to hear from their stories, getting to hear from their life lessons, I think you can build a community of support that helps you feel like you're not alone. So that has been my most recent venture is starting this. It's been going fantastic. I'm 35 episodes in and I next will be looking at creating courses to sort of take my work as a fellowship director and faculty and put it into online courses so that fellows, early career physicians, residents who want to work on their career and want to learn those sort of nuances that you don't learn about in med school, you know, dealing with perfectionism, dealing with imposter syndrome. How do you negotiate all these sort of skills that a physician really needs or that, again, a sports medicine, professional athletic trainer, strength and conditioning coach, would really benefit from having. And so by putting this into an online course, then I'm able to really serve an even larger audience than the two fellows that you get per year when you're a fellowship director. So that's my next phase. We're working on it right now. So it's been really exciting and different journey for me. Absolutely Dr. Arnie, this is so cool to hear and see you do all these things right. You're just you're wearing so many hats but what I really love is you found your passion right like as an athlete and you're almost repurposing it right not only just as a mentor in person whether you know it's being a program director but also being a coach which you're also taking actionable steps you know through your podcast. And so how do you how do you develop that passion right was there was there any particular event that comes to mind where you say this is it this is what I want to do and I want to impact women. Oh that's a great question. I don't know. I think going along in medicine as a woman part of what you have to do to succeed is pretend that you're not a woman and attack it almost okay here's how the men do it I've got to go after it and it takes a while sometimes to realize that you're being kind of stuck into this label and you have to kind of act differently to fit in with medicine and to fit in with all the male leaders and and having situations where I'm in a position coming in new being asked to overhaul a department make changes that was like why I was hired seeing a young male pharmacist in this case come in being tasked with the same thing for the pharmacy department and then watching the two of us at this exact same level being tasked with the same goals and the male can fire people get rid of people make changes and everyone thinks that he's strong and capable and I try to say hey we need to do things differently and I get just push back just why are you being you're not playing nice you're you're not working well with others and it's really going you asked me here for my experience because I've done this work because I know what I'm doing and I'm not even trying to fire this person who maybe we don't actually need I'm trying to say how can we even incorporate them in the department differently so that we're being most effective and it gets full push back so the more that you know you see these things kind of pop up from you know big issues like that to even small issues of no we're not going to buy you a women shaped coat because we want everyone to look the same on the sideline so you have to get the same man shaped coat which looks stupid it makes me look like a child like in dress up clothes um and so kind of just as I keep going along and as I've had my female fellows you just become more attuned to what's going on and so this for me again you know there's always not there's not always a lot of women sports medicine physicians around me and so I built my network and my community by being friends with the female athletic trainers and the strength and conditioning coaches and the sports psychologists and building that network and then building a network outside of where my institution was but through our national societies like AMSSM and ACSM that's how I started to begin to build a group where I could go oh geez this ridiculous thing happened to me today and have someone on the other end who knows exactly what I'm talking about and can talk me through that and so that kind of prompted the you know I think something like this would be worthwhile I think because I've always been multidisciplinary and worked with large groups and done this coaching and mentoring that it just kind of feels like this is the next step and I could be the one to do this for other women so that they would have this support. Dr. Arnie a lot of what you're talking about to me you know it's very much this conversation about gender disparities and sports and medicine and a little bit of both right and you know at the risk of walking down and making this a history class I'm really interested to know you know why like I know how we got here and what I'm not understanding is why haven't we progressed more in every other aspect of when it comes to sports and medicine and exercise science and physiology all things that we routinely talk about on this show we are making strides but when it comes to this gender disparity in sports and women we are it's a very antiquated mindset for instance the recent debacle by the NCAA and the failure which I told Darsh I just brought this up to him the other day you know him being intern he's not disconnected when I first saw that on a social media I was like okay it wasn't April first but I was like this is clearly a joke right this is not possibly true and then it was just getting a lot more you know a spotlight and then I went and looked into it I just it blew my mind it baffles me that somebody will drop the ball now to the NCAA is credited you know this is a beginning of April recently they had a large video conference with the president of NCAA a lot of coaches and the women sports talking about the issues how we can get better but I'm curious to hear your thoughts you worked with as you mentioned division one division three you're a program director you've had the role as a team physician how are we still here where the NCAA this multi billion dollar institution is still dropping the ball to this degree eight honestly is shocking and not shocking all at the same time you know I think that in many ways there's a lot of clear disparities that are much more subtle that are easy to say that you know all the winter coats that the athletes get they're all man-shaped like that's just and nobody questions that nobody says is this a title nine disparity that the sports clothing that the athletes are getting is going to primarily for you know coats for long sleeve shirts for stuff is going to be for sweatsuits is going to be man-shaped and that they're not making like separate female shaped clothes for the women and so even things as subtle as that but then you know you look at what is the advertising budget for the women sports what is the marketing for the women sports you know the everyone kind of goes oh the men's sports are just paying for the women's sports they're just like tagging along so they just get the leftovers but when you look at NCAA recently right the Yukon Baylor game and go Yukon by the way I have my loyalties the Yukon Baylor game was the most watched game in the tournament men's or women's and it had like double the social media engagement and so like the hunger is there people like this but if you're not going to market it if you're not going to advertise it if you're not going to put the money in you're not going to get the money out you're not going to see it and so I think we have a lot of tired old tropes that nobody cares about women's sports that there's not a market for it that there's not a fan base for it but when you're again when you're not putting in the money to market it when you're not advertising it when you're not hyping it up the same way when March madness means men's NCAA basketball and not women's NCAA basketball and men's right when you default you know I saw recently an article that was saying US soccer didn't make the Olympics yes it did the women's soccer did the raining world cup champs did the men's soccer team isn't going to make the Olympics but right so it's it's truly everywhere I think that sometimes when you see it so blatant like with the weight room discrepancies at the NCAA most recently that's when it feels shocking because you can't hide that you can't pretend that that's not clearly different there's a lot of very subtle ways that that women are not given the same opportunities are not given the same support do not have the same access to women coaches rice and title nine in a weird way women's there's less women coaches for women's teams than there ever were before so you'll have a department that has equal men's and women's teams but has two women's coaches for the whole department so I it's it's frankly it's all over the place I will say that I think within medicine again you still see that the head athletic trainers are male even though we have a similar number of male to female athletic trainers same thing for the head team physicians both orthopedic and primary care sports medicine the head team physicians are are typically much more common to be male and less female even though the fellows coming into sports medicine fellowship right now are 50 50 split we have a pretty even split but those top positions tend to go to the men the lead positions the head coaching positions and then it's still sports medicine is still treated as a not sports medicine women sports are still treated as a joke you know in the media there's a new movie coming out I forget what it is but the it's a male coach is acting up and as punishment he sent to go coach the women's team like you know and so being the coach of the women's sports team is considered a joke it's a punishment so it's it's truly it's kind of pervasive I think that we are making small strides right so orthopedic surgery is only six percent of attending physicians are women but in the most recent if you look at the residents 15 percent of residents are women so it's it's moving right it's and you have to kind of I think you have to try to stay a little hopeful because otherwise it could just you know why bother let's all quit because this is ridiculous and I think that what is it the LA sparks just got the first beer alcohol sponsor I think Moulson maybe and so you know as we see this happen like with NCAA with the women's UConn Baylor game be the most watched game have the most social media engagement I think you're going to start to see the companies go oh okay they have a fan base and so maybe if we put some money there we'll get some money back and once you get the money involved then I think you know it's you're going to have a chance to kind of change the culture yeah absolutely no sorry I could talk about that I think for another day yeah and within which we would love to even get into right so what's crazy here is all too much text to me about that NCAA debacle a couple days ago and what's funny is I check ESPN almost every day right with sports unlike I'm I'm very into sports and what's crazy is that I never saw that headline and so all too much again sends me another post yesterday through Instagram that shows that only four percent of sports coverage is on the the women's side of sports right so there's a disparity within the disparity and I'm with you the NCAA March madness this year has been exciting I think more so on the women's side than it has been on the men's side and it's funny because when you watch that Baylor UConn game there was that foul at the end at least is what you know a lot of people are saying but it really only got publicity I believe because LeBron James tweeted about it and so when I got that when I got the notification says LeBron James tweets about you know this foul at the end and then it kind of becomes a big thing and so to me it's just it's just absolutely insane you know it would just drive me nuts to see that if if I were an athlete going you know being in their shoes and so for you personally when you were an athlete in college what were those things that really just you know drove you nuts were there any specific incidents that you said you know this is I can't I can't really do this anymore this is insane hmm that's a great question I mean I was at a division three school Mulemberg college loved it played lacrosse and what I don't even know if I was aware of differences at the time you know I think some you're you're just kind of going along you don't always notice when you're in it sometimes when you're external to it then you can see it I think that you know once we got a men's lacrosse that didn't happen until maybe my junior year um you know there would be some conflicts about like who's gonna get the field practice time things like that and um I I truly like I honestly can't I can't remember um thinking back to then if I within the context of like playing the cross during my D3 college if I felt like there was disparities that was also a very long time ago so no you know Dr. Arnie so that's interesting to me right I think that also it's it's our job now that we're further removed from college all of us and we're adults to kind of reflect back and make sure this doesn't happen I don't to your point that when you have a college athlete right whatever division it is at 18 year old I mean they're still teenagers it's not their responsibility to recognize these things and also speak up about it today's day and age particularly at the division one level because I forget who which athlete it was who who put that thing on tiktok the donor price yeah who who are actually speaking about I mean it's not up to them it's it's the it's the president of the NCA NCAA it's all these people in leadership organizations that you're supposed to be setting an example you are supposed to be mentors you talk a lot about mentorship on and you're bringing all these I use your word badass women to to be mentors and you're very serious about paying that forward and so yeah we can expect because I mean now I know you're you're being very humble you were an elite martial artist from from what I understand right you competed at the junior Olympics I want to talk more about that a little bit later on but so for us to say that hey like you know these athlete 18 19 20 year olds should be recognizing this and then because they just at least just want to play right I'm sure when you were you were playing division three I didn't play in college you just wanted to play you didn't really care about that kind of stuff and perhaps you know I'd be curious to say is if you know other women or other female athletes who even if they are cognizant of that maybe they're concerned that if they do speak up if they'll have some type of repercussion right what are your thoughts about that oh for sure so this is a huge problem because the repercussions are there absolutely if you speak up I I do think that as we talk about kind of what is hopeful as we move along I think that because of social media because of the women's basketball having a higher platform so don't a price able to post that video it gets out there people follow that so I think eight of the top ten uh I forget I'm gonna mess this statistic up but there was looking at which athletes were the most prominent on social media maybe maybe this was of NCAA men's and women's basketball eight of the top ten were women and so they have the biggest following they have the most reach and so people are really invested in these women as players so so they're able to have that reach where so don't a price can go hey guys look at this bullshit pardon me if we're not swearing on this podcast um and people will see that and it gets out there and it goes viral so you're able to speak up in a way where now what she almost can't have a repercussion from that because everybody has jumped on this and seen it so if her coach gets her in trouble for that if her athletic director gets her in trouble for that if the NCAA tries to punish her or keep her quiet it's it's way too far gone but when you are you know talking about disparities in medicine when you're in a fellowship program that has two fellows and if you have been harassed abused toxic behavior sexual assault you can't anonymously report that because it's not it's not anonymous right like your program director knows who you are like you can report it up through the like hospital system through gme but you can't if they do anything about it if they try to investigate at all while you're still there like there's going to be repercussions right and there's no way to prevent repercussions you're just like waiting for them to happen and so it's I think it's a really difficult thing um within ortho twitter they have this new platform going up speak up ortho check it out um it's anonymous so all these women in ortho that whether they were during their resident med student or just as an attending they're anonymously posting things that have happened to them during their training during their career that are uh that are just unreal like you think this doesn't happen anymore but it is it is still happening to not just like oh we're not giving you this plum position because you're the women and we're going to take the man but to the sexual assaults to you know just it's really pretty atrocious so these things still happen and when you're especially in a sports medicine world where it's a small group it's harder to speak up and stand out about it because of those repercussions so yeah I think and to add on to particularly for us individuals who are all you know I say people there's no such thing as type B in medicine it's really type A and type A1 somewhere in the middle and so for all individuals where we're just taught to you know put your head down and you just keep going hurtle after hurtle after hurtle so I also imagine that a lot of those individuals who've had who've had to deal with that type of adversity they're just like I just got to get through this right I just got to get through this fellowship or whatever residency what it is I am encouraged to hear that statistic about now that 15% of women in the orthopedic surge resonances are or 15% of residents are women but you know this is also brings back to this larger point that I know you've talked about on your podcast before is lack of recognition for titles as well right for instance I was familiar with this literature prior to listening about it but I was happy to hear that I think it was with Dr. Sarnia Miller if hopefully I'm saying her name right that you talked about how you know for instance when if Darshan if I was the moderator for a conference for those who don't know usually one person's gonna be moderating a conference and if I'm going to introduce hopefully I won't do this but a lot of times individuals if I introduce Darshan I would say Dr. Darshan's and Dr. Shau come to the stage whereas with Dr. Arnie a lot of times individuals who say Jazeel is here and it's not again I mean just it's very subtle and it's maybe at a subconscious level so I would love to hear your thoughts and maybe your experience because I know you've been in that stage where you've gone up to stage and talked about it so has that ever happened to you and is that getting better or you know what are your thoughts about that yeah that's definitely happened when I was starting at Yukon the team docs that there was two men in myself and they were both known as Dr. T Dr. A like by their last name first initial that's just kind of how everyone was casually saying everyone's name I'm also a Dr. A that would obviously be confusing and so they're like oh well we'll just call you Dr. Jazeel and I was like nope no you won't I'm Dr. Arnie you know and it's it's you know for some professions like I think of pediatricians like a lot of them go by their first name with their patients because they're like little kids and so you're just like oh Dr. Bill oh Dr. Sarah which is fine you know if that's what you're choosing to go by great if that's you're like blanket everyone in the practice goes by that great but if me and the sports medicine world coming in as a new team physician if the two male team physicians are known as Dr. their last name then I will be also known as Dr. my last name and I had to speak up about that and say no and um you know so that happens there it happens in conferences you know I think it there's things that happen like that all the time in medicine and just like you said we're taught to just be quiet especially in training like you don't speak up you don't speak out you don't stand out like you know exactly what you need to know you're as the best you can possibly be but you're not trying to like ruffle feathers um and especially I think double as a woman like that's just society tells us that we should be quiet that we should be seen and not heard um and that if you speak up if you're loud if you're standing up for yourself then you're bossy you're bitchy like there's you know all the the characteristics that in a man makes them a confident leader and um in a woman makes her mean and bitchy and not nice and doesn't play well with others um and so there's times where as I've gone along in my career it's gotten easier and easier to have that voice and some of it is the confidence within myself of knowing who I am and the value that I bring to the table um and some of it is just like fricking fed up within you know and so we'll be at you know I remember a lecture recently where we had a cast tech was coming and it just helping do cast tech and he's a former military guy and one of the residents was a former military guy in opposite branches and I'm gonna get them wrong um but the the guy leading the group was just kind of joshing like just making fun of this other uh guy and was like oh the Marines was that that was the girly branch right and I just went ha ha like slapped my thigh so hard was like that was funny I get it because girls are weak oh yeah girls aren't strong or capable that's why that's so funny and I just in the middle of the whole class everybody just like what and I was like yeah that was sexist it's not funny guys like and 20 years ago oh my gosh I never would have said anything I might have been not even noticed or been pissed but not said anything and now I speak up about it you know we had a patient um who I was gonna do hip injection on and we do that from an anterior approach and so you know he's wearing these like paper shorts they're cut up right near his growing that's basically where we're gonna have to inject him and it's me and my MA and this guy this older guy he thinks he's just being an older adorable guy and he's like oh the only way I'm gonna get through this procedure is by I've been picturing the two of you girls naked and I was and I just stopped and said no that is completely inappropriate that makes me feel very uncomfortable you may not say things like that to us and he was like just stopped and was like what I I was just joking I just you know it's just funny I was just I was like no that's not funny that makes us very uncomfortable and he just was completely taken aback and my MA afterwards she like teared up because she's like you know they say these things all the time and I just I feel so uncomfortable and I didn't know we could do anything about it like I didn't know we could even say anything and you just stood up to him and stopped him and that was like incredible and and I think it's I couldn't have done that 15 years ago you know I would have just awkwardly laughed along with him trying to you know you can't make the patient upset with you and and I'm past that point now so it feels good but I also think that when you're early in your career when you're a young athlete like you said you you don't always have that confidence that capability you're concerned about the consequences and so I think it does even more fall on women who've been doing this for a while who have the experience who have that confident place to be like nope we're not putting up with this so I'm going to call that out because I have that platform that I can so it's everywhere unfortunately. Wow Dr. Arnie that is really intense and I really appreciate that story though because the first step is acknowledging it and saying that hey this is not right this is not appropriate it's much easier I shouldn't say it's easier because it's definitely challenging it's well what I always say it's it's easier for us as males to let us slide right because it's not affecting us right I mean we have this implicit thing and we're tribal in nature humans and so if a male makes this type of comment even if a female makes it it's not attacking us directly so we might let it slide so in a second we'll talk about how we can be better as members of the opposite sex but but I do want to come back to this point though you said it your past that point right I'm wondering how did you get that past with that point you said it's been 15 years and was it a conscious effort to work on it day after day month after month year after year did you have a mentor who helped guide you be better one specific person was it a couple of people I know this is what you're doing with your podcast to pay it forward but who helped you get there and how did you get there so I think from the how did I get there a lot of it was time and self reflection because I definitely had that like nose down you know you're just grinding through it you're just going to get through it mentality for a long time and and frankly these things keep coming up and they just keep sort of smacking you in the face until you can't ignore them anymore you know and so having issues of you know like gender inequalities at work seeing it in the sports but seeing it like personally affect me and affect my career it it oh man because some of it also ends up being kind of gaslighting you're like well is it just me like him and I actually just the problem and it's when you reach out to other women like I said and you have that network of other women sports medicine physicians and they're like what's going on they're like no that's horrible like that's totally not right like that's you know sometimes when you're so stuck into it and you are that victim like when it's happening against you it can be hard to sit there objectively and say this isn't my fault like I am not earning this behavior of other people you know there's nothing that I have done besides being a woman that is making this happen to me and that's not okay and not fair but when when it is happening you're so you know you're taught that you can be whatever you want to be you work hard you're going to get whatever you want to get you'll get that promotion and that's not really the way life works but what it does work is to make you internalize this if something doesn't go your way instead of thinking oh well I be like that was just pure sexism like I've seen this you know side by side me and this pharmacist like that's clearly just the only difference there is my gender you know and but but you're so conditioned to well what I need to work harder right like we're type in I need to work harder I need to be better like obviously that was me that was the problem and so having that network of other women and talking to them and men I've you know I've had a lot of really wonderful like Dr. D like he's fantastic talking to some men that I trust and think are good men to say you know here's what's going on what do you guys think and you know if I can talk to five six ten different people and they're like oh no yeah yep we've seen that before that's some good old quality sexism then you know I think that helps but it's still not a quick journey because part of that sexism part of dealing with that kind of gender disparities is that as a woman it's meant to you know break you down and it's meant to have it so that you are not confident in yourself you question yourself you don't know what's going on you don't know what's right and so it really is hard to come out of that and to build yourself confidence to believe in yourself you know some simple things honestly or that I have like the world's most wonderful husband he's just a gem of a human being I love him to death he's always been incredibly supportive my family my parents my sister and then even things like we're on top of our finances like I'm a big finance geek like I love getting into this and you know being financially independent and what are we doing with our money and having a plan the even just things like that make me feel like you know what if this job isn't serving me anymore I can leave and I don't have to stay here and put up with things you know whether it's toxic environment or just saying this is not the job for me like I don't have to do this work for you if it's just not the work that I want to do if it's not the way that I want to be helping but it has it takes a long time to get to that place you know it if if you're a badass strong woman out of the gate like heck yeah I'm all about supporting you but I think for a lot of us like just the way that we're trained and how to act how to be how to respond to things it is not easy to break free and have that self confidence to say nope here's what I'm not tolerating anymore nope I'm calling you out on that comment like nope this job isn't serving me so I'm gonna step away and I don't have to have something else lined up because I've taken care of my finances because I know my worth and I know that I can do this work and so yeah it's not been quick and I don't think there has been one specific individual that I have like looked up to that's helped me through this but it has been many it's really been a community of people so that's part of with like you said that's part of with my podcast with Madame athlete with what I'm doing is creating that community and seeing that story seeing the story while hearing the stories of all these women and what they've been through I think even if it's not your identical story or your identical career I think you still can learn so much from feeling like oh I'm not the only one I'm not alone out here oh man you mentioned personal finance and if you know our buddy Ryan Inman's listening right here his ears just perked up shout out to him with his podcast financial residency but you know that that is really insightful stuff for me and you know what I'll say is yeah to point personal finance you're right the the cost of education for medical school is astronomical right we're talking about how the system just can't loss it it's it's gonna break this it's gonna break eventually right both for undergraduate and for medical school and they say that the average physician is like like 185,000 dead I'm well above that my wife is also a resident so you know together we're not doing too hot but you know so a lot of physicians I imagine do feel hamstrung and they're like okay I can't do this this is why I'm doing this so I love the fact that you have that order and now you're only doing it because you're passionate about it and this is truly because most people don't go into it and now Garsh does a lot of pre-med coaching and you know if undergrad's want to go into medical school or be a doctor to make money and it's a really really bad investment it's not the reason to do it right and so I always tell them all the time but I want to come back to this point that when you pointed that pointed out to that patient right hey this is inappropriate you weren't attending at that time is that correct yes yes yeah so you know I hear these types of horror stories I'll say from my wife all the time she's a she's a resident right now she's a actually she's a pediatric resident and you know often what patients will she'll walk into the room when she's rounding it and they're like oh hi nurse can you do this right where is that I mean of course you know I think just by statistically and just anecdotally from my experience there are less male nurses there are female nurses from what I've seen you know please correct me if I'm wrong on that one but so that's really the assumption number one and the second thing will be a lot of times when she'll be you know either on a console service or just issue the part of the primary team if she's kind of conveying the plan to the family as a pediatrician as you can imagine you have multiple patients in the room and the parents and the actual and the actual patient and sometimes they're like okay well you know we want to hear from the attending and she's recently been asked to leave the room because you know the father at the time didn't respect because the attending was a male wanted to hear from the male and and I've had multiple stories like that which it's hard I mean I can't relate to that right it doesn't happen to me and also like we have slightly different personalities in the sense the way that I carry myself you know you know I've been very much northeast mentality as well and and and she does it and so for my northeast nurse you guys might appreciate that is you know we can I'll call it you know there's something for people from New Jersey to say we have a resting blank face so less people tend to mess with us right but I'm you know I digress there I guess my question for you the other thing that I've noticed and I'm very conscious of this is a lot of times when patients will come to me so actually my first question will be what would you advise trainees right such as my wife and resident is without like disrespecting obviously there's a tactful way to do it but in this era where systems are all based on reviews patient satisfaction scores those types of things and and this idea that patient is the consumer right we've got no way from the idea of like where medicine the you go to the doctor says now it's where team base we're equal we're working together and in pediatrics it's a lot more than that depending on the hospital right it's you're trying to make keep the parents happy so how would you advise residents to do that right because that's that's a challenge and then my second thing that that I've noticed over the last couple of years is I've been guilty of this a full disclosure is when a patient will say to me is like you know doctor Richards did this for me and I'll say oh well what does you know did he do this like did he do this procedure did he do this procedure and I'm much more and then often not often I'm getting much better at it patients will say oh no she I'm not like oh I'm I'm so sorry about that and so sometimes I can be very critical with that regard in the sense that you know again I go back to the point that we're tribal so I wonder when you ask those types of questions do is your automatic pronoun she and if not how do you think that we overcome that like for instance for the males to automatically assume that doctor Richards is a male sorry that was very long no that's okay there's a lot in there it's good it's this is a great topic so my automatic pronoun which I wish it wasn't is still he and I think that goes to show just what society is is telling us since we have been little boys or doctors doctors are men like that's just what you know nurses are women doctors are men and so those are even for myself someone who's like I'm feminist I am a woman physician like this is me I help train women physicians like this is something I'm very passionate about and still if I'm being very honest that is my default pronoun I think I am much quicker to say oh doctor so and so wait is that a sorry is that a man or a woman okay so it did she do this did you know did he do this so I'm quicker to kind of ask and think about that and I'm quicker to notice when I have made that assumption and then beat myself up about it and then feel about about it but it's it's not going to be something that goes away overnight to be fair which stinks but that is something that has been around for so long you know there's a really interesting study that they looked at little kids and they said draw scientists it's the draw scientist study so similar to doctor but and you know 30 years ago like 99% of the scientist drawn were men and even the women like even the sorry even the girls were drawing men scientists and then more recently repeating the study they had more women scientists being drawn still predominantly men but they had this big uptick in women scientists being drawn by these little kids and it was still more of the girls drawing the women scientists but still some of the a couple boys would you know draw a woman scientist so I feel like again when we talk about like there's hope there's progress it is slow it is frustrating but the more that we see you know you have to have that representation right like this is important for male female this is important for our you know people of color to see this right like the the the breakdown of women being in these lead positions in medicine I mean how much worse is it for women of color to be in medicine there's so much so fewer of them the representation isn't there so what is that little girl who's been to the doctor all her life and the only doctor she's ever seen is a man or maybe a white woman but when is she going to get to see a physician that looks like her you know and so I think Doc McStuffins like I think there's stuff happening at these little levels that are going to build up but it's not going to be quick I think when you are the woman whether it's a physician a resident a med student and you're dating to kind of stand up for yourself it's hard because yes I can tell you to go ahead and stand up for yourself but that would be disingenuous if I'm not telling you there's going to be consequences to your patient reviews right like just like you said and and medicine is so drawn by did you get five stars did you get one star that patient hated you why because you didn't give them narcotics like you know and it's and I can't go in and fight that and and put in the HIPAA information to say why that review is nonsense like I would like to review some of my patients at times I would like to give you a star rating that could go around and travel you everywhere right so you know as a as a woman when you're going to correct someone if you're going to give some feedback if you're going to stand up about something you do have to be really careful about how you are doing that to not suffer those negative consequences and so I think you know it depends on where you are in that level where you're just like you know I've been doing this 20 years I don't I don't care I'm just going to tell you like you can be at that blunt level when you feel like I'm confident enough my finances are secure like I don't need you to be happy for my career to work or you're at the beginning where you're just like dependent on every review every evaluation every performance you're solely dependent on what other people think of you and then you have to try to you know do that differently you have to be nice you have to say it with a smile you have to you know joke along be like oh no I'm actually the doctor yep get that a lot because I'm a woman you know and say that with a smile and kind of just jokingly acknowledge that like oh yes you assumed I was a nurse because I was a woman and and that's a little bit sexist but hey I'm still smiling so maybe you won't be offended but now you'll know I'm the doctor so it's it's not an easy thing so I don't think there is even a a everyone can do this right it really depends on your setting or situation your environment what you can say how you can say it and how you can get that um how that can be perceived by other people yeah and to to your point actually I one of my students you know as a pretty med coach actually her personal statement was about she growing up she uh as a person of color she never saw a physician you know of that was a person of color um until she was a teenager and to her she never realized that people that looked like her could go into the field of medicine right and likewise I think women also go through the same thing you know growing up what what environment they're in sometimes they have to get out of that environment to see oh wow look at the possibilities you know it's actually infinite um and so everything you've been saying up to this point really resonates with me and there's one word I can think of and it's it's self-worth and it hits me really deeply because when I started my personal development journey and self-growth you know at the prior age of 23 is when I really started getting into this stuff it was about self-worth and it was about understanding that if I know I have value and I know my strengths and I can work on my weaknesses then I deserve to be wherever I'm gonna go right and so I just love everything you've said to this point because it just really reminds me of that but as Altamash said me and him will never truly understand what you have to go through and we probably never will but what advice like what would you tell us not only as men but as sports fans as athletes and as physicians right we can always advocate we might not be able to go through what you can go through what we can be there to support and advocate what advice would you give us this is great okay so a hundred percent we need our male allies in order to succeed you know it's we can't do this on our own um there's a lot we can do but um but we I think that we we do need male allies so even something as simple as when you're in a meeting this is something that happens all the time women talk about this women will we'll say an idea present an idea and then right after or maybe a few people later a man will say the same exact idea you know we're did a little differently but like the exact same thing and you can be the person who points out and goes oh that's great I'm so glad that you agree with Dr. Arnie's idea you know and just kind of calling that out or women get interrupted a lot they get talked over in meetings and so if you can be the person to say hey you know what I think Dr. Arnie was still speaking let's let her finish you know you can do that as a man right as the woman who's about to be interrupted or as a woman who's like I just said that guys like then we start to seem like we're whiny we seem like we're complaining we're you know we're not being friendly but as the man you have that cultural ability to be like oh no I'm gonna cut you right off because you were interrupting this other woman so let's let her finish or to say you know I'm pretty sure that she just said that so I'm glad that you're on the same page um I think little things like that to help the women around you are beneficial we know that even with negotiating right if a woman goes to try to get a raise try to negotiate she's looked at as being like greedy and like all these horrible things whereas a man is just like expected that a man's gonna negotiate and they're actually like applauded for being ballsy and they're strong and they're gonna go after what they deserve um and for a woman to get a raise or to get recognition at work or to get promotion it's actually more helpful to have other people around her speak up for her and um sponsor her and so you can be a sponsor to your woman colleagues and talk up about their good work to your boss talk up about what they're doing um and so I think those are some ways that as uh as a male who cares about your women colleagues that you can try to pay attention to when these things happen and use your platform and your privilege to kind of speak up and stand out about those things absolutely no thank you for that and I know all to us and I were just talking about this like we're gonna do you know this is this is why we have this podcast right and I think it's our duty as men um and you know he has a wife that's a pediatrician I have a wife who's actually in organizational psychology focusing on leadership development and is very much about women empowerment so for both of us it's it's it's really close to home um but also for the other gender than any advice you'd give to females you know when you look back at your younger self what would you tell her buckle up um I don't know I think I've had a really incredible journey there's been some really you know difficult times um there's been some really wonderful times um you know I think there's times where I do wish I had stood up for myself more than I did you know when it was time for going up for promotion and um you know I've been interim head team physician for like a year and a half interim fellowship director for two years and at some point you're just being taken advantage of they're just counting on you to be the woman who's just gonna do the work while they take their sweet time to figure out a hiring process and you know to have said hey this is if this isn't working out if I'm not the person that you're considering then then no I'm not just gonna keep putting up with that and and lasting longer and doing all this work um and having that kind of self confidence and worth to say no no if if this isn't gonna work out I'm not gonna just sit around and keep doing all this work for you um I don't think that's easy and I don't think that I was I would have even at the time mentally been ready to do that and so some some lessons you just only learned in hindsight you gotta get through them um but I I think that I've had a really I've had a crazy ride I've gotten to do some amazing things work with some amazing people I have dealt with some horrible people but I have learned so much coming out of that about who I am about my worth about you know my confidence my value what I bring to the table that you know I wonder if I hadn't had those difficult times those difficult frustrating you know sexist situations would I be this far along in my you know personal development and self development you know I don't know that I would be so as miserable as some of those things have been to go through um they they weren't my whole journey right they were like a small piece of my journey and but I think they really have helped move me forward a lot in my own understanding of myself and and my worth and and what I really want to you know be doing so such a great show with Dr. Arnie to cast the rest of our awesome conversation be sure to tune in next week same time same place and before we end don't forget to reach out to MR insurance consultants where their goal is to assist physicians in obtaining the most comprehensive coverage available to fit their unique situation reach out for both excellent and quality service at drpodcastnetwork.com slash MR insurance before you take off please remember this important disclaimer everything in this podcast is for educational purposes only it does not cost you the practice of medicine nor should it be construed as medical advice no physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers however if you enjoy the show please be sure to subscribe review and share with anyone who you think will gain value from this as well thank you for listening and I'll catch you next time