Spotlight on Gender Equity, Belonging at DoctHERS Event

By Dirk Hoffman

At the Jacobs School of Medicine and Biomedical Sciences, UB DoctHERS is a leadership network of female physicians, scientists, faculty, health care professionals, residents and students whose goal is to address current issues in the medical and scientific fields to enhance advancement, mentorship and equal opportunities for future generations of women in medicine and science.

This year’s event, conducted on Feb. 13 in the M&T Auditorium in the Jacobs School building, featured Julie K. Silver, MD, a leading expert on gender equity, as the keynote speaker.

Silver is an associate professor and associate chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She has published groundbreaking research on workforce diversity and inclusion topics.

In her introduction, Allison Brashear, MD, MBA, UB’s vice president for health sciences and dean of the Jacobs School, noted Silver has been a renowned advocate for women in the STEMM (science, technology, engineering, mathematics and medicine) fields for many years.

She pointed out Silver’s research has been published in the New England Journal of Medicine (NEJM) and JAMA, she has appeared as an expert on “The Today Show,” and was recognized by the Boston Globe as a “Top Innovator in Medicine.”

“She is passionate about physician well-being and she has done a lot of work in cancer rehabilitation,” Brashear said. “But what I would say is that she is a real champion of mentorship and sponsorship — topics that are near and dear to all of our hearts here.”

Silver said accelerating gender equity is really about disparities.

“We have made a lot of progress, but this was probably the most discouraging study for women in medicine when it came out in 2020,” she said, noting a NEJM study titled “Women Physicians and Promotion in Academic Medicine” that included a sample of 559,098 graduates from 134 U.S. medical schools.

“It found that over a 35-year period, women physicians in academic medicine centers were less likely than men to be promoted to the rank of associate or full professor or to be appointed to department chairs, and there was no apparent narrowing in the gap over time,” Silver noted. “We know that critical mass theory does not work in gender equity.”

Silver also pointed out that at Harvard and other institutions, in order to advance from associate professor to full professor, one has to have a national reputation — which means needing to obtain grants and presenting at medical societies.

She said she decided to use her strategic experience to look for tipping points in the process to assist women in medicine in advancing in their careers.

“The hardest thing to do is find the tipping points, but when you do that’s gold because you can drive change really fast,” Silver said. “I decided I was going to start with medical societies and recognition awards.”

“I wanted to make the argument that our professional societies had to be treating people more equitably in order for deans and chairs to do their job of promoting more women in medicine.”

Silver pointed out that medical societies are the only one of the four gatekeepers in academic medicine (the other three being home institutions, journals and grant funders) where money flows the opposite way.

“The only time we are asking you to write a check is to medical societies and professional societies.”

She decided to “blow the whistle” on this multibillion set of businesses to force them to treat people more equitably.

“And part of the reason was that I had been telling women to leave their families, leave their patients, and spend money to present at medical societies. And if they did that, they would get promoted all the way to the top.”

“But they weren’t getting promoted, so what I was saying was not consistent with the data and there was no way I was going to keep telling women something that wasn’t true.”

Silver noted an example from her own field of physical medicine and rehabilitation — where in the past four years no women received recognition awards despite representing 42 percent of the physicians in the specialty.

Another tipping point Silver said was a Lancet study that showed women in medicine were underrepresented in clinical practice guidelines.

“In response, what I heard was ‘it is not our fault women were not included,’” she said. “There was this idea that organizations had to fix themselves and they were not complicit if they worked with an organization that was not treating people fairly.”

That led her to author a paper in the journal Cell that presented a novel concept Silver called “interorganizational structural discrimination.”

“The idea behind it is if an organization that has known problems with structural sexism or racism or whatever, that if you work with those organizations and they have fixable problems, then you are complicit,” she said.

On the topic of retention, Silver said she looked at Harvard Medical School’s numbers and found a “stickiness factor,” — if someone stayed for a year or two, they were significantly more likely to stay longer.

“All of the minority hires were more likely to leave, which tells me we need better onboarding and we also have to do a much better job of supporting BIPOC (Black, indigenous and other people of color) individuals,” she said.

Silver said push factors and pull factors both lead to attrition.

“A push factor would be discrimination, a pull factor would be a job offer of a promotion and more money,” she said. “We have to start thinking about stay factors. We’ve got to decrease the reasons that people are pushed away, and we have to create opportunities, so they are not pulled away by our competition.”

Silver said it is important to use the language of belonging while mentoring.

“What if you had a romantic relationship and the word ‘love’ was never used?”

“I think you have to use the actual words in belonging — not just that you are part of a team, but that you belong,” she said.

Silver noted the idea of sponsorship in academic medicine was brought over from the business world.

“A lot of women in medicine know they need sponsorship, but they do not know how to get it,” she said. “The whole idea is very anxiety-provoking.”

To address that issue, Silver said she created the idea of a “sponsorship party.”

“You can do it in different ways, but we are going to do it live right now. I worked with three women and tasked them with making a slide that identifies their top three sponsorship asks,” she said. “And this is really hard because a lot of people know they need sponsorship, but they don’t even know what to ask for.”

Second-year medical student Nitya Murali; Melissa L. Rayhill, MD, clinical associate of professor of neurology; and Emily Ceccarelli, a UB alumna who is an engineer at Moog, Inc.; each gave a brief presentation about themselves and outlined their sponsorship asks.

Silver encouraged everyone in the audience to take a photo of the slides and contact them if they had a way to sponsor them.

“Even if you can’t sponsor them, please email them to tell them they did a great job and that they belong,” she said.

Silver said another sponsorship technique she created is called “Elevate Her to a Bigger Stage.”

“I am on a big stage a lot and I realized that if I could carve out a few minutes in each of my talks for another person, I could elevate them to a bigger stage,” she said.

Silver then introduced Ashley Alex, MD ’16, a clinical assistant professor of neurology who joined the Jacobs School faculty in 2021.

“Dr. Alex is going to talk about migraine headache, and she is going to do it in a way that I train our researchers to do,” she said. “The technique is called PechaKucha (which means chit-chat in Japanese). It is 20 PowerPoint slides, for 20 seconds each, for a total of 6 minutes and 40 seconds.”

In her talk, “Novel Therapies for Migraines in Women,” Alex noted migraine is an invisible disease that affects 39 million Americans and while it affects all ages and genders, it primarily affects women of working age and child-bearing age.

“This is so important because uncontrolled migraines can negatively impact a woman’s career goals, her finances, her ability to start and maintain relationships, as well as her decision about having children,” she said.

Migraines represent a high socioeconomic burden, but receive relatively low amounts of NIH funding, Alex noted.

“Women have had to deal with medications that were made for other conditions, have low efficacy and intolerable side effects for many years,” she said. “But now we have a number of new therapeutics to offer patients to allow them to lead more productive lives.”

Alex also noted the role of artificial intelligence (AI) — it is already being used in terms of diagnosis in Emergency Rooms, as a screening tool for comorbid conditions, and even looking for neuromarkers to identify migraine based on an MRI.

Silver returned to the stage and expanded on her thoughts on belonging — noting the need to belong is a fundamental human motivation.

“One thing that is important is that it is your individual perception,” she said. “Belonging is actually different than inclusion. I can say you are all a part of DoctHERS, but maybe there are people in this room who don’t feel like they belong just because they are a part of something.”

But using the language of belonging can help people feel like they belong, Silver noted.

“Belonging and social integration are on one side and thwarted belongingness and loneliness are on the other,” she said. “You hear that term ‘thwarted belongingness’ used a lot in the suicide literature.”

Silver said the interpersonal theory of suicide has two components — one is thwarted belongingness, and the other is the perception that someone is a burden to others.

“A lot of our trainees and early career fellows have suicidal ideation and suicide is a reason for attrition from medicine,” she said. “This is something I like to just briefly touch on, but I do think the subject of belonging and thwarted belongingness is super important.”

She noted, “belonging is an essential component of a positive workplace environment, and the lack of belonging is thought to be a risk factor for workplace attrition.”

Silver closed her talk with seven simple words woven into a powerful message: “No one belongs here more than you.”

Prior to the keynote speech, a group of third-year medical students gave a presentation on the UB DoctHERS Female Mentorship Pilot Program. The students initiated the project at the urging of Rayhill while they were co-presidents of the group in 2022-2023.

“We created the program with two goals in mind,” Shefalika Prasad said. “Primarily, we wanted longitudinal mentorship and career counseling that lasted more than just one day. We also wanted to facilitate interclass mentorship between preclinical and clinical medical students.”

The group used an email campaign to ask students to submit names of any female attendings who they believed would make excellent mentors.

Lauren M. Kuwik, MD ’08, clinical instructor of medicine and UB DoctHERS chair, also reached out to UB faculty, DoctHERS members and on social media on the students’ behalf.

Mentors and students were asked to complete online questionnaires and the group took that information to manually construct mentorship families with an emphasis on keeping groups smaller than five along with interclass diversity.

In total, 130 medical students and 52 physicians (49 attendings and three residents) were organized into 50 mentorship families, according to Beatrice Bacon.

Final surveys of mentorship sessions revealed one of the most discussed topics of interest was work-life balance. Other topics included research opportunities, subspecialty areas and leadership.

Elissa Goorman said the feedback survey also identified four different strengths of the program:

• small group environment
• interclass mentorship
• exposure to male-dominated fields
• exposure to career at different levels of training

Using the feedback they received, Lauren Todaro said the group created some goals for improving the program.

“We would like to incorporate more residents and clinical medical students into the mentorship families to achieve a more equal distribution of training levels,” she said. “And a common area of concern for students revolved around residency applications, so our other goal is to provide these resources to all members of the program.”

With UB DoctHERS support, the group was able to present its program at the AAMC Learn Serve Lead Symposium in Seattle this past fall where physicians and students from all over the country gathered to exchange ideas and discuss the current state of medicine, Todaro noted.

Locally, they presented at the medical student research forum at the Jacobs School to gather more feedback and recruit members.

The students thanked Rayhill, Kuwik, and Jennifer Britton, UB’s senior director of alumni and constituent engagement, for their guidance in developing the program and recruiting members.

“We would also like to thank all of the DoctHERS alumni who volunteered their time to mentor our students, as well as our students for being a part of the program and providing feedback to help improve it,” Todaro said.

The UB DoctHERS symposium is made possible by funds from the Medical Alumni Association, faculty and alumni donors.