Oncology fellow says education, visibility, advocacy can help tackle gender disparities
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Systematic changes in the hematology/oncology field to support and advance female oncologists are “essential” and “required now,” Johanna E. Poterala, MD, wrote in a JAMA Oncology viewpoint.
Poterala, a second-year hematology/oncology fellow at University of Wisconsin, wrote that her time as a fellow thus far has revealed how gender disparities have persisted in the field. For instance, only 22% of the programs where she interviewed had a female program director and, at some programs, the entire interview panel was composed exclusively of men.
These and other events Poterala experienced led her to write the viewpoint, published in June, and propose solutions to address these issues at a systemic level.
“As I complete my fellowship and start my career search, I will be considering the layers of support that an institution has in place and how well it supports employees,” Poterala wrote. “Given that during the past 6 months I have seen several women oncologists leave academia because of burnout, I view systemic changes as essential.”
Poterala spoke with Healio about this viewpoint and her experience thus far as a fellow, solutions to address gender disparities in the field and advice for women starting an oncology fellowship.
Choosing oncology
Poterala said that the lasting patient and family relationships she witnessed during medical school rotations originally are what piqued her interest in oncology.
“In oncology, when patients are going through treatments, you'll often see not only them but their entire support system sometimes as often as once every 2 or 3 weeks for several months at a time,” she told Healio.
Poterala said the ability to know patients on a deeper basis, the multidisciplinary aspect and the cutting-edge nature of the field ultimately helped her decide on a career in oncology.
“It's exciting that we're able to have new approvals for drugs that are not only more targeted for specific patients and their tumors, but also ideally leading to less toxicity and better tolerance of our therapies over time,” she said. “It’s a challenge to keep up with, but it's also a privilege to have things to keep up with.”
Life as a fellow
When she first entered her fellowship, Poterala said the beginning was an overwhelming and thrilling “whirlwind.”
“You graduate from internal medicine residency and think you're at the top of your game,” she said. “You're taking your internal medicine boards, and then you start hem/onc and realize it's an entirely different world and language.”
As her fellowship continued, Poterala said she grew to appreciate the field and people in it even more.
“As a practicing oncologist now, I recognize how much knowledge and thoughtfulness goes into each and every case,” Poterala said. “Oncology is moving toward a field of personalized medicine, so to be able to think about how we can best treat a patient based on not only their disease, but also their social economic situation and cultural background has been a great experience.”
Addressing gender disparities
Poterala wrote the viewpoint in JAMA Oncology on gender disparities in the oncology field under the guidance of her mentor, Narjust Florez, MD, the associate director of the cancer care equity program and thoracic medical oncologist at Dana-Farber Brigham Cancer Center.
Poterala told Healio one instance where she faced gender discrimination was when she was misidentified as a nonphysician despite the fact that she introduced herself as a doctor.
“I've had circumstances where I'll be in a clinic visit with somebody going through our treatment plan, talking about the cancer and prognosis, and they'll say, ‘Well, we're going to do whatever the doctor recommends,’ and I have to say, ‘I am the doctor,’” she said. “I’ve also had cases where they’ll want reassurance from my male attending that this treatment plan is the best one.”
Although typically it is patients and family members who misidentify her, Poterala said this has also happened to her with physician colleagues on occasion as well.
“They’ll walk in the room and presume I'm a different staff member. It's not only me; many of my female colleagues have experienced this as well,” she said. “It's frustrating because you've obviously worked many, many years to have the degree, and you want your position to be known. Those situations can really accumulate over time and lead to burnout, self-doubt and decreased levels of happiness at work.”
Education, visibility
Not only does Poterala discuss her experiences in the male-dominated field, but she also offers several solutions to help female oncologists and fellows. When asked about possible solutions for gender disparities in the field, Poterala detailed the importance of education and visibility.
“You'd be surprised at how many people think gender discrimination is an issue that was resolved in the 90s,” she said. “In educational trainings available for employees, we talk a lot about male allyship. It's important for anyone who witnesses a situation to be able to speak up, have their voice heard and say this is not right, this isn't how we treat people here at our facility.”
Visibility and recruitment of and retaining female staff across the oncology workforce is essential, Poterala added.
“This allows for not only female representation at all levels to be at meetings that are setting policies and changes, but for more diversity in patient care and having providers that can relate to their patients, as well as mentorship,” she said.
With the responsibilities society places on women — especially those that have been amplified by the COVID-19 pandemic — system-level changes are necessary right now, Poterala said.
“With greater demands on women, there needs to be increasing access to resources at the workplace that can help offload some of that,” she said. “This could include providing child care that fits the schedule of a physician, allowing for flexible work hours or hybrid format and other support systems that could be offered through the workplace, all to help offload the time that they would have to spend on that outside of work.”
Nontraditional advocacy
Although Poterala is a clear advocate for female oncologists, she told Healio that it has been a personal journey for her to recognize all the ways in which she can implement female patient advocacy in her career.
As a women’s studies major in college who chose a career in medicine, Poterala knew she wanted to include women’s health in her vocation but struggled with seeing how she could do that without going into OB/GYN.
“I thought naturally that meant I had to do obstetrics and gynecology because that was the epitome of women's health and advocacy work in my mind,” she said. “However, I found that the field didn't quite match my overall career goals. It took me a while to open my mind to other ways that I could be a woman's advocate.”
However, in working with Florez, Poterala saw how she could be an advocate for women in a nontraditional way.
“Dr. Florez’s clinic focuses on women with lung cancer, so it's opened up my mind further to the idea that you don't have to just specialize in a cancer that mostly affects women,” she said. “Women get all different types of cancer, so you can truly practice in any sort of way and create your practice to support them in those fields.
“I overcame this challenge with the help of Dr. Florez and my experiences through my medical rotations,” she added. “Keeping an open mind in terms of my career trajectory and being willing to shift if something is pulling me in a different direction have been key in facing this challenge.”
In terms of current advocacy projects, Poterala said she is working with a group called Women in Leadership and Development, or WILD, at University of Wisconsin to create training workshops on microaggression and male allyship for various fellows.
Find your support systems
When asked what advice she would give to women starting their oncology fellowship, Poterala first congratulated anyone starting out as a fellow and then emphasized the importance of both personal and professional support systems.
“For your personal support system, you establish who your social support network is during medical school and residency when things are tough at work,” she said. “However, for a professional support system, think about what we call a personal board of directors. These are people who you can identify as mentors and advocates for you, lift you up, recommend you for different awards or opportunities, keep you in mind, and are people that you can go to with professionals or personal questions. I think that is extremely useful, especially if you're within a big academic center.”
In terms of combating gender discrimination, Poterala recommended a tip and an online resource.
“It is important to be equipped with what you're going to say in a moment when gender discrimination happens,” she said. “I'm still working on this because it's difficult, especially if you're not prepared. You don't want to come off immediately angry because it's not typically from a negative place; it's a mistake because of what culture and society has told us a doctor looks like. Think about how you will take that moment and use it to educate and continue a therapeutic relationship with your patient.
“If you feel like you're suffering from gender discrimination, or if you're struggling with the transition from residency to fellowship, you're not alone,” Poterala added. “I found the ASCO Women in Oncology platform, which has a blog and an email that you can sign up for, really helpful. You can post a question or a comment, and there are members on that platform who will provide you with immediate support, thoughts and resources.”
For more information:
Johanna E. Poterala, MD, can be reached at jpoterala@uwhealth.org.
Reference:
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