As depicted in the new film “On the Basis of Sex,” Supreme Court Justice Ruth Bader Ginsberg devoted her legal career to eliminating gender-based discrimination. While great strides have been made in promoting gender equity in recent decades, some inequities remain in many areas including dermatology. Practical Dermatology® reached out to several top female dermatologists and asked them to share their very personal experiences and offer advice to female dermatologists who are just beginning their careers.
Many facets make dermatology an attractive specialty for women (…and men), including its inherent flexibility and the breadth of diseases and conditions that fall under the dermatology umbrella, which is why many of the panelists opted to become dermatologists.
Heidi Waldorf, MD: I grew up with a dad in dermatology, so I never thought about it as a “woman” choice, but as a life choice. I went to medical school not wanting to like dermatology. However, I couldn't ignore how pervasive dermatologic issues were in every other field of medicine and the happiness of the dermatology consultants.
Vivian Bucay, MD: Dermatology affords many of the same advantages (e.g. procedures, compensation, opportunities for research, etc.) of other specialties that place greater demands on our time. The most obvious advantage is the ability to tailor the practice to one that excludes a call schedule and whose clinic hours are usually limited to weekdays during usual business hours. Dermatology allows for a great deal of flexibility, including part-time practice.
Jeanine B. Downie, MD: Dermatology encompassed the ability to see surgical, medical, and cosmetic patients. Additionally, I liked being able to see all ages of patients and really love not being tied to a hospital. As an African-American female in private practice, my mother, who is a pediatrician, as well as my grandfather, a dentist, taught me the flexibility of practicing medicine early in life. While running a private practice in 2018 is far more complicated, I enjoy being my own boss, setting my own hours, and being able to see the progress of what I treat on the skin in real time.
Diane Berson, MD: Dermatology is an attractive specialty for everyone. We treat patients of all ages from babies to the elderly. We treat conditions that range from medical to cosmetic, and everything is visual. We can diagnose underlying systemic diseases by what we see on skin. Dermatology is not dependent on a hospital setting, which allows for a great balance between personal and professional time. We can still be paged by patients at night, but we are less likely than other specialists to have to go in to a hospital in the middle of the night to see a patient.
There are so many choices. Dermatology is a field where you can practice by yourself, with a partner, or in a big group. You can define your practice times and be available for patients but be available for others who need you. You can create a schedule that works for your life and give 110 percent to your patients and your family. I am very fulfilled as a clinician educator and leader in organized dermatology but also as a parent.
Gender Diversity in Dermatology: The Tables Have Turned
The gap between the number of men and women in dermatology is not as wide as it is in other specialties. Slightly more than 41 percent of dermatologists are female; males represent 58.7 percent of all dermatologists, according to data from the Association of American Medical Colleges. A pronounced uptick in the percentage of female dermatology residents suggests that we may be nearing a tipping point. The Association of American Medical Colleges' 2017 Report on Residents shows 64.4 percent of dermatology residents are female.
Dr. Downie: There is gender diversity in dermatology, however we can do even better. There are more women entering the field of dermatology now than ever before. We need increased racial diversity in dermatology, and quite frankly we are not doing as well in this area.
Dr. Bucay: The number of female dermatologists has increased since I matched in dermatology in 1987. Of course, the number of women in medicine has also increased since I began medical school in 1983, when my class was about 20 percent female.
Dr. Berson: The tables have certainly turned and basically the best and the brightest are applying to dermatology because of the many benefits that this field has to offer.
The Art of Maintaining a Career-life Balance
Many panelists feel that dermatology allows for a more balanced life, largely due to the many types of practices possible, but achieving balance takes work, involves setting boundaries, and carving out what one panelist calls “oui for me” time.
Dr. Downie: The key with career-life balance is to make sure that you are doing the things that fulfill you. If you always wanted to travel, you should be traveling. If you want to write papers and lecture, you can structure your dermatology career to accommodate these things. Learning to listen to yourself is most important.
Dr. Waldorf: My late mother went back to Columbia Law School when my youngest brother entered nursery school in the 1970s. She was expected to be a superwoman and somehow she continued to manage my father's practice, supervise the building of his new office, help my brothers and me with our homework, and attend our events and help my grandparents. I feel very lucky that I just had to keep me and my plant alive during med school and training. What I learned from my mom was that I could do everything as she did, but it is better to do as she told me to do and learn to say “no.” Taking care of everyone else is the gift and curse of most women. Remember to say “oui for me” and take care of yourself, too. We type A professionals tend to be our own worst critics. We must also be our own biggest cheerleaders.
Dr. Bucay: I'm not going to lie: the majority of the household administrative responsibilities have been mine, and our daughters tended to rely on me for many things and cut my husband (a cardiologist) much more slack. The key is to embrace life's opportunities and to leave the would'ves, could'ves, and should'ves elsewhere. I struggle with this, because I am very driven and have run my own practice since 1991. For me, the key to maintaining a healthy balance is to focus on family when it's family time and to focus on work when it's work time. That means setting boundaries. My daughters are grown, but when they lived at home, I made it a point to leave work at the office, at least until after their bedtime. Another important thing is to develop other interests and to set aside some “protected time” to pursue them. It can be something as simple as 15 minutes of time to meditate or to go grab a coffee with a friend. Also key is knowing what battles to pick and to cut yourself some slack. No one can be perfect in every aspect. Being good enough is perfectly good.
Investing in Leadership Development for Female Dermatologists
By and large, the panelists feel that there has been a pronounced uptick in female leadership positions throughout dermatology. There is still some room for improvement, and several panelists would like to see the societiess develop more mentorships for women.
Dr. Downie: I would like to see the pharmaceutical companies holding more leadership advisory boards for women and focusing on our individual needs and would like to see our societies continue to focus on mentorship.
Doris Day, MD: I would like to see women who are capable and who have the desire to lead feel they have the support they need to reach higher levels of leadership positions. Unfortunately many women underestimate the power and value of their knowledge and expertise and they just “give it away” without being properly recognized for their work and efforts. Women are naturally and organically rising in leadership ranks and my hope and expectation is that we will continue to take on greater roles at the top of companies.
Dr. Waldorf: Dermatology has been at the forefront of having women in roles of leadership for decades longer than our colleagues in fields like Plastic Surgery and Facial Plastic Surgery. However, that doesn't mean that we can slow down our efforts to support young women leaders, particularly in universities.
Dr. Bucay: I would like to see more mentorship programs through our societies. I definitely feel that the gap in female leadership has narrowed and am proud to have many close female colleagues actively involved in leadership positions within the American Academy of Dermatology (AAD) and the American Society for Dermatologic Surgery (ASDS).
Dr. Berson: There are still more men, but certainly we are seeing more and more women in leadership roles at the AAD, ASDS and WDS. I was president of WDS and on the board of ASDS and am now on the board of AAD. There are more and more women in these positions. It's going in the right direction and I would like to see it continue to evolve.
Having it All
It's possible to be fulfilled in your personal life as well as your career.
BY DORIS DAY, MD
Balance. Now there's a word! The modern woman fought so hard for the right to do it all, and we won! The challenge has been that we've added more to our already full plates and put ourselves at risk for burnout and loss of personal satisfaction. I always knew I wanted to be a doctor and equally important to me was having a family. I knew there had to be a way to do it all, but what I learned along the way was how emotionally satisfying it could be and how much my family would benefit from the process as well. Here are the secrets to making it happen:
1. Love what you do and do it with passion. Your children will feel that energy and appreciate it. If you come home happy and fulfilled, your family will thrive on that energy.
2. Be present. At home, put away the phone and laptop; your kids know when you're all there or when you're distracted. At work, get it done and leave it in the office. Compartmentalization takes practice and is an essential skill for balance between work and home life.
3. Make time for you. It's hard to make time for yourself without guilt. I submit that “you” time is as important as family and work. Time will expand to make room for it in your greater efficiency and joy in everything else you do.
4. Be maximally efficient. Take stock of everything on your plate. Do you really want or need to be doing all these things? Eliminate the extras, then determine the best way delegate what you can. Over time it gets easier as you get into the rhythm of being maximally organized and efficient in getting things done. It's truly one of the biggest secrets to success and making the most of your time.
5. Know it's a team effort. I learned early on that by expecting more of those around me, everyone rose to the occasion and the sense of accomplishment was a shared experience. At home, my children were expected to participate in… pretty much everything from a young age. I was the antithesis of the helicopter mom. When the kids wanted to go to sleep away camp, my line was, “Find a camp, make a presentation, and if I approve, I'll pay for it.” They did it, loved the camp, and still to this day talk with pride about the experience.
6. Let it go. You can't be all things to all people at all times. Be happy where you are and know that your kids appreciate you more knowing that your time matters, too, and they will be proud of you, as you are of them when they celebrate your success as you celebrate theirs.
I always say, “It's a man's world, and they can have it, as long as I get my way!”
In addition to her appointment as clinical associate professor of dermatology at the New York University Langone Medical Center, Dr. Day is also the author of several books including, “Beyond Beautiful.”
Equal Pay for Equal Work?
Pay inequity still remains an issue for female dermatologists—especially as it pertains to consulting contracts.
Dr. Downie: We need equal opportunities for clinical trials, top level consulting contracts, and more monetary transparency between male and female dermatologists. Unfortunately, some older males are still offering younger male dermatologists significantly more money than younger female dermatologists with the same qualifications. This just has to stop.
Dr. Waldorf: This is still the world in which we live. The gender gap in wages, in number of chairs of departments, and in industry leadership are chronic issues. In fact, it still is normal to refer to the “male nurse” or “female doctor.” You never hear anyone say the “female nurse” or the “male doctor,” because if it isn't specified, it is assumed.
Dr. Bucay: Unfortunately, there is still a gender gap in reimbursement for medical services, and there is most definitely a gap in compensation and opportunities for women when it comes to industry involvement. I once received a contract meant for my male co-faculty for a CME program. Our responsibilities were identical, but his payment was double mine. You can imagine how much fun I had with this! It was a golden opportunity to point out the unfairness that is pervasive across so many professions. I would like to see a program focused on how to negotiate the best contracts.
Zero Tolerance for Sexual Harassment
The #MeToo movement has given many women—including dermatologists—the courage to call out situations in which they were sexually harassed or assaulted by men in positions of power.
Dr. Downie: I have so many #MeToo moments that it is ludicrous. There was a cardiologist (call him Dr. X) back when I was a third-year student at SUNY Downstate/Kings County. Dr. X harassed me. He consistently asked me for sex. I told him no. I told him it was not appropriate and that I had a boyfriend. Despite this, he persisted. Dr. X informed a group of third year medical students (my peers, including my then-boyfriend) that he was playing basketball with that I had slept with him on his desk. I was informed of his flagrant lie almost immediately after the game. I confronted Dr. X in his office the next morning (where I knocked everything off of his desk and informed Dr. X that now someone could sleep with him on his desk, but that person still would never be me). I stormed out as security was coming and went directly to the Dean's office and broke down crying. I spoke about how victimized I was, how he had done this to other young women, and how he should be fired. Dr. X had a huge grant with the Downstate medical center, and was barely disciplined. I was livid. Many other female students spoke to me of how they had been exploited by him. They were violated, forced to sleep with him, perform sexual acts with him. They appreciated my exposing him for the predator that he is.
To the best of my knowledge, no charges were ever pressed against him and I am positive that after this incident he continued to defile many other young women.
Since my days at Tufts University, I have always carried pepper spray or mace. I carried mace all through medical school and unfortunately had to use it a time or two on sexual predators in the call rooms. I would recommend to today's young female physician to always have pepper spray/mace and your phone charged in case you need to record something and later play it back to authorities. Additionally, it is better to walk in groups and be paranoid. Park in well lit places. Finally, stand up straight, be firm, look sexually harassing/aggressive men directly in their eyes and even if you are scared to death, do not appear shaken. If something untoward does happen to you or your friends gather up all of the evidence and tell the school, tell the police, tell the newspapers until someone listens.
Dr. Waldorf: Although I loved my surgery rotations, there was a trickle down of verbal abuse—which in the late 80s was particularly harsh towards the female trainees. That was not the case in dermatology. In fact, even as a medical student I had numerous female role models as well as supportive male mentors. I have not had sexual harassment in my medical training including my dermatology residency and derm surgery fellowship. But I know others who have. I was also prepared for anything. My mom was a law associate at a Park Ave law firm in the 1970s and had a partner “hug” her from behind and grab her breasts. She knew she had to deal with him but had to squash it and said, “Please get your hands off my husband's property.” Clearly, she didn't think she was my dad's property but she hit home because it resonated with this guy and luckily he stopped there.
Growing up the daughter of a feminist was the best training I could have. It meant that instead of standing uncomfortably or angrily as an attending told a sexist joke, I could politely apologize that I must not have understood the humor and ask if he cared to explain it. (He didn't). When threatened by a superior who had the ability to ruin my career, I politely told him I was very disappointed in him. Being a lady isn't a weakness. It's a strength! Remember Queen Victoria, Golda Meier, Wonder Woman, my mom—all ladies!
Women Must Band Together
Sticking together and supporting other women, instead of putting them down, is one way to help achieve gender equity in dermatology and in life. Dr. Day notes, “In my career some of my greatest obstacles have come from other women. It's something not openly discussed, but not all women are supportive of other women.”
Visit PracticalDermatology.com for more from the panelists, including insights on supporting each other.
The editors of Practical Dermatology® thank Dr. Waldorf for her help in putting this roundtable together and reviewing the content.