Yalda Jabalpur 00:00:00 You don't need to bend to the system. Create your own path, but make sure then that you're going to your leaders and advocating for. Look at what I'm doing x, y, z. It's not the traditional way that you do leadership, but look at the impact it's having. I need to be rewarded for this and to fight for that. You know.

Alison Latreille 00:00:28 Welcome to Off the Chart, A Business of Medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the assistant editor of Medical Economics, and I'd like to thank you for joining us today. As we wrap up Women in Medicine Month, I sat down with Dr. Yalda Jabbarpour, a family physician in Washington, DC and director of the Robert Graham Center at the American Academy of Family Physicians, along with Dr. Annie Koempel, a qualitative scientist with the American Board of Family Medicine. We talked about their December 2024. Study on early career women family physicians and what it reveals about leadership, recognition and the future of the profession.

Alison Latreille 00:01:07 In our conversation, we dive into the invisible leadership roles that women physicians already take on, why those contributions are overlooked, and how medicine can move forward towards a more collaborative and inclusive model of leadership. Doctor Jabalpur and Doctor Temple, thank you so much for joining us. So now let's get into the episode. So we can just jump right in. September is Women in Medicine Month, and we're going to be talking about a study that both of you had a part in publishing late last year. The study highlights that women physicians already take on leadership roles that medicine rarely acknowledges. Can you describe what that looks like in practice?

Yalda Jabalpur 00:01:45 yeah, I can speak to the practice, and then Annie can speak to what she found in the study, when she talked to other doctors. So, you know, I still practice clinically as a family physician, along with, directing a research center, the Robert Graham Center. I think, you know, in the family physician role, a lot of the times it's it we're doing things that are, that I consider leadership that aren't being considered by our health system as leadership.

Yalda Jabalpur 00:02:16 So, for example, mentorship, I think is a great example of leadership, but that typically is not, compensated or valued by the higher ups in health care systems. teaching I consider leadership obviously also not valued, not compensated at all and not valued in terms of, you know, higher ups in the health care system. I also think leading the team within the clinic and doing it in a collaborative way, is a lot of things that, you know, all physicians, but, particularly female physicians take on that role. It's not compensated at all. It's not valued at all in any way in the in the higher ups. And these are important things that make our system run and foster the future generation of physicians, but aren't aren't compensated in any way, whether it's monetarily or not, monetarily.

Annie Kemble 00:03:23 I would absolutely echo the mentorship and teaching aspect. it's incredible that women are supporting other women, but that really needs to be recognized and rewarded. I would also add, just a little bit of the detail from interviews to the women taking on leadership roles within their clinic.

Annie Kemble 00:03:39 A lot of times that would look like the women in the study identifying where there were problems or workflow or where that certain people could be more efficient, especially working in their EHR, and they would go out of their way, take time out of their day or after work to help people increase work flow, get better at their job. And that was in no way rewarded or recognized.

Alison Latreille 00:04:02 And kind of building off of that. Could you talk about what that means, really for career advancement? I mean, compensation down the line, risk of burnout, maybe for these women physicians who are doing so much but aren't really getting any kind of reward or feedback for it.

Yalda Jabalpur 00:04:17 I mean, I think you can look at this in two ways, right? There are things that you need to put on your CV for career advancement. Right. And then you can look at it, in terms of wages for career advancement and the way that we're not valuing, not recognizing, not rewarding these leadership activities that women take on leaves it so that there's nothing to put on their CV that's valued to help them get kind of that next higher role or next higher role.

Yalda Jabalpur 00:04:48 And also, there's no monetary compensation. So you know that gender wage gap persists because they are, as Annie said, spending extra time doing these things that you know are benefiting the entire organization, that aren't aren't considered leadership and aren't compensated. and so so in both of those ways, I think in a way that we are, I guess, penalizing women for taking on leadership roles that aren't considered in the current way, that we view things as traditional leadership roles.

Annie Kemble 00:05:25 Yes. The only thing I would add to that is a lot of these things are also considerable emotional labor. And so there's kind of the emotional, psychological impact of doing these incredible things with no basically no things that can be really frustrating. And there was a lot of frustration in interviews.

Alison Latreille 00:05:43 The next part of the study that I want to talk about is many of the physicians who were interviewed described formal leadership positions as overly bureaucratic or disciplinary. Why do you think that leadership and medicine is still defined that way, and how does it affect women who might otherwise want to pursue those kinds of leadership positions?

Annie Kemble 00:06:02 Yeah, I just I mean, briefly, medicine has given us so many great things, but it's not immune to the white patriarchal influences that infect so many of our institutions, not only in the US but around the world.

Annie Kemble 00:06:13 And I think leadership will continue to be defined as bureaucratic and disciplinary and so on, until more women and others enter leadership positions and make real change and really change our understanding of what leadership does and can mean. yeah, I'm sure you all have that.

Yalda Jabalpur 00:06:32 I mean, I think that's exactly right. but yes, medicine is not immune to what happens in leadership in industries all around the world. I will also say that, you know what? Society. Maybe it's just American society. I can't talk for other societies. But what society views as a strong leader, which is characteristics of a strong leader, which is someone who can make the tough decisions and tends to be really strong willed and, you know, loud voice and can stand up and command a crowd. what we heard from many of these women, but also what we know just from experience, is that women lead in different ways. They tend to be more collaborative, more. It doesn't have to be my voice. It's all of our voices.

Yalda Jabalpur 00:07:27 And that is not what we value as a society in leaders. And so even though a woman is is, in my opinion, acting like a leader, you know, the health system that she works for may not feel that she is a leader because she doesn't have that loud voice. She's not standing up in front of a crowd. She's not making those unilateral decisions.

Annie Kemble 00:07:51 Yeah, one one physician said, and this is a quote, people in leadership positions are not interested in community and collaboration. And that was a turnoff to her that made her not want to enter a leadership position.

Multiple Speakers 00:08:06 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Multiple Speakers 00:08:12 Oh, then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again that's patient care online.com.

Alison Latreille 00:08:25 And continuing on that note in your interviews with I believe it was 25 family physicians, what stood out most about how women physicians define or practice leadership differently than the traditional models?

Annie Kemble 00:08:36 Yeah, I mean, I think exactly what Yalda was laying out, what that physician said, just the collaborative approach, the solidarity, the communication or the community approach over the I'm going to make the decision.

Annie Kemble 00:08:48 I'm going to be the one doing everything. Yeah, I think I think that's what stood out most to me. all of the 25 interviews.

Multiple Speakers 00:09:01 could you each share an example of the invisible leadership work that women are doing and why? It does go kind of unrecognized. I know you talked about teaching and mentorship. but maybe some specifics in practice.

Yalda Jabalpur 00:09:16 Yeah, I'm trying to think, I mean, about something that we haven't shared yet. I think Annie really did touch on this, but some of those quality improvement metrics that women take on, and it and it goes to what we just talked about, about how they do it in a collaborative and kind of, community based way. I don't know a better way to say that, but it's not, you know, I'm the doctor. I think this is what needs to improve. Therefore we're going to implement that and improve it. It's like, hey guys, what what do you think about this? What do you think about that? Should we do it this way or that way.

Yalda Jabalpur 00:09:57 Some. And and I think and again when we're talking about all this, we're speaking in generalities. Right. There are people in each gender who, who definitely, you know, there are men who are very collaborative and women who are not. Right. But we're talking about we're talking about the general, the general population. And I think that, you know, some people may see that as you're the physician, you make the decision, you're the boss. and, you know, you're being kind of wishy washy by asking all these people for input and saying, like, let's take a vote and make the decision together. No, like, you just make that decision. And that's why they don't seem like a leader. But, you know, it's actually, you know, there's so many studies that show that that collaborative way of leadership actually is a very important way to run anything, right, whether it's workflows in the clinic or a large organization. The importance of transparency, collaboration, not making unilateral decisions.

Yalda Jabalpur 00:10:57 But that's not what's valued. So I think it keeps going back to that. They're doing kind of this silent work, and maybe not being seen as leaders because of the way they go about doing the silent work.

Alison Latreille 00:11:10 Something else that came up in the study was kind of how these physicians are dealing with that balance, right between, their careers and their families. What did participants say specifically about balancing leadership responsibilities and their career goals with family?

Annie Kemble 00:11:27 Yeah. So there's there's kind of this myth that and this is not only that women want to make a conscious choice to not advance their careers when they have children. And this may absolutely be true for some women. Like there's no wrong path. I'm not saying that, but participants talked about how it wasn't their kids or their older relatives they had to care for. That kept them from taking on a family leadership position. yes. Women do overwhelmingly still do tend to have a full time job at home with care, work and homework. But they cited other reasons for not wanting to be an administration or leadership first.

Annie Kemble 00:12:03 they encountered discrimination due to being a woman who's pregnant or a woman's children. but that was seen as a barrier. And, if anything, they found a lot of support and encouragement from their families that they didn't necessarily find from administrators or their institution.

Yalda Jabalpur 00:12:28 And I think, you know, just to give some real life examples of what Annie is saying, it's, you know, it really is a lot of the time. Other people making the decision for you without even asking how you feel about it. I mean, there have been so many circumstances where I've been told, oh, we didn't think you'd want to be on that committee because it was at 6 p.m.. And don't you have to run around with the kids and get dinner ready? And I'm like, why? Why me and not my husband? Like, why am I the one that needs to be running around with the kids? So, you know, and and I shared this before, like my husband, who's also a physician, never gets to do.

Yalda Jabalpur 00:13:05 We have the same amount of kids. He never gets told that. Like, oh, we didn't we didn't think he wanted to be on that committee because it's at 6 p.m. or it's a Saturday at 10 a.m. and those are the opportunities that are just never presented to you to make that decision, because people are making that decision for you based on. And I think a lot of times they're doing it to protect you. I understand, but, in a way, it's too paternalistic. It's I don't need to be protected. Just ask me if I want to run around with my kids and don't want to do that. I will say that. And that is a fine choice. But like, let me have the choice.

Alison Latreille 00:13:42 Absolutely. Yeah. if practices and health systems don't broaden their definitions of leadership, what's at stake for primary care, the workforce as a whole and for patients?

Yalda Jabalpur 00:13:55 Yeah, I think we we started to see this already. Austin, when you hear patients talk about medicine right now on social media, wherever, a lot of patients are being very disgruntled about how they're not being listened to, how, you know, they're being told that, well, I don't know what's going on.

Yalda Jabalpur 00:14:18 And that's not what we do in medicine. And that's a very paternalistic view of way of practicing medicine to not include the patient in that decision making, to not include the patient in their own health. And I think it stems from the way that we are leading health systems with that strong unilateral, you know, on making the decision voice, what would happen if instead we had really collaborative, transparent leadership, at the top that that included the community in decisions that were being made, about health systems, about insurance. I feel like patient care would improve. There are things that are really important to patients that we, as a health system, never really take into consideration because our leaders are are making those unilateral business decisions without thinking about, well, what did the patients actually want? So I think there is a translation there between how leadership, is viewed like what women value in leadership, what men value in leadership, and how that's being translated to health care right now. And I think the more women you have in leadership or just in general, the more diversity of thought you have in leadership, it's going to ultimately be better for patient outcomes.

Multiple Speakers 00:16:04 Hey there, Keith Reynolds here. And welcome to the P2 Management Minute. In just 60s, we deliver proven real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before launch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow hack, an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at Kay Reynolds at Lifesciences comm with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching and I'll see you in the next P2 management minute.

Alison Latreille 00:16:53 Your paper also calls for innovative leadership models built on collaboration, flexibility and balance. What might those models look like in real practice?

Yalda Jabalpur 00:17:02 You know, it's a it's a great question.

Yalda Jabalpur 00:17:03 I think we've talked somewhat about this. Like, you know, in practice these models would look like including the community members who decisions are impacting. Right. So for example, if you're a health care system, you should have patients from the community as part of the leadership. And they should have as much of a voting role as the CEO of the health system does, because ultimately that's who you're serving is that patient population. I also think just thinking in a very that's like high level, but even just thinking at like a simpler, you know, on the ground, like the clinic level are we for example, do we have leaders within the clinic that are, talking to the doctors and nurses and saying, hey, or doctors, nurses, patients may be saying, hey, does this traditional 8 to 5 clinics schedule fit everyone's needs, or do we need to shift hours earlier or later? Simple things like that that no one thinks of doing because it's like, well, this is how it's always done.

Yalda Jabalpur 00:18:16 We're not going to ask people. We don't want to know the answer because then it's hard. Then we have to change things, right? so I think there are big high system level things. and then there are smaller, you know, boots on the ground if we had more collaboration in terms of how we set up physicians schedule or clinic schedules, how we, how we set up workflows in the clinic, things could really run better and improve for everyone who's there.

Annie Kemble 00:18:49 Yeah, I just want to pick up on one thread of that, which is I think a lot of times we see the way things are now as like the weather or the air we breathe or like, we can't fix this, we can't impact this. but our health care system and other systems was and continues to be built and maintained by people. And I think we can sometimes take this for granted. But like all of us said, I think we can make real practice on practical, real, practical changes on an individual level.

Annie Kemble 00:19:15 And I mean, it would be hard and long and slow, but I think that can lead to to broader change.

Yalda Jabalpur 00:19:23 And also give you like small examples. you know, we're, we're used to working in like a certain time period of the day, and sometimes that's conducive to family life or caretaking, like taking care of elderly parents. And sometimes it's not. And, you know, like right now I have a woman, chair of my department who is very aware of these things. And like everyone in the department now has these these little things at the bottom of their email. That's like, I may be answering you at a time that's convenient for me because of how I live my life. Please don't feel like you need to answer me right away. Answer at a time that's convenient to you. I mean, I know it seems like. Okay, yeah. That's common. Yeah, everyone does that. But I'm telling you, when I was in medical school, when I was in residency, when I was first out in practice.

Yalda Jabalpur 00:20:24 No way, no way. Like, if you had that quote at the bottom of your email, people would be like, whoa, no, you answer my email when I want you to answer my email, right? So I think, you know, it's just like little changes like that that make the environment feel so much more welcoming for everyone and kind of change how we think about how things need to be run. And medicine is not unique there. I know that's happening in a lot of industries.

Alison Latreille 00:20:55 Absolutely, yeah. if you both could change one thing about how leadership is structured and family medicine, what would you change?

Annie Kemble 00:21:05 Can I pass it to you? You all did. Physician. No pressure.

Yalda Jabalpur 00:21:10 Really. I think I've touched on this. I think that the people at the top who need to be making the decisions, the leaders need to be the people that are actually impacted by those decisions. So when we're talking health healthcare. It needs to be a combination of physicians, support staff, nurses, front desk, and patients.

Yalda Jabalpur 00:21:36 It should not be, you know, someone with an MBA who's not practicing medicine or going to that clinic making the decisions for the physicians, nurses and patients.

Alison Latreille 00:21:49 What advice would you give to these women who are in the early part of their careers as physicians, that they see themselves as leaders, but maybe they feel boxed out by the traditional paths of leadership?

Yalda Jabalpur 00:22:00 I think find a good mentor who has gotten to where you want to get to, and ask them how they've done it. I think every system is different, every region is different. So you really need to find someone, whether they are a male mentor or a female mentor, and ask them how they got there. I would also say, don't, don't just think leadership is the way that we define leadership. You know, do leadership the way that you want to do it. Do the things that you want to do and then, make a strong argument for why that should be rewarded, either financially or in other ways to your leadership.

Yalda Jabalpur 00:22:46 So you don't need to bend to the system, create your own path, but make sure then that you're going to your leaders and advocating for. Look at what I'm doing XYZ. It's not the traditional committee. It's not the traditional way that you do leadership. But look at the impact it's having. I need to be rewarded for this and to fight for that. You know.

Annie Kemble 00:23:07 Yeah. And I would say also think about how start noticing the the leaders in your environment, like who who is a leader that is being recognized and rewarded. And what can you do to support them? And I don't know, I think going back to what we're talking about before with like community collaboration, any. Anything you can do to support that, even if you're not the one in that role? kind of lead to lifting everyone up.

Yalda Jabalpur 00:23:35 I know, I'll also say just engage with your leadership. Like I think people get disheartened and then just, you know, instead of engaging with the leadership, want to just dismiss them and, and be angry about it.

Yalda Jabalpur 00:23:50 And I think instead take a meeting with your, you know, whoever it is, the chair of your department, the CEO. I mean, they are there to lead you. They will take meetings with you and go and air your grievances. And you never know. I mean, always assume good intent. They might be doing exactly what you want. It's just not communicated that way. And I think it's that's that's a great way to learn. Also, you know what our good qualities in a leader. What are not good qualities in a leader as you're trying to develop yourself as a leader? So I think take those meetings, ask for those meetings, get involved. I mean, I feel like, right, the squeaky wheel, what is it? The whatever gets the grease or the oil or whatever the I'm not really great with sayings, but like, I think if you are the squeaky wheel, eventually they'll be like, maybe this person just needs to be on the leadership committee, you know? And if really that's what you want to do, I think keep, keep making noise and keep engaging in a respectful way.

Alison Latreille 00:24:53 To end things. On a positive note, what gives you optimism about the future of women in medical leadership?

Annie Kemble 00:24:59 Well, I mean, I think just straightforward how how critical and aware they are of the flaws in the current structure and system and how brave and courageous they are to speak their mind and advocate not only on behalf of themselves, but on behalf of each other and other people to try to, you know, make any small change, even when that is really frustrating.

Yalda Jabalpur 00:25:21 100% agree with that. This new generation gives me a lot of hope. I mean, there. You know, when when we have medical students or residents either rotate through clinic or come and spend a month with us doing research at the Graham Center, I'm always like, oh my gosh, I can't believe you're doing that. Or, you know, a feel confident enough to say that, you know, medicine used to be so much so hierarchical where, you know, if you were the attending, everything you said goes, no one can question you.

Yalda Jabalpur 00:25:58 No one can ask, you know. Are you sure this is right? Are you sure this is right? And I think that was horrible for patients. And I love that the new generation just comes in and questions everything. And I think that that is wonderful. That gives me hope. You know they're not just. They're not just going for systems the way they are. It's like, wait, but why are we doing like it like this? But why are we doing it? I love that, I think that's great.

Alison Latreille 00:26:30 Is there anything that I didn't ask that you think is important to share?

Annie Kemble 00:26:33 I will just add, I think this entire conversation, we did talk kind of on a gender binary. And there is, you know, we understand the gender. It's not a binary. There are all these other different understandings of gender. All of the participants we interviewed self-identified as women. so I just wanted to make that note. And I also wanted to say that this is not I think y'all have mentioned this, but this is not only in medicine, like these issues are occurring in other places, in other ways.

Annie Kemble 00:26:59 and so even if you aren't a physician, I'm sure sadly, some of this will resonate with you.

Alison Latreille 00:27:05 Absolutely. I think that's a really important note. And and especially a good point to end on. Doctor Davenport and Doctor Campbell, thank you both so much for taking the time today.

Annie Kemble 00:27:15 Perfect. Thank you so much.

Alison Latreille 00:27:20 Once again, that was a conversation that I had with Dr. Yalda Jabbarpour, a family physician in Washington, DC and director of the Robert Graham Center at the American Academy of Family Physicians, and Dr. Annie Koempel, a qualitative scientist with the American Board of Family Medicine. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask you please subscribe so you don't miss a next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts.

Alison Latreille 00:27:53 Also, if you'd like the best stories that Medical Economics and Physicians Practice published delivered straight to your email. Six days of the week. Subscribe to our newsletter. So that medical economics and physicians practice off the chart. A Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical economics, Physicians Practice and Patient Care Online are all members of the MJH Life Sciences family. Thank you.