For the first time in its history, the American Medical Association will have three consecutive female presidents. Drs. Patrice Harris, current president; Susan Bailey, president-elect; and Barbara McAneny, immediate past president; come from different life experiences and clinical backgrounds, but they agree that while the industry has made strides in promoting diversity, more needs to be done to give women an equal voice in leadership. The AMA has deemed September Women in Medicine Month. Modern Healthcare reporter Maria Castellucci sat down with the three AMA leaders. The following is an edited transcript.
MH: Can you reflect a little about what it means for the AMA presidency to be held by women in three consecutive terms?
Harris: I’ve coined the term for the three of us “We Three” because I think it’s a very exciting, very historic moment.
I think it means that the AMA continues to evolve, is more reflective of the number of medical students that are training today. Over 50% of women are continuing to aspire to leadership in the AMA. Although we are representative of that, we are not by any means where we need to be and we need to make sure that there are continuous opportunities for women in leadership. But I think we will use this year and this opportunity to highlight accomplishments and to be tangible evidence that a woman can aspire to leadership.
McAneny: We also send a great message to young women across the country about what the AMA can do and who we really are. None of us ran (for AMA president) because we’re women. We ran because we’re doctors. We ran because we see all this stuff going on in healthcare that we think is crucially important. And we all have important things to say about the future of healthcare. The fact that we’re women just means that we can send the signal to men and women across the country that women have ideas that need to be listened to.
Bailey: And I think the three of us serving together is such a visible display of how much the AMA has changed in general. Far too many people still have the idea that the AMA is a bunch of elderly, retired white-haired white men who sit around and think up things to do.
MH: Where do you see opportunities for improvement and strategies that the industry can take up to try to secure a pipeline for women in leadership positions?
Harris: It starts with recognizing talent early and nurturing that talent. Folks did that for us. Both men and women supported us in our journey at the AMA and I think that’s what we need to do … making sure when women are in the room, their voices are respected and heard. I’m sure all of us have had the experience where we talk about a great idea in the room and nobody says a word and then five minutes later, perhaps a male colleague says the same thing and it’s the best thing since sliced bread. What those who care about advancing women in leadership can do is make sure that women get recognized for great ideas and then sponsor them to further leadership roles, provide training opportunities, leadership development opportunities.
McAneny: Literature has shown that when you have a diverse group of opinions in the room committees are more productive, boards are more productive, people just get more stuff done than when you have a uniformity of opinion and male/female does that, people of color do that, people of different practice settings do that. Different ages, all of these factors, the more differences you can get in the room, the stronger you are and the stronger the organization is.
MH: Looking back over you personal careers, did you face any challenges based on your gender? How do you think it’s changed for women?
Bailey: I did not face any overt problems. And I worked my way up through organized medicine in a very traditional way. I was president of my county medical society. I was speaker of the Texas Medical Association House of Delegates and was on their board, ran for president, was chair of the Texas delegation to the AMA. On the other hand, I really didn’t have any female mentors. When I first started in the AMA, there were two women in the House of Delegates, and we had the women’s caucus in someone’s hotel room because that’s all the space that we needed. But I had great male mentors. The women mentors that I did have inevitably were just a step or two ahead of me.
McAneny: I was one of seven women in a class of 175. If I asked a stupid question, the answer was, “Women shouldn’t be doctors.” Truly. And I remember clearly my surgical rotation—(it’s) probably why I’m not a surgeon. All of the men would go into the doctor’s changing room and I was relegated to the nurses’ changing room and I would change quickly and run out and stand there and wait and then discover that all the men were sitting in the doctor’s changing room, going over the surgery and what was going to happen, what the anatomy was. And then at the operating table they’d asked me a question and I wouldn’t know the answer. And they’d say, “Weren’t you listening?” I also remember a time, my first night on call as an intern, which is intimidating anyway … and I was in the intensive-care unit. My resident was downstairs sending up admissions like mad. People were in cardiac arrest and doing all kinds of terrible things.
I just ran around putting out fires all night. The next morning, when my attending showed up, I didn’t even know it was morning. I thought that he was there to help. I thought, “Thank God somebody called in reinforcements.”
He dressed me down because I hadn’t written down any of my notes … And I said, “Nobody died.” I went into the call room and I closed the door and I cried. And I decided that no one was ever going to make me cry again when I knew that I had done what I was supposed to do. That was a defining moment. You need to have some degree of toughness to get through because it’s still a world where the powers that be are mostly men and any sign of weakness or tears are taken as being that you’re not competent. If a man screws up, it’s like that guy screwed up. If a woman screws up it’s, “See, women aren’t good enough to be doctors.”
Harris: My journey was a little bit different because I went back to medical school late. Growing up in West Virginia—in Bluefield, which was the gateway to all the coal mines—my mom was a teacher and my father worked on a railroad. My role model for medical school was the TV physician. Everyone’s heard that story.
But when I went to undergraduate at West Virginia University, I didn’t know what to do, didn’t know how to get to medical school. And my advisers were not helpful. So I did some other things, which actually, as I look back on my journey now, I appreciate, because I think that helped me in my leadership journey. I worked for the university for awhile. I recruited African American students to come to West Virginia because it’s not a very diverse state. So when I got to medical school, I had a little bit of experience under my belt.
Some of my attendings on my third-year rotation said, “Patrice, you’re very mature.” I allowed it as a compliment, but in some ways I thought that was even unfair to my colleagues because I was older.
McAneny: So implying that they’re immature.
Harris: Exactly.
I was the only African American in my class and that’s another issue to talk about sometimes: the intersection of being more than one group.
My journey through the AMA came through the American Psychiatric Association, my specialty association. We went through AMA rule changes, going from two delegates to seven. The APA appointed a very diverse delegation. Men, women, gay, straight, African American, Asian American. We decided that we really wanted to make sure that psychiatry was represented in the House of Medicine because traditionally, psychiatry had been an afterthought.
MH: The AMA is pretty involved in reforming medical education and is starting with residencies too. Is there anything specifically in those two areas where you see opportunities for improvements in diversity?
Bailey: There are still residencies out there that have no provision for women who become pregnant. They have no maternity leave policies and women are still having to cobble together a week of vacation here and a week there and without any support from their programs whatsoever.
It was that way 35 years ago and it really still is that way. Women are being shamed in professional meetings in 2019 for bringing a nursing baby into the meeting with them or just having a baby there period. That is absolutely ridiculous. We talk about burnout and we all want to do something about it, but if we can’t allow women to lead the lives that they want to lead, if they want to start a family, they should be able to start a family. If they don’t want to, they shouldn’t feel like they have to and everybody should be able to make their path and have a quiet baby in the back of the room. It’s not going to impede anyone.
Harris: You have to be intentional, meaning you have to think about the issue, identify the issue and make an intentional action. For instance, there’s a program where the dean, who is a male, has four women chairs of departments. Why does he have four women chairs? Because he saw that as an issue. He had to be intentional in the search and the search process. It’s not just enough to say, “Wow, women are 50% or over 50% of the class. Eventually they’ll catch up.”
MH: I had some questions about other issues in the news. Surprise billing is on everyone’s mind. The AMA supports a third-party arbitration approach. Where are you in terms of that legislation?
Harris: It’s difficult to predict what will happen in Congress. We continue to educate people about this issue. There is no question that we want patients out of the middle, but we also want a fair process. We want a level playing field. We think having arbitration—independent arbitration—is the way to go rather than giving insurers the opportunity to set prices, which would be likely to their benefit.
McAneny: We need to make sure that the insurance companies, when they’re selling a policy, that they are actually delivering what the patient thinks they’re getting, which is a full network. But the ability to negotiate a price is key and right now the playing field is very unlevel.
MH: The AMA recently dropped out of the Partnership for America’s Health Care Future, which is opposed to Medicare for All. Can you talk about that decision?
Harris: The partnership highlighted concerns that everyone had about a single-payer approach, a Medicare for All approach, but at this time, the AMA wants to spend our time focusing on the path forward. And the path forward is building on the progress of the Affordable Care Act. We believe that we should not disrupt the current system where about 90% of people in this country have affordable, meaningful coverage, which is our goal.
MH: Turning to gun control, what kind of lobbying or efforts are you doing?
Bailey: The AMA believes that common sense reforms that are broadly supported by the American public are needed. But the thing that’s needed the most is research into the causes of gun violence. We are a science-based profession. And as Dr. Harris said so eloquently in a recent interview, the science leads us and we are involved with the (American Foundation for Firearm Injury Reduction in Medicine), a group that is obtaining research money. Their goal is to prevent the next shooter from shooting. We support prohibiting assault style weapons. We support universal background checks, things that are fairly widely agreed upon by the American public.
McAneny: I will add on the fact that we declared this to be a public health emergency. If there were an infectious disease in the country that was killing as many people as gun violence is, the entire population would be demanding that something be done.
Harris: There’s no one-size-fits-all approach to this. It’s mass shootings, it’s suicide, it’s homicide and community violence. It is critically important that we not have a knee-jerk reaction and say that all of the mass shooters or all of those who perpetrate this gun violence have mental disorders. We have to make sure that we look in the area of risk and not a diagnosis.