We are so excited to share the truly rich content from our interview with the remarkable Dr. Tracy Sanson. She’s held leadership roles in the US Air Force, the University of South Florida, and TeamHealth, and she has some terrific advice about why you should work harder on yourself than you do at your job, and her mission to hold the door open for those coming after her:

Tell me a little bit about where you are currently in your career and how it was that you came to be there.

T Sanson: I’m currently at a crossroads in my career. I’m at that position now of being what we call the sandwich generation, both handling children who are in college as well as elderly parents, and the needs that go with both of them. And at that crossroads, I’ve made some changes in what I do. I was with the University of South Florida for an extended period of time. I was part of the group that started the new emergency medicine residency there. And I was the Education Director for greater than a decade. In the last several years I’ve taken off on my own in a new company that I’ve developed, as well as moved over to a loose affiliation with the University of Central Florida Emergency Medicine Program. For my emergency medicine now, primarily locums, I will work at various locations that work for my family. To be able to interact with them as well as do my shifts. So it both gives me that ability to connect with them, to be in the general area of them as well as to meet my needs of being who I am, which is an emergency physician. And that’s how I have kept the association with the University of Central Florida, is I’ve done some of my locum shifts at their relatively new emergency medicine program.

M Lin: Great. Tell me a little bit about your company now, and how that evolved.

T Sanson: So my company is Tracysansonmd.com. And it grew out of something that I started about 15 years ago called Beyond the Medicine. They were non-clinical topics. The professionalism topics, communication, negotiations, just bringing your soul to work. More recently a direction that I’ve gone has been in resilience, suicide prevention, how do we handle litigation stress, how do we handle interacting with colleagues; just life events.

I think you clearly realize, or at least I did as I’ve matured through emergency medicine, is that it’s all about life. Initially we used to worry about maternity leave. Now I worry about do I have enough time to make it to my mom’s chemotherapy treatments, things like that. There are life events all the way across, and through these we need to navigate as both being humans and emergency physicians, and academic emergency physicians. And a lot of that education is missed in our upbringing in medical school and residency.

I personally don’t have asthma, which I think is fantastic. I cannot count how many hours I’ve had on asthma as education, and yet very little on how to handle divorce, disruption, displacement, disruptive colleagues, all those types of things that I have on almost a daily basis. So that went into my professional speaking career, and that is now become the direction that I go as far as educating folks.

M Lin: How has gender played into your career?

T Sanson: It’s interesting. I’m as mature in emergency medicine to remember the days quite often of being the only female. I started as a young medical director as the only female in that group. I was in the military as a payback for my medical school scholarship, the HPSP program and one point was the only female staff attending. We had residents but relatively few residents.

For me it became a galvanizer. I would say that my career has been focused on bringing up women with me. Now that I’ve moved up and made the connections of making sure that I hold those doors open for the people behind me. I just finished my reign, I guess you would call it, as the president of AAWEP. ACEP’s American Association of Women Emergency Physicians. I believe very strongly that we need to be looking out for each other, amplifying and promoting each other. Then, as you mature like I am, of giving those opportunities to the folks that are around me.

That’s what got me here. When I first started out, it was called Women in Emergency Medicine. It was called WEM and the people that I remember, Pat Salberg, Ellen Toliver, Lou Andrews, Diana Fite, who came up and said to me, “Wow, could you come give this lecture?” I remember Diana Fite, she said “I have a domestic violence lecture I need someone to give. I’d like you to do it.” It changed the trajectory of my career. I found that the subject became a passion for me. The idea of speaking became a possibility for me. It was one woman saying to another one, “You can do it.” And that is what I have continued to do.

My career’s been pretty variable. I graduated residency and then had a military payback. I was in the Air Force. I became vice-chair of the department and education director for a joint Army and Air Force military program. I left the military. Moved to Florida where I became a medical director of a small ED then an associate director of an even larger director ED. Then we started the University of South Florida EM program. I did that and then I went back out into the community again which is where I am with emergency medicine now.

Through all this, I think a constant has been for me, is the reconnection with women to allow me back into places that I had stepped away from a little bit. For example, when I was Medical Director, no longer Education Director, I had stepped out of the leadership positions in SAEM. Yes, when I came back as Education Director for the University of South Florida, that is who welcomed me right back in. People like Mary Jo Wagner and Millie Willy. Ellen Weber, Gloria Kuhn who said to come back in and here’s where we are, let me give you these tips. Or here’s policies we’ve done, here’s a curriculum you can use. That constant ability to step out and step back in as life ebbs and flows with you has been important for moving my career forward.

M Lin: That’s great. Can you point to other initiatives outside of, or other opportunities that you might not have otherwise had if it weren’t for women-focused career organizations?

T Sanson: I don’t know. Several of the things that I was able to take advantage of, for example, being on the peer – I was part of the group that put that together. That was Mary Jo Wagner in our AWAEM connection saying, “I need you as a writer on this.” I was Chair of Faculty Development Committee for several years and the woman that I met that comes to mind was Ellen Weber, that would not only champion somebody moving up and into it or, as in her case, had laid the foundation to begin with, that allowed me to take what are my skills and leave an imprint on a community like that.

T Sanson: What I find is that we share and champion, I can’t tell you how many times someone said it to and I now say it to them, “You can do it. Are you crazy? You can do this. And, if you can’t, then we will find a way to keep this opportunity open for when you can.”

T Sanson: I don’t think we should say I can’t do it because my husband says this or my childcare requires this or whatever your obstacles may be. We have women look at what their careers at the moment and their life at the moment and say, “Can I meet whatever this deadline is?” What’s the deadline of this committee, this article, this chapter, this presentation. Whatever it may be. Can I meet this based on what my life is right now? And we make those decisions based on making that commitment or not. Not all these other things. I think that’s been an evolutionary process to learn that.

M Lin: So you’ve clearly been at this a very long time. How have you seen AWAEM and other women-focused organizations evolve over time?

T Sanson: What I have seen is a couple of things. One is the size. There used to be 10 of us and how it has grown from that. What I’ve also seen is the splintering off which I think is fascinating to watch. As we’ve matured and as more women have matured, have taken on leadership opportunities which then brought it back down to say we need more chairs of committees. We need more speakers, we need more program directors. We’re not keeping up with the residents and medical students. The percentage that are females with the percentage of opportunities and advancement.

T Sanson: So there were enough of us who were vocal about that. The door is starting to creep open. What I’ve also seen is a willingness to take on those tough topics. It used to be when I first started talking about what I call Beyond the Medicine, they were quote “the soft skills.” And they’re not. The tough decisions on the lactation rooms. A lactation room that is four floors up and over in OB is not possible as an emergency physician. The being in a little cubby hole where you don’t control the door is untenable for us. I think it took women, and enough women advanced in their careers to say yes, I went through that. I’m going to make sure somebody else doesn’t.

T Sanson: For example, myself personally. I delivered my twins, first children, at 29 weeks. I began to look into that and the impact of circadian rhythm disruption on preterm labor. And then the impact then of preterm labor on the development of those children. Now mine and my whole families life and then how that impacted my potential, my husband’s potential for the rest of society. Well, that can’t happen. So, for our program specifically, and then others that we’ve talked to and who have thought and taken it in, is that women do not do nice as residents their last trimester. Now it’s the circadian rhythm disruption, so you could potentially do all nights. It’s not the nights, it’s the disruption. But then you can’t be at Grand Rounds.

T Sanson: So, this was a decision born out of who I was, trying to go through emergency medicine and then bringing that out to the people that are around us. As we became bigger and bigger and more women and more women, it wasn’t just eight of us sitting around talking about this, or 20 or 30. It was a couple of hundred.

T Sanson: Now you had the, I think, need to change it for the people around, but you also had the support. That’s how we started making some of these changes. We still have a ways to go on paid transparency, on advancement, those types of things. What I’m seeing is that we’re making those changes where in the past, it wasn’t even talked about.

M Lin: Great. Having developed this expertise and leadership and these what you’ve described as non-medical or perhaps softer skills, how do you perceive that leadership in these arenas or leadership in women-focused organizations might be perceived for the purposed of academic advancement such as promotion?

T Sanson: Well, I think we’re going to have to throw our idea of promotion out the window, I really do. So many of the things that we had in the past, because I’ve gone through the promotion. I’ve written the letters. I’ve not been on a committee but I’ve talked with the people that are one there, are archaic. The idea that you stayed at one institution for your whole career and therefore developed your notoriety or your niche or whatever it may be, doesn’t occur anymore. Most of us, and I’m an example of my own.

I’m not a millennial but I’m an example of that moving and deciding every three to five years to add more to your own personal career and development, while in the archaic old way of advancement that actually is a detriment for you. The idea of doing research being the only way of advancing where education wasn’t counted as much. Twitter, podcasts, the short quick articles, the presentations, the high impact items that impact people globally but yet don’t count in advancement, or at least don’t count to the extent that the older ways did. That’s all going to have to change. I think the idea of getting on this tract and continuing straight and only in one direction and on only one time frame does not allow life events.

As two women discussing this, we can say one of the life events might be pregnancy or child-rearing but clearly there are enough other life events out there. Whether or not they’re health issues, family issues, depending on where you live. Right now, if you’re in the Panhandle of Florida, you are not able to continue what you were doing based on tragedies of a natural type. I think we need to start responding to life events in how we advance people as well.

If we don’t, we’ll lose out on the diversity and the rich, rich potential and skills and talents that everybody has instead of the old, kind of longitudinal tract we had.

M Lin: Definitely. Tell me a little bit more about how you came to be involved in AWAEM specifically.

T Sanson: I graduated from medical school and then residency. We had a very strong proponent when I was in residency. Marion Cooper who was in academic emergency medicine. At that point, I think it was actually called WEM maybe. She encouraged us to get involved in AWAEM. Then, I went on to the military and was, as I said, one of the few, if not the only, depending on which year it was.

T Sanson: When I was in SAEM, and then looked for people who looked like me, or who could commiserate like me. I remember one person specifically was Diane Birnbaumer who I was able to sit and have those discussions. How did you do this? What would you have done? AWAEM was always a place of safety and of nurturing and of being able to bounce my experiences off in what, I always felt, was very non-confrontational and safe place to discuss.

M Lin: Yes, absolutely very important. How do you anticipate AWAEM might evolve in the next 10 years to better meet the needs of academic women emergency physicians?

T Sanson: I would like to see a needs assessment. Who is AWAEM now? I’m not sure we know. What are the ages, what are the ethnicities, what’s the sexual orientation. What are the true needs of who’s there right now. As you gravitate towards the top, those that are in higher levels of leadership right now, still tend to have had very similar, almost vanilla-ish, type of experiences. They were tough, I mean, a lot of us were trailblazers in being the only but we were still pretty homogenous in who we were. That’s changed right now. I’d like to see what are the real needs. Yes, advancement, things like pay transparency, pay disparity. But, I think we also have a wider audience who identify as female who have varying needs and we need to start meeting those as well.

T Sanson: I would like the women who step into either ACEP or SAEM, AAWEP or AWAEM, to be able to say there’s somebody here that looks like me and somebody here that I can identify with, I can bounce things off. And maybe, putting two, three, ten of us together, we can take on whatever our need is and make it better for everybody else.

T Sanson: Almost every time, we find when we’ve taken something on, let’s say women just talk about lactation rooms or maternity leave. You start talking about lactation rooms, you invariably make it better for the nurses. You invariably make it for somebody else who had an accessibility problem, whatever that was. They had a gastric sleeve surgery and they need to be able to eat frequently. Somebody who has any kind of process that doesn’t meet our very regimented emergency medicine current lifestyle. Well, once you start looking at how do we become accessible for everybody, it’s not just the woman who needs to pump or nurse. It becomes everybody around you.

M Lin: What career accomplishment would you say that you’re the most proud of?

T Sanson: Oh wow! I would say that it is mentoring. It is. I feel in my career right now, I’m not striving to be the top. There was a time I was going to be chair of this, president of that. I feel like the connections that I have made, the life experiences I’ve made, the opportunities that I’ve tried to create or at least kept somewhat open somewhere. My job now is to find somebody else behind me and bring them up and usher them into it, encourage them into it, browbeat them into it. Whatever it is.

T Sanson: I would say I’m very proud of being very staunchly pro-everybody, clearly the marginalized, and unfortunately as women, I’ve felt that marginalization. I’m going to be pretty damn sure that the people behind me have it a little easier.

M Lin: That’s really important and thank you for that.

T Sanson: You’re welcome.

M Lin: What piece of advice do you have for an AWAEM member at an earlier stage of her career or perhaps a younger version of yourself that you didn’t know back then that you wish you knew?

T Sanson: I have a couple. One of my favorites is work harder on yourself than you do your job. We work harder on our jobs than we do ourselves. Then when the contract’s lost or you don’t get promoted or you need to move, whatever it is, we’re lost. Where if I’d have worked harder on myself, if I knew what frustrates me, what motivates me, what my talents are, if I worked on those talents, if I took skills and sharpened them for myself, I’d be a better mother, I’d be a better administrator, program director, whatever it may be. So, I think it’s to work harder on ourselves than we do our jobs.

Another favorite of mine is to say think – your opinion of me is none of my business. If I’m doing what I’m doing from integrity with what my values are and with the best that I can right now based on what’s going on in life, that’s good enough. We don’t have to be perfect at everything. Pick something to be great at and a little better at everything else. That allows you to live life.

And then I really have taken this from Brene Brown. Two things hold us back in life. Am I worthy and will I belong. I think that’s what AWAEM does. There’s somebody standing next to me saying yes, you belong. You belong here, you belong in medicine, you belong in academics. And yes you’re worthy. You keep moving forward instead of holding yourself back. Those risks, those opportunities we don’t take are usually because of those two questions. Am I worthy and will I belong.

T Sanson: Those obstacles that come our way, which always will, exacerbate those. Oh man, I knew I didn’t belong. I knew I wasn’t worthy. Whereas if we would take both of those and look for somebodies support and develop us through them, we would do better.

T Sanson: One last one is I love the word yet. We think that life is binary. Either or. Either I’m good at this or I’m not. Oh man, I’ll never be able to do this or I can’t believe I did that. If you would use the word yet for yourself, internally in your own brain and when you hear somebody else say it, yet gives hope. Yet says to me, okay, I didn’t get that promotion. They made the wrong decision. They’ll have to live with that. I’m not a chair yet is very different from I’m not a chair. I wasn’t that material. Yet. With a better committee, with more skills, with a different time, with a different place, it’s a possibility. So, I would say as a teacher, I think there are two things for us as faculty. My job is to make sure that you come out as the best possible, credible emergency physician. You could take care of my mother, my daughter.

T Sanson: The second is that you remain employed. With that need to become employed, you have to have those soft skills. Those communication, negotiation, sociability to interact with people. Those social skills. When we hit those roadblocks, which sometimes will stop us… that word yet. Okay, whatever it was, yet I can move on to whatever the other things is with a new skill, more time. Sometimes even a Snickers bar or a good night’s sleep.

M Lin: Yes, those definitely make a big difference sometimes.

M Lin: Name three other AWAEM members we should interview for this project.

T Sanson: Mary Jo Wagner, Valerie Dobiesz. A new young one starting a new program, Sarah Temple in Sarasota. Stacy Marlow Fischer. These are all folks that…. Gabrielle Jacques. All of these folks are people that are at various stages and have talents and skills and nurturing abilities and tenacity and discipline that all are having an impact in their own little niches. I think they can have words of wisdom for the folks around them.

M Lin: Great. Well, that has been so nice of you to make this time. Sorry, I’m going to read you that.

M Lin: It’s been so nice of you to make time for this. Anything else I haven’t asked about AWAEM or about yourself that you’d like to share?

T Sanson: Don’t do it alone. I think don’t do it alone and that’s what women’s groups do. When you get lonely, and when you get isolated for whatever reason it is. You’re the only mother with premature twins or you’re the only woman in the program or the only one lactating or the only researcher when no one else is. There are so many ways you can find I’m the only and I’d like to flip that around that there are people just like you, we just need to look for them. A group like AWAEM has, I think, the ownership to start reaching out and pulling people in so that we are not alone.

M Lin: Wonderful message. Thank you so much again, Dr. Tracy Sanson.

T Sanson: Oh, you’re welcome. Take care of yourself.

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