Michelle Lin, MD, MPH, MS This week, we’re featuring Dr. Stephanie Abbuhl, Professor of Emergency Medicine at the Hospital of the University of Pennsylvania to discuss leadership and the impact of AWAEM.
M. Lin: Tell me a little bit about where you are currently in your career, and how it was that you got there.
S Abbuhl: I am very senior in my career. It’s almost shocking to hear me say that. I’ve obviously been in this business for a while now. Sometimes I have to stop and just think about that. It’s really been an amazing experience. I’m so happy I went into medicine. Not that it hasn’t had its challenges, but I feel good about it. I am thrilled that I actually had the opportunity to do medicine. I actually was on the wave of women back, literally, in the late ’70s and early ’80s that went into medicine when really there had been just a few women before me. Anyway, I’ve had this wonderful view of how women have changed medicine because I’ve witnessed it over my career. It’s been fascinating. That’s why I became so fascinated with the status of women in medicine and to watch them enter what had previously been a pretty much male not only dominated but almost exclusively, except for just a handful of pioneers.
S Abbuhl: I’ve witnessed that, became fascinated by it. About halfway through my career, I decided that I was so fascinated by it that I wanted to make it the focus of my scholarship. For the last 15 or so years, 15 or 20 years, that’s been the focus for the scholarship part of my career. I’m still loving it. I’m still fascinated by it. We still have more challenges ahead of us. I still have energy to work on those, at least for the time being. I am senior. I’m a full professor in emergency medicine at University of Pennsylvania. I am the Vice Chair of Faculty Affairs [inaudible 00:04:30] professionalism. I’m the Executive Director of Focus on Health and Leadership for Women, which is a program at Penn that’s been in existence for 25 years. It’s funded through the Dean’s office. It has a dual mission of advancing women at Penn and hoping to serve as a model for other programs, and to do research on women’s careers and on women’s health. That’s the mission of Focus. I’ve been the Executive Director since 2001.
M Lin: Most of the conversations have been about how organizations have affected women. You mentioned how women have changed or affected medicine. Tell me a little bit more about that.
S Abbuhl: Oh. Yeah. Women have been a changing force in medicine over the last 30 years or so. It may be more difficult to see that if you’re entering medicine in the last 10 or 15 or maybe even 20 years. Women reached 40% of medical schools in the early ’90s, and have been essentially 50% since the mid to late ’90s. It’s fascinating because the latest data from the AAMC, for the first time in history, women make up greater than 50% of incoming first-year medical school classes across the country two years in a row in 2017 and 2018. The percentage of women in the matriculance in the first-year classes is 50.7% or something. I mean, we’re talking about just over 50%. Just as a landmark statistic, for the first time in the history of medicine, that’s just amazing. That’s amazing.
S Abbuhl: Women have brought their talents to medicine. They are clearly 50% of the best and the brightest. They are, I think, bringing slightly different … I mean, I think, obviously men and women have mostly the same talents, the same sensibilities, the same qualities, that they bring to the profession. Are women different? Yes. Slightly. They are. That slightly different is the diversity that we need to be creative and to bring outstanding healthcare to our patients and to do outstanding research and to be the best teachers. We know that now. Right? We know that diversity brings excellence in problem-solving and in teamwork. Women have done that over the last 30 years. Medicine is better for it. It’s something we can be really proud of and excited by.
S Abbuhl: Now we just need to further diversify medicine by remembering that there are still underrepresented groups that have talent to bring that we need to create environments where we can bring them in. Underrepresented minorities is obviously what I’m alluding to. We have more work to do. There’s more work to do surrounding women in medicine. But we have come a long way. Because of where I am in my career and where I started, I can see that.
M Lin: Tell me a little bit about your involvement in women-focused professional organizations including AWAEM over the course of your career.
S Abbuhl: Yeah. AWAEM has been a great organization and exciting to be part of. I was part of the initial group with Kathy Clem and Gloria Kuhn and myself and others. I’m not mentioning everyone who deserves to be mentioned. It was a time when, I think, emergency medicine really needed for women to organize so that they could share their experiences, share in strategy, to not only be successful as individuals but to think about institutional changes both in our specialty and in our own institutions that create the cultures that we all try to survive and thrive in. I think it was needed. I think that’s been needed all across medicine, the big house of medicine. That’s why almost every specialty, probably everyone, I just don’t know about them all, has a women in medicine arm or organization or something. The women surgeons and the women radiologists and on and on.
S Abbuhl: There’s work that can be done in all these different spheres. You can make a difference just in your own department. You can make a difference at the level of your specialty organization nationally. You can make a difference at your institution. We all, I think, those of us that have really wanted to make this the focus of their career try to find the sphere where you can have the most impact and make the biggest difference. We need all of the above. AWAEM came along and it was a great time. Of course, a similar organization at ASEPT, I think, got formed at about the same time, or maybe shortly after. It has been, I think, extremely important for emergency medicine.
S Abbuhl: Again, the voice of women brings a slightly different point of view but an extremely valuable one. One that needs to get organized well enough so that it can be heard. I mean, there’s power in numbers. I mean, that’s what’s so exciting about where we are right now. Women are just a force. If we can organize to the extent that we have a clear voice. I mean, again, we won’t all agree on everything, but to the extent that we can come to some general recommendations and general conclusions that can be implemented and that can be conveyed and communicated across our specialty, that’s how we can impact change. That’s one of the ways we can. AWAEM has done that. That’s been great.
S Abbuhl: If I’m thinking about what does AWAEM bring, and it brings many things, but not only does it, as I just described, to organize us, bring us together, come to some general conclusions that we agree on. We also can do a search and scholarship together, which allows us to have a voice in a scholarly way, which, I think, in medicine when you’re trying to make change, that’s a really important approach. Right? I mean, we’re evidence-based in our clinical practice. There’s no reason why we shouldn’t strive and want to be evidence-based in the way we approach issues like unconscious bias or issues like how we define leadership and is it the best way to define leadership, et cetera. AWAEM has also led to some significant scholarship that I think has helped move the needle in our specialty.
M Lin: How would you say AWAEM has impacted your career specifically?
S Abbuhl: That’s an interesting question. When I became involved in the AWAEM, I had already committed myself to advancing women doing research and scholarship in this area trying to think about best practices. I had focused my sphere of influence primarily at my institution where I had been since I’d done my residency. I understood my institution very well, at least I thought I did. I cared enormously about the faculty around me, many of whom I had known for years, and many of whom I was mentoring and helping to bring through the system. I had committed originally my effort at Penn. All along, it wasn’t as if I didn’t care or want to be involved with a more focused approach in our specialty of emergency medicine. It’s just you only have so much time and energy in your career. You do sometimes have to just focus where you think you might have the most impact.
S Abbuhl: Then AWAEM came along and I just couldn’t say no. They were great women. It’s our field. I really felt like emergency medicine could benefit from what we were going to try to do. I was grateful to many of my colleagues back then who said let’s work together. I was part of that group. Again, it was very much a team effort. In fact, really led by, I think, Kathy Clem, although I hate to single any one person out because it was such a group effort, but she certainly was a powerful force in the beginning. And Gloria and others, too. We were part of a task force that was the beginning of the formation of AWAEM. I mean, basically, the task-force recommendation was that an organization like AWAEM should be started and that this would be a vehicle again to bring women together, to make recommendations, and a force for change.
S Abbuhl: So then I worked with that organization and was, I think, the second president of AWAEM after Kathy. It was just a whole another area, and emergency medicine … It’s interesting. I mean, emergency medicine, in my simplistic view, sits somewhere between a surgical specialty and a medical specialty, and it has a piece of that surgical culture, at least it did, I think, initially. I mean, I do think it’s been changing and evolving since its inception, but I think, as we all know, the surgical culture has been an area that was even more difficult, I think, for women because it was so male dominated and just had its own unique culture that, I think, it was a challenge for many women to enter that culture, survive, and certainly to thrive.
S Abbuhl: And so I think emergency medicine had a little of that and for many other reasons, because again of unconscious bias, because of work-life integration and balance issues, for all the many causal factors that create some challenges for women. So it continues to have a very low percentage of women chairs. I think the latest data was 10% of chairs are women, and that’s on the low side. The average is about 16% or 17%, if you’re just looking at the average of AAMC data of chairs who are women. And of course, it differs in specialties. In a specialty like orthopedics, there’s zero women chairs as of the last benchmarking data from AAMC. And in OB/GYN, it was something like … I think it was like 28% or 29%. I might have the exact number wrong, but that was the highest field. Actually, preventive medicine was the highest field. But of the clinical specialties, OB/GYN.
S Abbuhl: And then emergency medicine was way down towards the bottom of that list. But, listen, chairs in emergency medicine is only one of, of course, many metrics that you would use to look at the status of women in our specialty. But we have a ways to go, but we certainly have more and more of our residents are women, and that’s been exciting.
M Lin: I wasn’t aware of the major disparity in leadership attainment. What do you think women-focused professional organizations can do to help grow that pipeline?
S Abbuhl: Oh, yes, I do think that the biggest challenge in academic medicine, and realize I really am speaking about academic medicine, the big house and emergency medicine. Many of the issues are the same for folks out in private practice and community practice, but that is not an area that I’m as knowledgeable about as academic medicine. So what can specialty organizations do? Oh, a whole ton. They can do many of the things that AWAEM does. Again, they can do scholarship, do even research via whatever mechanisms they can, either by their data that they get from surveys or focus groups or even more ambitious kinds of research. Write papers, get them out in the journals, get them out on various social media platforms.
S Abbuhl: They can have their own leadership courses or what I would call professional-development career-development courses, where you learn about … improve your skill sets for career and leadership development. Host seminars and workshops on time management, negotiation, managing up, managing down, mentoring, sponsorship, work-life balance issues, finance issues. You name it, the whole gamut of career and leadership development. Now, there’s many ways to take advantage of those kinds of courses and workshops. I mean, there’s ELAM, an Executive Leadership in Academic Medicine program. That’s a year-long fellowship that brings women from all different specialties and all across the country together.
S Abbuhl: There’s the AAMC’s early career and mid career. And then there’s specialty organizations, like AWAEM and others, that have their own leadership and career skill-building sessions at their annual meetings, sometimes at regional meetings. So a specialty organization has a special role in doing that because, of course, cultures exist sort of in overlapping spheres, and emergency medicine issues are going to be common to all women in academic medicine, but there are also going to be some unique features that are just all about our specialty and emergency medicine.
S Abbuhl: So AWAEM has done that. At many of our national meetings, there’s courses that you can take advantage of or even just workshops that last one, two, or three hours. Those are incredibly helpful. Networking, I mean, just bringing women together to take advantage of the incredibly rich network that is there to be just taken advantage of, a network that can help you in terms of changing jobs or seeking your first job if you’re a resident or fellow, getting mentorship because you are able to find other women colleagues who are interested in the same area of research that you’re interested in, or just again sharing strategies and sharing experiences and learning and gaining insight just from those rich discussions and relationships that form.
S Abbuhl: I think again a specialty organization can offer recommendations. Again, for example, the best practices paper that Esther Choo and many of us were on as co-authors that was published in Academic Emergency Medicine, I think now, actually two years ago, but that was the title, “The Development of Best Practice Recommendations to Support the Hiring, Recruitment, and Advancement of Women.” I mean, that’s really important. What should organizations be doing? What should chairs and chiefs and the leaders in emergency medicine be doing, since most of them are men? And they may still have valuable ideas about how that can be done too, by the way, and actually I think we should tap into that more than we do. But it’s important for us to come together for best practices. Anyway, there’s probably more. I’m sure there’s more, but those are some of the ways that these specialty organizations, like AWAEM, need to work on advancing women.
M Lin: Tell me a little bit more, in your experience, how leadership in women-focused professional organizations might be considered for the purposes of promotion.
S Abbuhl: I think it’s a difficult one to answer because I mean, my quick answer is that involvement in your specialty organizations is definitely, at most academic institutions, one of the elements that they’re looking for, for promotion. They would love to see you involved nationally in committee work, in leadership of those organizations. And so AWAEM is one … It’s just one of the many organizations within SAEM, within the Society for Academic Emergency Medicine. It’s one of them. And so in that way, if that’s where your interest lies and that’s where your passions are, then involvement there and leadership is one of the things that I think could definitely be on your CV and be absolutely part of your meeting the criteria for your promotion. So, I think the answer is yes.
S Abbuhl: I guess my hesitation is honestly that we know that there’s unconscious bias about women. I mean, that is so clear and compelling in the psychosocial literature for decades now, that for reasons that have to do with the stereotypic gender schema that we have in our culture. And I’m talking about the greater culture, the culture of our society, not even medicine. This is a societal thing.
S Abbuhl: I wonder if, in some way, there may be some unconscious bias about involvement in an organization for which the main mission is about women. It wouldn’t surprise me if there was some degree of unconscious bias that somehow devalued that slightly, but I don’t know that in any way. It’s just a speculation, and I guess I had to just be honest because I was hesitating a little bit, but frankly, I don’t care about that. Obviously, that’s why I devoted the second half of my career to thinking and caring and academically thinking about these issues, because if we’re going to change the unconscious bias, we have to just not worry too much about that and just move forward.
M Lin: What do you think is the biggest challenge for women in academic emergency medicine in the next 10 years?
S Abbuhl: I have to pick one, the biggest challenge is making this leap to leadership, is going from creating a specialty and creating environments in each one of our emergency departments across the country where women can thrive, where women are welcome, where women can thrive, where women have equal opportunity, where women and men, by the way, have a chance to have sustainable careers where they can meet their goals in their careers and their goals in their personal lives, in their family lives, and family defined as just the people that you love, whatever family looks like to you.
S Abbuhl: I mean, we have to create sustainable careers. We cannot expect people to give up what’s important to them in their spheres outside of their work. And we know, from the burnout literature, that women are more affected than men by burnout. And burnout, in my opinion, is very real, and it’s very real across the big house of medicine. So I think the challenges that I see are to advance women into leadership positions. I mean, we need the talent, and slightly different perspectives, again slightly emphasized, over and over because men and women are mostly the same in what we bring to medicine, but the difference is important and is the richness, and the diversity that we’re looking for and we can’t … and wait. We have to have women in leadership so we can all gain the advantage of their perspective and their leadership. And in the meantime, as we do that, we need to think about everyone in Emergency Medicine and in my opinion, in the big house of medicine to make sure that careers in medicine, while I think none of us want careers in medicine to somehow be nine to five or easy, it is always going to be challenging. It’s a huge responsibility.
S Abbuhl: And so I don’t ever want to be misinterpreted to think I’m somehow thinking that medicine is going to be nine to five and we should have bankers’ hours. But I also don’t think that we can just expect people to give the devotion both, in terms of hours, but also in terms of stresses. People’s lives are incredibly complicated in 2018 and dual-career couples and single parent households are more common than ever before in our society. These are societies different and our institutions and our concepts about our expectations of careers like medicine haven’t really changed with the times. I do think that it’s a dual-career couple issue is a very big piece of burnout and a very big piece of the stress and the non-sustainability that happens for many people after their five or 10 years in to their careers, and they’re thinking, “Wow, how am I going to do this for the next 30 years?”
S Abbuhl: This is for men and women, because you know, again, the recent data shows that 50% of men in academic medicine, at least if you look at the data that comes from Reshma Jagsi, who’s done such amazing work in this area, 86% of women and 49% of men have partners or spouses who work full time. So that is not the landscape that existed in the 1970s. Institutions and all of us in academic medicine have to really think about that as a very big piece of this challenge of work-life balance, which I think continues to be an important issue and one that women’s organizations who need to think about.
S Abbuhl: And also we need to include our male allies, right? Because I’ve just told you that almost 50% of men in academic medicine have full-time working spouses. Those guys get it, and maybe they don’t get it quite like the women do because we know that there’s still a disproportionate amount of home and child rearing that the women have disproportionate responsibility for in the way that our society and this is what we know still exists. So it’s a challenge, but we got to think about that. So burnout and leadership.
M Lin: Absolutely. I’m going to transition a little bit more towards your career. What career accomplishment would you say that you’re most proud of?
S Abbuhl: One of them is that, as I told you, I spent my whole career at Penn, right after my residency, I took an attending physician in the Emergency Department where I have been ever since. So that’s 35 years, 36 years now. Back then, which was the early ’80s, and then the mid ’80s, Emergency Medicine at Penn was a division. Well, it wasn’t even a division actually. It had like no academic status. It was part of the Department of Medicine as a clinical area. And I was just lucky enough to be in as a new attending in this part of the hospital when our brand new chairman of medicine at the time decided that Emergency Medicine, should be a division and I was the division chief of this brand new division. And it was just an incredibly exciting time, and I was able to work with the chairman of medicine and then the new dean to basically start the Department of Emergency Medicine at Penn. We were the first full academic department in the Ivy League, it was just a huge, big deal and it was so exciting to be part of that. And it was actually because of those experiences being catapulted into the c-suite of Penn at a time when I had no business being there. I was very junior. I was like 39 and I was an assistant professor. But I was just able to be at the right place at the right time.
S Abbuhl: The status of Emergency Medicine was improving by the year across the country. And we started this brand new department and I was the interim chair at age 39 or 40, of this brand new department. And while they were doing the national search for the first permanent chair, obviously someone senior and an academic, and that was Bill Back who then was recruited about a year and a half, almost two years later. So for a year and a half, I was the brand new interim chair and it was just so exciting. I guess I’m proud of being part of that. It was again, as all these things are, they’re never a single person. It was a team. We had a great group of early colleagues, and it was just exciting to be on that crest of that wave. So, that’d be one.
S Abbuhl: And I guess number two would be just, I’m proud of Focus on Health and Leadership for Women at Penn. It’s an organization that I really hope has had an impact on both women and men. We try very hard to bring value to two women as our primary mission, but also try very hard to bring our men colleagues and allies into the fold as part of the solution, and to bring value to them so that our organization can be not marginalized in our school, and I don’t think Focus is, at least I hope it’s not. I do think that’s important. I think that it’s difficult, a challenge to do, but I’ve tried to do that. So there you go.
M Lin: What piece of advice would you give a younger version of yourself or an AWAEM member at an earlier stage of her career?
S Abbuhl: Yeah. Well, let’s see. I would say to self, “don’t be quite so cautious. You can take more risks. You don’t have to be afraid of failure.” I’m absolutely convinced now, and I obviously didn’t realize this when I was younger, that making mistakes and failure is actually how you grow and how you actually gain more confidence. And how does that work? Well, it works because when you fail and you move on, you realize that it’s not that big of a deal. Now, not to say that I suppose there are incredibly big mistakes but, that’s really not how it works. Mistakes are a way of learning, and so I wish I had been less cautious.
S Abbuhl: I wish I had taken more risks, but I’m a cautious person by nature and a little bit of a, unfortunately of an unreformed perfectionist and I think that, that held me back in terms of taking risks. I wish I had known then what I know now, which is actually is how you gain confidence and how you learn, and probably how in the end, you’re able to have an even bigger impact because you’re not cautious, you’re just going to take the risk and go for it.
M Lin: Last question. Can you recommend three other AWAEM members at different stages of their careers who we should consider interviewing?
S Abbuhl: Absolutely. Oh my gosh. Yeah. So, and I don’t know if they’re AWAEM members, but Jean Marie Perrone is a full professor in Emergency Medicine here at Penn and a toxicologist and just an amazing person and an amazing scholar in the opiod epidemic. She’s just a powerhouse and an incredibly, outstanding emergency physician clinician, in addition to just a force, and our institution and nationally in the opioid epidemic. You may have heard of her, but she’s just super.
As a senior, she’s a senior woman, Raina Merchant. I have to tell you, these are our three Penn people, so forgive me for being so Penn centric, but they’re just so outstanding. That has to be my three, but there’s so many more. Raina Merchant is one of our mid-career women faculty, she’s an associate professor. She’s just a powerhouse of really innovative research in the realm of using digital and online and social media to really think about big public health issues. She just really has leadership written all over her, as does Jean Marie.
And as does Gina South, who was my third woman to mention who is junior in our faculty. She’s an assistant professor and her area of scholarship is disparities in health and in medical care. She’s doing some really innovative research about green spaces and about making the connection between neighborhood green spaces and health outcomes. She is also, again, just an outstanding clinician, a scholar, wonderful, these are just ladies who are dripping with talent.
These are all the reasons why we need to have these great women and many more in leadership because they have so much to offer us now. We’ve got to capitalize on all their brain power and talent power.
M Lin: Perfect. Great recommendations. Well, it was so wonderful to talk to you. Thank you so much again, Dr. Stephanie Abbuhl.
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