I’m particularly excited to speak with Dr. Esther Choo, who is well known for her leadership in social media advocacy and as founder of TimesUp Health Care and Equity Quotient. She speaks about her day job as an associate professor and NIH-funded researcher at the Oregon Health and Science University, and how pivotal AWAEM mentors and networks were in her own academic career. We talk about the contrast between the vision of true gender equity and much of the work happening now—which is critical work, but only “just pouring the cement.”

Tell me a little bit about where you are in your career and how it is that you got here.

Dr. Esther Choo:            I’m an associate professor of emergency medicine at Oregon Health and Science University. I spend about 75 to 80% of my time in research and then the rest on clinical practice and teaching. And then do a lot of interesting women’s development and advocacy work on the side. And I got here by doing a health services research fellowship after residency, and then going from that into a faculty position where I was able to have protected time to apply for a K23 Career Development Grant from the NIH. I got that and was on it for five years, and then recently transitioned to an R01 level grant of my own in addition to being a co-investigator on several other similar grants. And I also have a large foundation grant, so I do spend much of my time on both clinical and policy research.

Michelle Lin:                 Those are tremendous accomplishments. I think that a lot of the world knows you as primarily an advocate. And you describe yourself primarily as a researcher. Can you elaborate a little bit on those roles and how they interplay?

Dr. Esther Choo:            Yeah. I think of my core job … my real job I guess … as being a researcher. So I think of my kind of nine to five job … it’s not really nine to five … but the job that I go in and do every day is really being a research scientist. So that’s just what you think it is. It’s a scholarly life and a quiet one. I’m in my office by myself a lot. I work with a few research teams. There are meetings and planning for research studies and a lot of data analysis, and I work collaboratively with other scholars and do a lot of very interesting work around drug use disorders and policies affecting drug use and clinical outcomes, particularly as it relates to emergency care.

Dr. Esther Choo:            So that’s a really dominant part of my career. And then the other piece that I’m paid for is, of course, to do clinical work. I’m a nocturnist. I only work night shifts, and I do that both at the OHSU main ED and also at the VA hospital which is connected to it. So that’s kind of my main job. But I have gotten involved outside my main job in a number of things. So I have gotten involved outside my job in advocacy, mainly to raise awareness of racism and sexism in healthcare. I’ve also started my own business, which provides metrics and analyses for healthcare organizations to understand how they might better support women in their workplace. And then I’m active on social media, raising awareness of racism and sexism and am involved nationally in a number of organizations.

Dr. Esther Choo:            So AWAEM was a big one for me, initially. And then, of course, the natural life cycle for AWAEM is to step a little aside and let other people grow into those roles. So as I stepped out of that, I became more involved in an organization called FemInEM, which was started by Dara Kass, which has a website and a podcast and a lot of career-development resources and runs a great annual conference and retreat.

Dr. Esther Choo:            So my involvement has really, outside my regular workday, has really started to revolve around some of these issues of why are certain groups being held back in medicine and what can I do to advocate for them and make it better for them, and by extension for their patients.

Michelle Lin:                 And tell me a little bit more about how you came to become involved in AWAEM.

Dr. Esther Choo:            It is a random chance, as some of these things happen. So I knew vaguely about this meeting of women emergency physicians at one of the SAEM meetings, but I was not planning on going because I wanted to go for a run that day and … I’m kind of an obsessive runner so I skip lots of things that I can make sure and get my run in. And then I saw Gail D’Onofrio and she was headed there and she kind of dragged me there.

Dr. Esther Choo:            So I was at AWAEM in running clothes that first meeting. And that was the meeting where Kathy Clem and Gloria Kuhn and Stephanie Abbuhl and a lot of those senior women who wanted to build a community of women emergency physicians … They all brought us together on that day. And it was super intimidating. I didn’t know anybody in the room except for Gail. And so these sheets went around to sign up for committees and I thought that would be a good way to get to know other women leaders in emergency medicine. So I signed up for a committee and that’s how I got involved and it kind of just took off from there.

Michelle Lin:                 And what motivated you to then seek a leadership position in AWAEM?

Dr. Esther Choo:            So I didn’t really seek a leadership position, but the committee I signed up for was the awards committee and nobody else signed up for it, so by default I was the chair as well as all the members of the awards committee. And so I really wanted to do well for AWAEM because none of these women knew me, so I really put my heart and soul into that awards committee and just in doing that work got to know the senior AWAEM leadership and they were the ones who really mentored me into a senior role.

Dr. Esther Choo:            So I think, like many women, when I became … I think I became vice-president and then president-elect and then president. So I sort of eased into it over a period of years. I felt very not ready for the role initially and then, with their mentorship and guidance and encouragement, I stepped up to the presidency really not having had a national leadership role before. And so it wasn’t something I’d planned for. I think if it had been a question of asking when I was ready for that, I would have waited forever, like ten or fifteen years. But because the women encouraged me and felt that I was ready, I went ahead and did it. It was a very enriching experience.

Michelle Lin:                 How has AWAEM contributed to your personal career development?

Dr. Esther Choo:            Well, you’re always told in your career to network, and I never liked that word. It always felt like a different way of saying be fake and make fake relationships. I just never felt great about pursuing relationships simply for career advancement. I felt like I wanted true friendships and organic relationships. And I think AWAEM gave me a way in which I felt comfortable networking because I was involved. You spent a lot of time with people, those became friendships and genuine relationships, but they were also people who were in a position to advance your career and give you very good advice. And so it was the best kind of networking because it was natural and felt comfortable and I didn’t have to really act differently or do things that I didn’t feel comfortable doing.

                                    So the senior women were there to do what I needed which is to provide mentoring and sponsorship. Really to guide junior women into the kind of experience that allows you to move forward a little bit, and then more, and then more, and attain graduated responsibility until you were in a position to lead in major way. And so I think it’s very difficult to get those experiences from any one person or within your institution, especially as a woman. So AWAEM gave me the kind of national networks that allowed me to filter through and find the people who were really good fit mentors for my career.

Michelle Lin:                 Any other specific AWAEM initiatives that you felt that have a significant impact on your career or perhaps the careers of others?

Dr. Esther Choo:            Well, it was really the awards committee that made me aware of the disparities in healthcare for women. So the first time I presented awards data to the AWAEM leadership was kind of a turning point for me. At the end of my first year leading the awards committee, I did a presentation to the AWAEM executive committee and other members who wanted to go to the business meeting. And I decided to, rather than just talk about the awards, to put together a little presentation. And in order to do that, I decided to look back on all the emergency medicine awards and create a figure of how often they’d been awarded to women.

                                    It was shocking to me how many emergency medicine awards were essentially awards for men. In other words, there were a few awards that had almost never gone to women and even awards that had never gone to women over a period of like 25 or 30 years. That piqued my interest, and that’s when I really started looking into the literature about disparities and many other factors for women in medicine, like things like salary and promotion.

When I was president in 2013, right around that time, or maybe a little bit before, that was kind of when all the literature started coming out about the salary gap. It really hasn’t been that long that we’ve had the kind of national data we have now about the very persistent physician salary gap, and so all those things came together. I was reading this awards data. I was like, wow, women are really excluded from things, and there’s this big disparity that is so disproportionate to the number of women who have been here for a long time. Then, I was reading the salary papers, and I read the promotion papers, and more and more has come out demonstrating that the association between gender and all these factors that are important to your career were real.

                                    AWAEM planted a seed for me that has really grown into a pretty consuming interest, which is what is underneath these disparities for women and how do we eliminate them?

Michelle Lin:                 That’s so important. Tell me a little bit about how this has translated into career advancement based on your own experience.

Dr. Esther Choo:            I think before AWAEM, it never occurred to me that I would ever go past assistant professor. I didn’t think that I would have that level of attainment in my academic career, and so I think it gave me a lot of confidence. I was meeting women who were full professors and seeing that that was a model that was possible for me. But I wouldn’t say that I was aggressively ambitious in my career ever, certainly never before I entered that room. AWAEM brought a lot of goals into sight for me that weren’t even there for me before. They were not visible to me. They just weren’t on my radar at all. But here were women who I knew well, who had risen to those roles, who seemed mere mortals, and were telling me that I had that potential. That was very influential for me. And there were actually people I met in AWAEM who have given me very specific mentorship with regards to my research career.

I think AWAEM has also provided a very reassuring framework for me when I hit the ceiling in medicine, because there are many ways in my career where I still feel like I bump up against the ceiling, that I have failed to progress for a number of factors, including my gender, at least compared to male peers of similar backgrounds. And it’s been very psychologically helpful to understand that this is not unique to me, that this happens to all women, and also to go back to AWAEM and develop some skills and resources to try to negotiate those barriers.

                                    But I will say that, for me, the fight to continue to advance my career in academia is one that has made me look outside academia. That’s why I started a business. That’s why I’m involved in a couple of nonprofit organizations for women in medicine. And I think AWAEM gave me a lot of confidence that I could be creative around this issue.

                                    I think I will continue to pursue advancement in academia, but part of me is impatient with women’s lack of progress. I have a pretty good 30,000 view on the problems for women in medicine, and I am aware that that is a long and difficult path, and so I’m stepping outside and finding other ways to accelerate my career that are a little bit nontraditional. I think that’s kind of the scrappy-ness that women have to have, and some of those things I’ve learned through AWAEM and other groups like it.

Michelle Lin:                 How has AWAEM potentially translated into greater gender equity in your own workplace?

Dr. Esther Choo:            AWAEM has developed some great resources. The beginning of the whole thing was a taskforce report that was put out by some of the senior women who would then become future AWAEM leaders. They laid out the needs of women in academia, and that was a nice statement to put the whole specialty on alert about this deficiency that we were seeing for women, that we were not meeting the needs of women well, even though we wanted a diverse workforce.

                                    AWAEM put out the consensus paper that I worked on where we developed a body of policies and practices for the specialties to support women in medicine. That actually came out in a number of forms, came out as a process paper and also as a policy adopted by ACEP and AESM, just general guidelines around the way that workforces should approach building a supportive environment for their female physicians. And, of course, every year they put out a great body of didactics supporting women in medicine. I think they work at the education of leadership-

                                    AWAEM works at all levels. They target what do organizations need to know to support their women physicians? What do physicians themselves at all levels, from medical students to residents to junior physicians on upwards, what do they need to do to accelerate their careers? Things like how do you build a better promotions packet to how do you negotiate well?

                                    They’ve really built a rich body of resources. It gets better every year. And I think that’s one of the reasons they’ve maintained such a robust membership is I think there’s a lot of really great concrete resources in there that were never there for women when I was coming up in my career early on.

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

Dr. Esther Choo:            I think early on when you go into research, you make this commitment to have your science and knowledge have an impact. I am not there yet with my individual research. I think that’s still an early body of work, and I’m building towards things that I want to accomplish in my research.

                                    However, I think because of social media, I’ve been able to be in a role where I can take other people’s science and broadcast that to a wider community that includes people beyond physicians. It’s been a very new but fulfilling experience for me to sit in that position where I have access to people from journalists to a wide variety of professionals in other fields. And then, of course, health professionals too. It feels like an accomplishment of sorts to have a much bigger voice in translating science.

                                    I’m not sure that’s my biggest accomplishment, but it looms large in my mind right now because we’re in an era where there’s a lot of skepticism around science and I’m trying to bring a positive feel to hard science and make it fun, and accessible, and desirable, and really make a case that we need more of it and that we need more support and funding for it and public engagement in it.

                                    Every day I see ways in which I fall short of that, but that is the goal. And I feel like at least I’m in this place where I can start doing that more and more, so that feels good to me.

I think that the other part of feeling like I have more of a public face is that we need more women in STEM fields. I think, specifically, a lot of my messaging is about girls and women in STEM and in medicine, and it’s to them and it’s for them. Every time I’m approached by a student or a resident or a junior faculty member early in their careers and they’re at all encouraged by anything I’ve put out there, that to me feels like a tremendous accomplishment because there was so little of it as I was coming up and I feel lucky that I had the individual mentorship so that I was able to fall into these fields and not get lost in the wayside but I know not everybody has that. They just don’t happen to run into the right people so if I can be a little bit of that person for other people that feels like an honor and I would feel lucky to accomplish that.

Michelle Lin:                 How do you anticipate the needs of women in academic emergency medicine or perhaps medicine in general are going to evolve over the next ten years?

Dr. Esther Choo:            That’s a good question. I think we have started with such the basics. When we first stepped into that room at AWAEM, I don’t know if anyone else has remembered that, the conversation, a big part of the conversation was around lactation facilities. The lack of lactation facilities in hospitals. And you know, that is something that is dictated by law. And there’s a recent report by the National Academies of Science and Engineering and Medicine and it talked about how hospitals and healthcare systems and academic institutions are really stalled on litigation, you know. We tend to worry only about gender discrimination, sexual harassment, to the extent that we’re worried about legal action. And to me the lactation facility thing was so basic it made me sad.

                                    To me those basic things are such a foundation, you can’t build up from there, you can’t build up from there unless you have it down. We can’t pretend like we have a good working environment for parents of any kind unless first me make sure that women can come back from maternity leave and have a decent physical workplace. And so, some of these things were just so obviously and such a gaping need and it felt bad to have to start there but you have to start somewhere. We’re so aware of how we’re laying down the roughest floor. I want a beautiful house with gorgeous wood paneling, but actually somebody has to just pour the cement. So I think we’re really aware that we were doing a lot of cement pouring. Right now, I just wrote a statement for one of my non-profit organizations that was like, there shouldn’t be sexual harassment in the healthcare workplace. That was a fundamental principle and it was almost laughably basic. And yet, huge organizations have not committed to that basic principle. I think I’m well aware we are just pouring the cement.

Dr. Esther Choo:            And we’re pouring the cement on top of just ground clearing which is what the women who just entered our fields did, you know what I mean? But they laid the foundations for the cement pouring and now we will step back and our cement has dried and the next generation will build up from there to really getting the fine metrics that will allow us to track little inequities as they creep in and hopefully the next generation can do the finessing that will really bring equity and compensation and promotion and then we get women up into leadership roles.

Dr. Esther Choo:            I was trying to identify a number, I was sitting around a table with a bunch of other women leaders and we’re like, “we can’t have the motto 50/50 by 2050.” That’s something that some companies are using by saying we want fifty/fifty women representation by 2050. And we’re like, “that is such a distant goal. There is no way we could get …” Say we were just talking about chair roles. We cannot get a goal like that. It’s not gonna be in my lifetime. But we can start somewhere, so maybe for women in medicine it’s 20% by a certain day. So I think that’s where we’re gonna start, baby steps, and then at some point some generation can really see the sea change we’ve been dreaming about.

Michelle Lin:                 What piece of advice would you give a younger version of yourself, or an AWAEM member at an earlier stage of her career?

Dr. Esther Choo:            I think I would just say not to be discouraged. I think there are lots of points where you can feel really held up by the systems that tend to devalue women. And I just want to tell them it’s not personal, it’s not about you. You’re enough and more. I just want to tell junior women that it’s not personal and it’s not about you and everything you’re experiencing is experienced by women everywhere. I think people tend to internalize and make those things so specific to their experience and feel a lot of guilt and blame and inadequacy and the truth is we are enough and we deserve to be valued just as our male peers are.

Dr. Esther Choo:            And it’s the same thing for people of color in medicine and those with other differences of any kind whether it’s sexual orientation or gender identity or disability. It’s all the same issue which is that these systems systematically devalue you and then they tell you that it’s you and that you are not worthy of being here. I internalize all those things and what programs like AWAEM are about it bringing people together in the same room so that they see that these experiences are in fact shared, they’re not isolated. And when they’re shared you can start seeing the patterns and then you can go after the things that are maintaining that pattern of behaviors and inequity. And so I would tell younger physicians to try to find a network so that you can really see that it’s not you and then focus back on your true value and move forward in medicine and bring that to our field that can be better. That is the vision.

Michelle Lin:                 Wonderful advice. Please name three other AWAEM members we should consider interviewing. Maybe one around your stage, one who’s more senior and one perhaps more junior.

Dr. Esther Choo:            Well, for junior you should talk to Elizabeth Goldberg and Tracey Madsen, sorry those are two. And you should talk to Dara Kass. I consider her a product of AWAEM. As she and I got to know each other through AWAEM and she was drawn in because she was nominated for an award that I helped develop and so she’s definitely part of the AWHAM lineage and everything that she has built. So, Dara is my peer and then as far as somebody senior, I would say … I’ sorry my brain first goes to all the senior women who have already been president because those are the ones that I know so well because we have to get Gloria Kuhn and Tracy Sanson and Diane Birmbaumer.

Perfect. Thank you so much again for your time, Dr. Esther Choo. On behalf of AWAEM.

Listen to the full interview here.