Michelle Lin, MD, MPH, MS We excited to share this amazing interview with Dr. Dara Kass, the founder of FeminEm and Director of Equity and Inclusion in the Department of Emergency Medicine at Columbia University. She talks about the critical need for different platforms to elevate women in emergency medicine, and why joining AWAEM was the single most important decision she made in her career.
Tell me a little bit about where you are in your career and how you got there.
D Kass: That’s a really … It depends on the day. That’s a complicated question. But right now I am a part-time attending at Columbia, I work about a 0.4 FTE, where I am the director of diversity and inclusion, or equity and inclusion, I guess, in the department, helping to promote programs that support equity and inclusion for the faculty. I also work a clinical shift a week, which is exciting. The rest of my time is spent actually doing stuff on FemInEm, doing some other entrepreneurial ventures, traveling, giving grand rounds, basically you know working the gospel of the women in emergency medicine work.
M Lin: That’s amazing. And tell us a little bit more about FemInEM for readers who, the few readers, who may not have heard of this.
D Kass: Okay, so FemInEM started in 2015 and it’s amazing that this is actually part of the AWAEM 10th anniversary issue because I think that we will go further into why, how AWAEM actually specifically was integral to FemInEM’s existence entirely. But AWAEM started in 2015, it was actually an extension, ironically of the AWAEM newsletter. So the real, one of the real reasons it started was because we had had this great AWAEM newsletter and I remember and I was on the newsletter committee, I had done enough in AWAEM that we were actively doing stuff, I was on the board, and there was this amazing newsletter with an article about post-partum depression. And I was like-so there was this amazing newsletter with an article about post-partum depression that I just thought was extraordinary.
D Kass: And I read it and it was so moving, I was like, “Wow, nobody’s gonna read this”. Cause it’s a newsletter, and it was newsletter on a listserve and it was part of a great group of women that were well-connected but I felt like it needed a broader audience. And if you paired that with the evolution of FOAM, which was free open access medical education, and our knowledge about podcasts, well not, I’m lying, that was before podcasts. So, blogs, and Twitter and Facebook and stuff, I was like, you know, that, coupled with another experience of a woman in emergency medicine who is frustrated by her child’s son, her son’s school calling and not knowing which parent was a stay-at-home parent, I was like we, we need better information dissemination.
D Kass: And so we started this website called FemInEM that just was basically a repurpose of newsletter articles. I said I have enough AWAEM content, I got permission from all these writers, I went into AAWEP, as another organization and tried to find old content that had never really gotten the platform it deserved and wanted to make it open access. And since it wasn’t really a membership thing, we could facilitate and support getting into those groups, by people seeing the amazing content that those groups were generating. And then obviously FemInEM evolved into something much different and on its own, complimentary to all of the groups. But that was basically how it started.
M Lin: That’s amazing.What’s changed since then?
D Kass: Everything! My whole life changed since then, so we started it actually, and I think this is part of the growth story of any big project, right? So everything about FemInEM is mission-based. It’s about the idea of supporting gender equity in medicine, specifically, emergency medicine. And everything we do actually is really aligned with that mission. I mean even this morning, Jenny Beck-Esmay, who’s my co-editor chief and I, you know had a problem and we think we both knew we were going to be part of the platform today that is just an answer to a problem that we realized we hadn’t solved in the past. And so it has been really fast.
D Kass: We started out thinking that we were just gonna repurpose old articles and content and then we got a massive number of new articles and content. And some of it was me, emailing people and being like, remember that story you told me over a glass of wine at a, you know, conference? That would make a great article. Facebook groups, speakers’ bureau, you know, we have a job board, now we have obviously the conference and the podcast, and the bookstore and all these other little things that have just added up to be what I think is the best central resource across the house of medicine for women that are both academic in the community, out of the country, not only in emergency medicine. So it kind of, it spans a network that’s larger than any of these individual groups and what I hope it does also is reminds people of the power of women’s networking, individually and as a collective, and reinforces the value of each of these other groups for a specific purposes.
M Lin: Absolutely. I’m gonna rewind a little bit and have you tell me about why it was you joined AWAEM in the first place?
D Kass: So, involuntarily is always the right answer for AWAEM. The second answer is always Gloria Kuhn, at least as my generation has it. So I literally was, I remember I was angry at-I just had my first daughter I think and, or she’s my only daughter, my first kid. And I was complaining, as I do loudly and as frequently as anyone will listen, about the lactation support at my job. And I was at SAEM, and I was in the hall, and I was talking to Gloria about something and I was complaining how I had to solve this problem on my own or whatever it was. And Gloria says to me, “You know where you should complain about this? In this room I’m going into right now” which was the AWAEM meeting.
D Kass: And I got there and I was like, wow, these are my people. Like I was done, I was hooked from day one. And I remember that Stacey was there, Poznanski, who was the president after Gloria that year, I think. And then she set the stage for what became this network of my people who were really my fundamental team that then supported me through everything that I did in medicine. So Gloria Coon is the answer why I’m in AWAEM, it was probably one of the most formative organizations in my life, certainly in my career in medicine.
M Lin: Tell me a little bit about what caused you to become such a leader in this space?
D Kass: Rage. Rage is a really good motivator for women, I think. And impatience. I think for me those are my two biggest driving factors. I don’t have that long on this planet, and I don’t have that long in medicine, actually and I’m angry at people not solving problems and so I try to solve them. And I have a certain element of energy in my gut that other people don’t have. Like I will acknowledge that I am built a little different than most people in that I get driven to make change when other people accept things as factually final, I accept them as transitionally inconvenient. And so I’m really, I’m trying to make change in the world, and so that’s why.
D Kass: And it’s not about being a leader, as much as it is believing in change, seeing it fruition and inviting people along with you. I haven’t set out to be the head of anything. I don’t have-I love the attention that I get for being successful at things but this isn’t about an aspiration to be in charge, it’s about an aspiration to make a difference and I think that maybe that’s a better leadership quality than almost anything else because it’s also really-I’m humbled in the change we’ve made, and I’m excited for the new changes we’re gonna make.
M Lin: That’s so wonderful. Tell me a little bit about how both AWAEM and FemInEM meet the professional needs of its members.
D Kass: So I think that-I want to continue to protect the personality of each of these women’s organizations for a specific cohort of women, because I think that allows them to live symbiotically in this space. AWAEM was founded specifically to support women in academic emergency medicine. It is the, it’s the interest group of SAEM. And in that vein, it should be able, it should be able to provide a service to women in academics that would otherwise either not be provided, or would other organizations shouldn’t even-they should support women in that mission, and not try to provide it themselves, and I’ll give you a good example of that.
D Kass: So we at FemInEM get a lot of interest in a lot of things to solve. Lot of problems to solve. And one of them was about letters for promotion. And you know, we know that women get promoted less than men and we also know that getting your letters for promotion can be a barrier and that one of FemInEM’s missions is to connect women towards solving problems in inequity. But, letters for promotions are actually specifically academic need and so, although people brought it up on the FemInEM Facebook group, and even in conversation, one of my-well I looked at the landscape of who needs to solve what problems and how. My answer was, let me reach out to the women in AWAEM and see if we can work together to solve this and have it be an AWAEM product as opposed to a FemInEM product.
D Kass: Because FemInEM doesn’t need more products, it has its own space and it’s really great and everything, it’s wonderful and I felt like amplifying a way that AWAEM is specifically valuable to its members, was more important at that moment. So, now AWAEM has a letter writer bureau service that we’re developing that allows women who need to go for promotion to find other women, specifically, but other letter writers across the board who will help support them in their promotion.
D Kass: To me, that is organically innately AWAEM idea and product and it belongs with AWAEM. The same thing is true with AAWEP, which is another organization that is from ACEP, and their policy or operational support programs that go to the practice of medicine, emergency medicine, as a specialty, that belong at AAWEP as well. Some of those may be leadership academies for directorships, some of them may be policy initiatives for advocacy as far as payer mixes go, but there are going to be programs that belong specifically under those organizations.
D Kass: FemInEM is really the incubator for those ideas, and in all fairness, the catalyst to how, by which change will occur. Because historically, large organizations that are bureaucratic make change very slowly. And they don’t really-even their websites don’t have the infrastructure to accept new platforms and exchanges easily. So it may mean we build something on FemInEM and then it feed it over to AWAEM to make it seed to fruition until SAEM can get there. Which is fine, because there are different policies and different structures that happen, we have a large organization that has a huge membership and a big infrastructure. FemInEM is only an organization, you know? It’s a start-up for all intents and purposes, and we can change things faster. But our goal is to very supportive of these traditional organizations, because they are necessary to our progress.
M Lin: Tell me a little bit about how your experiences have translated into increased gender equity in your own workplace.
D Kass: Heck of a workplace, right? So I mean I told you at Columbia, I am now the director of equity and inclusion, which specifically is a reflection of the work that we’re doing at FemInEM and my experience in all of these equity spaces and understanding how to make change, kind of disruptively and then turning that back around and doing it kind of traditionally.
D Kass: And I have a really supportive boss who is also active in AWAEM and SAEM, and is a board member of SAEM, and that means that together we can take lot of the lessons we’ve learned and bring them back to traditional academics, which I think is really important. You know, we know that we have problems with pay equity, we know we have problems with promotion equity, we know we have problems with you know, kind of schedule viability for parents of both genders, but you know, like everything else, you know, what rolls downhill fastest hits women first. And so I’ve learned a lot about those across the entire house of medicine from all the women that we work with and I’m able to take a lot of those lessons to my department specifically and also support other people in their growth of their women’s groups, in their growth of their mentorship programs, in their growth of their other support programs that allow them to solve their problems in their departments.
D Kass: The other thing is that, much like federal laws versus states’ laws-so much like federal laws versus states’ laws, or federal rights versus states’ rights, every solution is not gonna be the same in every department and it’s really important that we at FemInEM, and at AWAEM, and at AAWEP and in every other organization that I think is created for women, or even just to solve problem, understands that local solutions are best for their membership. National support is important, guidance is really important, I think guidelines are really important but ultimately it’s gonna come down to what works in each department and making sure that the people in that department are supported in the way that they need the best.
M Lin: Are you still involved in, you know, academic promotions, like are you still required to produce scholarly work?
D Kass: So I’m really lucky in that I get to be the invited contributor to a lot of scholarly work now, which is the best place to be. Like, in your academic career, that’s exactly what you want, right? You wanna become the content expert that people are like, oh I have this idea for a paper, I wanna start getting a first draft done, we do come in be either the last author or middle author just to contribute and see what happens. So I’m actually more productive now than I ever have been before. Some of is is that I get to put my ideas out there and say, this is a great project, let’s see it to fruition and then somebody else makes it happen.
D Kass: The other part is, we started a non-profit research foundation which allows us to fund research for gender equity and so we’re starting that and getting that off the ground now. The other part is I give grand rounds literally every month at a different institution and that means that I have to stay current both on the research and what answers we need to have to certain questions. And the other part is Esther Choo is like the yin to my yang, we are like integrally connected and so she requires that I’m a smart academic and you know I require that she’s a little extroverted, I don’t know. But it really helps me want to continue to write and produce and to be academically productive, so yeah I mean, I am more academically productive now than I have ever been before.
M Lin: I’m gonna rewind you even more, tell me how gender has affected your own career development.
D Kass: So I think for me gender roles actually more than gender identity were the more formative factor in my life and career. So I didn’t-my personal gender, like being a woman in medicine, if I had not gotten married and had kids and been in a very kind of cis-gender heterosexual traditional marriage, probably would not have affected my work as immediately and as absolutely as it did because I was married, having babies with a husband who worked full-time, and so-as the primary parent. And so all of those decisions that I made that were quote-unquote “choices”, I knew I was making them at the expense of my own career aspirations and success. And I knew that I was doing that because the structure of the job didn’t allow me to be both successful, aspirational, and also solutions-oriented when it came to my life.
D Kass: And that was by far the largest driving factor in even building FemInEM, right? Because even like I said, the two things that were formative to me, saying we need a big platform were post-partum depression, and somebody’s school not knowing, you know, who the primary parent was.
D Kass: And it’s not to say that then, once I was open to that, that then once my eyes were open I was paying attention. Then, there were all these other gender-based issues that I saw women facing, including me, but for me, I’m an agentic female in a lot of ways. Like, I don’t-my personality traits are, if you look at the continuum of like communal traits versus agentic traits, I have a lot of agentic traits, right? I am relatively, I mean-I am a little louder, I’m more assertive, I don’t necessarily get-I have-whatever, I have certain traits that have not always served me well, when people are looking at, you know, gender-based responses that I am-I have a lot of agentic traits.
D Kass: So I don’t know that I ever took personally a lot of the gender-based judgements that people had although I knew I was affected by them. Many of my evaluations were based on the fact that I was agentic and not communal, and therefore I was being judged as being bossy and pushy and loud and obnoxious and yet men who were just like me were being judged as being smart and assertive and, you know, leaders and God knows what somebody-what happened to me if I was noticed to be a leader early. Why is it that I built my leadership style and I built my leadership platform from this when I wasn’t even elected chief resident, as a resident, right? Think about it. Like now, if you look at the whole country of leaders in emergency medicine, it’s pretty impressive that I was not even elected chief resident in my residency. I’m not that different, right? It’s just the qualities that I have are now amplified in a different platform. So I think that gender has affected my career, at least, I didn’t internalize when I was younger, but it was gender-based roles, especially within the family that got me, that affected me the most to change my career.
M Lin: That’s such a thoughtful answer.
D Kass: Thank you!
M Lin: What career accomplishment would you say that you’re most proud of?
D Kass: If I don’t say FemInEM I feel like it’s the wrong answer on many levels. But I actually-it is the most-it is the thing I’m most proud of because, you know, it literally started from nothing. Like, it started from an angry idea that I had. Like I said, rage and impatience are my two most important qualities and when the come together they can spark magic, they can also totally undercut my success, right? So if I’m impatient with rage in the wrong environment, I have a lot of backlash and it doesn’t serve me well, so knowing where to channel it has been my biggest growth.
D Kass: But I would say taking an idea, seeing it to fruition, and then watching it be, in all fairness, a financially successful endeavor that’s sustainable without me. It’s like parenthood. It’s like giving birth to somebody and then watching them go to college. I could transition all the leadership of FemInEM to other people that are ready to take it over and it would be on its own, productive enough to sustain itself in perpetuity, as long as the mission was continued to be followed, and that is a pretty cool thing to say.
M Lin: What piece of advice would you give your younger self, or an AWAEM member at an earlier stage of her career?
D Kass: So I actually get this a lot about, the idea that there’s a lot of time. I’m an impatient person, like I said, and my younger self, I would tell that there’s time. These solutions are coming, be part of the solution, but remember that the, like you don’t have to do everything right away. Right? I went to medical school, I took no time, it’s fine. The most important advice I would give to AWAEM, and this was the best advice I’d figured out without being told it was, develop your network of women in medicine outside your institution. And be-develop your network in your institution as well, but having a really-having a really strong network of women, and men, but peers outside of your institution that can travel with you even if you change jobs is the most important thing you can do for your career’s sustainability. It’s actually the reason to be involved in national organizations and not just in your hospital.
D Kass: So, if you’re only involved in your hospital leadership and your departmental leadership, and your institutional leadership, that’s-you need to do that, that’s important for promotion, it’s important for your job security, it’s important for your stewardship in your department, I’m not minimizing that.
M Lin: Yeah, oh yeah.
D Kass: But, if you want to have portability, confidence, and in all fairness, your-and in all fairness, your brand? You need to have a network of people outside of your institution that will help highlight jobs that are good for you if you need to change, support you in the application somewhere else, communicate your value across institutions, write letter for you when you’re up for promotion, so having national presence and a network outside of your institution is by far the most liberating thing you can do in your career. It’s probably the healthiest thing you can do in your career, it gives you a safe place to have conversation about your job that is not directly affected by the people that you work with, and I think it’s the most-it’s the smartest thing young people can do as they build their career.
M Lin: What an incredible endorsement for joining an organization like AWAEM.
D Kass: I’m telling you, it changed my life.
M Lin: Alright, please name three other AWAEM members we should interview.
D Kass: So, I mean, obviously, I don’t say at every interview I mention Esther Choo somewhere, I get dollars for it actually, she pays me. So it’s all good. So I will always mention Esther Choo, I think that she’s somebody who AWAEM has absolutely changed their career. Flavia Nobay is another one that I would interview and I’m sure that you are already going to do that. And Liz Goldberg, who I, although they’re all really smart and academic, I think they’ll have different perspectives about how influential a group like this has been in their career aspirations and their career success. And I think they’ll have interesting stories to tell.
M Lin: How do you anticipate the professional needs of women in academic emergency medicine will change in the next ten years?
D Kass: Oh, that’s an interesting question. I really hope that we have less gender-specific issues and that AWAEM as an organization is going to have to fuse into something more universally supportive, maybe even be just about equity in emergency medicine or something. I think that, you know, I’m not ignorant enough to think that we’re that close to solving these problems, but I am hopeful enough to think we might be. I think that many of the gender-based problems we have in medicine are actually operationally possible to solve. When it comes to the contract of promotion and pay gaps and culture of harassment, and I think we can get there with an active and, you know, aggressive push towards equity.
D Kass: Then the next thing comes to supporting women as they face bias. And again, with education, and with active open communication and with a culture of inclusion for solutions-oriented men, I think we can get there as well. So then I think AWAEM does something different, and I don’t know what it does. I-don’t get me wrong-it’s gonna take a long time to get to those places. But I think we’re getting there and I think that we are, it’s about getting the right men at the table, it’s about talking about these issues objectively and consistently. It’s about our cultural changes in emergency medicine first before other specialties. It’s funny. We are the last littlest children in the house of medicine. And still really poorly respected across the stage.
M Lin: As a specialty?
D Kass: As a specialty. Yet, like the last youngest children in anything, we are changing the world faster. We see all patients, regardless of ability to pay, we see every disease that everyone else sees, we are omnipresent, we are, you know, problem-solvers, and at the end of the day, we are humane in a way that, for the most part, but there’s plenty of us that aren’t, don’t get me wrong, I’m not ignorant, but I do think we are the specialty that’s changing things fastest, especially as it relates to equity and inclusion.
D Kass: Look, and again, like everything I say, this is gender, not race, and certainly not the rest of the under-represented community, because god knows we have so much work to do there. But I do feel the sea changing, and I feel like people are aware. And that’s the first step. And they’re accepting, and they’re interested in progress, and you know it’s the reason FemInEM is so successful. Like, people aren’t afraid of talking about it and that is absolutely the first step. So again, maybe not during my career, because I don’t know how much longer I have left, but during maybe my daughter’s career in medicine, although she’s not gonna become a doctor, but I do think that we are getting towards real change.
D Kass: And then AWAEM has to find new problems to solve.
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