{"id":18120,"date":"2019-05-07T08:00:20","date_gmt":"2019-05-07T13:00:20","guid":{"rendered":"https:\/\/feminem.org\/?p=18120"},"modified":"2019-05-05T13:57:09","modified_gmt":"2019-05-05T18:57:09","slug":"awaem-anniversary-interviews-10-years-of-progress-esther-choo-md-mph","status":"publish","type":"post","link":"https:\/\/feminem.org\/2019\/05\/07\/awaem-anniversary-interviews-10-years-of-progress-esther-choo-md-mph\/","title":{"rendered":"AWAEM Anniversary Interviews: 10 Years of Progress \u2013 Esther Choo, MD, MPH"},"content":{"rendered":"\n

I\u2019m particularly excited to speak with Dr. Esther Choo<\/a>, who is well known for her leadership in social media advocacy\nand as founder of TimesUp Health Care and Equity Quotient. She speaks about her\nday job as an associate professor and NIH-funded researcher at the Oregon\nHealth and Science University, and how pivotal AWAEM mentors and networks were\nin her own academic career. We talk about the contrast between the vision of\ntrue gender equity and much of the work happening now\u2014which is critical work,\nbut only \u201cjust pouring the cement.\u201d<\/p>\n\n\n\n

Tell me a little bit about where you are in your career\nand how it is that you got here.<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            I’m an associate\nprofessor of emergency medicine at Oregon Health and Science University. I\nspend about 75 to 80% of my time in research and then the rest on clinical\npractice and teaching. And then do a lot of interesting women’s development and\nadvocacy work on the side. And I got here by doing a health services research\nfellowship after residency, and then going from that into a faculty position\nwhere I was able to have protected time to apply for a K23 Career Development\nGrant from the NIH. I got that and was on it for five years, and then recently\ntransitioned to an R01 level grant of my own in addition to being a co-investigator\non several other similar grants. And I also have a large foundation grant, so I\ndo spend much of my time on both clinical and policy research.<\/p>\n\n\n\n

Michelle Lin:                 Those\nare tremendous accomplishments. I think that a lot of the world knows you as\nprimarily an advocate. And you describe yourself primarily as a researcher. Can\nyou elaborate a little bit on those roles and how they interplay?<\/em><\/p>\n\n\n\n

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

Dr. Esther\nChoo:            So that’s a really\ndominant part of my career. And then the other piece that I’m paid for is, of\ncourse, to do clinical work. I’m a nocturnist. I only work night shifts, and I\ndo that both at the OHSU main ED and also at the VA hospital which is connected\nto it. So that’s kind of my main job. But I have gotten involved outside my\nmain job in a number of things. So I have gotten involved outside my job in\nadvocacy, mainly to raise awareness of racism and sexism in healthcare. I’ve\nalso started my own business, which provides metrics and analyses for healthcare\norganizations to understand how they might better support women in their\nworkplace. And then I’m active on social media, raising awareness of racism and\nsexism and am involved nationally in a number of organizations. <\/p>\n\n\n\n

Dr. Esther\nChoo:            So AWAEM was a big one\nfor me, initially. And then, of course, the natural life cycle for AWAEM is to\nstep a little aside and let other people grow into those roles. So as I stepped\nout of that, I became more involved in an organization called FemInEM, which\nwas started by Dara Kass, which has a website and a podcast and a lot of\ncareer-development resources and runs a great annual conference and retreat.<\/p>\n\n\n\n

Dr. Esther\nChoo:            So my involvement has\nreally, outside my regular workday, has really started to revolve around some\nof these issues of why are certain groups being held back in medicine and what\ncan I do to advocate for them and make it better for them, and by extension for\ntheir patients.<\/p>\n\n\n\n

Michelle Lin:                 And\ntell me a little bit more about how you came to become involved in AWAEM.<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            It is a random chance, as\nsome of these things happen. So I knew vaguely about this meeting of women\nemergency physicians at one of the SAEM meetings, but I was not planning on\ngoing because I wanted to go for a run that day and … I’m kind of an\nobsessive runner so I skip lots of things that I can make sure and get my run\nin. And then I saw Gail D’Onofrio and she was headed there and she kind of\ndragged me there. <\/p>\n\n\n\n

Dr. Esther\nChoo:            So I was at AWAEM in\nrunning clothes that first meeting. And that was the meeting where Kathy Clem\nand Gloria Kuhn and Stephanie Abbuhl and a lot of those senior women who wanted\nto build a community of women emergency physicians … They all brought us\ntogether on that day. And it was super intimidating. I didn’t know anybody in\nthe room except for Gail. And so these sheets went around to sign up for\ncommittees and I thought that would be a good way to get to know other women\nleaders in emergency medicine. So I signed up for a committee and that’s how I\ngot involved and it kind of just took off from there.<\/p>\n\n\n\n

Michelle Lin:                 And\nwhat motivated you to then seek a leadership position in AWAEM?<\/em><\/p>\n\n\n\n

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

Dr. Esther\nChoo:            So I think, like many\nwomen, when I became … I think I became vice-president and then\npresident-elect and then president. So I sort of eased into it over a period of\nyears. I felt very not ready for the role initially and then, with their\nmentorship and guidance and encouragement, I stepped up to the presidency\nreally not having had a national leadership role before. And so it wasn’t\nsomething I’d planned for. I think if it had been a question of asking when I\nwas ready for that, I would have waited forever, like ten or fifteen years. But\nbecause the women encouraged me and felt that I was ready, I went ahead and did\nit. It was a very enriching experience.<\/p>\n\n\n\n

Michelle Lin:                 How\nhas AWAEM contributed to your personal career development?<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            Well, you’re always told\nin your career to network, and I never liked that word. It always felt like a\ndifferent way of saying be fake and make fake relationships. I just never felt\ngreat about pursuing relationships simply for career advancement. I felt like I\nwanted true friendships and organic relationships. And I think AWAEM gave me a\nway in which I felt comfortable networking because I was involved. You spent a\nlot of time with people, those became friendships and genuine relationships,\nbut they were also people who were in a position to advance your career and\ngive you very good advice. And so it was the best kind of networking because it\nwas natural and felt comfortable and I didn’t have to really act differently or\ndo things that I didn’t feel comfortable doing. <\/p>\n\n\n\n

                                    So the\nsenior women were there to do what I needed which is to provide mentoring and\nsponsorship. Really to guide junior women into the kind of experience that\nallows you to move forward a little bit, and then more, and then more, and\nattain graduated responsibility until you were in a position to lead in major\nway. And so I think it’s very difficult to get those experiences from any one\nperson or within your institution, especially as a woman. So AWAEM gave me the\nkind of national networks that allowed me to filter through and find the people\nwho were really good fit mentors for my career.<\/p>\n\n\n\n

Michelle Lin:                 Any\nother specific AWAEM initiatives that you felt that have a significant impact\non your career or perhaps the careers of others?<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            Well, it was really the\nawards committee that made me aware of the disparities in healthcare for women.\nSo the first time I presented awards data to the AWAEM leadership was kind of a\nturning point for me. At the end of my first year leading the awards committee,\nI did a presentation to the AWAEM executive committee and other members who\nwanted to go to the business meeting. And I decided to, rather than just talk\nabout the awards, to put together a little presentation. And in order to do\nthat, I decided to look back on all the emergency medicine awards and create a\nfigure of how often they’d been awarded to women. <\/p>\n\n\n\n

                                    It was\nshocking to me how many emergency medicine awards were essentially awards for\nmen. In other words, there were a few awards that had almost never gone to\nwomen and even awards that had never gone to women over a period of like 25 or\n30 years. That piqued my interest, and that’s when I really started looking\ninto the literature about disparities and many other factors for women in\nmedicine, like things like salary and promotion.<\/p>\n\n\n\n

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

                                    AWAEM\nplanted a seed for me that has really grown into a pretty consuming interest,\nwhich is what is underneath these disparities for women and how do we eliminate\nthem? <\/p>\n\n\n\n

Michelle Lin:                 That’s\nso important. Tell me a little bit about how this has translated into career\nadvancement based on your own experience. <\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            I think before AWAEM, it\nnever occurred to me that I would ever go past assistant professor. I didn’t\nthink that I would have that level of attainment in my academic career, and so\nI think it gave me a lot of confidence. I was meeting women who were full\nprofessors and seeing that that was a model that was possible for me. But I\nwouldn’t say that I was aggressively ambitious in my career ever, certainly\nnever before I entered that room. AWAEM brought a lot of goals into sight for\nme that weren’t even there for me before. They were not visible to me. They\njust weren’t on my radar at all. But here were women who I knew well, who had\nrisen to those roles, who seemed mere mortals, and were telling me that I had\nthat potential. That was very influential for me. And there were actually\npeople I met in AWAEM who have given me very specific mentorship with regards\nto my research career. <\/p>\n\n\n\n

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

                                    But I will\nsay that, for me, the fight to continue to advance my career in academia is one\nthat has made me look outside academia. That’s why I started a business. That’s\nwhy I’m involved in a couple of nonprofit organizations for women in medicine.\nAnd I think AWAEM gave me a lot of confidence that I could be creative around\nthis issue.<\/p>\n\n\n\n

                                    I think I\nwill continue to pursue advancement in academia, but part of me is impatient\nwith women’s lack of progress. I have a pretty good 30,000 view on the problems\nfor women in medicine, and I am aware that that is a long and difficult path,\nand so I’m stepping outside and finding other ways to accelerate my career that\nare a little bit nontraditional. I think that’s kind of the scrappy-ness that\nwomen have to have, and some of those things I’ve learned through AWAEM and\nother groups like it. <\/p>\n\n\n\n

Michelle Lin:                 How\nhas AWAEM potentially translated into greater gender equity in your own\nworkplace?<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            AWAEM has developed some\ngreat resources. The beginning of the whole thing was a taskforce report that\nwas put out by some of the senior women who would then become future AWAEM\nleaders. They laid out the needs of women in academia, and that was a nice\nstatement to put the whole specialty on alert about this deficiency that we were\nseeing for women, that we were not meeting the needs of women well, even though\nwe wanted a diverse workforce.<\/p>\n\n\n\n

                                    AWAEM put\nout the consensus paper that I worked on where we developed a body of policies\nand practices for the specialties to support women in medicine. That actually\ncame out in a number of forms, came out as a process paper and also as a policy\nadopted by ACEP and AESM, just general guidelines around the way that\nworkforces should approach building a supportive environment for their female\nphysicians. And, of course, every year they put out a great body of didactics\nsupporting women in medicine. I think they work at the education of leadership-<\/p>\n\n\n\n

                                    AWAEM works\nat all levels. They target what do organizations need to know to support their\nwomen physicians? What do physicians themselves at all levels, from medical\nstudents to residents to junior physicians on upwards, what do they need to do\nto accelerate their careers? Things like how do you build a better promotions\npacket to how do you negotiate well?<\/p>\n\n\n\n

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

Michelle Lin:                 What\ncareer accomplishment would you say that you’re the most proud of? <\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            I think early on when you\ngo into research, you make this commitment to have your science and knowledge\nhave an impact. I am not there yet with my individual research. I think that’s\nstill an early body of work, and I’m building towards things that I want to\naccomplish in my research. <\/p>\n\n\n\n

                                    However, I\nthink because of social media, I’ve been able to be in a role where I can take\nother people’s science and broadcast that to a wider community that includes\npeople beyond physicians. It’s been a very new but fulfilling experience for me\nto sit in that position where I have access to people from journalists to a\nwide variety of professionals in other fields. And then, of course, health\nprofessionals too. It feels like an accomplishment of sorts to have a much\nbigger voice in translating science.<\/p>\n\n\n\n

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

                                    Every day I\nsee ways in which I fall short of that, but that is the goal. And I feel like\nat least I’m in this place where I can start doing that more and more, so that\nfeels good to me. <\/p>\n\n\n\n

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

Michelle Lin:                 How\ndo you anticipate the needs of women in academic emergency medicine or perhaps\nmedicine in general are going to evolve over the next ten years?<\/em><\/p>\n\n\n\n

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

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

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

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

Michelle Lin:                 What\npiece of advice would you give a younger version of yourself, or an AWAEM\nmember at an earlier stage of her career?<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            I think I would just say\nnot to be discouraged. I think there are lots of points where you can feel\nreally held up by the systems that tend to devalue women. And I just want to\ntell them it’s not personal, it’s not about you. You’re enough and more. I just\nwant to tell junior women that it’s not personal and it’s not about you and\neverything you’re experiencing is experienced by women everywhere. I think\npeople tend to internalize and make those things so specific to their\nexperience and feel a lot of guilt and blame and inadequacy and the truth is we\nare enough and we deserve to be valued just as our male peers are. <\/p>\n\n\n\n

Dr. Esther\nChoo:            And it’s the same thing\nfor people of color in medicine and those with other differences of any kind\nwhether it’s sexual orientation or gender identity or disability. It’s all the\nsame issue which is that these systems systematically devalue you and then they\ntell you that it’s you and that you are not worthy of being here. I internalize\nall those things and what programs like AWAEM are about it bringing people\ntogether in the same room so that they see that these experiences are in fact\nshared, they’re not isolated. And when they’re shared you can start seeing the\npatterns and then you can go after the things that are maintaining that pattern\nof behaviors and inequity. And so I would tell younger physicians to try to\nfind a network so that you can really see that it’s not you and then focus back\non your true value and move forward in medicine and bring that to our field\nthat can be better. That is the vision. <\/p>\n\n\n\n

Michelle Lin:                 Wonderful\nadvice. Please name three other AWAEM members we should consider interviewing.\nMaybe one around your stage, one who’s more senior and one perhaps more junior.<\/em><\/p>\n\n\n\n

Dr. Esther\nChoo:            Well, for junior you\nshould talk to Elizabeth Goldberg and Tracey Madsen, sorry those are two. And\nyou should talk to Dara Kass. I consider her a product of AWAEM. As she and I\ngot to know each other through AWAEM and she was drawn in because she was\nnominated for an award that I helped develop and so she’s definitely part of\nthe AWHAM lineage and everything that she has built. So, Dara is my peer and\nthen as far as somebody senior, I would say … I’ sorry my brain first goes to\nall the senior women who have already been president because those are the ones\nthat I know so well because we have to get Gloria Kuhn and Tracy Sanson and\nDiane Birmbaumer. <\/p>\n\n\n\n

Perfect. Thank you so much again for your time, Dr. Esther Choo. On behalf of AWAEM. <\/em><\/p>\n\n\n\n

Listen to the full interview here<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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