Oct 27, 2014
Reshma Jagsi, MD, DPhil, is an Associate Professor and Associate Chair of the Department of Radiation Oncology at the University of Michigan. She has been a member of the University of Michigan faculty since completing her residency in 2006, and has held the position of Associate Chair for two years. In addition to her work in radiation oncology, Dr. Jagsi in involved in research exploring gender issues in the medical profession.
How did you choose radiation oncology for your career path?
RJ: I have a bit of an unusual background in that I pursued a second doctorate in social policy prior to completing medical school. I initially thought I would pursue general medicine or neurology because of my interests in ethics and policy. I found radiation oncology largely through serendipity (the recommendation of a resident I was working with), and I was delighted to find a field where I could help patients with complex decisions, contribute to both cure and quality of life for patients with serious disease, and do research that spans all the way from traditional clinical-translational studies to studies of health services, outcomes, and policy.
Describe your typical work day.
RJ: My work days vary quite a bit.There are days when I am mostly seeing patients in clinic (either a multidisciplinary breast care clinic or a clinic within my own department, where I also perform radiation simulation scans and treatment planning). On those days, I have the privilege of always being paired one-on-one with one of our fabulous resident physicians; this is one of my favorite parts of our field, that we are constantly teaching and learning. Other days, I am mostly doing my own research. I lead several clinical studies in breast cancer treatment and a number of health services research studies that look at improving the quality of breast cancer care. Those studies involve a lot of meetings where my colleagues and I work together and bounce ideas off each other, make sure that data collection and analysis are going as intended, and so forth. I also do research about the medical profession more generally, including studies of gender issues and ethics, so sometime sI lock myself in a quiet office and think deeply about really complex philosophical issues. My department begins most days with academic conferences, like most radiation oncology departments, and I also take part in committee meetings, both at my institution and via teleconference to national organizations. I really enjoy the variety in my schedule, as well as the fact that I have a good deal of control over it, especially on my research days.
Based on both your personal experience and your research, what are some of the challenges facing women in academic medicine?
RJ: I have been fortunate not to have encountered overt harassment or discrimination; there are studies that suggest that these are still experiences that some women do have. What is harder to appreciate is whether one has encountered unconscious bias. The literature suggests that it's highly likely that I have encountered it; numerous rigorous social scientific studies have demonstrated the ways in which both men and women harbor certain biases that make us more likely to give the benefit of the doubt to a man over a woman with identical qualifications, and that lead us to respond differentl yto men and women in certain circumstances. Cultural norms for the ideal worker are not inconsistent with norms for the ideal man, but are inconsistent with norms for the ideal woman. The most obvious challenge to me has been the difficulty of succeeding in a relatively demanding career within a society that continues to have gendered expectations regarding the distribution of domestic labor. I have a wonderful husband who probably does even more at home than I do, and we have a great nanny, but there are times that societal expectations intervene. For example, the protocol seems to be that the mother's name is listed at the top of school contact sheets in this state, so I always get called first if a child is ill. It is those sorts of subtle expectations that can cumulatively become problematic.
Women confront these issues all along the career spectrum, but they can manifest in different ways. Anna Kaatz and Molly Carnes published a lovely piece that speaks to the ways these effects can differ for women from different generations and in different stages of their careers: "Stuck in the out-group: Jennifer can't grow up, Jane's invisible, and Janet's over the hill" (J Womens Health (Larchmt). 2014;23:481-4).
I am a firm believer that the most important interventions should be at the level of institutions rather than directed at "fixing the women." I am particularly excited about innovative programs to effect culture change, improve bias literacy, and provide support at vulnerable stages that have been identified through careful study. There is growing appreciation of collaborative leadership styles and certain mannerisms that are encouraged in girls at a very young age, so to the extent that I have internalized norms of femininity, I may have unwittingly benefited. Such traits are increasingly appreciated and may be seen as complementary to the more agentic behaviors that have been inculcated in many of the men who currently hold leadership positions.
How have mentors played a role in your career success?
RJ: I have been fortunate to count among my mentors some of the most accomplished and truly generous members of my field. I once went to a standing-room-only session held by the American Association of Women Radiologists at the American Society for Radiation Oncology Annual Meeting. I realized that every single woman on the panel was someone who had been a major mentor to me. I felt a bit guilty that I had managed to find such a rich group of mentors when there was clearly such pent-up need in the crowd. Now I serve on those panels myself, and hopefully I can offer myself as a mentor to others in the same way my mentors have done for me.
Women may gain more from mentoring than most men. Mentorship can allow access to opportunities that would otherwise be allocated by other mechanisms (including, sometimes, the so-called old-boys' network). Mentorship can also teach skills that we rarely learn formally in medical school, including negotiation skills and resilience in the face of rejection, which my own research has shown to be essential and particularly challenging for women to develop. Of course, men benefit from mentorship in these ways as well, and men who are "outsiders" probably benefit more than those who are already well-versed in what expectations are and who are already well-connected. A rising tide lifts all boats: that's what mentorship does.
What recommendations would youg ive to a young woman starting acareer in academic medicine?
RJ: It is good to recognize the ways that gender may affect how others perceive your behaviors and their expectations of you. Reading some of the qualitative research can be very illuminating; women who have walked this path before us can tell us a great deal from their experiences. Building networks of strong female role models and peers who are going through the same experiences can also be very helpful. Make sure that you have a broad and deep bench of mentors to whom you can turn if a challenge arises. You are not alone, and there are many members of our profession—both men and women—who really want you to succeed and be happy.