Ophthalmologist Barbie

Practicing retina consumes your life. Add a pair of X chromosomes into the mix, and you face a very different set of circumstances. In the debut episode of New Retina Radio, we sit down with Julia Haller, MD; Anat Loewenstein, MD; Jessica Randolph, MD; and Talisa de Carlo, MD, to hear about the how women in retina operate-and how men factor into the equation.

Scott: Okay. 3, 2, 1. I'm Scott Krzywonos.

Ranna: I'm Ranna Jaraha.

Scott: This is New Retina Radio. We're trying out something new here.

Ranna: A podcast.

Scott: And it's going to give the readers of New Retina MD a new way to access the publication.

Ranna: Yeah. So we have the smartphone app, the tablet app, but we know doctors, retina doctors, especially the young ones, are on the go.

Scott: So we created for you a podcast. This is perfect for listening when you are on a flight traveling to the next conference or you're in your car traveling to a satellite office.

Ranna: We're going to talk about issues that are relevant to the most recent issue of New Retina MD. We're going to get into some of the things that we couldn't necessarily cover in the publication, maybe get into the nitty gritty, ge- ... hone in a little bit more.

Scott: Exactly, and sometimes we're going to take, uh, sort of funny angles. So, for this one, we're going to start with Barbie.

Ranna: The doll?

Scott: Uh-huh.

[Newsreel montage of Barbie broadcasts]

Van Sustren: It’s about time! What am I talking about? The new Barbie. Yep. Barbie-maker Mattel announcing today that the iconic doll will now come in three different body types, as well as a variety of skin tones and hairstyles, too.

ABC News Broadcaster: Mattel, the company that makes Barbies, released a brand new line of doll with different body types so that more women are represented. Barbie, after 57 years of a very unrealistically proportioned figured, Barbie now comes in petite, tall, and curvy.

Degeneres: It only took 57 years. So good for them. Don’t panic: They’re still gonna make the original skinny Barbie that’s a great inspiration for super models and The Bachelor contestants.

Scott: And you played with Barbie?

Ranna: Of course. She was an icon.

Scott: And you look just like her.

Ranna: (Scoffs) No.

Scott: And that's why we started with Barbie.

Haller: Can you hear me? Testing 1, 2, 3.

Scott: That’s New Retina Radio’s first guest.

Haller: Hi, I'm Julia Haller, I'm the ophthalmologist in chief at Wills Eye Hospital.

Scott: Julia was oddly excited about something when she sat down for our discussion: It was a new toy, and a tweet.

Haller: Oh (laughs). So, I got a great Christmas present this morning from Susan Umfer and Cathy Moss, here at Wills. They gave me a Barbie, an eye doctor Barbie. She has a pink exam chair, 6 inch heels, her usual bodacious figure, she's in a little pink and green miniskirt and she has all sorts of different glasses. She has a little girl patient and lots of equipment and she has an ophthalmoscope she is holding in her hand. So I tweeted out on my twitter account, “best present ever,” and then I shared the picture of Barbie. I put in some little emoticons including a kiss (laughs) MM-HMM and as I was coming down for this interview I looked at my cellphone and I saw that Barbie had liked me on twitter (laughs).

Scott: Yes, that Barbie, the ultimate feminist nightmare, or, as Julia put it…

Haller: “Iconic bubble head.”

Scott: Here she was, an ophthalmologist.

Ranna: Was she a retina specialist?

Scott: That much is unclear.

Ranna: For this episode, and our next episode, we discuss the topic of women in retina with four women in retina. The first is Julia Haller, who we just heard from. We also chat with Anat Loewenstein, the chair of the ophthalmology department at the Tel Aviv Medical Center.

Scott: And then there's Jessica Randolph, who's a few years out of fellowship and in private practice; and [00:02:00] Talisa de Carlo. She's a fourth-year med student who took a break between years 3 and 4 to enroll in an OCT angiography fellowship over at Tufts.

Scott: Together these women show us something rather complicated, and apparently contradictory. They show us that, while each experience is wholly unique, it fits into some larger continuum of feminine experience in the field that's markedly different from that of a man.

Ranna: Where do we start?

Scott: We start in the OR.

Haller: This is an example of how things happen that ...(pause) When I was coming up through the ranks I didn't think of as sexual harassment but now, in retrospect (laughs), they would definitely be considered in that category. I was a first year resident…

Scott: She was at the Wilmer Eye Institute for residency.

Haller: …and I was assisting one of the retina surgeons on a case and I was horrified to find at the beginning of the case that when he put on the in-directive ophthalmoscope and picked up his 20 diopter lens he focused it on the breast of one of the scrub nurses.

Ranna: Wait, what?

Haller: So he asked her to turn around and he held his 20 diopter lens right over her breasts and he said, this is a perfect target because it's round, large, and it fills the field perfectly. Everybody in the operating room just, kind of, rolled their eyes and accepted it.

Scott: But that didn’t ruffle her feathers.

Haller: And so, we did the case and fixed the retinal detachment

Scott: …and the surgeon said…

Haller: Why don't we give the in-directive ophthalmoscope to Julia and let her take a look at the eye…

Scott: …and with her chance to get even…

Haller: … I put on the in-directive ophthalmoscope and I grabbed the 20 diopter lens. I was only a first year resident so I had a quick moment where I thought, should I do this or not (laughs). Then I decided if he had done that then I was going to do this so I put the 20 diopter lens right over his crotch. I said, this is a terrible target it's not large enough and it doesn't fill my field at all (laughs).

Ranna: That is ballsy.

Scott: For sure, and it didn’t hurt her in the long run.

Haller: …years later during the Anita Hill trial.

Scott: This was in 1991, when the Supreme Court nominee Clarence Thomas faced a pretty fierce confirmation battle. There were sexual harassment allegations from a former colleague named Anita Hill, and they called into question his qualification.

Haller: We were at the American academy of ophthalmology and it was right at the time Anita Hill was testifying. I walked in to a party at the academy that evening, and I heard this guy who'd been doing the case.

Scott: That is, the surgeon with the 20 diopter lens all those years ago.

Haller: I heard him telling that story to everybody so it's to his credit that he recognized the whole situation, and remembered it, and thought it was a good story to tell.

Ranna: We found that a few other women in ophthalmology had interesting OR experiences.

Randolph: Hi, this is Jessica Randolph, MD. I am a Retina specialist in Burlington, North Carolina.

Ranna: Jessica describes a time when she was under the weather during fellowship.

Randolph: I got nauseated. I had been sick all week and vomiting all weekend long. And I got sick in the OR and there was definitely the question of 'oh-oh, is she pregnant during fellowship, like what are we going to do?' And then (laughs) two cases later when I was scrubbing in with my attending I said, 'you know I am not pregnant right. I am just sick.'

Ranna: And he breathed a sigh of relief. And he was like, 'oh good, I didn't want to ask.’ What does it matter (laughs)? Why does that have to be an issue?

Ranna: That’s one of the uniquely female stresses women in the OR feel.

Randolph: You get a stomach bug, and everyone thinks you’re pregnant.

Scott: One thing we noticed during these interviews: some of these stories are funny, because the women telling them think that the stories are funny. Our interview subjects laughed off some of these cases as, like, occupational hazards, like Jessica just did.

Ranna: But sometimes, confrontations founded on sex become uncomfortable and can affect professional development. Jessica told us about some questions she encountered while interviewing for fellowships and jobs.

Randolph: You are not allowed to talk about things like maternity leave. And like I am not married or anything, but I know people who were married. Or I know women who were married and pregnant and interviewing and had to hide the pregnancy

Scott: From interviewers?

Ranna: Yes, because…

Randolph: Because it would change the outcome of things. And I mean that's just the way it is. But you know what makes a woman having a small baby at home much different from a man with a small baby at home. Either way there's a small baby at home. And someone's got to take care of it.

Scott: I assume there are ways around creating an uncomfortable situation?

Ranna: Not really, according to Jessica.

Randolph: Even just asking what the maternity policy is kind of colors the discussion after that. And I feel like people take that a certain way. They feel like you are going to start cranking out kids, neglect your work, and not be a good employee anymore, which is just false.

Scott: So, job interviews and fellowship interviews deal with these questions. What about residency interviews?

de Carlo: Hi, my name is Talisa de Carlo. I'm a fourth year medical student at Tufts University and previous OCT fellow at New England Eye Center.

Ranna: She actually just matched at UIC for residency.

Scott: Talisa says she has not faced the same problems that Jessica faced on the interview trail ...

de Carlo: I haven't gotten that experience yet. I think part of it is potentially because I'm a little younger. Also, I think generally ophthalmologists are a really kind people. It definitely hasn't come up.

Scott: Now just because she hasn't faced some uncomfortable situations during interviews doesn't mean that she hasn't felt it professionally.

Ranna: How do you mean?

Scott: Well she isn't facing the overt discrimination that Jessica felt or the obvious harassment Julia countered so definitely in the OR that day. But she knows what they're talking about even if the biases are inadvertent.

de Carlo: There is some subtle bias, I think, that not necessarily (pause). It's not necessarily on purpose. I remember I showed up for a rotation once, and I was standing with a tall male who just looks much more intimidating than I do, and I'm a really small female. We both walked up and a resident immediately greeted the guy, had a great conversation with him, and then briefly, introduced himself to me, and I felt somewhat ignored. It was definitely not on purpose, but he definitely paid so much more attention to the guy, and it wasn't until a day or two later when I was talking and asking questions and showing enthusiasm, and showing some knowledge and interest that he started to pay attention to me and realize that maybe I'm someone that he should also take seriously.

Ranna: That's yet another example of women dealing with a situation that men likely don't face as often. Scott: Agreed, but I'm seeing improvement. Think of it as a continuum. For Julia, there was overt sexual harassment.

Haller: I was horrified to find at the beginning of the case that when he put on the in-directive ophthalmoscope and picked up his 20 diopter lens he focused it on the breast of one of the scrub nurses.

Scott: And years later, Jessica faced uncomfortable questions during her interview process but there wasn't overt evidence of gender-based discrimination ...

Randolph: Even just asking what the maternity policy is kind of colors the discussion after that.

Scott: And now Talisa, just last year, faces unconscious bias

de Carlo: There is some subtle bias, I think, that not necessarily (pause). It's not necessarily on purpose.

Ranna: So the biases have disappeared?

Scott: Well, not so fast.

Haller: They're pretty intact.

Scott: More on that, when we come back.

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Scott: Welcome back, I'm Scott.

Ranna: I'm Ranna.

Scott: And where we last left off, things seemed to be getting better. That is, until we asked Julia Haller if the barriers that kept women from shattering the glass ceiling were still standing.

Haller: They're pretty intact.

Scott: Sure, I believe her. But by what measurement?

well we have some idea of metrics from one of our speakers.

Loewenstein: My name is Anat Loewenstein, I'm the chair of the Department of Ophthalmology in the Tel Aviv Medical Center and vice dean at the Sackler Faculty of Medicine in Tel Aviv University. Tel Aviv Israel.

Scott: In Anat’s estimation, about 50% of Israeli ophthalmologists are female. But if you measure the number of women in academic leadership roles, the numbers don’t match up.

Loewenstein: If you look at chairs of department we have 20 departments and only actually four are chairs of departments and two more chairs of what we call units in smaller hospitals. So you would say it really shows a bias against women because it's not 50% and then someone else said these are the only ones wanted. These are the only ones who are willing to take the responsibility that it takes.

Scott: Or we can look at the podium.

Loewenstein: I saw a few months ago at a meeting that says, Best of Retina, I don't even remember what meeting it is. It's purely American and there was one woman out of 20 men in the in their participants, in the faculty. This woman also is not an Ophthalmology, but a researcher.

Scott: Or we can look at the literature.

Loewenstein: When you look at scientific journals there are women and as first authors, there are also women as senior authors on the papers, there are also women on the editorial boards, however almost no editorials are written by women.

Haller: I wrote an editorial in JAMA ophthalmology this year ...

Scott: That’s Julia again. She’s delved (do you mean dove?) into this topic quite a bit.

Haller: … A paper that showed that if you looked at the past ten years and you compared how many women were first authors on papers that were in the peer reviewed literature in the top three ophthalmology journals. There had been an increase over those 10 years so more and more women were writing papers.

Ranna: That sounds like progress to me.

Haller: But if you looked at editorials by women. Again in those top 3 journals there actually had been a decrease in the number of editorials by women in the last 10 years.

Scott: So although more women are writing papers, more women conducting research, more women are successfully publishing papers…

Haller: At the at the other end of the pyramid where there were people who were commenting, people who were considered the experts, people who were weighing in, we haven't made any progress yet in the last ten years.

Ranna: How small of sample size are we talking here?

Haller: I think I started out by saying if the statistics hold true my authorship of this editorial will increase by 10% the number of female authored editorials in the top 3 ophthalmology journals this year.

Scott: By the way, the article she wrote was called Cherchez la femme. The title is French, but the article is in English. Find it in JAMA Ophthalmology, volume 133, issue 3.

Ranna: Julia and Anat offered a very defined observation: that there's a disconnect between the number of women in the field, and the number of women in leadership roles. This is the glass ceiling women are talking about. They can get to those leadership roles in theory, but reality is something completely different.

Scott: It seems like it would be enough to make you hate the industry, like you'd feel like the game's rigged.

Ranna: Yeah, but no one we spoke to really dwelled too long. It just didn't seem to get them heated or frustrated, per se.

Haller: No, it’s all water under the bridge.

Ranna: Jessica agreed.

Randolph: In the end, I know what I am capable of. I know that I am competent and knowledgeable and skilled. And that I can do anything and everything that anybody else in the room can. You know it's not … It's not something that I sit here and kind of dwell on.

Scott: So, back to the question of Ophthalmologist Barbie, the ophthalmologist woman with it all. She's got the brains and the looks and the bank account and the respect of her colleagues and the ability to retain her femininity while succeeding in a masculine dynamic. How does she do it?

Ranna: Well, I think that's debatable.

Scott: What do you mean?

Ranna: That's the whole problem with Barbie to begin with. That's why her recent body adjustment was such a big deal. She created an impossible physical standard, and now she's creating a near-impossible professional standard.

Scott: So she's not just a toy.

Ranna: I mean, of course, very few female ophthalmologists are looking at Barbie and aspiring to her standards, but that's the point. That very concept of Ophthalmologist Barbie at its base is charged with idealism and, and some would say unrealistic standards.

Scott: It's not like the cosmic forces have aligned against women entirely. Right? Like, there's, there's a few organizations in retina that provide a structure for women to encourage each other's careers. And mentorship, when it's combined with feminism, takes on a really unique flavor. Or in even making the decision to enter medical retina versus surgical retina might be influenced by gender differences.

Randolph: And you know kind of compounding this I am black, and so there's like the black woman thing too.

Ranna: Yeah. So, we'll tackle those topics and more in our next episode. Special thanks to Julia Haller, Anat Loewenstein, Jessica Randolph, Talisa de Carlo.

Scott: I'm Scott Krzywonos.

Ranna: And I'm Ranna Jaraha.

Scott: See you next time.

de Carlo: Hi, this is Talisa de Carlo here to read the credits.

Randolph: Hi, this is Jessica Randolph and I’m reading the credits. New Retina Radio is a production of Bryn Mawr Communications and New Retina MD.

de Carlo: The show is produced by Scott Krzywonos with help from Rachel Kagan.

Randolph: Our staff includes Ranna Jaraha, Dave Levine, Megan Beisser, Elisa D’Amato, Laura Geise, Julie Kassab, and MJ Stewart.

de Carlo: The show was mixed by Greg Nothstein, and recorded by Greg, Bryan Bechtel, and Frank Conte.

Randolph: Our publisher is Alan Guralnick.

de Carlo: For advertising questions, contact us at NewRetinaRadio@bmctoday.com. Thank you and goodbye.

Randolph: Bye! Thank you.