Je Ne Sais Quoi

Last episode, we heard from women at various stages in their careers about the unique nature of practicing retina as a woman. In part 2 of 2, they discuss the role of men in the development of women, the merits of joining groups like Women in Retina, and how experience shapes perception of how the industry treats female candidates. Featuring Julia Haller, MD; Anat Loewenstein, MD; Geeta Lalwani, MD; Jessica Randolph, MD; and Talisa de Carlo, MD.

Krzywonos: Uh. Greg, are we good to go?

Nothstein: We are good.

Krzywonos: I'm Scott Krzywonos.

Jaraha: I'm Ranna Jaraha.

Krzywonos: This is New Retina Radio. We're continuing our conversation about women in retina. Don't worry. We're going to change topics for the next episode, but there was just too much good stuff to not follow up on.

Jaraha: I'm sure you noticed by now that the episodes were running relate to topics covered in New Retina MD. They are topics that withstand the test of time. That's the goal, after all, to provide you with content that will still be relevant in a few years.

Krzywonos: I love clinical trial data. Ranna loves clinical trial data. You love clinical trial data.

Jaraha: (laughter)

Krzywonos: But it's not going to be relevant in a couple of years. And, ye- You can read about that, you know, in print or on EyeWire or hear it from the podium. We hope that these topics are going to be relevant for years down the line.

Jaraha: That's right. And as a reminder, that topic is women in retina. We'll continue to speak with Julia Haller, Anat Lowenstein, Jessica Randolph, and Talisa de Carlo. We also added a fifth voice. She'll come in later.

Krzywonos: A few of our listeners commented that we sounded too optimistic at the end of the first episode. Like we made it sound like the problems for women in retina were once really severe and now they've completely vanished. And while things have certainly improved, there's still along way to go.

Nothstein: Don’t be intimidated by it.

Haller: Laughs. I feel like I’m about to kiss the microphone.

Krzywonos: Isn’t that what they tell you?

Haller: “Eat.” I thought it was “eat the mic.”

Krzywonos: Let's start with Julia again.

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

Krzywonos: I'm sure you remember her.

Jaraha: Yeah, she's hard to forget.

Krzywonos: I asked Julia about the avenues to success as a young woman.

Krzywonos: Do you have to, because you're working in such a male dominated field as a young woman, do you have to prove yourself. Like, do you have to work twice as hard to get the same amount of respect from some people?

Haller: (pause) I mean, maybe (laughs). I think it's, for me its been more that I had to work hard to not seem as pushy and driven and hardworking as I was, you know to um ...

Krzywonos: Why? Is that because if that's a woman is pushy she's a bitch?

Haller: Yes, yup.

Krzywonos: Okay.

Haller: Mm-hmm, mm-hmm (affirmative).

Jaraha: I know that feeling.

Krzywonos: I do not, I am a guy.

Jaraha: It's kind of hard to explain. But it seems like when a women has confidence and holds a position of authority, for whatever reason, it's not respected the same way it would be for a male counterpart.

Krzywonos: Mmm.

Jaraha: Instead of being revered as a positive symbol of strength and achievement, women in power are sometimes perceived more as unapproachable and somewhat of a brute force.

Krzywonos: Oh, okay, okay. So it's like a, it's a balance between bitch and boss.

Jaraha: Yeah. Right. Uh, one of our other interview subjects, Jessica…

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

Jaraha: She knew balance between boss and bitch isn’t easy.

Randolph: Everyone loves to call a woman in charge a bitch or a boss.

Krzywonos: Right.

Randolph: Because we know what we want, and we want to get it.

Krzywonos: And if it’s a guy…

Randolph: Then it's just a guy you know doing this thing and running his, you know, running his business or whatever. But for women, it's you know, we are, we are being a bitch or we are emotional because we are PMSing or whatever.

Jaraha: Jessica understood Julia’s sentiment about working harder to achieve. But her motivation is a little bit different.

Randolph: kind of a common quote in black households is that you have to work twice as hard as everyone else, (pause) to achieve the same things. And that's, that's true.

Jaraha: For Jessica, race and gender played similar roles as roadblocks during her professional development.

Randolph: I mean, racism is real. Um, and although it's not overt, there's definitely some um, inherent discrimination in the whole medical system you know and all the interviews and everything. And um, you know being from the South and training in the South, there, there's definitely things that are there you know.

And again, most of the time nowadays things aren't so blatant and obvious. You know you don't show up for an interview and they say well, you are not going to get this job because you are black or because you are a woman.

Jaraha: In our previous episode, Jessica said that asking questions about maternity leave during residency or fellowship interviews is ill advised.

Krzywonos: Yeah that's right she said it kind of throws some stank on the conversation.

Jaraha: Yeah, yeah.

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. Um, you know, they, they feel like you are gonna start cranking out kids and neglect your work. And, you know, not be a good employee anymore, which is just false.

Jaraha: Similarly, the tone of conversation with regard to race is subtle but present.

Randolph: You definitely get kind of the vibe that some people are like, oh well, you know she is just here because of affirmative action or she is just pretty and that's how she's gotten where she is.

Krzywonos: What about if she weren't a black woman?

Jaraha: No, she says the circumstances would be different.

Randolph: Whereas you know if it were the same resume with a white guy on it, then it'd be you know “Oh, he worked hard and he got here on his merit,” instead of you know questioning or throwing doubts into things.

Jaraha: The interactions with patients are strange when you consider race and the fact that Randolph practices in the south.

Krzywonos: Different from um gender stuff?

Jaraha: Similar, but yeah, it’s different.

Randolph: People are more verbal about, um, racist things than they are about sexist things. So, you know, the sexism thing is people thinking you know thinking I am the nurse. Or not believing that I am the doctor. Or, you know, that sort of thing.

Um, whereas the racist thing is the patient who will say um, “I want a different doctor.” And, like, well, you just met me. You don't know anything about me.

Krzywonos: Mm-hmm (affirmative).

Randolph: You just know my name. You don't … We haven't even had a conversation about your actual disease process yet. And, you know, “I want another doctor.” Okay, fine

Krzywonos: I assume she picks and chooses her battles in this regard?

Jaraha: Exactly.

Randolph:, I am not going to change your mind. I am not going to like you know change hundreds of years of inherent bias from your racist parents and et cetera. So, you know, just let it roll. Keep it moving.

Krzywonos: This sucks. It's just an extra thing to deal with in an already busy clinic.

Jaraha: Yeah, but she's optimistic. Jessica sees the tide turning more toward open-mindedness or at least away from prejudice. She framed it as a generational shift, both in patients and in the founding fathers of retina.

Randolph: I think a lot of these issues are you know the older generation of retina specialists who you know were there when there was literally like Alice McPherson and no other woman in retina. That's the generation of, of men that think that women are not as good as men or not as capable of reattaching a retina.

Krzywonos: Or, to use a retina cliché…

Randolph: It’s a paradigm shift.

Jaraha: So there’s the younger folks who seem to get it…

Randolph: All the guys that are, that I know in Retina that are my generation, I don't have a problem with them.

Jaraha: And then there’s the older crew…

Randolph: The older generation that is doing the interviewing and hiring the new physicians and things like that. Those are the ones that mostly you know kind of have this inherent bias. And you know the same goes true for racism I think. You know the younger crowd is a lot more liberal and accepting and it's you know the old white guy retina specialist who think that you know affirmative action is the only reason I was in medical school or whatever.

Krzywonos: I asked Jessica about black female mentorship in retina. You’ve already guessed it: It’s a pretty scant population.

Krzywonos: You mentioned being a black woman is a unique role in retina. Um, where there any black women role models that you encountered?

Randolph: Um, (pause) yes?

Krzywonos: You said that sort of skeptically.

Randolph: No, there are. I am just thinking you know there's, there's literally not very many of us.

Jaraha: And one of our other subjects said that appearances matter, and that racial diversity is part of it.

Lalwani: My name is Geeta Lalwani. I'm a retina specialist at Rocky Mountain Retina Associates in Boulder, Colorado.

Jaraha: Geeta told us how her race intersects with retina.

Lalwani: My background is from India. Both my parents are from India. I do not come from a medical background, um, but entering into medical school, residency, fellowship, there are a lot of Indians in the world of medicine. A lot.

Jaraha: We were at VBS when we spoke to her, and she said that the meeting confirmed her observations.

Lalwani: I look at this meeting today and I always pay attention to, you know, how many are women and how many are Indian because those are the things that are relevant to me and the number of Indians in retina is quite amazing. Astounding!

Jaraha: Which is all well and good for Indians. But other groups aren’t represented so well.

Lalwani: And then I also think at the same time that some of the other minorities are very well under…underrepresented.

Jaraha: Appearances are important, she said, particularly from the podium.

Lalwani: What a difference it makes for me seeing people up on the podium who look like me in one respect or another.

Jaraha: And for those who don’t see someone who looks like them on the podium…

Lalwani: It's discouraging when you don't see anybody up there who looks like you.

Krzywonos: You can see why a minority woman in retina is a double-whammy, because 1, you're female, and you're already a rare breed, and 2, unless you're, uh, you know, like a well-represented minority, like Indians, as Geeta pointed out, your isolation is compounded.

Randolph said that despite the fact that there are only a few black docs in ophthalmology, they stick together.

Randolph: The black ophthalmology, um, kind of unit, is very tight. And at the National Medical Association, which is the medical association for essentially minorities and African-Americans, there's always a very strong ophthalmology section with a research program.

Krzywonos: Which made us here, at New Retina Radio think of mentorships in general.

Jaraha: Mm-hmm (affirmative).

Krzywonos: When it comes to women, uh, what organizations exist and, and how do they function? Are they even useful? And what are the personal mentorships like?

When you talk about personal mentorships with docs, you put yourself at a risk for hearing, just, you know, a- like a laundry list of people, all of whom get shout-outs. And this isn't because docs are trying to cover their bases, or check all the boxes. It's because the mentorship world in retina, you know, it- it really is, like, a rich environment where a bunch of important people positively influence uh, like, one young doctor's life.

So for our purposes, let's stick to a single mentor for these subjects. Talisa, for example. 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.

Krzywonos: Talisa mentioned a particular person…

De Carlo: Dr. Nadia Waheed.

Krzywonos: …who influenced her professional life.

De Carlo: She is an extremely strong woman. She manages, and I'm not sure how, to have an incredible clinical practice. She manages so much of the OCT research. She's the director of the Boston Image Reading Center.

Krzywonos: The admiration is professional…

De Carlo: She would spend all of Tuesday working with me, or working with another med student, or working with the residents, and it was her committed research mentorship day.

Krzywonos: …and personal.

De Carlo: And she's an incredible mom. She has this loving daughter, Kadisha, who just is the most loyal of any children I've ever seen. So she really seems to have a great grip on life and she has a great attitude, even in the face of, uh, fairly significant adversity. And I really look up to her, and I hope to be quite a bit like her in the future.

Jaraha: Isn't that interesting, though? The desire to emulate someone both professionally and personally?

Krzywonos: Yeah, it- it is, but it doesn't seem that farfetched. Like, I do it in my own life, and if you see someone like yourself on the bench, like Talisa did…

De Carlo: I think that we have very similar personalities, in a way.

Krzywonos: …then you wanna emulate them in real life, too. Geeta, when asked to name a male mentor, brought up someone in particular.

Lalwani: Phil Rosenfeld is another one who's been supportive to my career coming up. I was lucky enough to do, you know, the PRONTO paper with him and, you know, he promoted both, myself and Anne Fung, as much as he could.

Krzywonos: All right, points for the fellas. (laughing) But it's uh, yeah, it's- it's not that shocking, but you would assume that a woman would be the first to jump in to help other women.

Jaraha: Au contraire. Geeta said mentors are mentors, regardless of gender.

Lalwani: It doesn't necessarily need to be a female. It needs to be someone who's willing and able to promote women retina specialists, and that goes for men or women.

Jaraha: She had the philosophy that what's good for the goose is good for the gander.

Lalwani: I think, honestly, that everybody benefits by bringing women up. But it's culturally different.

Krzywonos: And how do we bring women up, as Geeta says? More on that after the break.

[Commercial Break]

Krzywonos: Scott.

Jaraha: Ranna.

Krzywonos: New Retina Radio. We've decided that everybody wins when women are promoted in retina, and that the same goes for minority groups. This reminds me a lot about uh, that phrase from Adam Smith about rising tides.

Jaraha: Which one?

Krzywonos: The one that rising tides lift all boats. It's not a perfect analogy, but the same principle applies. If representation of women or underrepresented minority groups, in this case, is the tide...

Jaraha: Yeah.

Krzywonos: ...then everyone in Retina are the ships. Better representation then, equals greater success.

Jaraha: Ah ha.

Krzywonos: But, how exactly do we raise this tide? Well, there's a few organizations in retina that try to do so, but our interview subjects have a few ideas of how they work, if they work at all, and how functional they are. First, Jessica.

Randolph: Men are automatically surrounded by men in medicine and in retina.

Krzywonos: And for women?

Randolph: Women there's um, you know we, I think we take a little bit more um initiative to kind of meet other women because there are fewer of us.

Krzywonos: And the meetings themselves? Part of the meeting is lecture format, and part of it isn't formatted at all.

Randolph: There are you know social events or lunches where you know, uh, there are speakers that talk about different things.

Krzywonos: And some of the meeting is one-on-one.

Randolph: But there's also a specific mentoring event for the Women in Retina group where, um, there's a mentor brunch. And you sit down and have brunch with another woman in retina who is assigned to be your mentor.

Krzywonos: Julia added a bit to the discussion, too. She’s uniquely qualified to discuss female mentorship groups in retina.

Haller: I helped start women in retina. I came up with the name WinR, which is our acronym (laughs).

Krzywonos: In addition to the general sessions and the one-on-one mentoring…

Haller: It also features meetings such as our, uh, fluorescein conference, ah, at some of the ... At the ASRS meeting, which is a nice chance for women to get together and kind of know each other in terms of clinical skills, too.

Krzywonos: Julia sees the organizations as a positive.

Haller: Those organizations are hugely beneficial and they make a concerted effort to educe scholarship and, um, to help women particularly understand about negotiations and promotions.

Jaraha: She clearly has an opinion on them.

Haller: I can't say enough good things about them. I'm very impressed with the groups and their leadership

Jaraha: Geeta attends WinR when she attends the ASRS meeting.

Lalwani: When I’m at the meeting, I definitely attend their meetings.

Jaraha: Then there’s OWL, wish stands for Ophthalmic Women’s Leaders. We asked Geeta if she thought OWL and WinR were useful. Her answer was yes, but with a caveat.

Lalwani: You know, that's an interesting question. I think that it is…they are both very useful in certain aspects.

As I was thinking about coming to this interview, of what I would say, really, there's a couple of things that come up and one of the strong ones is looking for a strong mentor and I think both of those organizations facilitate that. In fact, I think both of them have made it a priority to help mentees find mentors.

Jaraha: (Guffaw) Which is a great thing, according to Geeta.

Lalwani: So in that respect, I think they do a very good job.

Jaraha: But the times they’re changing—for the better, yes. But that means these organizations need to adapt, too.

Lalwani: The one drawback, I think is that they are separate institutions and I think that we have ... I think women have gotten to a point where we have done a lot. We've come a long way.

Jaraha: Back again at VBS in Miami, when we chatted with Geeta, she pointed to that very meeting as an example of progress.

Lalwani: I mean, our meeting today, the Vit Buckle meeting, we had 42 female attendees out of 165. That is almost 25% of attendees here are women and I think the conversations now need to happen with men in the room.

Jaraha: So, in short…

Lalwani: Women still have a long way to go in retina, but I don't think it can be accomplished with women alone.

I think that men have to be brought into the conversation. And I think that they need to take a role in changing it.

Krzywonos: I see what she's saying for sure, and I agree that the organizations that she was discussing are integral to, to the industry success, but I wonder if women always want to join.

Jaraha: Mmm. Yeah. I agree. It's likely that some women may be a tad reluctant. After all, it can be argues that joining a group that is exclusive to women is counterproductive to the goal of establishing equality. Remember Anat Loewenstein?

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.

Jaraha: She felt conflicted.

Loewenstein: For many years I had the concept that I do not want to be differentiated from men so I do not want to be in these organizations, so I'm not very heavily involved.

Jaraha: But experience led to a change in perspective.

Loewenstein: But as I mature in my career I am more open to see the objective difficulties that young women may have and I'm more open to, to try and, uh, and be involved in these organizations and try to correct the situation. Maybe a little bit artificially as these organizations are doing for, for women.

Jaraha: Anat pointed to allocation of grant money as an example of how her views have changed, and as an example of how women can have an impact on the careers of other women outside of organizations such as OWL and WinR.

Loewenstein: For example, if uh, we're in-charge of granting, uh, research, uh grants, of giving research grants, so I was always against looking at women differently when they applied.

Jaraha: But now, with experience…

Loewenstein: Nowadays, I'm more open to think that maybe one grant a year needs to be colored, just for a young woman, to help her in trying to correct the fact that she maybe cannot ... The early stages cannot devout so much time to research as her male counterpart and may need more help in this regard. So I'm now more open to be involved but I'm not very heavily involved until now.

Jaraha: Basically, Anat wants to try to adjust for difficulties at the outset of a career by providing more opportunities.

Loewenstein: So I think basically being a woman should not be a factor, so everyone that is willing to do the effort should be able to do it. Uh, but as I said, I think there, there is room for some correcting maneuvers such as giving them a little more opportunities, especially at the early stages, that will enable them to overcome objective difficulties that they may have as compared to their male counterparts.

Jaraha: To Anat, it's a practical matter. If retina doesn't provide opportunities for women to enter the field, the specialty threatens to cut itself off from a good batch of doctors.

Loewenstein: First of all, we're missing a lot of resources because women are 50% of the population and I think their number in medical school is growing, so we need to give all the women the opportunity to go to retina, not to miss this wonderful bunch of people that are there.

Jaraha: Anat made a point that Maria Berrocal made in our most recent issue of NRMD. She said that women provide a certain touch to retina that men cannot provide.

Loewenstein: Their look maybe different on various, uh, issues. They may have different point of view, they give to the, to, to the, to the culture of the profession, another something.

Jaraha: So I suppose that something, that je ne sais quoi, might be the element that keeps retina among the strongest fields in medicine.

Krzywonos: We're shifting away from this topic on New Retina Radio. It was a fun set of debut episodes and we hoped you liked what Ranna and I put together here, but before we go, two final things. First, we asked our two most senior interview subjects, Julia and Anat, to offer advice to young female retina surgeons. Unsurprisingly, their advice was identical.

Loewenstein: I would like maybe to give a take home message to young women in their, in the beginning of their career. I think that retina is a great profession, they should not give it up. When they negotiate their position they should not put themselves in an inferior status. They should look at themselves as equal as being able to contribute and they should really believe in themselves and believe that what they need to do is to be the best retina specialist and not necessarily to be nice to the, to the person who's recruiting them.

Krzywonos: Julia, too, had some thoughts on negotiation

Haller: I had a situation a few years ago where I was talking to one of our third year residents and she left. She said, I've got to go now because I've got my last negotiation for my job that I'm about to take and I was already turning back to my email and I kind of said over my shoulder to her, “Remember not to take the first offer.”

She came back in the room and said, what did you just say? Why did you just say that and I was already back in my email and I turned around and went, “Oh sweetheart, don't you know that you're a girl so you're going to take the first offer and you won't negotiate?” And, and she didn't know that and that's just ... I, I felt, you know, I've really let the women in my program down. (laughs)

Jaraha: Not taking the first offer is something everyone has been advised at one point or another, yet when you're in the situation, it's easy to forget or just take the easy way out for the sake of having your first job in the bag.

Haller: We've started having some more formal mentoring sessions and we've put together some discussion groups, but there's so much scholarship out there that helps inform women and, you know, one of the things that's well known is that we will take the first offer, we won't negotiate, and that 15% or 10% salary differential over the years makes a huge difference.

Jaraha: The solution? Well, that's part of behaving like a mentor, both inside the OR, and at the business level.

Haller: If we can equip people with that knowledge so that when they walk into the negotiation and they are tempted to take the first offer they know that that's something that they're programmed to do and they have to fight it in order to get to the point that they need to be.

Krzywonos: And now, a final note. After Jessica heard the first episode, she sent us an email; after hearing the draft for the second episode, she sent us another email. I’ve combined both emails for the sake of narrative coherence, but I’ve kept Jessica’s language verbatim. Here it goes.

“Hey Scott. So it's funny. Since I listened to the podcast part 1, it's like all these things I either noticed more since we were talking about them, or had been more apparent. Just thought I'd share them with you in case they help out with the podcast.

Patients call me Jessica. Not a lot, but a few. In fact, I have a friend who works with a male nurse practitioner. They call her by her first name, and call him doctor. WTF. I don't introduce myself by my first name, I don't even mention my first name. I introduce myself as Dr. Randolph.

It's just...disrespectful for people to call me by a name I haven't even introduced to them. I've discussed with a male young colleague and he said that it happens to him some, but not that often.  It happens to me all the time.

I don't know, I just don't want to sound bratty that patients don't call me Doctor, but its a little disrespectful when I don't offer them my first name and they decide they're going to use it anyways.

I have a patient that refused to see me because I'm black.  He was a patient of the guy before me.  When it came time for me to start he told my head tech he would not see me because I'm black, without knowing a single thing about me, other than that.

Not to mention he's a lawyer in town, so it’s not like he’s a redneck hick. He ended up a patient of another retina specialist in town.  For whatever reason he ended up disgruntled with his current doc and had an appointment to see me.  He then proceeded to no show that appointment, then call and demand a certain date and time appointment.

Once my staff realized who he was, they called and told him to stay with his current retina specialist.  Aside from once in residency when a patient refused to let me examine them face to face, this is the most blatant racism I have encountered.

Patients say I don't look like a doctor. Um? Is that because I'm young? Black? Female? Attractive? All of the above? I get this a lot. And kind of part and parcel, patients question my medical knowledge because of that. One of my partners has a mug that says don't confuse your Google search with my medical degree. Tempted to plaster that on all of the walls of my exam room.

Best, Jessica”

All right everybody that's all we've got for this episode, thanks for listening. Special thanks to our speakers Julia Haller, Anat Loewenstein…

Jaraha: …Geeta Lalwani, Jessica Randolph, and Talisa de Carlo.

Krzywonos: I'm Scott Krzywonos.

Jaraha: I'm Ranna Jaraha.

Krzywonos: See you next time.

Voicemail: Press 2 to play new messages.

Haller: Hello, Scott. This is Julia Haller, and I’m here to read the credits.

New Retina Radio is a production of Bryn Mawr Communications and New Retina MD.

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

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

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

Our publisher is Janet Burk.

For advertising questions, contact us at NewRetinaRadio@bmctoday.com.

Thank you, and goodbye. 

Voicemail: End of messages.