Fix the System, Not the Women: Shikha Jain on Why Medicine Is Failing Female Physicians

We really need to take a hard look at where the money is going because doctors are not the ones who are making billions of dollars off of all these healthcare costs. And if premiums are so high that patients can't afford it, I mean, I am a physician and I can't even understand my own healthcare plan, which is embarrassing to say, but I will get on the phone, I will say, "Why am I getting charged so much money for my son's albuterol inhaler?" And it doesn't make sense. The way that our insurance companies are set up, it's really profit over patients. And we need to get back to what I said at the beginning, which was we need to put patients first.

Thank you so much for having me and for that lovely introduction. I'm so excited to be chatting with you today.

I'm the kind of person who if I see something that's wrong or not just, I would always speak up. It's a part of who I am. I mean, I have a younger brother and my parents joke all the time. If somebody was breaking a rule or someone was doing something not right, I would get something in the pit of my stomach and I was like, "I have to say something." So, it's intrinsic in my personality. I used to think of advocacy work as, oh, you go to the hill, you lobby, writing bills. That's where I thought advocacy lived. And over the last decade or so, I really realized that there is so much more to advocacy. Whether it's patient advocacy or whether it's clinical advocacy or changing systems, there's so many ways to do that that I very proudly wear it as a badge of honor now, but I really didn't realize that's where I was heading when I started doing some of this work about a decade ago.

So, my dad's a physician. He had a private practice. He actually was the president of a multi-specialty group for years and he became a national leader in vascular surgery as a private practice clinician in Kalamazoo, Michigan. So, I always thought I was going to go to med school, do residency. I was going to become a private practice doc. I was going to see patients, have kids, have a family. And that was my dream, to be a doctor, take care of people and have my own practice. When I went through a residency fellowship, as everybody does, I initially thought I was going to be a pediatrician, then I thought I was going to be a surgeon. And eventually, I am so grateful that I found this amazing field and I became an oncologist. And when I was in my fellowship, actually, the way I ended up in academics to start was I was looking for jobs and I was actually looking for private practice jobs because that was in my head what I thought I was going to do. And then this amazing opportunity presented itself to me at Northwestern and that's where I had my first faculty position and I said yes. And so, that's how I ended up in academics. And then the nonprofit came a few years later with all the work I continued to do.

Yeah. It's so funny you mentioned that because so when I was a resident actually, my first really big advocacy win was I had a patient who I will never forget him. He ended up coming into the hospital cord compression. He was really, really sick. They ended up fixing that, but he ended up paralyzed from the waist down and he couldn't get into this skilled nursing facility because of some insurance loophole. And I was a senior resident at the time and I called and I called and I called, and I ended up finally somehow getting the head of the company on the phone. And I was furious. I was like, "This is this guy's only hope. He has survived cancer. We have fixed everything. He is now paralyzed and you're going to tell me that you won't take him because of an insurance issue." I was furious. He ended up getting accepted to this facility. And it was the first time where I, even as a resident, felt, "Wow, I can really make a difference in people's lives." And so, I think to be an oncologist, you have to have some core desire to advocate for your patients, especially in the current healthcare system. I feel like we're doing it even more than we normally do.

The sad thing is sometimes you have to figure out, okay, let's say I'm seeing 30 patients today, I'm going to have to do peer-to-peers and prior authorizations on X, which ones do I need to prioritize because there's only so many hours in a day. They only give you a certain window. You're seeing patients. Literally, five minutes before I got on this call, I got a message that I have to do a peer-to-peer on somebody who needs a CAT scan to rule out a pulmonary embolism. And I responded, I said, "This is absurd." And they said, "We agree, Dr. Jain, but this is the number to call to speak to somebody." And so, I mean, it is unfortunately become a part of a very broken healthcare system that is now integrated into us balancing that along with everything else we do for our patients.

There's two key moments when all of this started. So, first, I had just given birth to my twin boys and I was doing a little bit more work online advocacy work. I was doing a little bit more just on social media and I started noticing women posting things that seemed very similar to my experience going through my training and my career where I thought I was a problem. I thought that I didn't get an opportunity because of me or I thought I was talked to a certain way or bullied or harassed because I was a problem and that's just a system and I just have to deal with it.But these women were posting stories and I said, "Holy cow, I grew up in a physician household and I did not realize what a systemic problem this was." If I am an informed individual who came into medicine knowing what medicine is, and I did not realize that I was not the problem, I was at home crying saying, "Oh my gosh, this person did this to me, but it's really my fault because I didn't do well enough," then obviously there's something wrong with the system. And so, I decided to create a conference and I was at Northwestern at the time, so I created the first ever Women in Medicine Symposium at Northwestern while I was there, and it was a huge success.I ended up leaving Northwestern for another job at another hospital a couple months later, and I realized there was such a need for this. And so, I launched the Women in Medicine Summit. This was September 2019 and March 2020, pandemic happened. And all of these people started reaching out to me. They said, "Oh my God, you created this amazing thing. What are you going to do?"

Yeah. And I think one thing that's so interesting, if you think about how healthcare and medicine was delivered back in the '50s and '60s, right?

The doctor, the doctor prescribed you stuff, you go home, you take it.

Right. It was a very paternalistic way of medicine, right? It wasn't a team approach. It was, "I'm your doctor. I tell you what to do, you do it and you go do it." But I think that there's still that very paternalistic hierarchal way of thinking in medicine because traditionally, that's how it's been and men are socialized to be like that when it comes to the healthcare system. I also think that there's a certain way of teaching the next generation that men have been often taught. Well, you tell the patient, they do it. And I think that's changing, but I think there's still a lot of people who are in leadership who are practicing in the '60s and '70s who are still in leadership.

Well, I think there's a lot of men out there who want to help, but they don't always know what to do in this situation. So, sometimes I'm going to give you a couple of tips of what you should do and what you shouldn't do. So, what you should do, if you are in a situation and you see someone being harassed, bullied, it might not even be so outward that they're making comments on their appearance or they're doing something. So, it could just be that they're talking down to them or they're discounting their opinion or mansplaining them. As a male ally, it is amazing if you step in and you say something, because it will always mean more coming from you than coming from the female who's being attacked. So, in the moment, and you don't have to be mean about it, what I tell people is ask a question, say, "Hey, I don't think that is really how you want to come across. Do you think we could reframe the conversation?" Or if they're being a real jerk, you can tell them, "Hey, that's not nice. You're being a jerk." But I think that asking the question in the moment and calling it out in the moment is really good. The second thing you can do if you're in a meeting, and this happens all the time, women will give an idea and somebody else steals the idea, but they're not really stealing it. They're repackaging it.

So, what I tell people is that you can be proactive and if a woman gives an idea after she gives the idea, you can say, "Jennifer, that's an awesome idea. Let's talk more about Jennifer's idea and keep representing as Jennifer's idea." If someone has already stolen the idea, if Jennifer gives an idea and now John is saying, "Oh yeah, well, I had this idea to do this and change the system in this way," you can in the moment say, "John, thank you so much for summarizing Jennifer's idea so well. Jennifer, what do you think of John's ideas in relation to what you propose?" So, bring it back to the original person and that way, you're not saying, "Hey, John, you're being a jerk and you just told Jennifer's idea." You're actually saying, "John, nice job summarizing what Jennifer said. Now let's talk to Jennifer about where she sees this vision going." So, these are two ways to really be great allies in the moment. What you don't want to do is don't try to tell the woman what she is doing wrong in the moment. I've seen this happen where somebody is saying something to a female colleague and another guy comes and thinks he's being helpful because he thinks he's deflecting what the first guy is saying. And he's like, "Oh, I think John is just trying to say this, Jennifer, so maybe you should do it this way." Don't do that. Let's not hope because now she's got two men telling her what she needs to be doing.

And then the biggest thing men that you need to do, don't just suggest your friends for opportunities. Don't just suggest your male friends for opportunities. That happens all the time. It's totally unintentional. You don't even realize you're doing it. Start thinking intentionally, who is a woman I can suggest? And I'm not saying just some woman off the street. Women are very qualified. You can think of, I can guarantee if you think hard enough, you're going to find three qualified women who are just as qualified, if not overqualified for the position as compared to your friend who you just thought of who would be fun to work with. You need to be thinking intentionally about whose voice needs to be at the table and you need to be saying their name when they're not in the room and getting them in that room.

So, you can contact me on almost all social media platforms. I'm @shikhajainmd on almost every platform. You can also go to my website, which is shikhajainmd.com. I try to make it easy for people. If you're interested in learning more about women in medicine, our organization, our website is wimedicine.org. We also are on all social media platforms. You can find us at wimedicine or @wimedicineorg, depending on the platform. We are always looking for women to join what we're doing to... We want to elevate you, so we have lots of ways we can do that. If you're looking for a safe space to join an incredible network, really, please feel free to reach out. Join us at our summit in September in Chicago, September 24th to the 26th. And if you're a guy and you want to get involved, we've got a lot of men who are actually involved with the nonprofit, with the summit. We've got allies. We have men who champion our work and we would not be where we are today without all of the incredible people who have worked on the organization. So, come find us. We'd love to have you.