In 2018, Forbes Magazine declared Penn Medicine the second best large employer for women in the country. This honor came amid a provocative national conversation on women in the workplace, and the challenges they face. These events inspired us to bring together three Abramson Cancer Center physicians to discuss their careers, and the rewards and challenges they have presented.
The conversation was led by Lynn M. Schuchter, MD, C. Willard Robinson Professor and Chief of the Division of Hematology Oncology. Dr. Schuchter spoke with Julia C. Tchou, MD, PhD, Associate Professor of Clinical Surgery, and Neha Vapiwala, MD, Associate Professor of Radiation Oncology.
On November 11, Drs. Schuchter, Tchou were Co-Chairs of the Women in Oncology event hosted at Penn's Smilow Center for Translational Research. Watch the event video.
A Seat at the Table: Beginnings and Rewards for Women in Oncology
LMS: Neha, Julia, it's wonderful to sit with you today. It's rare that we can sit and talk and reflect. I'd like to talk about your experience as women physicians, not just at Penn but how you've experienced your careers. You've accomplished so much. Neha, why did you become a physician and why radiation oncology?
NV: I immigrated to this country when I was five. My parents encouraged me to take full advantage of this opportunity. I always enjoyed science and math, and helping people. Medicine had all of that. I'd never heard of radiation oncology but I always gravitated towards cancer patients during my medical school rotations. The path of radiation oncology first became apparent when I took the clinical elective. It opened up my world — that there were options within oncology.
LMS: Julia, tell us why you became a physician and why surgery. Even today, women in surgery are the minority.
JCT: I wanted to be a physician since I was seven. After watching my grandmother die of lung cancer, I decided that treatment for cancer should be better, and no one should have to suffer from cancer. I was only seven but I knew that I wanted to be a medical oncologist.
LMS: It's not too late. We would still have you in our field. But we need you in surgery.
JCT: I entered a medical science training program (MSTP) because I wanted to develop better cancer drugs. My PhD research involved pharmacological work on DNA repair. I was dead set on medical oncology until I tried surgery. I loved it. Yet, I second-guessed myself because I didn't think I'd be able to do both research and surgery. My MSTP director said I could not do it. He said that I should not choose surgery.
LMS: I want to be clear. It was he said, "don't do?"
JCT: Yes, correct, but I stayed with it because my gut told me I could do it. I knew it would be hard, and it was. I trained at a time when attending physicians talked to the male residents like they were their buddies and invited them to ball games and golf. Women residents weren't part of the conversation and were excluded.
LMS: How many women residents were there in surgery?
JCT: In my class there were two, which was good at the time. Despite this, I almost switched to radiation oncology in my second year.
LMS: Was it the career of surgery that was dissuading you or was there something about the culture affecting your decision?
JCT: I think both. The culture did not offer the mentorship to let me know I could do both surgery and research. I talked to several people during the decision making process. Don Coffey told me to do breast surgery and breast cancer research. I listened to him, and I never looked back.
LMS: Don Coffey helped so many people. He was a great mentor. Neha, did anyone discourage you from going into medicine or radiation oncology?
NV: My parents are not doctors, and they didn't exactly discourage me, but were concerned that I was choosing a long road. They assumed that I would want to have a family and suggested that I think long and hard about whether this would be the best career choice. The conversation just made me more committed. It helped me understand that I was choosing a path for life. Since then, I've had patients refer to me as the nurse or support staff but I never felt that I needed to apologize for anything.
LMS: How do you handle it when people assume that you're not a doctor?
NV: I usually handle it with humor because the patient is in a position of vulnerability. No matter what the patient says, I'm still the person whose job it is to heal. Sometimes, I give a very direct response such as, "Sir, as I mentioned yesterday, I'm your physician."
LMS: Julia, have you experienced this?
JCT: Oh, yes. Being smaller in stature and Asian always puts me at a disadvantage when I'm standing next to a tall white male medical student.
LMS: It's happened to me too. I tell medical students and fellows to wear their white coats so people know they are doctors. You will never see me in clinic without my coat. Patients now sometimes mistake my [female] nurse practitioner for a doctor. This is progress.
NV: Yes, I think the white coat inspires confidence on the part of patients that the individual taking care of them is competent to do so, despite whatever biases they may have.
LMS: What's the most rewarding aspect of practicing medicine? What are you most proud of?
JCT: I feel like what I do every day is so meaningful because I can help women individually and advance breast cancer research at a larger level. It's a privilege to be able to do this.
NV: I agree. It's such a privilege to be able to do what you love, to have an impact as Julia describes, and to impart that to trainees. Some of my proudest moments are when I see my medical residents follow in some way the steps I've helped pave for them.
Obstacles: Parenting and Academic Medicine
LMS: Penn Medicine is an incredible place for women. Yet, I still occasionally see and hear challenging situations or inappropriate comments. Julia, what obstacles have you faced and is it still happening today?
JCT: Women have to make so many sacrifices at home and at work compared to our male counterparts. I feel like I have to work so much harder than my male colleagues. There's a subconscious bias in everyone including myself. I don't know how to get around it except to mentor the younger generation and to set examples for them. We need to encourage them in a way that is not gender based.
NV: As an example, I took 12 weeks off when I had my first child. When I told people I planned to do this, they acted as if it was extreme. I had a stressful maternity leave because I kept questioning whether I had closed a door on my career that would never open again. I was on the computer nearly every day working, yet I still worried that I would be written off. I got through it because I knew that I wasn't going away or compromising my career. And, at a very difficult time, a male mentor reassured me that I would be fine. He told me to enjoy my family. It really helped. This experience has stuck with me. I don't know any male colleague who has gone through this.
LMS: I've been the chief of hematology/ oncology for 13 years. I've only recently seen how a woman leader has the potential to influence the culture. For example, it is the expectation that women in the Hem-Onc Division take three months of maternity leave. Yet, the last few times a woman has come to tell me she's pregnant, she's walked into my office as if she is delivering terrible news. I've thought there was a medical crisis or a death in the family. This is joyous news but they focus on the inconvenience and coverage. I have to reassure them that we've got this. For the first time, a male physician in Hem Onc took a three-month paternity leave. I'm hopeful that this will provide some balance and help change the culture.
NV: Your being in this position speaks volumes. I was extra productive on maternity leave because I felt the need to prove that I was committed. We often overcompensate. People still talk about the "mommy track."
LMS: I was 42 when my boys were born and my career was already established. I delayed starting a family, which was not ideal. The best time to get pregnant often coincides with the time when we need to be very productive from an academic perspective. On a different topic, we've heard a lot about sexual harassment in the workplace this year, and no work environment is immune. In my career, I've experienced it and addressed it. As we know, it still happens today. It's important to be willing to have those conversations. Julia, have you seen or experienced sexual harassment?
JCT: I haven't experienced it directly but the operating room is an intimate environment. There's a lot being said, some appropriate and some not so appropriate. As a resident, I felt pressure to think of a joke with sexual innuendo to amuse one of the attending physicians so he would be in a good mood.
Advice for Women Considering a Career in Medicine
LMS: What would you tell young women who are considering a career in medicine or already in medical school?
NV: This generation is not ashamed to state their needs. They speak up about their limits and work/life balance. It's our job to let female trainees know that they can have it all. It's not easy. They will have to prioritize and decide when to have children. It helps to find mentors who have done it. We should encourage them to get advice from different mentors. It also really helps to have a supportive life partner. My husband is 110 percent helpful at home. It takes a village; I want the male students to hear this message as well.
LMS: Would you recommend that young women go into medicine?
JCT: Yes, women bring many strengths to medicine. They may be more detail oriented, and bring a different quality to treating patients and the healing process.
LMS: It's the most, most wonderful career. You hear people discouraging their children from going into medicine due to the changes in healthcare or the hours. But I still love doing this and can't think of a more rewarding career. You make sacrifices at home but our children are very proud of us.
JCT: I agree. I will never retire.
LMS: I treat melanoma so more than 60 percent of my patients are older men. I've been impressed by their acceptance of a female physician. There's no issue. Research suggests that some patients even prefer women physicians because we listen well and interrupt less.
NV: When I first started in prostate cancer, people questioned whether patients would open up to me. Male mentors in urology and oncology supported me, especially early on. They let patients know that it was okay to see me. Now that I've built my career, I don't need this as much, but I still don't take it for granted. I'm always appreciative that my male patients feel comfortable with me.
LMS: A final question, as a medical community, what we can we do to support women in medicine?
JCT: Mentorship is key. Having mentors set concrete milestones and be more transparent about how to succeed. Many mentors are mentors in name but they don't spend a lot of time or energy to concretely mentor younger physicians.
NV: Some of the work-life balance steps being taken by the Abramson Cancer Center and Penn Medicine (like opening a daycare) speak volumes. They send a positive message.
LMS: So much in medicine depends on who you know. Male and female leaders need to be proactive in thinking about opportunities for women. Women are often offered tasks or leadership roles that come without funding. Women don't always negotiate as well or initiate conversations about money. We, as leaders, have to have this at the front of our minds. We also have to create an environment in which it's acceptable to go to our child's soccer game or take care of a family situation. When I do these things, I let people know that I'm doing them so I'm modeling that it's okay to do that.
NV: In GU radiation oncology, there are a lot of male giants in the field. I always felt that I lacked opportunities in the professional community. Lynn, when you were chair of the Scientific Program Committee at ASCO, you appointed me to the GU group. I never would have gotten this opportunity otherwise. It opened the door to so many things. Many of us need a chance to show that we can do meaningful committee work. I'll never forget that you did that for me. You weren't even my formal mentor.
LMS: You both are incredibly successful. Your respective fields are lucky to have you. I know that you mentor both men and women beautifully. We'll keep paying it forward.
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