Delivery of Care

The calling of care: women, wisdom and the path to achieve equity in health care

Extraordinary conference at Brown offers women practitioners in the art of health care an opportunity to measure how far they have come on the journey to achieve equity – and where they need to travel to next

Photo by Richard Asinof

Dr. Katherine DeAngelis addressing the conference, "Achieving Equity in Medicine and Science: An Era of Change," on June 15, at the Warren Alpert Medical School.

By Richard Asinof
Posted 6/19/17
A day long conference about achieving equity in medicine and science in an era of change brought together a cohort of women leaders in the health care profession in Rhode Island to have an extraordinary dialogue.
Will the conversations and presentations from the conference be transcribed and made available, to create a public record of what transpired? Why were there so few men who attended? How can this kind of discussion become better integrated as part of the medical education for students and residents? How often do the women leaders in health care and science get together as a formal discussion group? Beyond the medical school, is there an opportunity to include health practitioners outside the world of academic medicine, such as community health centers and nursing schools?
At a time when the entire health care delivery system is in disarray, challenged by both the unsustainable medical costs and the attempts by Congress and President Trump to undo the Affordable Care Act, is there an opportunity to discuss how to build an alternative model to health care not based upon the hospital system?
The career of Dr. DeAngelis has been focused on developing a new vision of pediatric care and academic medical education to support that vision. As one pediatrician told ConvergenceRI, DeAngelis was one of his heroes, because she described the process of how most primary doctors were being trained as akin to training forest rangers in a sawmill.
Could the Office of Women in Medicine and Science convene a gathering to start the discussion of developing a new model for health care delivery? Stay tuned.

PROVIDENCE – When Dr. Catherine D. DeAngelis held center stage as the opening keynote speaker at the “Achieving Equity in Medicine and Science: An Era of Change” conference on Thursday morning, June 15, at the Warren Alpert Medical School, recounting her remarkable journey and offering advice, the more remarkable story, perhaps, was to be captured in the roomful of nearly 100 women [and a few courageous men] in the audience, the leaders and practitioners of health care and medical science in Rhode Island.

The conference, organized by Dr. Katherine Sharkey, the assistant dean for Women and Science and associate professor in the Departments of Medicine and Psychiatry and Human Behavior, captured the sea change now underway in health care as more and more women assume leadership positions.

DeAngelis was funny, acerbic and forthright in telling her stories, such as recounting her experience in standing up to the pharmaceutical companies when she served as the editor of JAMA, the Journal of the American Medical Association, refusing to budge from her position that all papers published by JAMA and 11 other prominent medical journals needed to have all clinical trials registered or they would not be reviewed.

When an official from the U.S. Food and Drug Administration challenged her at a meeting, DeAngelis recounted that she replied: “I care, because you don’t. I care, because if you were doing what you’re supposed to be doing, and you were enforcing this, I wouldn’t be standing here, I’d be doing something I would much prefer to be doing.”

DeAngelis continued: “If the pharmaceutical companies want to use the integrity of my journal [to sell their products], you’re going to follow my rules.”

The deadline to register clinical trials or not be published was set to take effect in a year, DeAngelis explained.

Right up until the last moment, DeAngelis said, the pharmaceutical companies sought to challenge the rule, leading to a last-minute rush to register clinical trials.

“The following Monday [after the deadline], the director of the National Library of Medicine [which was responsible for registering clinical trials], called me up and said, ‘Kathy, I don’t know whether to choke you or hug you. We’ve gotten so many clinical trials over the weekend, I had to hire four people to get them all registered.’”

To which DeAngelis said she responded: “Good.”

The lesson to be learned, DeAngelis said, was about the power of one person, making a suggestion for 11 other editors, and doing what the government was doing. “It helps if you care,” she said.

The four T’s

DeAngelis also presented a series of watchwords for women seeking to achieve equity in the medical profession: being tenacious, being tough minded, having thick skin, and possessing a tender heart.

“You’ve got to be tenacious; if you’re on to something, keep at it, keep at it, keep at it, until you get a headache, and then you take something for the headache, and keep at it again,” she said.

“You’ve got to be tough-minded; not tough, but tough-minded,” DeAngelis continued. “That means you known you’re right, and even if people try to tell you you’re wrong, [keep at it] until they can convince you that you’re wrong. Stick with that idea.”

“You have to have thick skin,” she said, explaining the third concept. “It’s easy to be put on the defensive, that people don’t like me, or they are picking on me.”

“And, the fourth one, which is easy for women, you have to have a tender heart,” she said.

Women are expected to be thick skinned and tender hearted, DeAngelis continued, especially by men, who often view women as difficult. “It doesn’t matter what you are called,” she said, “because the tender heart is necessary to forgive the sob’s.”

The more authority you get, and the higher up you go in leadership ranks, she said, the more likely that you will become a target. “Use the bricks they throw at you to build a firm foundation,” she offered. “Think about it; when people throw things at you, if you can turn that around, and build on that, you’ll be amazed at what you can accomplish.”

On a cautionary note, DeAngelis suggested that, if and when you come across an untrustworthy person, keep a paper trail.

The double bind of ambition
While DeAngelis was clear about the current state of affairs in the battle to achieve equity in – citing statistics that only 22 percent of women were professors, 15 percent of deans at medical schools were women and only 16 percent served as chairs of departments, the second panel of the conference, “Pathways to Leadership: A Discussion with Trailblazers,” offered a snapshot of the profound manner in which women leaders in Rhode Island are transforming the caring profession.

The panel featured Dr. Maureen Phipps, chair of the Department of Obstetrics and Gynecology, Dr. Phyllis Dennery, chair of the Department of Pediatrics, Dr. Karen Furie, chair of the Department of Neurology, DeAngelis, and Dr. Michele Cyr, associate dean for Academic Affairs for Biology and Medicine.

Sharkey, who moderated the panel, set the stage by referring to a new book, Double Bind: Women on Ambition, a series of essays on women and ambition edited by lawyer-turned-author Robin Romm, asked the panelists to respond to questions about ambition and leadership.

For Phipps, it was not a matter of ambition, which she said felt like a negative word, but her rise to a leadership position was a result of being driven. “I have always known that I am a mission-driven person. I want to improve women’s health; that’s what has motivated me in my career,” she said. “And I have taken the opportunities that have allowed me to make that impact, to have influence both at the community level and the patient level, and now, with my faculty, who are really the people doing it everyday.”

Her focus, Phipps continued, “it’s about the patients, it’s about the women, it’s about the community. That’s what drives me, and that’s where I have put my energies, and that has led me to these opportunities. I think of it more of a drive and being mission driven [than ambition].”

For Furie, she admitted that she never really had a clear plan. Her desire to assume roles that had more leadership components was based upon wanting to affect change and having the authority to actually accomplish that.

“A lot of people working in academic medical institutions get frustrated,” she explained. “Things don’t quite work out the way they wanted. You see opportunities about how things could be done better, but often times, there are three layers of people above you.”

“What you find,” Furie continued, is that the more you do, the more responsibility and authority you get, and the more you can affect change. For me, that was a very potent driver. It’s rewarding, because you can actually have an impact on the system that you’re working in.”

For Dennery, in pursuing her career path, she acknowledged that there was some truth about recognizing that she was thinking about where she was tracking and where she was going.

At the same time, Dennery cautioned not to try to do too much contemplating of the future, “where you are not enjoying the moment, living in the moment, and not always be looking at how you are going to get to do the next thing, because you have to be good at what you’re doing now to get to the next thing. To say, yes, I’m here, I’m embracing it, I want to do this. That will help you get to where you need to go next.”

For DeAngelis, it was never about titles or becoming a dean. “I always knew I wanted to be a physician, no question about that.”

In describing her career as a series of choices about what she wanted to do, rather a proscribed path, DeAngelis shared the decisions she made as being related to seeing an opening and seizing the opportunity.

“If anybody had said, are you planning to do this, I would have replied, ‘Are you out of your mind?’”

If you know there’s a problem, DeAngelis continued, “You go after solving it, and the rest just sort of happens.”

She later added, as a one-liner worthy of Henny Youngman, “Dean is just one letter away from dead.”

For Cyr, she said she was very much the product of the era when she went to medical school where ambition was considered a derogatory term.

“I had no plan; my plan was to do a get a job and do medicine,” she began. Cyr expected that she would be in Rhode Island for three years; her husband had a three-year commitment. “So I said, three years and then we’re gone. That was 1982.”

Cyr said that she did see herself as ambitious. But reflecting upon the question posed by Sharkey, which she said was a “great” question, Cyr said: “I was ambitious for causes, for the group with whom I was working; I was much more comfortable being ambitious for those people.”

A questioner from the audience challenged the panelist about their reluctance to openly embrace ambition as a positive force. “Every one says those things, that we all love our patients, and we all do things for altruistic reasons, but I’m sitting here in a room full of women, and it sits very poorly with me that we cannot say we are ambitious and want to get to the next level,” she said. “I don’t want to apologize for being ambitious.”

Which opened up a new round of conversations and questions between the audience and the panelists, a creative tension that continued throughout the conference.


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