A FeminEM in NYC – Reflections from #FIX18 Part Two

This post is the second of four covering my learning points and reflections from #FIX18¹. FIX – the FemInEM² ideas exchange – took place in New York on Weds 17th and Thurs 18th October 2018. You can find my thoughts from the first half of day one here³.

Jennifer Walthall⁴ told her story of addressing health inequalities and recognising social determinants of health with the following quote; “the social context of people is more important than the medicine that we learn”. She challenged us to embrace the dichotomy of inside the system vs outside: the solution to OR, she says, is AND. Her reflections on moving through leadership ranks were pertinent too:

1. Influence happens when you show up (you have a choice between fighting the jerks, or becoming one of the jerks)
2. After you install yourself with the jerks, don’t become one!
3. Not every possible battle is one you have to win. You can have one hill to die on: choose it wisely (and when you don’t die on it, choose another hill)
4. “Do what you can, with what you have, where you are” – Teddy Roosevelt

Rules of compromise and battle by Dr. Walthall

1. Go be one of those jerks.
2. Don’t actually become a jerk.
3. You have one hill, but if you don’t die on it- find another one. @confectionsmd #ThisWomanRocks #FemInEM #FIX18 #sheMD pic.twitter.com/1BXxZuRzul

— Lexie Mannix, MD (@ALMannixMD) October 17, 2018

Aisha Liferidge⁵ encouraged us to trailblaze with courage, consciousness and curiosity. She opened with a story of role-modelling the power of courage and curiosity in challenging those who seem to have different perspectives from us. Finding common ground with other people takes courage. As a trailblazer, we need to be conscious of our differences but not distracted by them, otherwise we can slip into feeling like being an impostor – and there’s too much work to be done to be feeling like an impostor. 

‘There’s far too much work to be done to feel like an Imposter…’ & remember that ‘trailblazing starts curiosity.’

Great advice from ACEP board member @AishaLiferidge at #FIX18 to make change with courage & avoid #impostersyndrome @feminemtweets @ShivaniMody @EmergencyDocs pic.twitter.com/tjeVDnkmrk

— Julia Hellman, MD, MPH (@DrHellman) October 17, 2018

I loved this: Dr. @AishaLiferidge respectfully confronting her Confederate flag touting Uber driver. I truly believe we can heal the divisiveness that currently afflicts our nation thru face to face conversations w/those who hold different views. #weareallhuman #FIX18 #SpeakUp pic.twitter.com/GFMBdiOquQ

— Alison Hayward MD (@Alisonation) October 17, 2018

Stefanie Simmons⁶ described how being a trouble maker can be a good thing – that disruptive good is welcomed in some industries – but that disruptive docs are often seen as destructive and out of control. So how can we help doctors identified as disruptive? She provided excellent advice for anyone in a position of pastoral care in an ED:

• Defend (believe in the good in these people)
• Observe (diagnose/listen)
• Coach

The skills you developed as a clinician, you can use as a leader and as a manager of people – and clinicians are good at transferring these skills!

@StefatMI brilliantly redefining leadership!! When one of your colleagues are struggling or under attack:
-Defend (not attack them)
-Observe them (Find out why they are struggling)
-Coach them along #fix18 @feminemtweets pic.twitter.com/OyhFHRPzVC

— Dr. Mizuho M. Morrison (@mizuhomorrison) October 17, 2018

Inspiring talk by @StefatMI – skills that make us great clinicians (listening, thinking through a differential, caring for others) can be translate to making us great leaders #FIX18 @feminemtweets

— Kate Kellogg (@KateKelloggMD) October 17, 2018

Gennifer Geller⁷ spoke about the value and importance of finding your political voice, adding more tips on leadership. Listening, she reminds us, is a critical part of leading – if they’re listening, they’re watching and they’re talking about you. You need to know what the hot topics are and look over your shoulder, otherwise your followers might not be there. 

She encouraged us to believe that little things add up to bigger things. “You’ll end up believing that religiously,” she says, “but it’s not religion – it’s maths.” She reminded us that whenever we give to things, it’s an extension of what we are and we are sharing ourselves. And remember: as a leader, not everyone is going to like you. If you need to be liked by everyone, address that because it’s not going to happen!

4 things that make a good leader according to @drgenngeller
1. Listen
2. Little things add up to become larger things.
3. Respect (gratitude/kindness/decency).
4. Conflict management.
(P.S. not everyone will like you … deal with it)@feminemtweets @ShivaniMody #FIX18

— Lara Goldstein (@drlaragoldstein) October 17, 2018

Reminding us that “EM is full of outspoken and opinionated individuals”, Mary Claire O’Brien⁸ gave us five rules for an effective leadership team:

1. No take-backs: embrace the differences in your team – differences in experience, cognition and motivation. The best predictor of future behaviour is not what they did in the past but what motivated them to do it. She suggested we might want to read more around the strength deployment inventory; recognising that there are three main motivators⁹ that your team members might have – data, people or outcomes
2. Everyone should speak up! If everyone is thinking the same thing, somebody isn’t thinking. Team members share responsibility to express their opinions – and the best leaders listen. 
3. The team wins or the team loses. Praise in public, criticise in private. As a leader, give credit, but take the blame.
4. Thank people the way they want to be thanked (in their love language). Gratitude is like glue to a team; appreciation is not one-size-fits-all.
5. Share your recipes – are you preparing someone to take over from you?

5 rules of leadership @MCOBrienMD
1. No take-backs: embrace differences
2. Everyone speak up, it’s a team responsibility
3. The team wins or loses: praise in public, criticise in private. Give credit, take blame
4. Thank people in their love language
5. Share your recipes #FIX18

— Natalie May (@_NMay) October 17, 2018

Ali Raja¹⁰ spoke about the importance of negotiation skills “to improve your career and life.” There are some great resources on negotiation at the FemInEM webpage, particularly this from Becky Parker.¹¹

Here are his five negotiation fundamentals:

1. Prepare – have the data for your position 
2. Know yourself (especially how you react to confrontation and difficult situations)
3. Memorialise agreements – when you come to a complex agreement, send an email reminding the other party of what you agreed on and the solution you came up with
4. Use time to your advantage – it’s not about winning, it’s about finding a solution together and you can always come back to the table 
5. Listen, you can often find unique solutions you hadn’t considered once you understand the other viewpoint

In the event that your negotiation prompts the other party to make an extreme offer, he says, get the data, and use time to return to the table. And if you find yourself in a stalemate situation, use the other three components.

“If they say no, you can always come back to the table later” @AliRaja_MD on using time to your advantage. #FIX18 pic.twitter.com/750ikJ8Fbd

— Carol Pak-Teng, MD FAAEM (@CPakTengMD) October 17, 2018

Jane Van Dis¹² spoke about the Equation for Equity. She talked about the Equity Quotient project she is involved with, collecting data analytics around gender equity (this usually falls under one of four categories: pay, promotion, culture, harassment).

She drew to our attention the significant pay gap in the US – there is no medical specialty where female docs earn more than male colleagues, and the gap between genders actually increased in 2017. The gap exists from resident start salary. The salary numbers are almost inconceivable to those of us working outside the US but I would be interested to know if pay gap research exists for Australia and the UK. She also reminded us that sexual harassment in the workplace has high cost; there are significant health and social effects for women who report it and financial costs for organisations.

Gender gap in pay for women docs is *real* (and don’t tell me it’s because of our choices because I’m sick of that tired excuse). Stats from @janevandis of @Equity_Quotient #FIX18 (1/) pic.twitter.com/CKfzGb5KSu

— Kelly Doran MD MHS (@KellyMDoran) October 17, 2018

The average cost of gender inequity is $9000/physician/year according to @Equity_Quotient. That’s how much it costs to replace a physician who leaves because of gender inequity. #fix18 @feminemtweets @janevandis pic.twitter.com/oA456Dq73J

— Torree McGowan (@ERdisasterdoc) October 17, 2018

And with that, day one was over (for me anyway – the programme was running a little late, so I missed the last few talks as I had to dash off). Many of the attendees headed off to networking dinners arranged by the conference organisers (I’ll admit I headed off to a Broadway show… no regrets, it was great!). But there was more goodness to come on day two…

Nat

@_NMay

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