EP167: Beyond the Operating Room: Dr. Celeste Royce on Mentorship and Equity

Navigating Medicine with Dr. Celeste Royce: Mentorship, Motherhood, and Advocacy

In this episode of The Girl Doc Survival Guide, Dr. Celeste Royce, a Harvard Medical School OB/GYN educator with over 35 years of experience, shares insights from her comprehensive career. Dr. Royce discusses her journey from initial medical school fears to her love for OB/GYN, shaped by camaraderie and a pivotal surgery block experience. She reflects on her challenges as a female physician, including balancing motherhood and her profession in a male-dominated field. Dr. Royce highlights the significance of mentorship, equitable access to hidden medical curriculum knowledge, and advocating for academic freedom. The episode also delves into her personal experiences with maternity leave, the importance of choosing the right time to have children, and the pivotal role support systems play. Furthermore, Dr. Royce discusses her advocacy work, particularly a legal challenge with the ACLU over censorship of her gender-inclusive research on endometriosis. She emphasizes the importance of speaking out, mentorship, and understanding that life’s different phases dictate the focus and balance in one's career and personal life.

00:00 Introduction to Dr. Celeste Royce

00:59 Dr. Royce's Journey into OB/GYN

02:22 Mentorship and Leadership in Medicine

04:27 Balancing Motherhood and a Medical Career

08:37 Advice for Aspiring Physicians

15:35 Advocating for Academic Freedom

19:19 Final Thoughts and Reflections

Transcript

Christine Ko: [00:00:00] Welcome to The Girl Doc Survival Guide. I am happy to be with Dr. Celeste Royce, an OB GYN with more than 35 years of clinical experience and a longtime educator at Harvard Medical School. Dr. Royce is known not only for her clinical expertise, but for her leadership in medical education, especially her work designing innovative clerkship and bootcamp curricula for aspiring OB GYNs. She's also been a powerful voice on issues of gender, motherhood, and equity in medicine, speaking candidly about what it was like to become a mother while working in a male dominated practice and standing up for the right to discuss reproductive health without political interference. In today's episode, we dive into her personal journey, her fight for academic freedom, and the wisdom she shares with students and physicians alike about building a medical career that actually works for your life.

Thank you so much, Celeste, for being here. 

Celeste Royce: Thank you so much for having me. I really appreciate it.

Christine Ko: What [00:01:00] first drew you to the field of OB/Gyn? 

Celeste Royce: Oh my origin story. I went to medical school, like many, thinking I was gonna do one thing and ending up doing something completely different. I thought I would be a family practice doc. I was really fortunate to be in a class at UCLA that went over 30% female. I was terrified of surgery and doing anything in the operating room. So I chose to do my surgery block first when we went into clinical years, and I was fortunate enough to be teamed with a group of five other women. Out of those six women, five of us ended up going into a surgical career. And I can't help but think it is because of the camaraderie, and the shared experience that we had, and the real support that we gave one another. I loved every minute of being in the operating room. I absolutely loved it. But at that time, [00:02:00] residencies in surgery were oftentimes every other night call for many years. And I did not know how that would be a sustainable lifestyle for anybody. Then I did my OB GYN rotation and the only thing in my mind better than being in the operating room is being in the labor room and helping with childbirth. And I knew I had found my home, I'd found my people, and that was that. 

Christine Ko: How did your experiences as a female physician shape your approach to mentorship and leadership?

Celeste Royce: It's a great question because I don't think that there was much in the way of mentorship at that time. One of the deans was a woman at UCLA. And even in those days, most of the positions in OB GYN were male. All the leadership was male. We had female attendings of course, but I think it was really pivotal when I went out into practice. Some women who weren't actually in my practice, who were maybe 10 or 15 years older than I, had really fought to get where they [00:03:00] were and to be leaders. Having those women as role models was important. My idea is to democratize knowledge and make sure everybody has access to all the hidden secrets many of us were not given access to coming up. 

Christine Ko: What are maybe like a couple of these secrets in the hidden curriculum?

Celeste Royce: Personal interactions that maybe they weren't taught at the dinner table the way some people are taught at the dinner table. If you come from a family where you weren't taught those secrets, it's not a level playing field.

Christine Ko: You mentioned the dinner table and some people have access to that from just growing up and eating dinner every day at the family table. Are you touching on that it's really communication and being able to just communicate?

Celeste Royce: It's more about knowing what the expectations are, making connections, networking, reaching out for mentors. We know that women, people of [00:04:00] color, and LGBT students are much less likely to reach out for mentorship.

As we work to advise students as a team so that all students have access to the different information and suggestions that come from that network, we hope that we are increasing the viability of candidates across the board.

Christine Ko: That's nice. Yeah, it does sound equitable. Everyone gets the same advice. That is nice.

You became a mom back then when you were working in a mostly male group. How did you and the system handle that at that time?

Celeste Royce: I did struggle to have a successful pregnancy with my daughter. I ended up going into preterm labor. I was actually on bed rest, which we now know is not the right thing to do. But I was put out at 28 weeks of pregnancy and there was a lot of blow back from that. I was in a practice of four men and myself [00:05:00] and really little to no support of how hard that was.

My husband was a high school teacher, so our income was drastically impacted by that. I was, fortunate to have some disability insurance. And I would encourage anybody who's starting out to make sure that they have that disability insurance because it was the difference between being able to, follow my doctor's recommendations and not. Thank God I gave birth to a healthy, happy baby girl. This was in the day of what they called drive-by deliveries. I was in the hospital for 12 hours after she was born and then left. I had six weeks off for maternity leave. Again, there was some pushback on that because I had been out for a number of weeks before. Yeah, it was not easy.

Christine Ko: I had two maternity leaves. I had the wrong idea that maternity leave would be "easy". And I would have so much [00:06:00] time to take care of the baby, and read what I needed to, maybe pick up a hobby. And it's so hard I have to say. It was just, I feed the baby, baby takes a nap for 20 minutes, and is up before I've even finished washing the bottles. And there's still food all over the floor... never could take a shower, hardly could go to the bathroom.

Celeste Royce: The concept of the shower was just amazing, right? 

Christine Ko: Yes. I had no idea what was coming for me, and I don't know why I had no idea, but I had no idea.

Celeste Royce: But that's the thing, right? We are told that we can do these things, and nobody really pulls the curtain back, right? And says, oh, by the way, you're gonna be doing laundry, and you're gonna be doing dishes, and you're gonna be taking care of a baby. And, if you're breastfeeding, it's this intimate physical relationship that precludes any other physical relationship. And your spouse or your partner may not be on board with everything.

The second go round, I had twins. 

Christine Ko: Oh, wow. 

Celeste Royce: Yeah, which was also exciting because I had taken a new job and I became unexpectedly pregnant [00:07:00] with twins. And again, not a lot of support, right? From the institution, from the state, from society, I was able to take eight weeks off postpartum with the twins. Thank God for my mother-in-law who came and lived with us. We joked, you can never let the children outnumber the adults in the family. Kudos to Jenny because I really don't know I would've done it without her.

Christine Ko: That seems to be a common theme when I talk to working moms, whatever their profession. The way people seem to make it work is have family members, in-laws or someone, helping them, living nearby enough that they can just be like, come help me, right now! Or they hire someone. But I think for physicians it can be especially difficult, especially in a field, a surgical field or any field that has emergencies, where you just need to drop everything and go sometimes.

Celeste Royce: Yeah. And we did hire nannies. We had a nanny who was with us for the first nine months with my [00:08:00] daughter. And then for about a year and a half when the boys were born. But we eventually made the decision, and it was a financial one, that my husband would stay home with the kids. His entire income essentially would've been going to pay for childcare. He was an educator, liked kids. It was a really hard decision to make, but I think was the right decision for our family. But not every family has that luxury, and not every family has a partner or one of the spouses who can give up their career. 

Christine Ko: Yeah. I can't imagine the difficult conversations that go into a decision like that. Do you have advice now for residents, trainees, women who are about to have children or are pregnant and imminently about to have a child? 

Celeste Royce: Number one, there is never a good time to have a child in your career, right? It doesn't matter if you're a physician or not, but I think it's particularly true for women in medicine. So you should [00:09:00] just have a child when it's the right time in your life. And the other thing I really try to emphasize to my trainees and my students is this, you're in this for the long haul. You're gonna be doing that for the rest of your life. If you take a little bit of time off now, it is okay. We can't do everything all at once, but we can frequently do things in series. You may have goals of leadership, academic success, ideas about research, or ideas about technical innovation in your field. That's great, and you will do those things. Don't hesitate to take the time you need now to make your personal life a priority, because those things will still be there.

We all have this idea in our mind, oh, if you don't get things done in the first 10 years out from training, you're far behind the eight ball. My personal story is I was in academic medicine for one year. I realized it [00:10:00] was not the right time in my life for that. I went and worked in community health and other situations and then came back to academia. Part of that is the luck of the draw and falling into a wonderful department. But some of that is recognizing that you can't do everything all at once. For me, it was important to be there as more of a family member for the first 12 or 13 years of my kids' lives. And then once they got into high school, go back and restart an academic career. 

Christine Ko: It sounds like you took maybe a little bit more than a decade off from academia and then went back. I agree with you. I think there's a misconception that there's only one path, and you have to get on that path right away, otherwise you'll never do it. I do think academia presents its particular challenges, so sometimes it's easier to get used to them when you're younger.[00:11:00] 

Celeste Royce: Acclimate yourself to it.

Christine Ko: Yeah, but I agree with you. At any time, you can go any direction that you want.

Celeste Royce: One of my colleagues has recently come back into academia after many years, and she's doing great. Her kids are all grown. Flourishing. 

Christine Ko: When you see trainees or others hitting some of the barriers that you have faced or even just stress, like high levels of stress, or maybe true burnout, or just difficult life transitions, how do you support them?

Celeste Royce: That's a great question. I'm a member of a peer support team at our hospital. We try to look out for adverse outcomes or really stressful clinical situations that people might be involved with, where they might withdraw a little bit, making sure to reach out to people and check in. Sometimes that's a little bit of a difficult [00:12:00] balance. I'm clerkship director and sometimes an email or text from the clerkship director can be a little bit intimidating.

Christine Ko: Absolutely.

Celeste Royce: Yeah. Yeah. Just trying to normalize that outreach of, Hey, I recognize that this might be a intimidating text to get, but you doing okay? If I don't hear from people, I'm a mom, I worry about them. Are they okay? Are they eating? I think that as faculty members, one of the things that's really incumbent on us is to recognize when our trainees and students are overwhelmed, and to really make access easier for them, whether it's to talk with them or to provide other outlets for that stressor, burnout to be expressed. One of the things that we have been doing on and off and more recently on is providing activities for our residents. It's that concept of a third thing to discuss. For example, we go [00:13:00] to an art museum and have an arts educator work with the residents and some faculty members to talk about or bring up things that maybe otherwise people wouldn't broach.

Christine Ko: Yeah. 

Celeste Royce: I think providing or cultivating an environment in which open communication can happen is the first step. 

Christine Ko: I like it. You already touched on the misconception that we can have it all. We can't really, and at different phases in our life, we should recognize that maybe we focus on this, and then in 10 plus years we might focus slightly differently. Do you have other advice to give people who are feeling burdened by the expectation of being able to do it all?

Celeste Royce: One of the best decisions I made in my life was I worked in community health for a long time. With the pandemic, I realized that I was hitting burnout. I was no longer bringing my best self, I wasn't [00:14:00] being there for my family, all of the things. It happened to coincide with the pandemic, and I was fortunate enough to have a department that supported me making a huge transition in my practice style to becoming a hospitalist. Giving up part of my clinical practice pained me a lot at the time. I still miss the longitudinal relationships with patients, but recognizing that I could not do it all was really important.

I think when you hit that wall of, I am not functioning at the level I want to, in multiple domains. Then identifying where you can make changes that will allow you to continue to function at the top of your game in those areas where it matters. That may differ for different people. Some might be, I need to continue in this aspect of my career. I need to continue my research, I need to continue in medical education, whatever it [00:15:00] is. But identifying, what is your core value? What is the most important part of your job that gives you joy? And then letting go of the rest of it.

Christine Ko: Yeah.

Celeste Royce: It's hard, but it's satisfying and in the long run it makes it sustainable. 

Christine Ko: Some of your story that you shared goes along with that. I'm sure it's not pleasant in any way to have your colleagues not really supporting you through either of your pregnancies. Still, you're like, this is what I need to do right now, and so came through it without great support from others. You also do research, and your research was removed from a federal site, and you stood up and spoke about that. You are good at self advocating and recognizing when you need to say something. Could you talk about that a little bit? 

Celeste Royce: I'm happy to. About five years ago, in 2020, I wrote an article for the Agency for [00:16:00] Healthcare Quality Research, which was published on their PS network, which stands for Patient Safety Network. This is a government sponsored platform that publishes patient safety information, guidelines for safe patient care throughout healthcare. They have hundreds and hundreds of articles that they have published. They publish essentially a morbidity mortality series. I was invited to be a expert contributor for a case of delayed diagnosis of endometriosis, which as our audience may know, is frequently a delayed diagnosis. The average time between the onset of symptoms and diagnosis is seven to 10 years. It oftentimes requires multiple visits to different physicians before it's actually diagnosed. The symptoms associated with endometriosis, chronic pain, menstrual pain: many women with endometriosis are told, oh, that's just normal. [00:17:00] Come to find out they actually have a biologic reason for pain that can be resolved or treated through medical and surgical management. Uh, wrote this paper about a case report and then a discussion dedicated to this idea of patient safety improvement of diagnosis improving the rapidity with which diagnosis is made. That was the framework for the paper. One of our points as a takeaway was endometriosis is also a possible diagnosis in people who are gender nonconforming or transmasculine individuals and should not be ignored. This work was out there for five years, and unfortunately, the current administration came through and looked at all of the publications on the agency's website and really just looked for things that had L-G-B-T-Q. associations. So my paper was removed from the website because I referred [00:18:00] to gender nonconforming and trans masculine individuals. Another paper was about suicide risk assessment and prevention, mentioned L-G-B-T-Q status as a risk factor for suicidal ideation, by my colleague Gordon Schiff. Both of these papers were taken down. We did not originally know why they were taken down. We were informed by the editor of the website. I actually had to go back and read the paper again because I had no idea other than, oh, it's about women's health.

Christine Ko: Yeah. 

Celeste Royce: But it turned out I was inculcating gender ideology with that. They wanted us to remove those statements from our work, and we said no. And then we were approached by the ACLU to pursue legal action with that. So that's ongoing. I do feel I am in a position of privilege and power. I'm a middle aged white woman. I am a doctor. I'm well educated. I'm well off. [00:19:00] I have privilege, I have power. And If I don't speak out against First Amendment rights violations, who's gonna do it? How can I expect other people to do that if I don't? And so it was a no brainer when the ACLU came to me. It was like, of course.

Christine Ko: That's inspiring. Thank you. Based on this conversation and everything we've talked about, I would say that when you first started in medicine, there wasn't really mentorship or that kind of teaching by others around you, and you've really made it a big part of your career to do that and to create models like that. Even in this, you are continuing to show people and model how to speak out. So that's wonderful. Do you have any final thoughts?

Celeste Royce: It's actually pretty easy for me to speak out and to advocate. It might not be so easy for other people who [00:20:00] have other identities, who are in different points of their lives to have more that they perceive as on the line. And that's okay. We all have our inner compass that we follow, and sometimes in our lives we're just able to get dinner on the table for the kids or go to their basketball game. But other times in our lives, we can stand up and we can speak out. Other times in our lives, we can educate the next generation. Other times in our lives, we can be there for our communities. Recognizing that it's not everything everywhere, all at once. It's what we can do, when we can do it, when we have the strength and the power to do.

Christine Ko: I love it. Thank you. Thank you so much and I appreciate all your time and insights.

Celeste Royce: I really appreciate the opportunity.