EP169: Medicine's Dual Challenges: Gender Bias and Parenting with Dr. Wendy Stead

Balancing Medicine and Motherhood with Dr. Wendy Stead

In this episode of The Girl Doc Survival Guide, Dr. Wendy Stead, the Program Director for the Beth Israel Deaconess Medical Center Infectious Diseases Fellowship, discusses her dual roles in medical education and as a mentor for residents. She provides a personal anecdote about her experiences as a mother of two. The conversation explores gender bias in academic advancement, the challenges female medical providers face, and the importance of humane parental leave policies. Dr. Stead emphasizes emotional intelligence and resilience, offering her perspective on navigating a medical career while balancing family demands. She shares her hopes for her daughter's future in medicine and reflects on the intrinsic rewards and difficulties of the profession.

00:00 Introduction and Guest Welcome

00:54 Personal Anecdotes and Family Life

02:12 Challenges of Women in Medicine

04:38 Parental Leave and Work-Life Balance

17:36 Emotional Intelligence and Parenting

24:41 Final Thoughts and Advice

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I am pleased to be here with Dr. Wendy Stead. Dr. Wendy Stead is the proud program director for the Beth Israel Deaconess Medical Center Infectious Diseases Fellowship, and the Blumgart Firm Chief for the Beth Israel Deaconess Medical Center Internal Medicine Residency Program. In those roles, she teaches and mentors many medicine residents in those programs. And she's also interested in medical education and does research in medical education. More recently, she has been studying gender bias in academic advancement, and in the past she's also, done writing pieces in narrative medicine and has helped guide other providers in narrative medicine as well.

Welcome to Wendy. 

Wendy Stead: It is such a pleasure to be here. I'm really looking forward to this. 

Christine Ko: Could you first share a personal anecdote about yourself? 

Wendy Stead: I am proud [00:01:00] mother to two great kids, now adults. I'm hoping that we're gonna be talking about balancing a little bit of that during our conversation today. Shockingly to me, given how fast time flies, they are both about to experience big milestones. My daughter's about to graduate from college next weekend. She goes to UConn and she's gonna graduate next Saturday. And then my son is finishing up his first year of college down at the University of Maryland, so we're gonna go down after and pick him up. Those are super exciting things happening in my life right now.

Christine Ko: That's exciting. Does your daughter know what she's gonna do?

Wendy Stead: Christine, funny you should ask. She wants to go into medicine. So this is a timely conversation.

Christine Ko: How do you feel about her wanting to go into medicine? 

Wendy Stead: Yeah, I am very proud that she wants to do it. She has qualities that will make her amazing at the job. She has supernatural emotional awareness, [00:02:00] and I think a real gift at forming relationships and communicating with people. She likes to study, work, and learn. So I think that she'll be really good at it.

I would be lying if I didn't say that I come at it with mixed feelings because I know what it's like to do the job as a woman. And as much as I have loved my job and still love my job very much, there have been some challenges along the way, which I wish I could spare her and protect her from. I'm not sure I'll be able to, and it's all part of this crazy work we do.

Mostly I'm proud and wanna support her, and I do feel like she's had the advantage of getting to see me in the job as much as your kids can see that. She's certainly heard a lot about it at home. And she's come to shadow at times as well. So I feel like she's walking into it eyes open as much as anyone can. My husband's a pediatrician. We have a lot of [00:03:00] dinner table talk over the years as well. But yeah, I have some ambivalence. Mostly, I'm really proud of her. 

Christine Ko: I love what you said, and I'm just gonna ask you some questions about what you just said. One of the things you said is since it's your daughter, and you've experienced being in medicine as a woman, that's one of the concerns. Could you just share a little bit about what you think makes that a concern? 

Wendy Stead: Yes. I had the opportunity to get involved in research in this space over the last five years or so. So in addition to my own personal experiences, I've gotten to hear experiences of other women providers in infectious disease who have tried to develop careers as women and mothers as well. There are certainly challenges to navigating it as a woman period, even if you decide not to become a parent. We had this big survey that we did. And then also a [00:04:00] bunch of focus groups basically identified that women in infectious disease don't advance academically as quickly as their male peers do. And that's true I think across the board and in many, if not all, specialties in medicine. We wanted to ask why, so we did several focus groups. We did four groups, separated by rank, instructors or assistant professors, associate professors, full professor women. And then we did one man full professor group too. There were a lot of different themes that came out of those in terms of things that could be addressed to rectify disparities in that space.

The one that kept coming up over and over again was trying to balance the demands of family versus your job. And that, that kind of started from the point of birth of your child. Because it felt like, to the women in the group, that parental leave [00:05:00] policies were really inappropriately short, both for trainees as well as for junior faculty. It was rare to get a full 12 weeks, which is, I think, considered standard in the US. Those who took longer leaves then had to extend their training at the other end with some downstream consequences there in terms of when they could start their jobs. After that, it was hard move forward in academic advancement because you were just trying to make up for clinical time or just trying to, graduate from your program.

The other thing we found was that there were a lot of disparities between folks who were taking parental leave, who were the birth parents, and those who were not the birth parents. And so it was fascinating to me in one of our professor women focus group, a lot of the discussion was about how when those women who have had children, and now these women mostly had adult children, they talked a lot about how yes, their own parental leaves were [00:06:00] ridiculously short and they needed to come back and make things up.

But they also felt their partners had really gotten almost nothing for parental leave, and that was discriminatory toward their partners to not be able to take time off to bond and support and get to know their child. And that set the stage for prioritizing one parent over the other parent for the rest of their careers they felt like. So there were reverberations that kind of continued through the rest of their careers that limited their advancement. They never got that time back, and their partners never got to have that time.

As a program director, when I think about my own trainees, we've had many that have wanted to become parents during training, since I've been a program director, and we're really trying to both make sure that we come at it from the perspective of, okay, we're gonna do our best to create a leave for you that is humane.

We're always aiming for at least 12 weeks if we can. We follow the guidelines and [00:07:00] policy requirements although they are difficult and sometimes confusing. We recognize the non-birth parents as well and try not to let there be disparity.

The trainees that decide to become trainee parents are very worried in general about the impact that will have on their colleagues and whether their colleagues will have to do more work because they'll be on leave. That shows that they care about the people they work with. But I really think that we need to shift that perspective and look at the bigger picture. We want doctors who are women, who are parents, all kinds of different people, and so I think we really do have to try to create a system as much as we can that recognizes that's gonna happen and figures out at potentially the bigger, institutional level, policy level from our guiding oversight that would allow for us to take an approach to this that really makes space to be able [00:08:00] to take adequate leave time and not be so focused on the impact that's gonna have on their programs. I guess that I would say that I think that we often look to the other trainees to fill the gaps, and I'm not sure we always should do that. I think we should potentially turn to our faculty. We should turn to our advanced practice practitioners, whatever give we have in the system that can allow us to provide coverage so people can take humane leaves.

Christine Ko: Absolutely. What do you do for the non-birth parent? 

Wendy Stead: We have tried more recently to encourage them to take more time. Our program policy was two weeks of non parental, usually paternity, but non parental leave. And in the last few years we've been encouraging them to take more. So we had one non-birth parent. He took six weeks at the end of his wife's time off. I encourage them now to think [00:09:00] about taking 12. It's so important for the reasons we talked about.

Christine Ko: Yeah. It's hard. Reflecting back, I had 12 weeks for both of my kids. My daughter was such a crier. She cried every time. I dropped her off for two plus years, and every time I picked her up, she would start crying. I found it very traumatic. Very traumatic. My daughter would sometimes be in daycare 7:30 and the last one picked up at 5:30. I've gotten criticism, like, oh, you're leaving her there for 10 hours, how could you do that? She's almost an adult now and seems fine. But it was just traumatic. These are the kind of stressors that I felt as a parent, and I'm no in no way unique. I think every parent, especially the primary parent, if there is one, if it's equal, it's probably different, but I was I was the primary parent partially because I was breastfeeding. I tell my daughter it was [00:10:00] agony. One of the hardest things. I love my job. I'm not like one of those people, oh, I am at work, and I'm like really upset. I wish I could just be with the baby.  I wanted to work. But I would've liked to be with her more. The 10 hour days weren't ideal at all, but I had gotten this really nice 12 weeks.

Wendy Stead: So you felt like you had to pay for the 12 weeks off by going back and having to work more?

Christine Ko: So my colleagues could have made me pay it back, but they didn't, they were kind to me. I didn't have to pay anything back. 

Wendy Stead: We've talked a lot about parental leave, and I think that's really important that we try to make advances in that space so that we're giving humane leaves to our trainees who wanna become parents, both birth parents and non. But then there's coming back and the challenges that are present in that moment. Lactation challenges run the gamut. The additional work that is then piled onto people having to actually make up RVUs and things like that when you come back... feels so much. And you're sleep deprived, right? You [00:11:00] don't know sleep deprivation until you become a parent. It's almost super human strength that we require of our trainee parents or our faculty parents. And I just feel like that's a total failure of culture of our profession. It's a total failure because we are basically taking people who are a bit beyond the optimal childbearing time in their life, right? And then we're encouraging them to keep going, delay having children, then it's more risky to have children. It's harder to have children. You're in fertility treatments, trying to find time to do that, and you finally successfully have one, and maybe we eke you out a reasonable parental leave, and then you come back to it to the kind of situation that you're describing. And that kind of sounds normal, exactly like what you hear. That's what I experienced for sure. One of my kids had colic, a horrible word that we didn't use when we were going through it, but when we [00:12:00] were on the other side of it, we called it for what it was. And so we literally didn't sleep for about the first, I don't know three months of his life. We all battle various dragons in that space. But then to come back and have to put in the kind of super human performance. I can hear in your voice that it's still hard to think back to that. We have to stop this craziness and really expect more from our leaders and our systems that they will create the capacity to be to be humane and really support our trainee and faculty parents because so many people want to develop that part of their lives. 40 to 60% of trainees answered that they did plan to try to start a family during training and then junior faculty, I'm sure it's even more. We just really have to expect from our leaders that they understand that, and they're going to create the [00:13:00] capacity for people to do this without breaking the backs of everybody else. And I think with advanced thought, with the creation of systems, and with creating an environment that it's understood that is welcome and we will support you to the best of our ability. It has to start with leadership and culture change.

Christine Ko: Yeah. You mentioned culture, and I realized later in my life how toxic our medical culture is. It's not actually only parental leave that this impacts. If you are in training or done with training and have some illness.... 

Wendy Stead: Yes. 

Christine Ko: We saw that during Covid, like at first they're like, oh, you need to take time off. But then, as so many healthcare workers were getting sick, and they realize this is not sustainable to have that many of the healthcare workers out.

Wendy Stead: Yeah. That was just completely unique and [00:14:00] unusual and unprecedented. One small gift from Covid, at least at my institution, is that I do feel like some of that I'm gonna go to work regardless of how sick I am mentality has changed. That is not as widely held a value system as it was in the past. I think we recognize more both that doing that can put other colleagues and patients in danger. But also that's not good for your own personal wellbeing either. God, when I was a resident, I can remember people coming in with probably norovirus and literally their friends would put IVs in them and they would walk around admitting patients with an IV pole, pushing in front of them, because they were gonna get their IV fluids, and they were gonna stick it out and be a hero. Thankfully that kind of stuff doesn't happen anymore. But I don't mean to say that we do a great job making [00:15:00] sure that people who suffer from disabilities or chronic illnesses during their training or during their practice are always well supported. Because that is not true. Leave policies, whether it's for parental leave or other leaves, in Massachusetts, we're lucky to have paid leave because that also applies for leave for other health related issues as well.

Christine Ko: Since with the American Board of Internal Medicine, there's five weeks per year and then, you can give people another five weeks, 15 weeks total in the two years. And as you said the American Board of Medical Specialties, ABMS, it set six weeks across all training programs. That's true in dermatology as well as internal medicine. So residents or trainees, taking parental leave will amass it. Instead of taking vacation one year, they'll collect up to eight or 12 weeks for parental leave. But then the problem is they have no vacation at all. Any other time. And [00:16:00] so if they get sick, what are they gonna do? I think that feeds into this toxic culture. It's exhausting to work 52 weeks plus. You might work a year and a half with no vacation. That's not humane.

Wendy Stead: No, absolutely not. And so the ABIM does not let you forfeit all your vacation in a year. They don't let you hold over vacation and use it in another year for that reason, because they don't want people doing that. But I hear what you're saying. And even, let's say even if you didn't, like you're in a program that has four weeks of vacation per year for all of its fellows or residents, you decide to become a parent. And so you decide that year, you're gonna take all four of those weeks as vacation, and then you're gonna smack on the last five that you get for the deficits and training. You can get yourself to nine. But you're right, that's with no other vacation. That's a long year. Program directors from surgery and program directors from anesthesia and program directors from OB GYN are also beholden to the [00:17:00] procedure requirements that they have, whatever arbitrary number of surgeries it is that the trainee has to get done before they're considered qualified to graduate. That introduces its whole additional layer of real, real difficulty for program directors to allow for humane leaves, at least if you have a trainee that is still hoping to graduate from their training on time.

Christine Ko: System change does need to happen. It sounds like you're in a position to make some system changes for your trainees. Going back to your daughter and how you're very proud of her, you named a couple characteristics of your daughter that you said would serve her well going into medicine. One was emotional awareness. Another was she's good at relationships and connection. The third was you said that she likes studying. Could you elaborate?

Wendy Stead: When I was thinking of [00:18:00] emotional awareness, I was thinking more of emotional intelligence. Being able to read the room, being able to sense deeply what others are feeling and size up a situation quickly. That's a quality that will be helpful in helping her relate with patients and with colleagues as well. Because this is a hard job for a lot of reasons as we've been talking about it. Being able to understand and relate to your patients, but also being able to understand and relate to and support your colleagues is one of the most important parts of the job. The healing you get from your colleagues is one of those things that really, I think on the days that are terrible, and it feels you haven't figured out the diagnosis or haven't been able to help your patient, or you've made a mistake. They're the people that are able to keep you going.

I totally agree with everything you said about emotional intelligence. I think I really didn't have a good understanding of my own [00:19:00] feelings. And so I think in retrospect that created stress for me because if I had understood, like I wanna be a team player, and that really is a priority for me. Then maybe I could give myself a break on other things.Yeah. 

Christine Ko: Or if breastfeeding is the number one priority for me. Then I could focus on that. But I think I didn't have the mental space to realize that I was caught up in not just the medical culture, but I think maybe the way I grew up: I have to be able to do all of this. Why should I not be able to do all of this? That's where if I had the emotional intelligence to be like, you're exhausted. You are really working on the limit of your ability to take on all of this stuff. Hey, maybe be a little bit nice to yourself.... 

Wendy Stead: we're bad at that, Christine. Not individually. As a group, as a profession, as a [00:20:00] culture, we need to do more. And I don't know if you had this, but was there any, were these feelings that you were able to share with a group of other people going through similar things? We have to do a better job of helping those people connect with each other. I'm listening to you and having PTSD from my own experiences. I definitely was the first person to drop the kid off in the morning and the last to pick them up with the daycare people looking at me and seemingly trying to shame me. They probably weren't, they probably just wanted to get home, but the looks on their faces were like, how could you be so late? I think it would be helpful and healing and supportive to have parent groups or peer support. We should have systems set up like that so that we recognize that people are gonna come back from their leaves, and they're gonna be going through everything that you're going through, and you need other people to bounce it off of and realize that you're not crazy. You are trying to do something that's super human. Get tips from them and give tips and even just[00:21:00] have some space for them to normalize how hard it is.

Christine Ko: Normalize how hard it's. This ties into emotional intelligence. My daycare would absolutely try to shame me. I was late twice to picking my daughter up in all the time, the five years that she was daycare.

Wendy Stead: That seems like pretty good stats to me.

Christine Ko: I was late twice 'cause I was in clinic and I was running late. I ran a little over half a mile from the clinic to the daycare. Sweat is pouring down my forehead. Oh. I probably looked totally frazzled. The director and a teacher were waiting for me. All the rooms are dark. The director says, oh, we were wondering where you were. We thought you might be in the library. 

Wendy Stead: What?

Christine Ko: We thought you might be in the library. In the library. With my feet up reading a book or something. I was so out of breath from running there. I was like three minutes late. I just had no breath. Otherwise, I think I would've lost it. Yeah. But I just looked at her. They had everything packed up. They just handed her to me and left. And as I walked with my daughter, carrying her with all this [00:22:00] stuff, I was like, what?

Wendy Stead: It's so shocking, right? You just think that people who do that job would have an understanding that things come up. If they know you and what it is that you do, that they would understand that occasionally something's gonna happen that's gonna delay you.

Christine Ko: I appreciate what you said about the qualities your daughter has. If you don't have it initially, one of the reasons I'm doing this podcast is just to try to introduce people 'cause I don't think I really thought about the kinds of skills outside of actually learning whatever medical topic. Like, how do I really get along with people especially if I am totally sleep deprived, like you mentioned.

Wendy Stead: I tell my trainees that are about to become parents, it's gonna be hard. There'll be wonderful, really hard, stressful days. But being a parent has made me a better [00:23:00] doctor. I had to have this experience to come to this greater understanding. I think of every patient as somebody's kid. And it really helps, I think. It opens you up to the world in a way you might not be, or at least I wasn't before I had kids. It's one of those great equalizing moments where suddenly you understand a whole group of people that you might not have understood before. My kids are both very different from each other. And so I also got introduced to kids are hardwired, and they're gonna be who they are, and your job is to support and guide them as much as you can, but you can't control. Say goodbye to control because there's really no such thing. Those were really good lessons that made me better on the job side of my life as well. 

Christine Ko: I agree, and I think that's a big positive, a big reason to have parents be doctors and to support this kind of parental leave. Being [00:24:00] a parent and being able to realize that I fail at being a parent, but I can also fail at being a doctor made it easier for me to realize, okay, like just as I'm learning to become a parent, I've taken the time to think about how I come across to the patient.

Wendy Stead: As my kids are older, I have more time. I think I have that luxury now. Parenting has been a humbling experience for me in a lot of different ways that are good and have made me a better doctor. 

Christine Ko: I'm with you. As a parent you will fail, right? You have to fail because, why is the baby crying? And there's no answer, right? The baby's still crying. I've tried everything. It's a humbling experience. Do you have any final thoughts?

Wendy Stead: I've been thinking a lot about this journey because of what my daughter's about to do. I was talking with one of our fellows the other day too. The last piece of advice I have for women who are entering this field is [00:25:00] to be sure as you can that you really love what you do because there will be terrible days, there will be terrible mistakes, there will be exhaustion. If you love what you do then I think you will always find your way back to those inspiring parts of the job and the things that will carry you. And that's what I hope for my daughter. Like I know this will be hard and I know there will be some stresses along the way and definitely some hard days, and she's gonna have to work really hard and be tired. But I think she's gonna be really good at it if she wants to do it. As long as she finds her way to whatever path within it, and there are all kinds of different paths, right? But whatever path within it that is her passion that she loves, she will find her people by doing that. She will find the [00:26:00] joy that hopefully, in the equation, will balance out the hard things. 

Christine Ko: I love that. I'm very lucky to love what I do, but even with loving it, there have been times where I'm like, I can't do this anymore. The thought will enter my head, where I'm just like, I need to cut back somewhere. I'm not gonna cut back from being a mom. Some days like you said, if there's a mistake or just challenging colleague or patient or you have an illness, it's just hard. But medicine is really a beautiful profession. At least I still think we can make it that.

Wendy Stead: Yeah. How many other jobs are there where you can come home every day and feel like you made an enormous difference for another human being?

Christine Ko: Absolutely. And I think that's like something to remember because I think I'll get bogged down, and I didn't even have the mental space to think, did I help anyone today? [00:27:00] Human nature is to focus on the negatives. There was that patient who was so angry with me today and just ruined my day. But then think of, oh, but there were like 15 others who either walked out neutral from my...

Wendy Stead: which some days is a big win....

Christine Ko: ...but I would forget about that and be like, oh, this one person was upset with me.

Wendy Stead: Absolutely. 

Christine Ko: Yeah. Think about the wins on a daily basis. We do have wins even if they're small for our patients. Thank you so much for your time, Wendy. It was such a pleasure to talk to you.

Wendy Stead: Thank you Christine. I had a great time. I really appreciate the invitation.