Transcript: The Impact of COVID-19 on Academic Careers in Critical Care

TRANSCRIPTION: Announcer: Hello everyone. Welcome to "Women Leaders in Medicine," a special podcast series led by our section editor on Pulmonary and Critical Care Medicine, Dr. Jaspal Singh. The views of the speakers are their own and do not reflect the views of their respective institutions. Dr Jaspal Singh: Greetings everybody. I'm Jaspal Singh. On behalf of Consultant360, welcome into our next edition of Women in Critical Care series. I'm with two very prominent physicians here, Dr Stephanie Taylor and Dr Julie Freischlag. Welcome ladies, and happy International Women's Day. Dr Stephanie Taylor: Thank you. Dr Julie Freischlag: Thank you. Dr Singh: We'll begin with you, Dr Freischlag. Do you want to introduce yourself? We'll talk a little bit today about the topic of academic issues related to COVID‑19. Dr Freischlag: I'm Julie Freischlag. I'm a vascular surgeon by trade. Presently, I'm CEO of Wake Forest Baptist Health and Dean of Wake Forest School of Medicine. Since October, I'm also the Chief Academic Officer of Atrium Health. I'm more of an administrator, but I still operate. I'm a thoracic outlet syndrome specialist. I take care of patients with thoracic outlet syndrome. I have done that for a couple of decades. I've focused on that, and have patients that come from all over the country and the world for us to operate on them. I also spend a lot of my time as a surgeon. In the past, I was Chief of Surgery at Hopkins and also Division Chief of Vascular Surgery at UCLA in my past. Dr Singh: This topic is probably something you can relate to from what I can gather. Thank you. That's fantastic. And, Dr Stephanie Taylor. Dr Taylor: I am an Associate Professor in the Department of Internal Medicine at Atrium Health. I practice medicine at Carolinas Medical Center, our large hospital in Charlotte, North Carolina, as a physician scientist. I co‑direct our organization's Acute Care Research Program which takes a learning health science approach to clinical questions that are relevant to patients with acute and critical illnesses. Most of my own research involves improving outcomes for patients with sepsis. Using health services research and pragmatic trial methods to address questions like optimal timing of antibiotics, fluid resuscitation in early sepsis. Some of my work also tries to identify ways to help sepsis survivors recover closer to their pre‑illness health status. Dr. Singh: Well, that's fantastic introductions from both of you. That's very helpful to know your background. You're both very passionate about academics. I loved my time in academia, I remember it fondly. There are some parts of it that are a little bit challenging for many women, especially. My wife's a physician as well. She did a Research Fellowship in Health Services and Outcomes. Then in that process though, there was clear challenges that we both faced as a physician couple. I wonder if you could talk to us about what is it that draws you to academics. What are some of maybe the top challenges you might be facing today? Dr Freischlag, do you want to start? Dr Freischlag: Well, I think you identified the number one issue that the new frontier is "couples." Couples that are coming out of medical school. We've never seen so many partnerships of both being physicians. Last year we matched 12 couples out of the class here. Some male and female, some female‑female, some male‑male, but we had 12 couples. You show up to be trained and then to have amazing careers. Oh, by the way. You decide to have a couple of kids and then it gets confusing. When I went through it, I didn't have my son until I was 40. I did my training and everything as a single person. I was only the sixth woman in the country to be certified as a vascular surgeon. When I trained, I was that old school in the house every other night. There was no opportunity to have any outside life back then. They thought it was the right thing to do, but we've learned better as we've gone forward. Balancing not only your career but perhaps your partner's career. Then trying to integrate how you want to spend your time, of which all of it is important and joyful. As you go forward trying to make sure you have great time management. Understanding what resources you have to help you do your things such as... I haven’t cleaned my house since 1983, and I have no intention of doing that. My husband stayed home when our son was seven. He's a businessman, and he was a horrible cook, but now he's a great cook, and I don't cook. I like doing crafts and other things, and he does the cooking. Figuring out what you're going to do and what you're not going to do, and not feeling guilty about it. For me, the best thing about academia is Dr Taylor. Dr Taylor: [laughs] Drn Freischlag: Watching people come through the process to learn and to grow. Writing papers, doing presentations, mentoring, and being around young people that spear you on to make that happen. Actually, I was just going to say, Dr Taylor, I'm coming down twice a month now to Charlotte. I have an office on the second floor. There'll be a sign soon. I need you to come talk to me, and let me hear what you do. That's what floats my boat, so teaching, training. I still teach operations to young people in the operating room. I think that's my spirit as teaching the next generation to take good care of our patients. Dr Singh: That's very helpful. That's a great segue. I think you've given a lot of sage advice. We'll come to the challenges later. I want to dive in a little bit deeper into some of those challenges that you outline. First, let's hear from Dr Taylor real quick. Dr Taylor: I am also one of those dual physician couples. My husband is an intensivist that works with Jaspal. There's a lot of additional stressors that go on with that. I am drawn to academia. I know it's not for everyone. For me, clinical science research questions and the methods that we have to answer them are just among the most fascinating and important work that I think we can do. Particularly, the learning health science framework of generating knowledge, engaging stakeholders, implementing behavior change so that we're actually transforming practice based on evidence. This feels like such an important and fulfilling mission to me. It's very motivating to stick with it, despite multiple challenges, and it not always being the easiest road. Particularly, for women scientists, it turns out. Dr Singh: Stephanie, you have a few little ones running around. We've talked about this before. Parenting today, I want you to talk about that a little bit. The demands of parenting have probably shifted a little bit. We've watched our younger colleagues have different challenges than some of us have. Tell us a little about that, how you're balancing that work‑life balance a little bit. Dr Taylor: What pre‑pandemic or...? [laughter] Dr Singh: Both. Dr Taylor: It's very different. I spent a lot of effort pre‑pandemic orchestrating this intricate network of support. Like lots of flotation devices that kept me on top of the water while I could focus all my time on either career or family. Similar to what Dr. Freischlag said that I don't clean my house. [laughs] Things that aren't important to my career or directly bring me joy, I am fine with either not doing them or delegating them to someone else. I think that's really important is writing your own narrative about what you have to do. Particularly, as a woman. What a mom has to do and what a wife has to do, make your own narrative. Instead of just being beholden to the typical societal narrative about that. I will say that post‑pandemic [laughs] or during the pandemic, all of those flotation devices that I had made overnight deflated. Dr Freischlag: [laughs] Dr Taylor: I was drowning. Clinical work obviously exploded as we were stretching ourselves to care for the surge of really sick patients. Research exploded because not only were my pre‑pandemic grants and projects still needing to march on but now there were all these new clinical questions about COVID that needed answers. They needed answers quickly. Then family life exploded because we had no school, and we became full‑time child caregivers and full‑time educators. There was no balance. It was all full throttle. Everyone's got their little story about how their children unceremoniously appear in Zoom meetings. For me, [laughs] the tipping point was I was trying to submit a manuscript. I had the editorial manager software open. Then the kids needed something to do, so I was also trying to print out a coloring page for them. I had Optimus Prime, the main character in the Transformers, up on a different screen. Somehow I managed to accidentally print or paste the Optimus Prime picture into a response field in editorial manager. [laughter] Dr Taylor: I could not get it erased. I could not get it to go away. There it was supposed to be response to reviewers and there is Optimus Prime. Dr Freischlag: [laughs] Dr Taylor: This glaring mental image or physical image that the overlap between my work life and my home life had just gotten out of control. That was [laughs] the tipping point for me, where I realized I just can't do this. Fortunately, at that point, we were starting to get a little more comfortable with childcare providers and stuff like that. I won't lie it was really hard in the thick of it, right when COVID hit around the springtime. Dr Singh: Well, that's a great segue to the next thing. I can't imagine what that was like. Dr Taylor: [laughs] Dr Singh: I'm a little bit older. We have our own challenges with two teenage daughters at home. Dr Taylor: Sure. [laughs] Dr Singh: That being said, the aspect of you're trying to balance all this at home. You're trying to balance those at work. At some point, your benchmark, you're going to want a promotion. There's certain achievements or goals that you need to do to get that. It almost seems like if you're trying to be helpful at home and do all these things and be active. Do things that provide joy and value. It's hard to benchmark against people who don't have all those other outside pressures. What are your thoughts on that? Dr Freischlag: I'll start off with that because it's changed a lot. Some for the better and maybe not so much. When I had my first job at UCLA, you had four years to get published and be assessed or they'd fire you. They would get rid of you. You had a four‑year time clock that they would assess to say, "Are you going to be promotable to associate professor?" When you think back about that, how silly was that to get rid of people because you had four years to make that happen, when you're 31 and 32 years of age? When we did a survey at UC Davis before we came here, young men are feeling the pressure too. They want to know their teenage daughters. They want a partner. Plus, their partner's busy too, so they would like to be there. The other group that's under siege is more senior women taking care of their parents. There are other groups that can identify that you can talk to make it happen. What we've done with promotion is to give lots of opportunities to be promoted. The best thing that happened with outcomes, similar to what Dr Taylor was saying, you can make a career of outcomes. I started an outcome center at Hopkins Surgery. We put it right in the middle of everyone's offices so we could look at surgical outcomes and infection rates. Instead of looking back and counting what you did, which was interesting and impressive, you could do what she's doing. Look forward and do it in real‑time to make a difference in a patient. We flipped that so you could take your work and publish it. Everyone will tell you around here, every time you tell me what you're doing, I said, "You can publish that. Write that up." This whole Atrium partnership, I told Gene Woods, "We need to write this up about how we are combining faculty from both sides. How are we going to start this school? How are we going to take the great things at both legacy institutions? Make it this new way of doing things in a way that we appreciate each other's activities?" Making sure you write that up and make it happen. For reasons that she mentioned, women have been noted to be less productive during COVID. Dr Melina Kibbe who is the editor of "JAMA Surgery" which she took over for me ‑‑ I was editor for 10 years, and now she's the editor ‑‑ documented that in the press. When you look at COVID‑19 articles, it's mainly men that are publishing those articles and not women. I do think for the reasons that she said. You've got these kids. You can't do anything and now you're contained. You can't even have people come into your house because of the virus. I do think it has taught us to reassess a bit about what you can and cannot do. The last thing I'll tell you is we created a new clinical track since I've been here. You can get promoted on a clinical track which is education, outcomes, research. Those kinds of things that you love to do. You choose those and you can get promoted on a clinical professor track. Like those who want to be in the research lab which is maybe only about 10 to 20 percent of us. To do that, you have to do it full time with a team. You can't just do it on Tuesdays. Again, the appreciation that everything people are contributing to the advancement of knowledge and care of patients. Then also look at what's happened with COVID‑19. We have three vaccines that work. That work had been going on for years prior to the emergence of the virus. We certainly have learned how to take care of the COVID patients better. You both know that better than I do where our outcomes are even better with them once they get into the hospital at ICU. Having an open mind, having flexibility. I've told people as we get through this pandemic, the number one goal you should do is to have flexibility. Flexibility with your home life because you've learned to have to be flexible. Flexibility at work, and flexibility with each other so that we can appreciate each other and listen to each other. Dr Singh: That's well said. I hear there's a lot of sage advice. Stephanie, what are your thoughts? Dr Taylor: As far as the impact of COVID on promotion and women's careers like Dr Freischlag mentioned, there's certainly evidence that women scientists have lost research productivity due to the pandemic. There's a study from Harvard Business School that found that across the board, women lost research hours. The most important variable was having a young dependent. That a scientist who had one kid under five had something like a 20 percent larger decline in research time. Then multiple dependents were associated with a further decline. In some ways, this is incredibly obvious for those of us who have been living the experience. At the same time, it's validating to see it in print. What I worry about the most though is not necessarily the number of hours we've had to spend on research, but the type of work that we've been able to do during the pandemic. There's urgent work, and then there's important work. The important work is the big idea, career building, deep thinking work. The urgent work is more of these perfunctory tasks that have to get done. The career advice is obviously to focus on the important work first with your first fruits of energy and motivation. Otherwise, the urgent work will expand to fill the time and you won't have any time left for important work. What the pandemic did was brought so much urgent work, especially for women. That every day, it was put out the hottest fire and there was no space for this important big idea, career‑building work. My main concern is that that will have long‑term consequences on the careers of women scientists going forward. Dr Singh: Yeah, that's well said. A lot of people are saying what you're saying, essentially, is that, "Yeah, we got through this. Yeah, there's a lot of reasons for hope. Yeah, there's a lot of ways. A lot of us created new ways to get our daily work done. We got through it, the worst part of it." A lot of it was just survival. That's what I hear you're saying. You get into the day, get into the primary duties. When you talk about writing a grant or writing an impactful manuscript, we're collecting your data. Even if it's outcomes data. To design that process, to take a deep dive into it. Even as myself, I had all these great ideas. When COVID hit, we would do all this work. It ended up being hard to sit down and do the deep work. Dr Taylor: Yeah. Dr Singh: It might affect things that down the line. That's the reality of things. Dr. Freischlag, you've given some solutions. Flexibility, be flexible. Be willing to reach out and engage in different ideas. What are some other ideas that you think would be helpful moving forward now at this point? Dr Freischlag: What we saw with our researchers who aren't like Stephanie who are doing bulk. You got clinical work and researchers. My pure researchers, they were more productive. We found that many of them work better from home. My Public Health Sciences group doesn't need to come to the office. That gives me a lot more office space to hire more people as we go forward. They're very productive at home. We also found that people coming in and out of the labs, maybe when they would do experiments. They all went home, but then they came back, do experiments on Monday, Wednesday. They would spend Tuesday, Thursday at home. There wasn't so much density in the lab, and they got more writing done because they weren't there talking to the other people doing research. There are some people that this has actually coordinated what they needed to do. They certainly struggled just like she talked about if they had small kids at home. Teenagers were a problem too because you needed to wonder where they were. We also didn't travel a lot this last year. Somehow the days are long, but the months are short. You come to work every day. It's like Groundhog's Day. You don't go anywhere. I can say yes to these things because I pop on for an hour and leave. I found out I said yes to about 30 of them in the next three months. I'm like, "What was I thinking to do it?" I think there are some pieces of that, maybe it also taught us that not everything is as important as we thought. Maybe some of those things that we thought we needed to do to get an abstract together or make this happen, they're not as important as we thought. We can go back and reframe the important. I have found though I can't read. I was a big-time reader. I always read on planes and that. I haven't been a reader. I read a lot of fiction. I read a lot of leadership. I've found a COVID fog brain. I think as we all come out of that where you are so exhausted from putting out fires. Making sure your bottom line is good. How many COVID patients are in the hospital? All those things we worry about. We need to reframe what is going to be important and who's going to help us do that? I think including many others. I think we're so lucky. Hopefully, everyone down in Charlotte feels we're so lucky that in October, right in the middle of this horrible pandemic, we partnered with each other. The medical students started today. You just got a little coterie of medical students. I think seven or eight of them showed up today. There's 50 of them that can't wait to come down there. We partnered with a big engine of patients to study. Maybe we need to think of that better. There's going to be a medical school there in three years. We just put in the application for the third and fourth years. We got it done, because we didn't have any other place to go, so it just got filed through the third and fourth‑year students. You wonder whether or not we are the fortunate ones to have this strategic partnership as we emerge as a new type of delivery of care and teaching and training. Then do we need to learn how to do things, maybe, not as scripted? Certainly, when I raised my son, he had his school, he had his activities, he had this, he had that, we had all that. Then what happens, I loved how you described it, that everything deflated when you have nothing. I know, watching my step‑kids with their young kids, they've spent tons of time with them. Everybody's ready to go do something else. They certainly have spent tons of time with them. They may remember this at the time where they bonded with us a little bit more even though it seems so stressful. I do think it's going to be interesting coming out of this. They call it the next normal. We just had a retreat here. We can't call it the new normal. It's the next normal. We can't have expectation that we'll go to as many meetings. I think everything will be hybrid. I think you, as a young associate professor, Stephanie, will be able to attend meetings without any scorn from home, if you can't fly there. Dr Taylor: [laughs] Dr Freischlag: You'll be able to be on a panel even if you're not there. When I was young professor, I flew across the country for an hour‑meeting. If I didn't do it, I wasn't committed. I do think we'll see flexibility later for women that you can participate in many, different ways, and it's OK, or me as a CEO in a CAO at Charlotte, I can pop into your meetings without driving to Charlotte. I don't have to be there every day to make it work. I do think this next normal might be the most important thing we do. Not only to combat the virus and get on the other side, but redefine exactly how much we demand of ourselves. Dr Singh: That's really well‑said. I was thinking through. To summarize the podcast essentially, for both of you so correct me if I'm wrong, if I miss anything, sounds like for women, at least for the academics, you both love what you're doing. There's a lot of reward here in what you're doing on a day‑to‑day basis. You encourage people to explore academics, it sounds like, and then find rewarding careers. Recognizing that although there has been a traditional gender bias in a lot of these things, we think there's things that are being worked on from flexibility in the different aspects of promotion, how the day works, and the different milestones required. There's a lot of things that are out there that have potentially now people are paying attention to is from the solutions. To pay attention to that and really do what brings you joy. Let go of some of the extra smoke potentially and not get so busy caught up on things that may not matter and prioritize accordingly. You think this is an important thing to address. As you mentioned Dr Freischlag is the idea that this is becoming a more ubiquitous issue across genders, trying to balance work and home. It's going to be important no matter what you do in your career. We have to pay attention to those aspects. Overall that things are looking on the up and up and that there's actually a lot of reasons for hope. Am I getting that right? Dr Freischlag: I think so actually. The other thing I would tell women and men to do is we've embarked on a lot of bystander training, and it's really important. We call it wake. You don't have to call it wake. We could call it legacy, wake, whatever you want to call it, but really learning who you are. When you're in a situation where you're not being treated correctly or you think there needs to be a change, you learn to speak up. To say something about it. Especially for those in our hierarchy or younger people who may be women, students of color, people from foreign lands, people from Charlotte versus Winston that you speak up for people, not only for yourself or others. I'll give you example today. I had to go get my BLS CPR card redone. Even I have to go to the class. Now you get to do it all online. You only have to show up for one hour instead of four. As I was practicing with the AED, I asked the guy, I said, "Why does the AED have only a male voice? Why isn't there a girl AED voice?" I said, "All we hear is this man talking?" I had all my teams say we would like an AED that actually is a woman speaking like a GPS. Even things like that. I bet you would see one soon. The voice of power and God does not always have to be male, no offense, Jaspal. I think those are the things you can call out that. Plus, my class was 90 percent women today, and the person telling us to shock everything was a guy. It should half the time be a gal. Little changes every day. Dr Singh: Sounds good. I feel a little sympathy for your BLS instructor. I don't know if he was prepared for that. [laughter] Dr Singh: Stephanie, anything else I missed? Any last words? Dr Taylor: No. I think Dr Freischlag mentioned the important part of this whole picture of women in medicine. I think that is the consistent under‑representation of women in top leadership roles. Dr Freischlag, notwithstanding, I think there does continue to be a underrepresentation in the chair level, the Dean level, the high leadership roles. I think probably to get true change that probably needs to change. I just wanted to mention that I think one thing that, that has to do with is people assume that women don't want those leadership roles. It's not necessarily true. I've had multiple experiences where people have said to me, "Stephanie, you would have been great for this position, but I know you're so busy at home with little kids." Or "Stephanie, I would have considered you for this, but I try to keep my young mothers protected from too much responsibility." I know they meant well, but at the same time, I'm pretty good at managing my own time. I can decide whether I think a leadership role is compatible with my family responsibilities. I don't need that decided for me. I think as we have hope and as we move forward getting women in those top leadership roles is going to be really important. I think we can get there following the footsteps of wonderful people like Dr Freischlag. I think that's going to be important. Dr Freischlag: I just did another podcast today that said that you can influence from below, but to change the world you have to be in charge. You will see that with me endlessly, whether it's an AED or whatever I need. My teams at work, as we go forward, I need a new senior associate dean for education that we've posted. We'll make sure we include all because those are our patients. Those are our students. You're absolutely right. If you want something done, I would ask the most busiest person in the room. Dr Taylor: Yeah [laughs] Dr Singh: I appreciate both of you on today's podcast. I know we're out of time. I just want to thank you both again. This is a very important issue. This is Jaspal Singh from Consultant360, and you're listening to our Consultant360 podcast series of Women Leaders in Critical Care. Thank you so much, ladies. Have a wonderful rest of the day, and happy International Women's Day again. Dr Taylor: Thank you. Dr Freischlag: Thank you so much.