When I started my career in medicine, I thought that my path would be linear. After all, everything up to that point had been with a direct goal in mind. Looking back, I couldn’t have been more wrong. And as I reflect on the past two-and-a-half decades, sometimes I am amazed at the zig-zagged route I have taken. Yet what seemed then like a series of detours, somehow through chance and circumstance, have led me to where I am now.
Motherhood
As a third-year internal medicine resident, I had my future mapped out. I had been accepted to Columbia University’s General Medicine Fellowship (which included a master’s degree in public health) and would be joining my husband, a reconstructive surgery resident at New York University.
But when I became pregnant with our first child, I realized that having a baby at the beginning of a two-year fellowship, affording quality childcare, and living in New York City on two trainee salaries was going to be hard enough, not to mention the responsibilities of patient care, resident teaching, public health courses, and research.
To pay both rent and childcare, it became clear that one of us would need to get a job with a better salary. One of the hardest decisions I would ever make was to send a resignation letter to my future fellowship program director. Even though I knew that it was the right decision for me personally, I felt that I had let the program down.
But then what next? Finding a clinical job in a city where I had no connections turned out to be harder than I had expected. Besides the Yellow Pages, I really didn’t even know where to begin. In the spring, I found myself at the Society of General Medicine Conference, and a mentor told me that the same fellowship program director, when he heard that I was looking for a job, had encouraged me to talk to him.
To this day, I will be ever grateful to Dr. Steven Shea. Not only did he offer me a position that allowed a start date four months after my delivery date, but also he allowed me to work 75% time and join the division as a clinician educator.
I had not seen myself as qualified to apply for an academic position, but here was an unbelievable offer. I was even able to enroll in the MPH program part-time and thus complete the master’s degree program during my years at Columbia. While one door had shut, another had opened.
Voices of Women in Medicine
Shortly after the birth of my second child, I found the juggling act of managing a career with family to be even more challenging. My husband was still in his seven-year joint surgical residency and his hours were long and unpredictable. How had my physician mentors made it look so easy?
Though I eagerly read books about being a working mother, the demands of being a physician mom seemed to be different. I yearned to hear from other women physicians and secretly dreamed of one day compiling a book of stories. This was the era before social media and blogs.
That dream would sit dormant for more than a year and likely would have remained a figment of my imagination had I not stumbled across the piece “Doctor’s Daughter” in the Annals of Internal Medicine in 1999. Reading another physician’s story made me realize that others might also want to share their experiences.
And so began my journey as a physician writer with the help and encouragement of my colleague and mentor, Dr. Rita Charon, then director of the Program in Narrative Medicine at Columbia University, and Janet Bickel, then an associate vice president and director of women’s programs at the Association of American Medical Colleges.
In the days before social media, outreach was through snail mail, email, fliers, and word of mouth. The book project would become my main link to fellow physicians during the years I was a stay-at-home mom as we relocated the family for my husband’s fellowship training and practice.
I became inspired by the stories of women in medicine and delved into historical writings to learn more about the pioneer women physicians who had forged the paths before us. My anthology, This Side of Doctoring: Reflections from Women in Medicine, was published in 2002.
Association Leadership
My desire to connect with women physicians led me to the American Medical Women’s Association (AMWA). My first AMWA meeting, in Atlanta, Georgia, in 2003, was the first time I traveled without my three young children. Within AMWA, I discovered a community of likeminded peers and mentors. That meeting would be the start of a decade of volunteer leadership, first as a branch president and later as a committee chair and board member.
I was inspired to be part of an organization with nearly a century of legacy. I aspired one day to join the line of luminary women presidents, from the founder, Dr. Bertha Van Hoosen, to renaissance physician Dr. Esther Pohl Lovejoy, to New York’s first woman ambulance surgeon of New York City, Dr. Emily Dunning Barringer, to my mentor Dr. Leah Dickstein.
But I also knew that the organization was challenged by limited staffing, recent tax law changes, and the struggles that every nonprofit faced after the 2008 stock market crash. Years earlier, some in AMWA had even questioned whether the organization had served its purpose and could retire to a glorious sunset.
I began to worry that if I waited too long, there might not be an organization to lead, so despite being the youngest candidate in recent years, I threw my name in for president-elect.
At that time, I was working part-time as a primary care physician and a utilization review consultant. Compared to others, I had no high-ranking academic title or decades of work experience, but I had a deep passion for the mission of the organization, an unflinching work ethic, and a willingness to embrace new ideas and partnerships.
So began my presidency of AMWA in 2010–2011, at a time of enormous healthcare reform and exciting changes on the national level within the White House and the Department of Health and Human Services.
Over the next few years, AMWA continued to grow as a new generation of physician leaders invested their time, resources, and passion in the vision and mission of the organization. I continued to be involved in leadership capacities and will always credit AMWA for providing the training ground where I first understood governance and learned to use parliamentary procedure, manage budgets, and interpret financial spreadsheets.
Reentry to Clinical Medicine
After staying home to raise my children during our family moves, I decided that it was time to return to clinical practice. I sent my resume out locally and interviewed with a few groups, but my desire for part-time work ended up being a barrier for any serious job prospects. A year later one practice contacted me again. Would I be interested in providing primary care in a senior care community?
While I had not trained specifically in geriatrics, the practice set up could not have been better, so I enthusiastically accepted. Later, additional per diem work opened up in an occupational medicine clinic. Over the next decade, these two areas of work would constitute my part-time practice, allowing me the flexibility to adjust my work schedule around school hours.
I came to love geriatric medicine, and the relationships I established with my patients and their families would constitute some of the most formative years of my career.
Being in an off-site satellite allowed me the luxury of spending time with patients to provide the quality of care that I felt was necessary during these important years of a patient’s life. Later when I stepped into a medical director role, I gained insights to the challenges within our healthcare system and sadly also the realization that physicians, like nurses, were often considered dispensable, as easily replaceable as the next — despite the intangible losses with each upheaval.
Association Leadership Reprised
Two years after my presidency of AMWA, another opportunity opened up within the association. A call had gone out for a part-time physician executive director. I knew at once that this was the job that I had unknowingly been working toward during all my years as a volunteer leader.
While I didn’t necessarily have formal business training, my recent presidency and past participation on key committees had provided intense on-the-job training. And there was not a facet about the organization that I did not know. Years of volunteer leadership had fortuitously paid off.
Taking on the role of executive director was like being the founding entrepreneur of a start-up company in more ways than one. Beyond an association management company and a cadre of dedicated volunteer leaders, we had little support staff. But within the leadership there was a deep sense of connection and mutual purpose.
I felt like an intern all over again, in terms of salary and schedules. Yet despite those limitations, I had never felt more professionally fulfilled. The alignment of my work and my passion had never been so well-matched.
Thanks to the commitment of the leadership, each year was more successful than the last. We began to realize that not only was AMWA still relevant, but also our voice was very much needed to advocate on issues that directly impacted women physicians.
Over the past eight years, we have expanded membership and built up a revenue base to add staff and new programs. We are tackling relevant issues like physician fertility, gender equity, and physician mental health. Three years ago, we outlined a new strategic plan to lay out a roadmap for the future. The years of hard work had been worth it, and we set our sights on the vision for the next century.
Lessons Learned
I’ve learned that organizational leadership is vastly different from individual leadership. This can be more challenging for us as physicians because we are accustomed to leading clinical teams and being solicited for our individual expertise and perspective.
Serving an organization, however, requires a different set of metrics and a putting aside of one’s personal opinions to represent the position of the association. For physicians, this can take some adjustment, but for most, it is a skill that can be learned.
I’ve learned that building a team starts with a foundation of trust, and from there, it’s important to tap into each member’s passions and strengths to optimize each contribution, rather than force an agenda that can feel like drudgery.
Discovering Patrick Lencioni’s work was a gamechanger for me, both to understand why things weren’t working and find ways to harness the natural gifts of each leader. I gained keener insights as to what areas of work were likely to lead to burnout for both me and my colleagues.
This perspective is particularly important in an association like AMWA, because when volunteer work begins to feel like a grind, that is about the fastest route to disengagement. The process also highlights that everyone has a strength that is needed for the team to succeed. The key is to find and engage those strengths.
I’ve seen that teamwork is easier if everyone is following the same North Star. This concept is easier to understand in sports when the goal of winning the game is apparent to all. Within organizations, however, team members may come with priorities of their own. In those situations, it’s important to ensure that the mission and goals of the association come first.
When everyone is working toward the same goal, differences in opinion are welcomed as diverse perspectives and robust conversations to achieve the best solution can take place. There are no winning or losing viewpoints because all perspectives have been critical in reaching a final consensus. When goals are different, however, differences in opinion are seen as dissension and can lead to some feeling like winners or losers, or worse yet, to a breakdown of the team’s trust.
I’ve realized that partnering with others helps you get to the same goal faster. I’m a big believer in sharing both the work and the credit, because lifting each other up means that we all go farther. Leadership does not have to mean ownership; in the nonprofit world, the former is far more important.
I’ve seen that equity has many shades. As an Asian American and daughter of immigrants, I am all too aware of the biases that exist still today. Yet even as one often dismissed as being part of the “model minority,” I know that my ethnic heritage has been part of my consciousness for as long as I can remember. Would my input carry more weight if I looked different? Probably. Have I ever recruited colleagues to convey a message because it might be heard differently? Definitely.
Finally, I’ve learned that executive coaching works. I never thought that I would have the time nor resources to incorporate coaching into my life, but now I can’t imagine doing my job without it. What finally motivated me to seek coaching was the need for mentorship in navigating complex organizational dynamics, and what I gained as a result were life-changing insights about leadership, team building, and communication.
I now see coaching as a vital part of leadership training. Without it, directing an organization is like learning chemistry without the lab. Simply understanding principles may not always be sufficient. Having them reflected back through coaching helps us apply those principles to the work that we do and the relationships that we build.
Giving Grace
There is no doubt that the past few years have been tumultuous, both within medicine and society at large. This is most certainly a time of change and a time of learning, no matter one’s age or experience. It has been a humbling experience.
Perhaps because I am on the “learning” side of the continuum, I often feel that we as a society — and as a profession — don’t give each other enough grace, or enough time to grow and change. It’s like teaching someone to ride a bike but expecting success on the first try.
And then there is the compounded challenge of social media. Failing is hard enough, but when one person’s failure becomes another person’s public messaging platform, it magnifies that experience of failure a hundredfold. Yet it doesn’t have to be a zero-sum game, does it?
Maybe if we all took the time to listen more actively, walk a mile in another person’s shoes, realize that we each have learning of our own to do, we can be more generous in giving the grace that will help others grow and move forward in their own journeys. That is the type of leader that I aspire to be.
Gratitude
It’s been eight years since I stepped into the executive director role in AMWA. I love where I am now — to have work that I relish every day (albeit long days) is a gift. To be in a role that allows me to innovate, forge meaningful relationships, and make an impact in healthcare was not even a “job” I thought possible when I first set out as a physician.
I still have a small hand in the clinical world, as medical director of an assisted living community. Though I no longer have direct patient care responsibilities, I feel fortunate to be working with colleagues who value my input and contributions.
I have often admired other physician leaders for their bold career moves. Although my journey has also evolved over the years, those transitions have been mostly gradual and often serendipitous. Yet somehow, despite an unconventional path in medicine (which at one point admittedly felt stalled and even backward), I have finally come into a career that has been deeply rewarding.
For one who gave up personal goals in the early years to focus on family, it has been an unexpected gift to have a career where I can nurture my own aspirations, even as my children come into their own adulthood. My advice to others is this: never be afraid of exploring the detours along the way, even if they don’t promise the traditional metrics of success. If it is your passion, that detour may very well end up being your new road.
Excerpted from Lessons Learned: Stories from Women Physician Leaders edited by Deborah M. Shlian, MD, MBA.