Empower HER career chronicles: navigating women’s unique challenges in the workplace

Episode Transcript

Recorded live from the Cook booth at SIR and featuring leading experts in the field of interventional radiology discussing a wide range of IR related topics. This is the Cook@ SIR podcast series.

Welcome everyone. We are live at SIR with Cook’s podcast booth. My name is Anissa Majeed and I’m honored to be here with my esteemed colleagues, Dr. Sean Tutton and Dr. Sarah White. We want to discuss today how mentorship has worked in our lives and how you, the audience—particularly younger female interventionalists who are in training and coming up into their early career—and our male colleagues—can mentor others through the unique challenges of our interventional environment. Before that, let’s start with introductions and why we chose interventional radiology in the first place. I’ll begin with Dr. Sean Tutton.

Thanks, Anisa. I did all my training at Northwestern and—I started out in internal medicine—one of my patients, who was a woman in the ICU, was bleeding from varices and she came down to Interventional Radiology and she had the first TIPS at Northwestern, and that was such an impactful experience. The person that did that procedure, Dr. Vogelzang, who became my mentor—once I saw that procedure, it just sort of changed the whole picture for me, and I said, “This is the field I need to go into.”

Thanks Sean. And Sarah?

So I always say that I was sprinkled with fairy dust. My mother was sprinkled with fairy dust because I was born at OHSU, so Charlie’s daughter must have walked by my mom’s bed. But in reality, I had a really good close family friend that was a neuro interventionalist, and he had come home one day and—I was at their house and he was wearing a scrub top and, I’ll never forget, khaki pants—and he was very upset. And I came and sat next to him and I said, “What’s wrong?” And he said he had a very sick patient and he did the balloon procedure and she got better. And that was the end of it. I was going to be an interventional radiologist from that moment forward. So I probably knew when I was four. I mean, it was very early that I knew.

Wow. So for me, I didn’t have any exposure to interventional radiology when I was in medical school. My first exposure was when I was a surgical resident at Medical College of Virginia, and I got through two years at this very intense level one trauma place. And the vascular transplant surgeon was like, “Annisa, if I was 26 years old and I could go anywhere and do anything, I’d be an interventional radiologist.” He’s like, “That’s the future.” And I spent some time in the interventional radiology area and switched over, and there we went.

Cool. Cool.

So Sean, you mentioned that Bob Vogelzang was your mentor, which is a great kind of history point too, from when you trained to when I trained to when Sarah trained—to have him as your mentor. How did he mentor you? How did you look at it? Now we talk about mentorship, sponsorship, coaching—they’re very well-defined—that a mentor is kind of more of an advisor and a sponsor is somebody who kind of puts themselves out and says, “Here, you should do this. Let me talk to this person.” Was he both mentor and sponsor? Was he mostly mentor? And how was he a mentor to you? What did you need in that mentorship?

So after that procedure, I actually came and saw him the following day, told him how impacted I was by the procedure, and he said, “Well, let me put you in contact with our program director.” You know, the normal steps that you would expect to try to get me out of internal medicine and into radiology. And so in that capacity, I think he was both too early to truly be a mentor. He was sort of sponsoring me as somebody who was interested in the field, to sort of get me into the field. As I became a resident, and then ultimately a fellow, he was more the mentor. And how I approached patient care, how I approached procedures, creative thinking, getting yourself out of trouble—so Bob Vogelzang was famous for getting in trouble sometimes, but also being one of the best people to get out of trouble—and so I learned from him, mostly by example, how to approach patients, be creative in thinking, and it’s stayed with me till this day. I mean, he really was tremendous in that way.

And after you left, how often did you reach back out to him through your early career and onwards as a mentor?

So I got my first job out of fellowship at Evanston Hospital, which is just in the northern suburbs of Chicago. And my partner at that practice went on vacation right away, as you might expect. So as soon as I became an attending, he said, “Bye-bye. I’m going to go on vacation.” And I had my first SMA angioplasty on the schedule and I was terrified. I’d never even done it. And so I called Bob and I said, “Bob, talk me through this.” And not only did he talk me through it, but he actually came to the procedure and watched me do it and sort of held my hand from a distance and just encouraged me and said, “Yep, that’s good.” And so I mean, that to me was a foundational moment in that I wanted to be that kind of person for my trainees and for my mentees, to sort of be there for them when they really kind of need it. And whether that person realizes they need it? Sometimes they do, sometimes they don’t.

And what I’ll tell you is my very first call ever—I’d come to the Medical College of Wisconsin, had no training in PAD at the time and had never done an EVAR independently—and my first call was a rupture. And we had backup in Dr. Tutton—Sean. I called Sean and I said, “There’s a rupture.” He said, “I’ll be right there.” And so, patient died on the table. And so I think you have different mentors at different times, and Sean was certainly that person that stood next to me. Other people in the group said, “Sarah, patients die.” And Sean was there with me, understood the gravity of your first patient—that you are independently supposed to be taking care of—dies on the table. And it’s pretty eye-opening that, hey, this is real. Your job is real. So you have done that, Sean, thank you.

That makes me happy. Yay.

To follow up on that, Sarah, you had said that you wanted to be an interventionalist from age four. So in that journey that you had to become an interventionalist, just to go from—to be a female physician, but then to go into a procedural field. Did you have early mentors to help you do that? Or did most of your mentorship really start once you were in training?

I mean, I think everybody knows me and once I make a decision, there’s no holding me back. So when I was in medical school, God love me, I decided that I was going to quit. And so my mom said, “You can’t quit. You have to stick this out.” I said, “Alright, well the summer between first and second year of medical school, I want to be a barista,” which was my out of medical school. She said, “You can’t do that. What’s the most amazing thing that you could think of doing? Why don’t you do some research? You like that.” I said, “Okay.” The most amazing place that I could think of was going to the NIH. She said, “Apply.” I applied and in walked Brad Wood to my life. So Brad Wood called me on a very cold February night—I was out in the city with my friends—and he said, “I’d like you to come work with me.”

And the reason he picked me is that I had done some research in von Hippel-Lindau, and HIF-1α, and he had patients and he thought, what an extraordinary experience for somebody to go from bench to bedside. So I was looking at protein, protein interaction, and now I would be able to see patients with the disease that he had. So that’s where I started in who was my first IR mentor. It would be Brad Wood. And then I had to make this decision about, do I do the direct pathway or not? It was a new pathway. There was nobody in it ever. Kurt McCall was an attending. He had retired to UMDNJ. My chairman at the time, Steve Baker, sent me to SIR meetings. He paid for me to go. I mean, talk about amazing mentorship in a chairman, understanding that maybe this—we have something here.

And I certainly called Brad, he wrote letters for me to get into fellowship. And all of the guys at UMDNJ really fostered my love for procedures. They would let me do procedures, they’d put me up on the H level and I’d do pics all day every day. Then I’d come down and help them with other procedures. So, Phil Bahramipour, Allison Barone, Hani Abujudeh—all of those guys—I mean, they were fantastic and really fostered my love, and introduced me to Michael Soulen. And so I met Michael Soulen at RSNA on an elevator. I was stalking him a little bit, I admit. So we bumped into each other on the escalator and he said, “I don’t want to talk to you until you get in.” Which was a little—if you know Michael, that’s how he is. And so I got in. I got an interview, and the rest is history.

I went to Penn, and at the time, Penn only interviewed one day. All the residents came, we all came together, and there was one spot for the Direct Pathway. And he had me sit next to him at dinner and people would come and say, “Well, I’m not sure about the Direct Pathway.” And—not trying to impress Michael—I would say, “Well, why not?” I mean, I was so dead set that I was going to do this and it didn’t matter and it didn’t matter if it was a new pathway, this is what I wanted to do and I knew it. And so that’s the history. And I obviously was accepted, and I think Michael was an easy and early mentor, and he’s been there my whole career and he still stands beside me every day. And then I had the good fortune of coming to Medical College of Wisconsin, which was the best decision I ever made for my career, coming to a group of very wonderful mentors and friends, and I call them my brothers, my extended family. So I think mentorship has had a huge role in my career.

Can I just interrupt? Because I want us to key in on something that Sarah said that I think is really important for younger interventionalists and trainees, especially women, is that Sarah did and Sarah does put herself out there. So Sarah took the initiative, took the risk of stalking Michael and saying, “Hey, I want to know more about this. I might want to do this.” Putting yourself in a position and a place to succeed. So chance—one of our colleagues, Bill Rilling, talks about chance favors the prepared mind. So this is a character trait of Sarah’s that has allowed her to be as successful as she is, is that she takes risk. And she says, “By gosh, I’m going to do that.” And she puts herself in a position to be selected for a committee, for a position, for a number of different things. And so that I think is a huge take-home point for this, is that you got to put yourself out there.

And I think that’s hard sometimes for everyone, but I think especially for women in medicine. I didn’t want to look like a total idiot today in this podcast, so I did do a little bit of homework and reading about the challenges that I’m aware of and some of the challenges that I’m not aware of for women in medicine. And so being passed over and being a little bit reluctant to raise your hand and to sort of stand up and say, “Hey, I have an opinion about this,” or “I could do this.” These are things that I think are unique challenges to women sometimes, in our field.

Yeah, and I think it’s a huge advantage that Sarah also had, to be able to put herself out in the right channels, right?

Place of safety.

And place of safety too. But I went to St. George’s University for medical school, so there’s one strike against you in terms of trying to get back in, especially in 1996. And then I went to the Medical College of Virginia for residency, which was great, but there was no match. There was, you go and show up and maybe they’ll call you and tell you, yes, you got in or no, you didn’t. And so the network that Sarah, or you, were both fortunate enough to be in, to be able to have that and have these mentors who also sponsored, is a big deal. And so for me, I wish I had that advice when I was younger to really go and say, “If you want to go to Medical College of Wisconsin, find out who’s there and see how you can get in front of them.” It’s not easy. Everybody—I think it’s hard to put yourself out there, men and women.

I think mentorship for men, we don’t talk about it as much. It’s really very focused on women and there’s a reason for that, but men need it too. I think they also have some imposter syndrome and stuff. But when you’re coming from that perspective, I definitely didn’t know and I definitely didn’t have anybody there that I felt like, do I talk to this person? Will they help me? And I think that’s why mentorship and sponsorship is so important to me now—and that I’m so active in it—is because, especially in the private sphere—I went straight into private. It’s so hard when you encounter that first case and you’re in a new group, but you don’t know your partners as well, and you don’t know if they’re going to be like, “Why are you calling me?” Or “Why are you not? Why didn’t you call me?”

Or “Why are you calling me?” And that’s why, when—because we were just talking outside—I heard Gary Becker and I was like, “Yes, oncology is what I’m going to do.” And so anything that was oncology related, I was all over it in 2002, 2003. And you guys held that course like four months after I was an attending, and I left and there was this osteoid osteoma case in this pediatric, and I was like, I think I’ve got to ask somebody on this. And I called you and you very kindly took my call and said, “This is what you’ve got to do and these are the things you’ve got to be careful for. And just let me know.”

Yeah. Well, the ultimate privilege of getting older and being an interventionalist—and Al Nemcek touched on it today—is that you have these people that you’ve interfaced with, that you’ve had hopefully a positive effect on as a trainee or as a partner, and they keep reaching out to you and asking you, “Hey, what about this?” And I get texts from all over the world now, which is just such a privilege and such a delight to say, “What do you think about this? Is this a screw-and-glue patient? Is this an osteoid that I should be treating? What should I—?” You know, it’s foundational from a relevancy perspective, right? So I’m relevant in all these people’s lives and they think of me and it is just so rewarding. So I mean, we talk about the benefit to the mentee and the benefit to the mentor. Clearly I’ve just described what is a major benefit of a mentor is that you get that sense of, I’m having an impact on this person’s life and they still want me to weigh in. And I mean, that’s the wonderful part about being a mentor.

And what I’ll say is that Sean is a very gifted mentor. And so when I was early in my career, there was an opening at the SIR Foundation for the Chair of clinical research at the time, and Sean said, “That’s you. You should be doing that.” And I said, “There’s no way, Sean. I’m not qualified. I’m young.” And he said, “Who cares?” He set me up with a meeting with the SIR Foundation president at the time, and I said, “Sean, I can’t do this.” And he said, “You’re doing it,” and “Go.” And so I did. And six years later we made amazing changes in the SIR Foundation. And so I think sometimes mentors have to push you and make you—put you in your uncomfortable zones. Sean did that. Likewise, I’m now vice chair of research of the department, and he was a big proponent of saying, you can do this. And I said, “No, I can’t. I have too much other—everything—on my plate.” And he said, “If there’s anybody in this department that can do it, it’s you.” And so whether that’s because I’m a woman, whether that’s because I was junior, whatever, I think mentors sometimes can’t just sit back and have a dialogue but have to really push you and say, you can do this, and encouragement, and all of those wonderful things.

Well, and they get to see you in a different light than how you’ll look at yourself in the mirror. I look at myself in the mirror totally different than what I think a lot of people look at me as. And it’s the same, “I don’t know. I don’t know that this is this the right thing,” and a lot of calling around. So when you joined Medical College of Wisconsin, were you the first female attending?

I was.

So what was that transition like?

Well, we had some bumps. So the boys didn’t quite know what to do. They’re like, “Do we have to clean up our language?”

Yeah, we had to start to behave.

“Do we have to behave now? Do we have to stop cat-calling?” I’m kidding.

Probably long overdue.

They had just finished their sensitivity training and then they realized that I was one of them and I have as bad a potty mouth as all of them, and I could hang with them. And I had done surgery. And so I think at first it was, oh gosh, we have to clean up and be prim and proper, and then it turned into just a natural progression of how things worked. I think we talked about—this morning at one of the sessions—how a woman is received by young women who are—or older women—who are your nurses and technologists. And that was a very rough transition. I got called into Bill Rilling’s office very early, maybe month one, and he let me have it. And he said, “I don’t know who you think you are, but this is not the way we treat people. And if you think you’re some fancy east coaster—” and I said, “I don’t even know what I’m doing.”

And I was really terrified. I’d done my fellowship a year ago. I hadn’t touched a patient in a year because of my training. My fellowship was a year prior. I was doing aortas and carotids and PAD work that I had never done before, and so I was very quiet in the room. And so here in—again—walks Sean and he says, “Do you know why this is happening to you?” And I said, “No.” And he said, “It’s because you’re a woman and you have to build that rapport with those folks.” Now, fast forward 13 years, I’m one of the favorite attendings. And the three-sixties, they say, “She’s the nicest and kindest.” And so I think it’s just been a real evolution of how to navigate the system when people look at you differently than they look at all of your colleagues.

I want to go back to what you said. So Sean, how did you recognize that it was really kind of more of a female-female, like, trying to figure out this interaction—and a passive aggressiveness—and the nuance of it, to advise Sarah to do it? Because not everybody will see that. And I think that that’s been one of the struggles is that, especially if you’re like I was—similar to Sarah—first female IR or the only female IR in a group that’s mostly male, and that’s just the percentages that you’re going to see—that it’s hard to explain that passive aggressiveness. I can see it now. I’m 21 years in, and even with that, it still has happened to me. And even with that, I have presented it in that group that I was at when it happened and they’re like, yeah, no, no, no, no, you’re wrong. So how did you recognize it? How did you advise or nuance that? But then also, how would you—or Sarah, how would you guys advise that when somebody younger is going into that first group—five years, mid five years or so—and it’s not being resolved because they don’t feel like they have the support or the words, to navigate to get it to that point?

This is a lot to unpack. I think we could spend an hour on this and the interactions of women and women in medicine, and women and women in business and other professions. And since I’m not a woman, I am not a direct expert, but I’ve observed that it can be really challenging for cultural societal reasons that, you know, you walk into the patient’s room and it’s somebody who’s of the World War II era, and they immediately assume you’re the nurse or not even a nurse, and you couldn’t possibly be the doctor because of all the societal cultural stuff that still—we’re still working with and we’re still trying to sort of fix. And so as women, I think, I don’t deal with that. You all deal with that every single day and you deal with this sort of perceptions and misperceptions that, wait a minute, I thought my doctor was going to be a man. And it’s not. And you have to then overcompensate sometimes to sort of establish credibility, establish, “Hey, darn it, I’ve done—I was at Penn. I’ve done all this amazing training”—like Sarah’s done and you’ve done—”and I deserve to be treated the same and we shouldn’t have to even be talking about this stuff.” But you’ve got to talk, right? So you have to deal with all that.

And then you walk into an interventional lab where—even though in medicine there’s a preponderance now of women in medicine, which is a good story—but in interventional radiology, unfortunately we’re not there yet and we have a long way to go. We need more women in interventional radiology, more procedural based fields. And so the nurses and the techs who are women can be brutal. And it’s just the nature of, “This is my space, this is my lab. Who are you?” You’re coming into this lab and you’re trying to win their respect, which is an important word in all of this and—mutual respect. And that I think takes a little—it takes more for a woman to achieve that.

Did you notice that they were treating Sarah differently than how they treated you in a room, or how they treated Bill or Parag or anybody else? Or how did you come—?

For sure. I mean, I think that what I’ve learned over time is that I can walk into a room and I don’t have those barriers. I don’t have any of that sort of inertia to work against. It’s just, yep, he’s a white doctor of a certain age and he’s walking into the room and of course he looks like a doctor. And so

They’re not going to tell you, “Hey, Dr. Tutton, what’s wrong with you today? How come you’re not smiling?”

Exactly, yeah. And yeah, “You seem a little bitchy today.” They’re not going to say that to me.

Yeah, “What’s your problem today?”

And I don’t pretend to have this all figured out, but I’ve just tried to be aware, and try to see it happening and say, “What can I do at this moment to sort of head that off?” And I think anybody that knows me knows that I’m fairly diplomatic and that I try to be the glue between people and try to create a culture of let’s all get along, let’s be part of a team. So I think that’s my secret sauce if I can say so. And so in Sarah’s case, and other women that have gone through the MCW, as well as UCSD department, it’s just being aware of that and sort of being a little bit intentional and saying, “I’m going to head this off before it even becomes an issue.” When Sarah first arrived, I wasn’t savvy to that, so I had to kind of play recovery after those things were happening. And you have to pull techs aside and say, “Hold on here. This person’s a rock star. They’re very well trained. They trained at one of the best places in the United States. You got to give her a shot. Let’s not do that.” So those conversations were had.

And I can tell you I saw the evolution of Sean’s mentorship. I remember very distinctly coming to my office and sitting down and he said, “Sarah, have you ever had—?” You know, all the things. “Have you ever had the technologist not listen to the injector rate that you wanted because they listened to the male fellow?” “Yeah, of course, Sean.” “Have you ever had—?” and he went through this whole list of things. I said, “Yeah, of course.”

Have you’ve been given supplies that you didn’t ask for because somebody else uses that?

And I said, “Of course.” And it was like this eye opening—he’s like, “Really? Those things are happening here?” And I said, “Yeah, every day, Sean.” And it was like—he was like, “What’s going on?” And he just—I was very impressed that—You know, it just happens every day to us, and so it’s just another day. But this was really, I think, eyeopening to Sean saying, this is happening and pulling techs aside. And I certainly have had my run-in with fellows that were not respectful. And the first person I would go to is Sean. I remember going in a room and this fellow was like, no, that’s not it. And I was like, no, this is it. And he wouldn’t listen. And I came out and I said, “Sean, go.” And he set them straight, I think.

Yeah. So—one second, Sean—just to follow up on that. So when Sean said, “Hey, this is because you’re a woman.” What were the small steps—and I just want to kind of delve into this a little bit more before we go on to something else because I think people are experiencing what you and I are experiencing every day, and they’re younger and they’re lost and they don’t know and they’re unsure about going to their partner or their senior. I think talking about it helps them recognize it, but what did you do? What were the little things you did?

So Sean’s advice was, they need to know me. Because they didn’t know me. What they saw was the walking in scared and nervous. The nerves come off as being sort of quiet and not friendly, even though I say, “Please,” “May I?” always “Thank you” to everybody in the room, which now is really appreciated. Then it was sort of thought of as I was standoffish. And so instead of, you know, when a case was over coming to my office, Sean said, “Sit back there and be with them and joke with them and let them see who you are as a person, because that’s how you build a team. You have to have these folks trusting you and you’re going to be the captain of the ship.” And so instead of going back to my office and preparing for the next case, I sat and chummed it up with them. And that’s not sort of who I am as a person, but I mean, now I do all the time because I think that was really good advice to—they just have to know you. Because they don’t know you, and you’re this person that wants different equipment. I did it a different way. They weren’t used to it. I made them uncomfortable because I was asking for a piece of device and they couldn’t deliver it to me. So I think it was just making them know you.

So back to one of the prime lessons, which is communication is one of the best things anybody could do is open and clear, in terms of being a team member. We’re just all team members and how can we optimize our team overall?

Yes, kind of. Yep.

You were going to say something, Sean?

Well, to that, I think what I’ve learned over years is that you want to create a team where each person has such tremendous respect for each other that any of the BS that might try to sort of interfere with that is mitigated because the team is such a tight unit. And so I jokingly, but it’s not really a joke, will say that once I’ve gotten to know the techs and the nurses and the team members, all the team members, if the shit is hitting the fan—sorry for swearing on the worldwide web—but it’s the truth that if the shit is hitting the fan and a patient’s dying, the team has to work as a team, and they’ve got to swing into action and they’ve got to—there can’t be any sort of second guessing and all that. And your techs, will literally take a bullet for you is what I say.

They get to the point where they’re so committed to you and what you’re trying to do for the patient, they will basically stand there, hold the patient while they’re getting radiated so that you can complete your work. And that’s such an amazing thing to see. And it’s just building that culture of mutual respect—men and women, it doesn’t matter—of like, we’ve got a job to do. But I know who you are, I know who your family is, I get the kind of person you are, and I actually care about you. And they then care about you. You know, it’s just building—that’s just normal human interaction. So that, to me, is the most important.

I read something recently that in order to build a good team, you have to define your purpose. And when you define your purpose and everybody is committed to that, and in this case it’s the patient care and that procedure for that patient, then everybody has their roles to step up into to make sure that it just works together.

Yeah.

I would say who did an amazing job at that is Bill Rilling, right? So Bill Dr. Rilling has built this practice from the ground up. And the way that we have such an amazing group of technologists and nurses and administrative team and our clinical research coordinators, is we all have this vision. We want to be one of the best premier practices in the world. And so what I say when I interview anybody to come to MCW is yeah, you may be chasing me around to get a signature, but for me not to have to walk down to my office to sign that paper, that’s all the more time I can do what’s amazing. And I think the other thing that Bill did is he always makes sure that the techs and nurses get to come to SIR and see us up on the podium and see the amazing things that MCW does, because we’re so different than many of the other practices around the country.

And so we all work together quite well, I think. And I think it’s because we have the shared vision that Bill grew from the ground up. And what I’ll say to Sean’s point is, having this wonderful team is—when you start getting snarky because patients are dying and you start demanding and your voice gets terse, they understand. If I ask for something, give it to me now. And that’s not my normal demeanor, and so the techs and nurses have learned if I’m being terse, that something’s not good. I will tell them when it’s safe. And I feel like I am in a place where the patient’s stabilizing. I debrief afterwards and say, listen, I’m sorry I was getting upset, but this is what was happening. Now they know if I start saying, I need this now, they know something’s going on. Dr. White’s got this. I think it’s not confrontational anymore. It’s not, she’s being bitchy, it’s not, she’s being any of those things. It’s something’s going on because they trust me, ultimately.

I’m the reverse. I stop talking and they’re like, oh, and the music goes off and then it’s like, oh, this is serious. Some of the things that I wanted to talk about—Sarah and I talk about this all the time in terms of the size of our hands. The size—how we choose some of our equipment, just because it’s easier for us, how we have to accommodate our equipment to be really efficient at our cases. And I wonder, Sean and Sarah, where in your relationship did you realize that it’s not just that there’s this interpersonal stuff. It’s not just that, oh, one day your partner might be pregnant, which also has its attendant things in how you manage that in the practice and how you’re supportive. But also even all the way down to devices, to lead always being available for sizing, all of that. When did you realize that that was something that we kind of deal with every day, down to glove size, right? So some days they’ll be like, “I’m sorry, Dr. Majid, we only have seven and a half.”

So for me, it’s come in waves. So I think that watching Sarah practice as an interventionalist, be pregnant three times, and for us to try to be intentional about making sure that we didn’t unnecessarily have her in a place where she was going to get radiated for no good reason, and making sure that—

Or exposed to infectious diseases. He almost—he tackled me one time. There was this patient that had a very bad infection. He shouldered me—I was on the ground. He’s like, “No!”

You do not need to be that person, right? So biologically, duh, you all have the babies. So let’s just put that out there. And so then we need to figure out, how can you be successful while you’re pregnant? And then also provide you systemically and structurally with the time that you need to recover from pregnancy, bond with baby, do all the things that you need to do, and then bring you back and have you not be two steps back in your career, right? So I think that we’re at this point now where we need to be better at that part, where you come back and you’ve hit your stride and we get you right back to where you were. Or we take advantage of the time that you have bonding and doing the things that you need to do so that you’ve had time to think and reflect and maybe actually accelerate as you come back into your career.

So I didn’t answer the question yet because that part is now just coming to me. I’m just now sort of understanding that, just more logistics and the lead and okay, you’re not going to be in this five hour crazy case because you don’t need to be that person. Rupal Parikh is one of our current attendings, brand new mom. We basically parked her in CT and said, “Why don’t you just be in CT except for your specific UAE cases? Because you don’t need to be doing the biliaries and all these. Just take it easy, protect yourself, feel good about your pregnancy.” And she appreciated that. You touched on something about size of hands and devices and all that. And I don’t want to steal your thunder because I think you guys have been talking about this as well, but as somebody who does bone interventions and spine interventions, and these tools are like hammers and things that are fairly aggressive, the tools are not made appropriately for your physical strength. And it’s not just women. There are men that don’t have—

Smaller men

Or people that maybe have some specific disabilities that we need to accommodate. I’ll just share something about myself, that I’ve just gone through some surgery for carpal tunnel. It’s pretty hard for me to do the things that I used to take for granted, which is to pound a needle into a bone in the spine or crank on the handle of a cement delivery system. So it has given me a new appreciation for somebody who has to maybe get up on a stool so that they’re tall enough to be able to pound on some needle. So I think there are some barriers to getting into that part of our field—spine interventions, bone interventions—that maybe women would be intimidated by because they just don’t physically have the strength. I’m not making any assumptions, but—

I mean, I love kyphoplasties. I love doing any IO procedure anywhere, but I have a shorter working time. I mean even with the cranking of a Stryker that I use. But in the earlier ones with the kyphon system where you had to push that stuff in before you had to crank it, I was like, no, I don’t have that much time. Here’s when you have to make the cement. And I personally think that—you know, we talk about it amongst women, but I personally think that not a lot of people and not a lot of industry understands that, hey, well maybe you should—You know, it’s like data in data out, right? We talk about AI, we talk about all this stuff, but if you don’t bring in the ideo thought process of what’s the end user going to use this like? I feel like for women, that’s been a big thing that’s been forgotten.

Yeah, the companies are pumping out one device in one size that’s sort of good enough for everybody. And I’ve actually pushed on Stryker because I work with them and some other companies to say, you need to be intentional about designing these devices for people that maybe don’t have the same physical strength and aren’t maybe quite as tall. I just had a conversation with a R1 at UCSD, and I hope I didn’t embarrass her, but I said, I just want to point out that you’re not the tallest person I’ve ever met. And she took it well, and I said, in the operating room, they don’t even think twice about it. If a shorter male or female surgeon needs a stool, one of these step stools, they just slide it in and you step on it and you get up. We don’t do that in IR. That should be just normal practice that, “Doctor, do you need a stool?”

“Do you need a stool? How many do you need?”

And so our culture needs to think about that and be intentional about that to say, okay, this person is this tall, well, they need this type of lead, these types of gloves, this type of gown, and—so that they’re not getting radiated more because they’re shorter. They need to be up on a stool so they get less radiation, more mechanical advantage, et cetera. So we need to think that way.

And I would say IFU—per IFU, you have to use devices in a certain way. So it’s hard for me to push a 20 cc syringe into a 2-1 micro catheter. It just is—my hands don’t do it in the 45 seconds that it’s supposed to go in. It just doesn’t. I can’t. So it would be great to have an IFU that said, “Or a 10 cc syringe.” I mean, I do all my chemo mobilizations. Bill Riling can use a six and go to a microcatheter and infuse it in. I can’t do that. I have to use a one cc.

I can’t do it either.

So I think us teaching the next generation that if you have the strength, here’s the six, and if you don’t, you can use a one.

So we recently had a podcast with the four Women in IR champion award recipients, which was a very interesting conversation. One, just the fact that we had to make the award to highlight that there are women who are here, but also that there are women who are coming through and being really successful, and they’re not doing it without mentorship. They’re not doing it without—kind of similar to how Sarah’s path has been. But we’re still at, what, 13% women now. I think when I came out it was 4% in 2003, it was pretty low. So there are amazing men who are mentoring. I think there are more men like you than we realize, and we made this award—and one of my hopes as I step off of that committee is that I see more nominees for that

Male nominees.

Male nominees, because I think everybody thinks women in IR—it has to be a woman, we’re going to run out of women really quickly, right? Because it’s like you have to be here for 10 years and all of that stuff. But one of the things that we talked about was how at early meetings we would be uncomfortable to go up to the panelists and ask a question, aside from the fact that we’d be confused as reps. But now, encouraging everybody, men or women. I mean, I can imagine some men being uncomfortable going up to the panelists and saying, “Hi, I’m so-and-so.” I think it goes back to what you were saying in terms of putting yourself out there, for everybody.

How do you see—both of you—the evolution now, as we keep talking, we’re being more open about mentorship and sponsorship, even executive coaching, professional coaching, in terms of how you approach people who are really early in their career, but also peer mentorship. And I think mid-career is different. I’ve done this for 21 years, so I feel like I’m kind of not mid-career, but some people qualify 20 as mid if you’re going to go all the way to 60 or something. That peer mentorship, how have you guys found it as you’ve gone through? And how would you encourage it from the early stages to later, both in men and women?

Want to go first?

Nope.

Okay. So I mean, I’ve had some experience with this, held some positions where I had to think about mentoring in a structured way for a department. And I currently have that role at UCSD. So I think that peer mentoring is one of the most effective mentoring methods that we have. So to leave that there for a second, when I was thinking about Sarah as an example, I was looking in the department. We were naturally mentor, mentee and vice versa. She also was mentoring me. And so that’s how that relationship grew, which was great. But as a researcher and as somebody who I saw that would be a future leader, I needed to think about who is going to be a good mentor for her. I wouldn’t say that I have always got it right, but I said I need to step outside the department in this instance and come up with somebody who is not going to be encumbered and kind of—like, you know, the internal politics of the department and some of the things that were going on—I needed somebody outside the department that could give her a perspective of, this is how you do it and this is how you become a leader and this is how you do research and this is how you build a successful program.

And so I paired her up with a person who, at first wasn’t such a great situation because of some interdepartmental politics, but then ultimately I think is a reasonable resource. So you have to think flexibly. And what I realized is, for both men and women, in a department, even though the departments of radiology tend to be pretty big, but we’re not talking about hundreds and hundreds of people. So you have to think creatively about who is this? Let’s look at this person. Let’s look at you. Let’s look at Sarah and who can I find who would really be a good fit for you, man or woman? And then you try and then if it clicks, great. If it doesn’t, you have to try again. So those are structured mentorship agreements and relationships, and then there’s organic ones, right? And then the peer mentorship, because you’re going through something that is similar. So let’s just say that you’re women in interventional radiology and you’re going through similar struggles of not being taken seriously, pregnancy, all the different things that are challenges in balancing your work life and your home life. As women together, as peers, that’s a great and probably most effective way to sort of share best practices. So to me, that is one of the most important ones to create. So the WIR—

Do you feel like—I think men also need to have that message. Do you feel like it’s just such a bro club that that’s not something that gets discussed? Or is it like—and it’s like a natural kind of thing—or do you feel like this younger generation needs to hear that?

I think they do. I think there is this natural, if you will, bro club, meaning that you play basketball, and so you naturally are going to go play basketball with the trainees and your senior attending. So that’s just a natural thing that would happen where you’re on the basketball court on a Saturday or Sunday and you’re talking about work and you’re talking about life, and that’s a peer mentorship group that just happens naturally. But you could see right there where that’s going to be a problem for some women. They’re not going to go jump onto the basketball court and then drive to the basket and elbow Bill Rilling out of the way. That’s not likely going to happen. So we then have to be more intentional about, well, what are other peer mentorship kind of relationships that can be created that don’t sort of rely around sports or going out drinking or all these other things that just sort of happened societally for us.

Right.

Well, I would say I think these organic mentors that just come into your life, I think have been the most impactful to me. I mean, Sean and I had a structure because he was my chief at the time, and so there’s a structured mentorship, but Bill Rilling has been my mentor since I would walk through the door because of our natural tendency to do the same kind of procedures. And so there’s not a case that I do that he doesn’t know about. And similarly, I think the mutual respect you have for each other is how that grows. I have mentors in vascular surgery. One of—the chief of vascular surgery is my mentor behind the scenes. If somebody is not treating me with kindness and respect, that—he is the first person to get up out of his seat. And he says, “I’ll be right back.”

And then he comes back and he says, “That’s never going to happen again.” And that’s not a role that Bill or Sean ever took, but Pete Rossi, boy, he’s in my court. And then I have started this group of lady leaders, is what I call it. So there’s a bunch of very prominent women at MCW, and we have dinner once a month. We don’t have topics we’re talk about. We just get together and hang out, and all those issues that we all face come out. And I think it’s a really wonderful opportunity for us to sort of figure out life.

I wanted to ask that question because you also both come from the academic world, and this isn’t intentional thinking in the private world, and yet it’s so needed. So I wanted to just bring that into the conversation so that anybody who’s listening to this can be like, okay, well maybe I’m not going to find this in my group. I feel like that’s been my career. I haven’t always found it in my group, but what are the other places to go? And what I’ve heard with the Women in IR section, as you were mentioning, is that—it would be lovely not to have the Women in IR section, like not to have to need it, but for the younger people who have come to the programming or have been involved in all that stuff to be like, oh, so it’s not in my head. So maybe I can go to Dr. White and ask her a question, or, oh, maybe I can talk to this other doctor who kind of already—I just saw her, she was pregnant and now she went through—I think I’m going to be pregnant at this time, or infertility or whatever. To have that group, to be peer, they’ve got to put themselves out there a little bit. But in the private world, I feel like that group has been really helpful. It was for me when we first started. Shelly Josephs stepped up right away, and that’s how—many other people have stepped up. But I feel like in the academic world, sometimes it can be a little bit more structured and there are pathways there that you can explore a little bit easier.

Yeah, I think that the private practice world has more challenges, frankly, because as you say, in academics, there’s a structure and there’s a hierarchy, and there’s just—departments are supposed to do this stuff now. It’s built into the system and there’s deans and there are leads of diversity, equity, and inclusion, and making sure that we’re at least being intentional and thoughtful about this. Whereas in the private practice world, you’re doing your thing. You’re just kind of out there. So the Society of Interventional Radiology, SIO, these are organizations where we can develop resources for women and men to have mentoring, paired relationships, peer relationships. I think you’re right that it’s, in one sense, a shame that the WIR has to exist, but also as human beings, we want communities. We look to church, organizations, and sports, and being part of a town or being part of a school system. Like all of these things are sent, but they’re communities and humans need that. And that actually is what makes us successful as humans, is when we actually convene. This is a good thing also, because you share the pain, you share the success, you hold each other up. So I am all for it.

I think we are coming to the end of our time, so is there any last minute thoughts, other than—I think that was a great point to end on. Any last minute thoughts, Sarah?

I would just ask the industries to just think about when you’re writing an IFU, are there devices that maybe make it a little bit more easier for those of us with zero hand strength, and size of devices and technique that are needed? Because we’re not all the same. We’re not all built the same. To the men out there, I would say: women, we need maybe a little more prompting and prodding. We think that we’re not capable of doing things that maybe we are. And so I think just a little bit more gentle shoving, or pushing as Sean did. But I think you just have to think about that a little bit more with women than you would with men.

And I think back to using the word that Sean’s used, being intentional, that I hope that many of the people who have listened to us today or will listen to us, whether they’re trainees or they’re early career, or they’re men and women who have been there, but particularly the men in our society, will be more intentional having listened to these needs. And maybe there’s a couple of light bulbs to help their colleagues be successful at every stage.

Absolutely. I think just saying that you’re willing to be a mentor and just putting it out there. I think there’s even—I didn’t put it on my little badge, but I think there is a “I am a mentor,” which is great, right? So if that’s on your badge, I would expect that the point of that is that somebody could walk up to you and say, “Tell me about that, and how do you do that? And how do I find a mentor, et cetera, or how do I become a mentor?” Or if you’ve not experienced that, how is that relationship created? What are my opportunities? What do I need to do?

How do we do it? And what I’ll say is, thank you both Aneesa and Sean for being amazing mentors to me. I would never be sitting here without the two of you, so I appreciate all you’ve done for me.

I would say the same thing. This has just been one of the highlights of my day, is to hang out with my friends and talk about this.

Awesome.

So I appreciate likewise. I appreciate you guys all the time.

All right. Alright, thanks to Cook.

Yeah, thanks so much.

And to the Society

Yeah, SIR. And we’ll see you guys later.

Alright.