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International Women’s Day: Perspectives in Medicine, Nursing, and Fellowship From Richa Thakur, Nida Khan, Lauren Ghazal, and Gurbakhash Kaur

In this panel discussion in honor of International Women's Day on March 8, Dr. Richa Thakur, Dr. Nida Khan, Dr. Lauren Ghazal, and Dr. Gurbakhash Kaur discuss their perspectives as women in the fields of medicine and nursing, including their advice for negotiating, seeking mentors, overcoming imposter syndrome, building confidence, and making your voice heard.  

Keira Smith: Hi, everybody, and thank you so much for joining this special edition of Oncology Data Advisor in honor of International Women's Day. We have a really unique discussion planned for today with members of our Editorial Board and Fellows forum. Without further ado, we can have everyone go around and introduce themselves, and then we can launch into the discussion. Would you like to start off with your introduction, Dr. Thakur?

Richa Thakur, MD: Hi, my name is Richa Thakur. I'm a second-year Hematology/Oncology (Heme/Onc) Fellow at Northwell Health, and I'm also one of the members of the Fellows Forum. I'd like to pass this off to Dr. Khan.

Nida Khan, MD: Hi everyone, my name is Nida Khan. I'm a first-year Fellow in Medical Oncology and Palliative Care, and I am also part of the Fellows Forum. I'll pass it off to Dr. Lauren Ghazal.

Lauren Ghazal, PhD, FNP-BC: Hi everyone, my name is Lauren. I am a Family Nurse Practitioner and an Assistant Professor at the University of Rochester and the Beaumont Cancer Institute. I'll conclude it with Dr. Kaur.

Gurbakhash Kaur, MD: Hi everyone, I am a Multiple Myeloma Specialist, and I do autologous transplant and chimeric antigen receptor (CAR) T-cell therapy at the University of Texas (UT) Southwestern. I've been practicing for about four years now.

Keira Smith: Awesome, I'm excited to talk with you all today. In light of this discussion for International Women's Day on March 8th, I would love to hear all of your perspectives about being a woman in the field of medicine and specifically in oncology. Richa, we'll start off with you.

Dr. Thakur: I feel like it's definitely a mixed bag. A lot of times, especially in certain clinics, it's really rewarding to be one of the first few females in the group. Oftentimes what I've noticed is that patients actually gravitate to you because of your gender. The other thing, especially because oncology is so demanding, it's also very hard to manage a work-life balance. Have any of you guys noticed any of these issues?

Dr. Khan: I agree with Richa. I think it definitely can be either/or, but first and foremost, it's always rewarding to be able to bring your unique perspective to your patients. It's also true that a lot of patients, depending on the type of clinic you're rotating through, gravitate towards a female provider. I have found that rewarding. There are always challenges and obstacles, and in terms of work-life balance, I think there's a unique set of challenges in that realm too, specifically being a female health care provider.

Dr. Ghazal: I'm on the nursing and research side as a PhD nurse scientist. I just attended a women's leadership summit, and a lot of the discussion was on women being moms and having to manage childcare in addition to being in health care, whatever role it is. I like to challenge our dialogue around Women's Health Month with the awareness that it goes beyond saying, "Women can have outside lives outside of their careers in addition to being a mom and being a caregiver." I think that when it's reduced to just childcare responsibilities, it also is another reflection of, "Okay, what are we talking about when we talk about Women's Health Month?" I would also say nursing is a different beast, as the majority of us are overwhelmingly women in our profession, and that's another conversation. But there are other intersectional challenges too with being Black, Indigenous, or People of Color (BIPOC), being LGBTQ, having disability, and being a woman, and I think that warrants some discussion too.

Dr. Kaur I'll go next. I think I have the unique perspective over here as someone who's been in practice and has been where Richa and NIDA have been, as fellows. When I was in fellowship, I didn't really pick out the fact that I was a woman and having that be a different thing. I don't think I felt like the way I was treated or the challenges experienced in my field were unique to me being a woman. Maybe I was a shielded because there's the graduate medical education (GME) program and so many other factors that sort of form a protective layer around you as a female in medicine, which does change as you go into practice.

There are definitely unique perspectives, and you're right, the conversation when we talk about Women's Day doesn't necessarily have to be the role as just providers or just as moms. The question I often get when I go to conferences is, "Who's watching the kids?" I'm like, "Their other parent is," and that's my husband. It's almost like people are shocked that I could go away for five days and not have to worry about childcare or leave a list of foods and where things are at home. I never have to do that. I have a wonderful partner; my husband is a wonderful partner and parent. So, you're right, the conversations can go beyond that. Our roles are beyond that, but there are definitely unique perspectives of being women in medicine, especially when you want to do it all. I've sort of had to adjust that perspective to, "You can have it all, but just not all at once."

At each point of your life, you sort of adjust what you are going to focus on right now, in the next two years of your life, or the next four years of your life. In each phase of your life, you have to shift gear and reassess and reprioritize. If we constantly keep on doing that, I think there will be a sense of fulfillment. I have an almost-eight-year-old and a three-year-old, so clearly, a few years ago, I was just surviving as a new mom, as an oncologist, and someone who was interested in academics and wanting to get my research off the ground in the post-COVID world. That has reevaluated; my kids are older, they're more independent, and I don't have to always be there to take care of every part of their life. Now I've shifted gear, and I think one thing I've realized is that with each phase, whether you're a resident, whether you're fellow, and then when you're an early-career physician, is that there are different unique challenges with each phase of your academic growth.

Dr. Thakur: I feel like all of you guys brought some very good points in what I think most people gravitate towards when you say work-life balance is usually being a wife, a spouse, or being a mother, a grandparent, or a care provider for someone else in your family. As women, I think so much of our identities consist of a specific label. To me, work-life balance is just anything you do outside of work. I think it's really important, especially for women, to branch outside of a single label and try to build up a life outside of whatever you do at work. No matter what you do, your work is going to be stressful, but whether it's hobbies or family or anything else that you do, that's really going to reinvigorate you and make it easier to carry on your day.

Keira Smith: I love all those points that all of you made. I'd love to hear a little bit more about each of your specific areas of practice as well. Lauren, you mentioned how nursing is a female-dominated field, so maybe you could talk a little bit about that and all of your perspectives of being a practicing physician, a fellow, and a nurse practitioner, and how you view International Women's Day in light of those.

Dr. Ghazal: Nursing is very, very different than medicine, and it probably will always be a predominantly female profession or specialty. There are different challenges presented because of that, because when we think about gender representation and nurse leadership, there are two things—nursing leadership and also the gender pay gap in nursing—that I'll talk about. There's a quicker trajectory or pipeline for leadership and tenure among male nurses than female nurses. We know that nurses are underrepresented in health care leadership roles in general. I think about 70% of our global health care workforce is women, and nearly 90% of those are nurses, yet only 25% of senior health care roles are filled by those identifying as women.

In general, for the gender pay gap, we know that male registered nurses (RNs) report about $15,000 more per year in earnings, on average. Not surprisingly, this gender pay gap is more significant for BIPOC women. This pay gap unfortunately was also found to widen during the pandemic. There are some reasons for why this is. When we think about men and women in nursing, men are more likely to negotiate their salaries, and I'd love to hear how that is in medicine too. Also, men are more likely to report working more hours per week. Of course, this can perhaps just be from having more flexibility with working overtime and picking up extra shifts. Again, this is for folks who historically do not take on more caretaking responsibilities. Those are two things I wanted to bring to light—the trajectory to leadership and then the pay gap that still exists in nursing.

Dr. Kaur: I can go next and reflect upon the challenges of being a female attending. And I'm actually quite astonished that there is such a discrepancy in leadership and the pay gap. I was not aware of that, because I would think that because it's a female-dominated field that there would be more of a straight path or a trend towards women being represented in leadership. This is very much similar to what happens in medicine leadership in the proportion of chairs of divisions or departments who are female and how many women get promoted from Assistant to Associate to Professor in comparison to their male counterparts. There is a big, big discrepancy when you look at from a gender perspective, for sure. I'm also sure from a perspective of race and other factors, that's true as well, but definitely from a gender perspective. So, I just learned something new today that I did not know was such a huge issue even in nursing, which is very female-dominated.

I think you said the correct thing in that women don't tend to negotiate as much. I certainly didn't know that art when I started out in my attending journey, but I'm pretty good at it right now. Richa and Nida, as you go on to your journeys of completing your fellowships and looking ahead for jobs, I think the key is to reach out. Don't be afraid to reach out to other female physicians who've gone through this journey and ask how you could advocate for yourself or how to negotiate. We have such wonderful forums. Actually, there's a Physician Moms Group (PMG), and there are so many different sub-forums within that. There are so many great people that you can meet over there or mentors outside of your institution, not just within, who you can reach out to and discuss what's important to you, what you want to negotiate, and what you want to work on.

So, don't be shy. I think that's what I've learned, and that's been my journey. I don't think that I advocated for myself as much early on. There's an art to it, and you learn as time goes on and you get wiser. You learn to have both distant mentors and close mentors at your institution who can help point you in the right direction.

Dr. Khan I can go next and give a fellow's viewpoint. Actually, just the other day, I was counting what year of training I'm currently in after high school, and I think this is the thirteenth year. When you've had 13 years of medical training and you're in fellowship, this is what you've always wanted to do, and you're basically at the point where you're learning and training and having this influx of information thrown at you. You want to be the best of the best and be taken seriously. In fellowship, that's kind of your goal, to learn as much as you can in a few short years' time before you're basically on your own in attending-hood. I think that's always been my priority as a woman who's also a fellow, because there's so much going on in medicine and you want to be taken seriously.

I think that while going through residency and fellowship, there's always a thought of, "Are my male counterparts being taken more seriously than myself or my female colleagues, even though we have the same training?" That's kind of an undertone throughout residency and throughout fellowship. There might be little microaggressions that you notice or things that you pick up on. Really, the best way I've found is to fall back on my training and tell myself, "Hey, I know my stuff. I haven't gone through 13 years of this to not be confident in what I've been learning." I think that's the unique perspective of a fellow and being almost done with training, at the point where your goal is within sight. I always keep that in mind. And thank you, Dr. Kaur, I'll definitely keep that advice about the negotiating in mind since I'm about to enter that part of life soon.

Dr. Kaur: Reach out any time.

Dr. Thakur: My experience as a fellow is also very similar to Dr. Khan's. My journey is a little unique in that I did a Palliative Care Fellowship, finished that, and then went back to do a second fellowship as a Heme/Onc Fellow. I never worked as an attending in between, so I was still getting my feet wet as a Palliative Attending while also being a Heme/Onc Fellow.

One thing I struggled with the most was imposter syndrome. There were things that I could do completely easily, practically in my sleep, in June of my Palliative Care Fellowship year. Then the second I went back to being a first-year Heme/Onc Fellow in July, I would quadruple check my calculations on opioids even though I knew what was right. Sometimes my attendings who weren't trained in palliative care wouldn't know how to dose some of the medications as well as I did because of my other fellowship, but I still doubted myself even though I had more training. I think especially as a woman in any field, there's always this sense that if someone questions you, it's because they think that you're wrong, not so much that they're just trying to learn from you too. It takes a lot of time to build up that confidence, not only in your abilities, but also to show it once you actually build it up and feel confident that you do know something.

Dr. Kaur: You talk about imposter syndrome, and I think that bog us all down no matter how experienced we are when it comes to having ideas. I'm still early-career, but sometimes if I have an idea, I question if it's a valid idea, and then I see a counterpart or a colleague somewhere else who would execute it. I think that does impact our academic progress. The way to get over it is to talk about it and to reassure each other, just like Nida said, "I didn't go through 13 years of training and education just to end up here and question myself again." It's good to question and double check. You have to do that; you don't want to be too confident or cocky. The double check is part of our medical training, but to have doubts about our ability is something that I think hinders progress for women in academic medicine. That's something we need to keep on talking more about, because unless we do, we're not going to get over it.

Dr. Thakur: Another thing I've noticed on other panels that I've done, where I was the only female on the panel with other male colleagues, is that even the decorum of speaking is very interesting. People would jump in and interrupt each other, and the flow kept going. One thing I've noticed in this meeting is that everyone's taking their time and taking turns to be extra respectful of the other person that's speaking. I think sometimes these skills are very important, but in other situations like when someone is looking for leadership, these softer skills that I think we sometimes see more often in women are overlooked for other more assertive or confident skills, or at least the appearance of more confidence.

Dr. Kaur: Yes, you're very much right. This happens. I think more and more research has been shown about underrepresentation of women, whether it's on advisory boards or as moderators or speakers at conferences. There is an effort within our respective academic institutions, as well as societies such as the American Society of Clinical Oncology (ASCO), to change that. I see what Lauren has written in our chat, the "manels" They're definitely there. I think there are efforts to change that; it's not completely fixed yet, but at least there's recognition and awareness. I think progress is happening slowly but surely, and we just have to keep that in mind.

You made excellent points about when there's discussions going on, who speaks more often? It seems like whenever there's an issue going on, if the male counterpart is speaking, they're called "assertive" having "leadership skill." One of the challenges I've seen is that if you're being assertive as a female, then you get the label. That's something we have to fight in medicine. I'm sure that's true of other professions as well because there are certain stereotypical expectations we have of the gender.

Dr. Ghazal: Totally. You can show the same level of assertiveness, and as a woman you'd be "bossy" and "difficult to deal with," but as a man, it's "great leadership ability" and "very direct." It just spins it into a positive. I'm curious, you both shared some experiences with seeing these all-male panels, the "manels," as I put into the chat. Have any of you been in a situation where you were invited to speak at a conference and you wanted to see who the other speakers where, whether it's because you wanted to make sure that there was representation for your specific area of medicine or representation for women? I've had to have difficult conversations and think about how to strategically go about communicating that I don't want to be an "only" up there. I shouldn't be just a checkbox on something.

Dr. Kaur: I think we're all very junior members in terms of the academic ladder, so I would say that I personally haven't been in that situation where I'm the only one. I've had great champions. Some of my greatest cheerleaders are "He for She" mentors. My mentor at UT Southwestern, Larry Anderson, has recommended me for committees or recommended me for a trial even though I was a very junior faculty member. We definitely have that. So far, I haven't been part of such situations where there's only one female, but I do know of other women physicians and leaders in our fields who've been in those situations, and they've advocated for such changes.

Dr. Thakur: Dr. Kaur, I think you also brought up a really good point about leadership and mentorship. What have you guys found that's been really helpful with sponsorship or leadership? How have you guys sought out opportunities? I think sometimes it's just very hard to move up to the next step, and having someone's experience as advice for what you can do to move on to the next step is really valuable.

Dr. Kaur: I think I've found mentors in different places at different times of life. I have Larry Anderson, who's one of my mentors at UT Southwestern, but I've also had mentors elsewhere who have I reached out to discuss opportunities, what my research interests are, and if it's in line, if I can grow that. I think you just have to be willing to reach out to people, and sometimes you may not get the response that you want, but that's worked for me. I wouldn't say I have one particular mentor; I think I have a tribe of women that I go to for support. I have friends and mentors who are in different academic institutions—some are in medicine, and some are actually not even in medicine—who know how to navigate these things and who are good and effective leaders. That's helped me out. I think seeking out other people who you may have something in common with actually helps you advance your cause.

Dr. Ghazal: I use the word "sponsor" for someone who really puts your name out there, suggests you for things, or says, "There's an ASCO podium talk, I want you to do this. You should put your name in there." I didn't realize the extent of that person until my post-doc fellowship, when the director of my post-doc fellowship was able to serve in that role as a sponsor. It's valuable to have someone who you can say to, "I want these opportunities. If there's ever an opportunity, can you please bring my name up? Can you please put my name out there to be on a committee or speak?" There's a lot of power that comes into that relationship, which is really different from a mentor or a collaborator. Have any of you had those really special sponsor experiences?

Dr. Kaur: I like the way you have put it. I think it was Richa who brought up the sponsorship part too. I've had friends who've used the word "sponsor," and I didn't really get it; to me, it was sort of equivalent to a mentor, but I do get it now. There is a distinction. Sometimes your mentor could be your sponsor, and other times, your mentor is not going to be your sponsor. They have two different expectations, and the relationship is going to be different, so you have to seek it out. For me, social media has been wonderful. I've had a chance to collaborate with people on research projects. Rahul Banerjee, who is our Editor in Chief, has become a great friend. We collaborate and there's a lot of encouragement on his part. So, you just seek people out in different spaces.

Keira Smith: Absolutely, I love these points that you all have made. These are all such fantastic insights. I'd love to hear some more as well about ways that you personally have come across that help to overcome the obstacles or these biases that you've experienced. Richa, for example, you mentioned imposter syndrome. Is there anything that you personally have found that can help you overcome that? Or as far as things like the gender pay gap, Lauren, I know you do a lot of public advocacy work. Are there things like that which you've done to get your voice into the field? Or any tips you might have to share for other women who are either currently in your field or who are starting to embark on their careers in this field that you would like to share with them, especially in light of International Women's Day?

Dr. Thakur: I can start with something I learned at the American Society of Hematology (ASH) this year. Every year, ASH has ASH-a-Palooza, which is meant for trainees. One phrase that they discouraged us from using was saying "imposter syndrome." Part of the connotation of imposter syndrome is that you're an imposter. You don't really fit into the mold. The thing is, the world isn't necessarily always built for minorities, like women or people who are not right at the mean and median of every single measurement. If you look at surgical tools, they're built for people who have glove sizes that are large, not people with smaller hands or extra-large hands. There's nothing wrong with your hands if they're just a little off from the surgical tools.

The point that they made at ASH was basically instead of saying "imposter syndrome," just to keep telling yourself when you're faced with a microaggression, "You belong in medicine." The idea was that you will always face so many obstacles, so many microaggressions, and it's going to make you feel like this isn't your place. Even saying that you have imposter syndrome will make you feel like whatever role that you're taking on isn't really meant for you and you're taking an uphill battle. But when you tell yourself, "This is my place, I do belong here," it changes your mindset and helps you accomplish what you want to do.

Dr. Kaur: That's an interesting perspective, because the term "imposter syndrome" says that the imposter syndrome is your own issue. That is a great perspective and a different perspective. I think one of the ways that I've made a change in my life is remind yourself that once you know your craft, if you know your craft well and you know what you're doing well, the confidence is always going to come in. It is reasonable when you first start out for you to be humble, to know that you don't know it all and that you might not get the best opportunities at that time. It's going to be a growing pain. I consider this as a marathon. I want to love medicine 20 years from now. I don't want my fuel to run out because I was chasing something within five years of starting out. That perspective has changed how I want to accomplish things.

Could there be a lack of confidence? Early on, yes, but as you saw every patient, you refined your research ideas and built in more and more confidence. You got one project to completion, you got the second project out the door, you got the third project out the door, then automatically, that imposter syndrome changes into confidence. You stop doubting yourself and you're not afraid to make a statement when it's amongst a large group of people that you believe in. I think knowing your craft well distinguishes you. If you know what you're doing and the disease you're treating, it'll go a long, long way. From my personal experience as a clinician, my ethos was probably the same five years ago as it is today, but how I go about approaching things has obviously shifted in a much more confident way. I think that's one way I've been able to deal with it. Parts of it still remain at times, but that's good to have a little bit of uncertainty in your own mind, because that's what gives you fuel to keep on going.

Dr. Khan: I definitely agree. I think from the perspective of someone who's a learner still, yes, you have all this training and that's all behind you, but then you're still also actively learning. From what you see and experience around you, sometimes you have a lot of questions. More often than not, sometimes you're afraid to ask those questions for some reason or another. But for me, I always think, "I'm here to learn. I'm training. This is going to be important when I'm out in the real world as an attending." From that perspective, I really just come into as a learner who is here to learn. With that perspective, I can ask questions without the risk of thinking, "Oh, they're going to think I don't know anything." I'm sure a lot of people still think that in the back of their head, but that's not true. You're there to learn. That's how I frame it, and again, you can fall back on your training and be confident in your craft, like Dr. Kaur said.

Dr. Ghazal: Dr. Kaur, I like that you said earlier that I taught you something, because you taught me something too—the reminder that wherever you are in your career really is a marathon in the academic life. I just started as an Assistant Professor. Sometimes I put this rush on myself to get out all these projects and get out all these papers and do all this stuff, and it can be really overwhelming. It can be really difficult to navigate if you don't have a good team, like you said, your tribe. I think of it as my herd. I have all these people in my life who keep me straight, keep me focused, and keep me energized in my work, and then when they're feeling down, I pick them up too.

It can be so encouraging to find folks who you enjoy working with as collaborators, who challenge you and make you a better person in your work and in your research, and who challenge you in those good ways, so that when you leave a conversation, you think, "I've never thought of it that way, and I'm going to need some time to reflect on this." Again, nursing is very different, but the academic life is a common theme. I have a lot of collaborators who are physicians or in psychology or in social work, and we want to have these transdisciplinary research teams. That's the goal. We want to be able to work across disciplines, but that amount of respect and collaboration with others is so critical, because that's what you're able to bring back to your profession and to your clinical work.

So, thank you all. I very much enjoyed this. I feel re-energized. I love having moments like this to pause and remember, "Okay, I have come a very long way." Like Nida said, you can go through 13 years of schooling, and sometimes when you're so in it and when you're so focused with others around you, you forget—you forget how far you have come to be at this point.

Dr. Kaur: Yes, normally whenever I've been part of a panel, I'm one of the younger folks. I've always been with more senior, experienced folks. Just being at this panel, I've been able to reflect. As Dr. Khan and Dr. Thakur have been highlighting their journeys as fellows and how they go about it, I've been thinking, "Oh my God, I'm no longer there, I've already had that whole journey." I'm always the one who's absorbing information from others and watching how that person is doing this and figuring out what I could learn from them. It's sort of different to be in a position where I am the senior-most person in this space and am able to give positive feedback or influence in a positive way. It's good that we're doing this. Thanks for having us, Keira.

Keira Smith: Absolutely, this has been the most amazing conversation, so thank you all so much for sharing your insights into this. I'm really glad we can get this out for our audience on International Women's Day. And I'll just say that I feel very privileged to work with so many incredible female members of the Editorial Board and Fellows Forum. Right now, we have 28 total members between the Board and the Fellows Forum, and 16 are women. I love that we have so much amazing female representation and that we can have these types of panels so that all of you can convey your experiences to our audience. Thank you all again so much for sharing your insights.

About the Speakers

Richa Thakur, MD, is both a Palliative Care Physician and Hematology/Oncology Fellow at Zucker School of Medicine at Hofstra/Northwell Health. She graduated from Washington University in St. Louis with a Bachelor's in Chemistry and graduated from Medical School at Texas A&M. She has previously completed an Internal Medicine Residency and a Palliative Care Fellowship at Zucker School of Medicine. Her research interests include improving quality of life in patients diagnosed with hematologic malignancies.

Nida Khan, MD, is a Medical Oncology and Palliative Care Fellow at The Ohio State University Wexner Medical Center. She is passionate about treating cancer and cancer-related symptoms, with a focus in thoracic malignancies. She also has specific interests in global health and education as applied to palliative care and oncology. Dr. Khan has taken part in several global health initiatives, including working with palliative care and oncology patients in Uganda.

Lauren Ghazal, PhD, FNP-BC, is an Assistant Professor in the School of Nursing and an Associate Member in Cancer Prevention and Control at the University of Rochester Medical Center in New York. Her research focuses on nursing work-related challenges and financial toxicity experienced by adolescent and young adult cancer survivors, incorporating economic, clinical, and personal experiences to address survivorship disparities.

Gurbakhash Kaur, MD, is an Assistant Professor of Medicine in the Department of Internal Medicine at the University of Texas Southwestern Medical Center and Harold C. Simmons Comprehensive Cancer Center. She specializes in the treatment of patients with multiple myeloma, AL amyloidosis, and other plasma cell disorders, including the use of CAR T-cell therapy, immunotherapy, and stem cell transplantation. She actively participates in clinical trials investigating novel therapeutic options and quality-of-life improvements for patients with multiple myeloma.

For More Information

International Women's Day (2024). Available at: https://www.internationalwomensday.com/

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor. 


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