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Women hospitalists and the pandemic

Struggles, opportunities and achievements

July 2021
women-hospitalist-strength

2020 WAS THE YEAR that Paula Marfia, MD, planned to advance her career. After a dozen years juggling work as a full-time nocturnist at Chicago’s Loyola University Medical Center with raising three children, one of whom has special needs, Dr. Marfia had some big goals for last year. Those included seeking out a committee assignment, adding teaching responsibilities, finding time to travel to a national conference and pursuing mentorship. She would, in other words, take all the steps toward promotion that she’d put on hold.

But then covid struck. Schools closed, conferences were cancelled and medical students left the building. As essential workers, hospitalists were called to face the crisis, which—at first—was tough but exciting.

“It felt good to step up,” Dr. Marfia recalls, until the novelty wore off” and the world never opened.” Virtual school wasn’t working for her kids. Her husband’s dental practice first shut down, then resumed only slowly, putting pressure on her to maintain her income. “All the other things shutting down and me still having to do my job was overwhelming.”

“We were getting some recognition, and people were getting to know who I was.”

Paula-Marfia-MD

~ Paula Marfia, MD
Loyola University Medical Center

But a year and a half later, Dr. Marfia’s career has taken off. To manage covid, Loyola’s hospitalist leadership had to spread the work and decentralize; Dr. Marfia was named lead nocturnist and given new responsibilities. Physical distancing created new online opportunities, removing the barriers for her (and many working mothers) of traveling to meetings or coming to the hospital for off-shift committee work.

And hospitalist leadership in her hospital raised her personal visibility. “The whole ‘hero’ thing” was an ego boost,” she says. “We were getting some recognition for things that hospitalists do, and people were getting to know who I was.”

Looking back, hospitalists experienced a year like none other. During a time of such pain, loss, challenge and change, few call it a good year. But tackling the pandemic unexpectedly boosted many of their careers. While covid caused many women around the country to lose jobs and income, physicians were less likely to lose positions than nurses or non-essential workers.

That is not to say that many women hospitalists (like their male colleagues) weren’t traumatized by their work and aren’t still exhausted. And it remains to be seen whether longstanding gender gaps in pay and advancement—inequities on the radar before the pandemic—will be tackled anew. But we were able to talk to several women hospitalists who, now that they feel they are coming out of the pandemic, say that working through it gave their careers new direction and purpose. It also gave them a great sense of achievement.

Stresses at home
Given how hard covid hit hospitals, there’s no question the pandemic raised the profile of both hospital medicine and individual hospitalists.

In Quincy, Ill., Mary Frances Barthel, MD, MHCM, chief quality and safety officer for Blessing Health System, was just finishing a master’s degree in health care management when the pandemic struck. (She was also the lead for infection prevention.) “I was in the right place at the right time,” says Dr. Barthel, who agreed to coordinate regional covid operations for the health system.

“It’s been a transformational year.”

Mary Frances Barthel, MD, MHCM

~ Mary Frances Barthel, MD, MHCM
Blessing Health System

In addition, she has since added “principal investigator” to her resume for her randomized controlled study of a hospital at home program associated with Boston’s Harvard School of Public Health and Brigham and Women’s Hospital. The goal of the trial is to see if a model designed for an urban setting will work in rural Illinois. All that work and leadership have now put her in the running for a new chief operating officer post later this year.

“It’s been,” she says, “a transformational year in so many ways.”

At the same time, Dr. Barthel is proof that child-care arrangements—or the lack thereof—were a strong determinant of how well women hospitalists fared during the pandemic. She was lucky, she says, to have her mother come and live with her during the pandemic and help with her two teenagers. That, she notes, gave her the ability to take on the extra work.

In Sayre, Pa., the travel restrictions that hampered many people’s year were an unexpected boon for Marcelle Meseeha, MD, a hospitalist at Guthrie Robert Packer Hospital. That’s because her mother, who had been visiting from Egypt, was stranded here for months and couldn’t fly home.

As a result, Dr. Meseeha ended up with live-in child care just when she needed to pick up extra shifts to cover the vacancies caused by her hospital’s loss of locum work. While she had to cut back her research during the early months of the pandemic, that has since resumed. And she has been able to attend more committee meetings and grand rounds than ever before. “During my week off, I don’t go the hospital at 7 a.m. for an in-person meeting or grand rounds,” she points out. But since those all switched to virtual, “I attend every week even if I’m home.”

Sharing resources
Last July, Ijeoma Carol Nwelue, MD, moved from St. Louis to Ft. Worth, Texas, to become medical director of a new hospitalist group at Baylor Medical Center Ft. Worth. She was able to do that in part because her husband during the pandemic could be a stay-at-home dad to their two young children.

With virtual meetings, “I attend every week even if I’m home.” 

Marcelle Meseeha, MD

~ Marcelle Meseeha, MD
Guthrie Robert Packer Hospital

And in Albany, N.Y., Thea Dalfino, MD, chief of hospital medicine at St. Peter’s Health Partners until April and now interim CMO, says that she and other hospitalists with steady child care “shared their nannies” with colleagues coping with shuttered day care centers or babysitters lost to illness.

“We came together to help each other out,” says Dr. Dalfino. They also had colleagues whose family members were sick with covid in their hospital, “and we sent meals to their homes. When most of society wasn’t able to leave their houses, we at least had the advantage of going to work and being able to commiserate with and support each other.”

Moving forward?
Part of Dr. Nwelue’s new job is planning a residency program at Baylor Ft. Worth in association with a new medical school, TCU and UNTHSC School of Medicine, which admitted its first class just before covid struck. In recent one-on- one discussions with the hospitalists in her program, she says, “I have been surprised at the number of people— more women than men, actually—who want to get more involved and see this as an opportunity right now.”

But more female than male hospitalists left her group during the pandemic. Those departures were due to child-care complications or long commutes that became unmanageable because of added home pressures.

And she knows female hospitalists who say they just don’t have the energy to pick up a committee assignment or new project they would have jumped on if child-care burdens and other pandemic stresses had been less intense. As Dr. Nwelue puts it, “There are a lot of people just trying to get though the year.”

For hospitalists who appear to be struggling, “I do look at adjusting their workload or schedule,” says Dr. Nwelue. She also encourages them to reach out to the newly-minted hospital medicine wellness leader, a hospitalist in her facility who has special training in recognizing burnout and knows which resources are available for those who need them.

Gender perceptions
In her role advising trainees and faculty in her institution on how to grow their careers, “I have been excited to see that a lot are ready to take on things now—and many are women,” says Emily Mallin, MD, a hospitalist at Banner-University Medical Center Phoenix.

“I don’t think it’s fair to expect people to bounce back fast.”

Emily-Mallin-MD

~ Emily Mallin, MD
Banner-University Medical Center Phoenix

Dr. Mallin is director of education for the department of medicine and associate professor at the University of Arizona College of Medicine-Phoenix. “But I don’t think it’s fair to expect people to bounce back fast when nothing else in their lives has been able to change yet. Many whom I have talked to can’t think about anything bigger than covid yet.”

Recovering from the past 15 months “will look different for everyone,” she points out. And “it will take ongoing, deliberate effort to maintain awareness of how folks are doing, individually and at the group level, to make sure everyone’s needs are met.” But while many hospitalists “are still just kind of languishing, others are looking to reengage with the work they were really passionate about before covid.” They also “want to find ways to not go back to doing things exactly as they were done before.”

A Medscape survey this year found that 51% of women physicians reported being burned out, compared to 37% of men. (That’s up from 48% of women in 2020, when the percentage for men was also 37%.) And studies have found that covid has worsened gender disparities in medicine, including reducing scientific publication rates by women lead authors.

Some also worry that group efforts to correct unequal compensation, which were interrupted by the pandemic, may not be a priority going forward. They also wonder if covid will disrupt leadership search plans, tenure deliberations and networking opportunities, stalling advances toward equity that women physicians have made.

For Dr. Mallin, the pandemic was also an object lesson in gender perceptions. Like all hospital workers, she now wears scrubs and PPE, not suits and white coats.

That’s been a constant reminder that many patients still assume that every woman walking into a hospital room is a nurse or aide. “When I’m wearing scrubs, I’m never, ever, ever seen as the doctor,” Dr. Mallin says. “This type of snap judgment signals that society still has work to do to advance gender equity.”

A more level field
At the same time, some women hospitalists have found that changes imposed by the pandemic have helped level the fi eld with male colleagues. At Denver Health, for instance, academic hospitalist Lilia Cervantes, MD, had to put her NIH-funded research on pause for several months last spring due to covid exposure and PPE shortage concerns.

“Men have more opportunities to travel and make national connections. I’ve now been able to do that too.”

Lilia Cervantes, MD

~ Lilia Cervantes, MD
Denver Health

While she depends on publishing original research, Dr. Cervantes was able to pivot to authoring qualitative studies. One, published in JAMA Network Open this March, was on the challenges facing Hispanic patients hospitalized for covid. A second, published in May in BMJ Open, looked at the perspectives of front-line hospital clinicians caring for covid patients. While both men and women in that study reported distress, Dr. Cervantes says more women than men “described child-care challenges.”

And everything moving online during the pandemic created real opportunities for her. As the mother of two school-age daughters, she usually limits herself to only a few national conferences and grand rounds a year.

But during covid, Dr. Cervantes accepted dozens of invitations to speak at national meetings, grand rounds, and plenary and panel discussions—all virtual. She also credits her success this year to having a female department chief in touch with the challenges of hospitalist parents. Moreover, the University of Colorado’s department of medicine extended mentored career development awards by six months for physician-scientists like Dr. Cervantes who may otherwise have lost time. That support, she says, probably helped some careers.

“I think men have more opportunities to travel and speak about their research and make national connections and networks,” Dr. Cervantes says. “I’ve now been able to do that too.” While she hesitates to call anything a silver lining in the midst of so much death and suffering, “having those speaking engagements makes it possible to move forward through promotion faster.”

In Chicago, meanwhile, Dr. Marfia a says her group’s experience with covid helped everyone improve their collaboration, teamwork and cooperation. And while she had been struggling to figure out what she wanted to focus on, “I want to put my skills to work on things related to burnout and resilience.”

Deborah Gesensway is a freelance writer who covers U.S. health care from Toronto.

Yourself, online

HOSPITALISTS HAVE spent untold hours this past year in front of a camera. Videoconferencing has opened up networking opportunities that may have been beyond the reach of women juggling medical careers with childrearing.

It has also raised the profile of decisions typically made behind the scenes, like the work that Thea Dalfino, MD, was doing as chief of hospital medicine at St. Peter’s Health Partners in Albany, N.Y. As covid surged last spring, she retooled admission, discharge and comanagement policies.

“Because those meetings were on WebEx, it was easier for the CEO, the chief nursing officer and other administrative leaders to come on the calls”—something they wouldn’t do with in-person meetings, Dr. Dalfino points out. Executives saw the relationships, respect and rapport the hospitalists had with the ED and subspecialties, which in turn “increased the visibility of all the essential work we were doing.”

“Coming in as a leader to a new facility, I’ve seen how important in-person interactions are.”

Ijeoma Carol Nwelue, MD

~ Ijeoma Carol Nwelue, MD

Baylor Ft. Worth

One result: This spring, Dr. Dalfino was promoted to interim CMO. Her many roles during covid, which were highlighted across those virtual meetings, “showed leadership that I was able to rally the entire medical staff to make drastic changes.”

While the move to Zoom has helped many, it could be a career-breaker for others. Hospitalist leaders concerned with gender equity and women’s professional profiles worry that being out of the room for some women means fading into the background.

“I’ve seen it both ways,” says Emily Mallin, MD, a hospitalist at Banner-University Medical Center Phoenix and director of education for the department of medicine. This year, social science and communications researchers at Stanford University found that “Zoom fatigue” is greater for women than men, with one in seven women reporting significant exhaustion after Zoom calls compared to only one in 20 men.

While the participants in that study weren’t health care professionals, Ijeoma Carol Nwelue, MD, who last year took a job as medical director of hospital medicine at Baylor Ft. Worth Medical Center, noticed that many women in her group don’t talk during virtual meetings. Dr. Nwelue has learned to make a concerted effort to call on people and let them know they have the floor. She has also attended online meetings where the culture is for people to keep their cameras off. “I’m new here, so people don’t know me, and I don’t know them,” Dr. Nwelue says. “It’s hard to read mannerisms and body language. Coming in as a leader to a new facility, I’ve seen how important in-person interactions are.”

Published in the July/August 2021 issue of Today’s Hospitalist

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