Dr. Joan Cheng (Photo: Dr. Sydney Tam) and Dr. Carolyn Snider (Photo: Katie Cooper, Unity Health Toronto)

International Women’s Day is a global day of recognition to celebrate the achievements of women and to advocate for accelerating women’s equality. This year’s theme, break the bias, encourages everyone to take responsibility for their deliberate and unconscious bias.

Unity Health Toronto has strong women leaders across its corporate and medical departments. Nearly 50 per cent of the executive team is female, 71 per cent of Division Chiefs are women, and its Emergency Departments, a medical specialty that is nearly 70 per cent male, are both led by women.

We spoke with Dr. Joan Cheng, Chief of Emergency Medicine at St. Joseph’s Health Centre, and Dr. Carolyn Snider, Chief of Emergency Medicine at St. Michael’s Hospital, about their paths to leadership, the barriers for women in emergency medicine, and why they say a medical career ‘doesn’t have a shelf-life.’

What was your journey to pursuing medicine and leadership like?

Dr. Carolyn Snider: I actually dropped sciences in grade 10 and was quite sure I’d be following the footsteps of my father and many others in business. I went to business school and started my career initially in marketing and brand management. Early, even in my summer jobs as an intern, it was apparent to me that I needed to have more passion in my career. I lived in Bangkok after business school and it invigorated me and reminded me how much I missed adventure and being kept on my toes. It was a real lightbulb moment for me. When I came home, I went back to high school to get my sciences, I did a science degree at U of T. I developed web pages on the side to make money. Then I went to medical school at McMaster.

I mention the business side of my career because it really speaks to a lot of what we do in leadership – organizational behaviour, HR, finance. All of those things that we don’t learn in medical school but that I am fortunate to have experience in. I needed the right context to be a leader, and that’s where medicine found me happy about what I was doing on a day-to-day basis.

Dr. Joan Cheng: It’s really common in Chinese culture for your parents to expect that you will become a doctor and play violin or piano, and this was certainly the case for me.  I didn’t have a particular goal in mind – I don’t know that leadership was ever really in the cards because of the way that I was socialized in our society here in Canada, and then the layer of my cultural background, where the concepts of keeping quiet and staying in the background are highly valued. Leadership is male-dominated and we are so conditioned to believe that ‘behind every man is a woman’ or that women should ‘stand by their man’, there’s all kinds of examples of that in our pop culture. I was content with that paradigm and playing the ‘supporting role’ because I had adopted it and internalized it. But when my partner transitioned, there was this realignment of the concept of our partnership – that male/female dynamic had fallen away and it wasn’t relevant to us anymore.

I’ve always been kind of an outsider. First by being a racialized person, a woman in a field where men are usually in charge, and then suddenly becoming a member of the queer community. I really understand what it’s like not to belong and how that feels, so I can recognize it in people and I think it helps build trust. It has become one of my strengths.

A 2019 Canadian Medical Association survey showed that 69 per cent of emergency medicine doctors are male and 31 per cent are female. What are some of the barriers for women pursing emergency medicine?

Dr. Carolyn Snider: I think emergency medicine is a great career for women – I really do. It has given me so much more flexibility than many of my colleagues in different fields. I can switch a shift around to attend a school concert or to be able to go to choir every Monday night. We’re seeing far more women enter emergency medicine. In fact, approximately 50 per cent of emergency medicine residents have been women for the better part of a decade. So there is no reason to me now when someone is hiring emergency medicine physicians that they can’t achieve gender parity in their hiring – and if you aren’t – you need to ask what barriers are in place to do that. At St. Michael’s we already have gender parity across our entire group.

Dr. Joan Cheng: I was actually really heartbroken because someone I had been mentoring recently, a young woman of colour, ended up choosing not to enter emergency medicine. She’d had a bunch of conversations with women closer to her age in emergency medicine who spoke about burnout. The information she got was valid to her and the people who told her that, but to me it means a lack of the antidotes to burnout: support and role-modelling. Role-modelling is the best method of education, and if you don’t have somebody who’s going to be your coach or encourage you, then I can understand why someone would get overwhelmed. I can get how it would seem impossible – and this problem isn’t exclusive to women, but it’s a very acceptable one because this is how we’ve been socialized. It’s not that men don’t have these same fears, it’s that they can’t really talk about them.

Dr. Carolyn Snider: We need to ask ourselves: what stands in the way of leadership roles for women? Number one, we’re poor negotiators. We don’t think about negotiating well and that contributes to the gender wage gap. I also think meeting times continue to be a struggle. We don’t talk enough about how leadership impedes on your life at home. We’re losing people because to be a leader you’re supposed to be available all the time. And when we’re still in a society where certain tasks are done by women, then we’re losing disproportionately a number of female leaders, and that’s concerning to me. We need to think about how we can structure leadership to include people and not create more barriers. There’s also not a lot of visibility of equal partnerships – medical students don’t necessarily see a lot of people like Joan and myself who have equal partnerships at home that enable us to do our jobs.

When we talk about women and careers, the concept of ‘having it all’ always comes up. What does that mean to you?

Dr. Joan Cheng: I think you can have it all, but I don’t know that you can have it all simultaneously and you shouldn’t have to! In medicine, once you finish medical school, you are considered valuable if you do a thing, and you’ve got to do it pretty quickly – pursue research or speak at conferences – and if you don’t do something by a certain deadline, you’re not really valued. It’s important to know you can do all those things, you just don’t have to do them right now. Medicine isn’t sports, our careers don’t have a shelf life. This artificial timeline that’s imposed on us by the patriarchy is ridiculous. I think trying to shoe-horn all of us to fit into a paradigm that was created by somebody else… I don’t agree with it.

My message is: go and do the thing that you prioritize most and do it well. The last thing I’d want someone to feel is that they’re doing both things badly. My job is a leader is to support my team and help them stay in the game. The conversation is mostly around being the parent of young children and I want my team to know they can do whatever their top priority is, for example it could be parenting, or caring for an elder, and when they’re ready to come back, I’ll be ready to support them. And this isn’t just for the women, when I’ve had this conversation with the men, they are so relieved.

Dr. Carolyn Snider: I totally agree with Joan. I haven’t yet found anybody who actually “has it all” – superwoman doesn’t exist. And that’s really important for women leaders to show that to our junior colleagues because sometimes we get portrayed as ‘having it all.’ If you look at me on the surface, you could think: she has a successful research career, she’s a physician and health leader, she had a kid, travels the world, and she sings in a choir – she has it all! The thing is, I don’t actually do it all at the same time. It’s a continued rebalancing and reminding myself of what’s really important.

Something that’s really important to me as a leader is asking every person who has a pregnant partner how much parental leave they are taking, and to make sure people are open about taking protected time off or days off. They need to have their version of their ‘mini all’ at all times. The grand scheme of ‘having it all’ is impossible, and to expect that of ourselves is really what’s at the heart of burnout.

Is there anything you’d like to add?

Dr. Joan Cheng: I think we’ve been socialized to be quiet, not to draw attention to ourselves. And I’m not comfortable with bragging about myself, but it hurts women for us to adopt that stance. It’s not for our own gain, but for the young people who need to see us. We need to amplify our own voices for their benefit.

Dr. Carolyn Snider: Conversations like this are so important. We don’t know who will read this, and I want them to know that it’s possible to have a small version of ‘it all’ and to also love your job.

By: Jennifer Stranges

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