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Women in Radiology | An Interview with Melissa A. Davis, MD, MBA

Davis

Melissa A. Davis, MD, MBA, is assistant professor of radiology and biomedical imaging and section chief of emergency radiology at Yale University School of Medicine. She is also the clinical lead for the Yale Center for Outcomes Research and Evaluation. I’d like to extend my thanks to Dr. Davis for sharing her thoughts and experiences as they relate to women in radiology.

Q: When did you know that you wanted to be a doctor? Did you have a role model or particular experience that led to your decision to be a doctor?

A: My mother is an OB-GYN and my father is a dentist, so I was exposed to medicine early in life. To get an allowance, I used to spend time in my mother’s office filing papers, and she would take me in to see patients once in a while if they consented. One of her patients actually let me see the delivery of her child. When my father would go to the office on weekends during emergencies, I would be his office assistant.

When I was an undergraduate, I traveled to Ghana for three months and worked with the West African AIDS Foundation. I had started college thinking I wanted to be an engineer and not a doctor, but, after working with the Foundation, I decided that I did want to be a physician.

In Ghana we worked with many patients who were pregnant and, given the conditions, I actually helped deliver a lot of children. At one point, we delivered a breech baby who had the cord around his neck. The baby ended up dying in my hands. That sense of helplessness in that moment solidified my decision to go to medical school.

Q: And then you applied to medical school?

A: Yes, right after that. I majored in chemistry and psychology and wanted to move back towards home so I attended the Medical University of South Carolina in Charleston.

Q: It sounds like your mother was a major role model. Was she influential as far as your career path?

A: Yes. As much as we don’t want to admit wanting to be like our parents, clearly mine were very influential. My mom was my first female mentor. I loved that she had a job where she was helping people and doing great things. She was my first role model. I had several other female role models as I went through school.

I was an undergraduate chemistry major and my mentor was a chemist who focused on nuclear magnetic resonance (NMR). I had never heard of MRI before and she recommended I take her NMR course. In addition, her daughter was a radiologist. From then on, it was in my mind that radiology was something women could do.

Q: Did you think that you would do OB-GYN at any point, especially since it sounds like more of your experience was on the clinical medicine side?

A: No. That was the one thing I was sure of when I went into medical school. I think mostly because I saw the hours that my mother put in. Plus, I could never sneak out of the house because she would always be walking in at the same time!

Q: You had a relatively early awareness of radiology, but it seems to me that a lot of people don’t have an understanding of the field until somewhat later in their training.

A: I knew it was a specialty and something that people did, so I had baseline knowledge. Also, I was fortunate to have very early exposure — much earlier than most people I talk to.

Q: Was exposure to radiology built into your medical school curriculum, or was it something that you had to actively seek out?

A: Students definitely had to seek it out since radiology was not built in to the program. There was one anatomy lecture where a radiologist visited and demonstrated the imaging approach to
anatomy. I spoke with him after the lecture and ended up working with him on a few case reports. Students could also do a radiology elective at the end of third or fourth year, but otherwise there was no exposure.

Q: At what point did you decide that you wanted to be a radiologist?

A: It was in the back of my mind all the way through. I really liked surgery as well, so I did consider that. Part of my hesitation in not choosing radiology initially was the perceived competitiveness of the profession; the thinking was that radiology programs were difficult to get into and if I pursued it, I would be left without a residency. I pushed those doubts aside and forged ahead. I did a surgery internship in Greenville, S.C. and then went to the University of North Carolina for residency and stayed on for a neuroradiology fellowship. After that, I attended Yale University for the Healthcare Leadership Fellowship.

Q: How important do you think it is to have women role models throughout the education and training process? Do you think having women mentors was influential when it came to your enthusiasm about the field and your desire to go into it?

A: I think it’s very important to have female role models, especially during each phase of education. You have no idea what you can do if you never see yourself in those roles. In addition to my mother, who was a major role model, I was influenced by Leonie L. Gordon MB, ChB, the program director for radiology in medical school, who was amazing, successful, warm, and engaging. Otherwise, I didn’t know many women in radiology. Outside of radiology, one of my role models was Debra Dees, MD, associate dean of the medical school when I was there. She was the only black woman on staff I knew. For me, that was also very important, because I could see myself in her and say to myself —this is a goal I can actually attain.

Q: It sounds like most of your role models were accessible to you on a personal level.

A: They were, and I think it is very important to have somebody you can actually talk to. I have had role models far away, but to have accessible mentors — to really see what people are going through and for them to be willing to talk with you about their triumphs and struggles — is very powerful.

Q: Did you feel as though there were stereotypes about women that you had to overcome, either in medical school or, more specifically, in radiology?

A: Yes, there are stereotypes all over the place. Where I went to medical school, they tended to push females towards the general specialties: medicine, family medicine, pediatrics, and OB-GYN. They would say: you communicate well, you’re a nice person, your personality would make you a good pediatrician, etc. That sort of thing. If you said you wanted to practice radiology, they’d say: I don’t know why you want to do radiology — you would not be using all of the engaging personal traits that you as a woman have.

Q: From what you’ve seen, do you think more of the stereotyping is on a societal/institutional level, or that more of it is personal — for example, individuals thinking that radiology consists of sitting in a dark room and not talking to people?

A: I think a lot of it is institutional stereotyping, which people buy into, and I think we even buy into it as radiologists at times. Also, the way medical students currently experience radiology is not necessarily helping them to be enthusiastic about our specialty. We do spend a lot of our time looking at monitors and dictating films, but we should be showing medical students the engaging parts of the field as well. For example, medical schools could make students more aware that they can observe procedures in the IR suite or the mammography area. There are a couple of programs where radiologists are localized in the clinical practice and doctors visit them to consult throughout the day — that could be an interesting way to engage students. I’m in the emergency radiology section and we’re so busy in the evenings we hired a medical student to help us triage phone calls and consults. This is good way to show students that radiology involves discussion and collaborative problem solving.

Q: Do you have suggestions about initiating earlier exposure to radiology?

A: I think undergraduate exposure would be useful - perhaps through research opportunities. I know the ACR has great programs for medical student mentorship. Michele Johnson, MD, a neuroradiologist at Yale, participates in these programs; there are medical students who work with her for an entire summer, which is great.

Q: What do you think radiology programs can do to encourage more women to be accessible mentors?

A: Being a good mentor is a lot of work and there are external factors a program can use to incentivize people to serve as mentors. But a really good mentor is someone who is internally motivated, and I think that in order for people to feel internally motivated, they have to feel that they are succeeding themselves. So, in determining whether programs are encouraging women mentors, we should ask: are they on track for promotions, are they being promoted, are they getting raises, are their income levels on par with others in the department, are they getting tenure, are they involved in organizations like the ACR and moving up in those organizations? I think that good mentors want to see others succeed as they have done.

There have been problems with ensuring that mentoring is institutionally valued. Every year, for example, we as radiologists have to track everything we do professionally and that tracking report counts towards a potential bonus. Mentorship doesn’t show up on that document at all. There are some things programs can do, such as recognizing that mentorship is important, that should have some tangible value like writing papers or generating studies. But I think the bigger issue is ensuring that the program is successfully producing people who are internally motivated to be mentors because they themselves are being successful.

A lot of places are trying to formalize mentorship, but I don’t think that always works out. The element of personal relationship is what makes the process so valuable and while I think that formalized mentorship programs can work, in my experience, the best mentoring relationships usually result from a more informal process.

Q: As far as getting more women interested, can you suggest anything specific?

A: For me, the fact that there were influential women radiologists was very important. There was Julia Fielding, MD, who is amazing and very interested in the growth of women. Cherie Kuzmiak, DO and Sheri Jordan, MD were both very influential during my residency and beyond. There is Michele Johnson, MD, who very interested in medical student and resident education. And of course, Geraldine McGinty, MD, FACR. That’s my list of Rockstar female radiologists.

Q: Regarding work-life balance: do you think programs should think/talk about that more?

A: When I was in residency, I had a pretty good work-life balance, and now it’s pretty terrible, but this is something I have made a point to work on over the last year.

I’m the chief of emergency radiology at Yale. We have 24/7 attending-level staffing and at least three people on every night. We have seven people on over the weekend. The demands from our consulting physicians regarding what is read and how fast studies are read are increasing. This creates a situation where you can have a poor work-life balance. While there are still 9–5 jobs available, many new jobs are for off hours –after 5 p.m. and weekends. So we have to figure out how to operate under this new model and make sure that people are able to maintain a good life balance –that they aren’t always working at night or during dinner time. The hospitalists and ED physicians have adjusted to the off-hour demands; nurses have done it for decades. I think that our older radiologists are not happy with the changing demands; the younger ones who are finishing training are going to be exposed to these off-hour demands a lot more. Conversations regarding these changes should start in residency, and when people are looking at jobs, they should really understand what the job entails. It’s going to be an issue. It’s all a work in progress.

Q: Is there anything else you want to add?

A: There is also the issue of sponsorship, which has gotten a lot of talk lately. I do think mentorship and sponsorship are very different. A mentor is someone you speak with frequently, someone who will help with advice, whereas a sponsor is someone who will recommend you for a position. When you talk about women, we don’t have a lot of sponsors; we don’t have enough people who are helping us to get to the next levels, as opposed to our male colleagues. The fact that we are talking about that distinction is really important.

Q: How do you think we can help women progress in the field?

A: We need increased transparency at the baseline. People should know what other people are earning when they come in. When I applied for my job, there was a man who was applying for the same job at the same time. I knew what he was being offered and once I knew that number, I was in a much better negotiating position. So I think that transparency is very important for women. We face stereotypes such as: you just got married, now you’ll have a baby and you’ll go to part-time, so we won’t offer you that large salary. On the other hand, for women with no children, the thinking is: you don’t need that enhanced income because you don’t have people to take care of. Transparency and openness are essential, and I think that women hesitate to talk about things really concretely. A lot of people think it’s taboo. Women tend to keep these issues very close to the vest, which can ultimately be detrimental.


 Levin

By Elizabeth Levin, MD, Resident at David Geffen School of Medicine at UCLA.

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