Women physicians on scope of practice
Sonal Patel MD and Jou Jou Hanna MD discuss the difficult choices that women make to become physicians, and why that training matters.
Rebekah Bernard MD 0:07
Welcome to patients at risk, a discussion of the dangers that patients face when physicians are replaced with nonphysician practitioners. I'm your host, Dr. Rebekah Bernard, and I'm also the co-author of the book Patients at risk the rise of the nurse practitioner and physician assistant in healthcare. Today I'm being joined once again by Dr. Sonal Patel and Dr. JouJou Hannah to share some of their thoughts about the issues that women face in medicine. Dr. Patel and Dr. Hanna Welcome back to the show.
I wanted to start out with a discussion of a tik tok video that I recently saw posted. I don't know if you saw this or not, but I'm gonna put up the screenshot, but there is a nurse practitioner that made a Tik Tok video. So she has a badge and it says doctor and the TIk tock video is like, 'oh, nurse practitioners aren't real doctors?' and she's holding her badge and it says doctor, and she posted that 'we need to fight the patriarchy.' And she said, 'Here's your reminder, nurses are doctors, occupational therapists are doctors, pharmacists are doctors, you don't need to be a man with an MD or DO to be called Doctor. If you perpetuate selective title use you perpetuate the patriarchy.' What are your thoughts on that?
Dr. Sonal Patel 3:17
So working in the hospital setting, I have been mistaken from anywhere from a nurse to a social worker to someone who's cleaning up I had one rotation where I had an intern who was taller than me white male intern who's taller than me. And the parents kept asking him the question and the poor thing was just like, I don't know, Dr. Patel, Doctor. Hey, we've worked so hard to be physician women in medicine. And you know what, if you want to have the word, doctor, okay, I'm tired of fighting that fight because everybody in their mama are going to be doctors, but I'm going to be a physician. I'm gonna be proud that I am a female physician. And I want to be recognized as a female physician. There's nothing against nurses, there's nothing against social workers and that thing, but that's what I did. That's my accomplishment. Please don't take that away from what I did you know, and recognize what my title is.
Rebekah Bernard MD 4:23
So don't you see that happen? I wrote a big post. I actually put it on my personal Facebook. I was kind of fired up about national physician women's physicians day. I think it was Kentucky. No, sorry, Kansas, the hospital that said on women physician day, we would like to recognize all of our women providers
and it was really tone deaf and I was really angry about it because I said you know, this is really disrespectful to the work that women put in and the glass ceiling that we've had to break and the sexism that we've faced in the discriminate. nation in the role strain and all these things. And then just to say, well, you know, you're just the same as somebody who did it in a shorter time. And so I wrote that. And then I made it public because people asked me to share it because they liked it. And so because it was public, then people start weighing in that I don't know, including a lot of nurse practitioners, and they were angry at me. And they said, What you say is fine, but why do you have to denigrate other professionals to lift yourself up?
Dr. Sonal Patel 5:27
But it's not denigrating? Right? It is recognizing that this is a title that I've earned. I'm not taking away from nurse practitioners. I'm not taking away from what you've earned. You have a whole new you get a whole week with nurses, you celebrate yourself, then then you have a whole week with your own nurse practitioner part of it. It's one day for women's physicians. It's honoring Dr. Blackwell on that day. She is a woman physician. It's one day, people!
Dr. JouJou Hanna 5:57
I would like to say there are two things so go back to that post. So the one that you talked about the NP saying about the patriarchy thing, I think that's a cop out to put that in that category that saying like, 'Oh, the men are trying to keep the women down.' And that doesn't make any sense at all. And you go through your training, and be proud of what you did. Like, if I was an NP, I'd be proud of what I did say I'm an NP, I am not an MD, I'm not a doctor, I will still fight you know the title because I think it's ridiculous. If anybody wants to be a doctor, the janitor, the plumber that I mean, now there's a reason why we go to school for 11 years, whether you're male or female, that they're, they're losing the respect.
Dr. Sonal Patel 6:32
It's not taking away from anyone that and we have national physicians today, by the way, that I think it happens in April or something like that. But it's not taking away from and I love what you say, just be proud of what you became. Just be proud of that. Like, why is it so hard?
Dr. JouJou Hanna 6:49
There's a little part of you the jealousy of like, I wanted more kids, and I'm in that air time or my fertility is probably jacked. I would be crazy to do it on my own like, and single mom have a baby on my own. But I thought about that. But we work so hard. Like I almost wish I did that route because I would not be $200,000 in debt, I would have kids, and I would not be old and tired. And being a grandma when I'm like 80. You know. So there, there are things that are so appealing.
Rebekah Bernard MD 7:21
But I think the point of it is and one of the reasons why women physicians did get so fired up about this is the fact is we had to make some really hard choices. And in many cases, it did mean deferring, delaying, or potentially not being able to have children or even meet the right person, because you remember how difficult dating was in medical school and residency. And so a lot of us decided that we were going to make that sacrifice. And there is no part-time medical school, there is no flexible work while you go to school medical school, there's none of this, whereas to be a nurse practitioner or even a PA, there are routes that allow that flexibility. But for physicians, there's not. Now one of the things that some women physicians weighed in said, Well, maybe there should be what are your thoughts on that?
Dr. Sonal Patel 8:16
Two things. First of all, training matters. It's just evident. Secondly, we women physicians, we are kind of aware of the sacrifices that were going to and we are choosing that. And we're not doing this podcast and be like cry me a river like wow, look at me type of deal. But as for this understanding that we made those choices, we know what it's going to take to do that. And I'm sorry if you didn't realize the sacrifices that medicine actually has, or somebody didn't tell you. But this is the podcast is not to be like, Oh, look at me, I'm you need to, like feel bad for me. It's like, no, these are the choices that we have made. And we know we're making these choices over and over again. And we just want people to be aware of that, why that's why we need a female women physician day to celebrate the choices that we have decided to make
Rebekah Bernard MD 9:04
I think recognizing that sacrifice. And I think that's why women do get so frustrated and even angry when someone says 'well, yeah, but you didn't have to do all that it wasn't worth you could have just taken this other path. ' And the answer is no, we couldn't. Because to become a physician, you have to take the steps. You have to do this training because that's what it takes to be able to independently take care of patients safely.
Dr. JouJou Hanna 9:30
I completely agree. There's no shortcut. I actually thought I needed more training, but that's what makes doctors humble. Nobody knows what it's like balancing 16 NICU babies and you're on call and you're running and people are dying left and right. Like they're never going to understand that right? And so I was like I could always use more training. We thirst for knowledge. I personally think it's a calling. I don't think it's just a job right? It is a calling to heal others not ever. If it was easy, everyone would do it. Yes, it is a choice but some people Want to be a doctor but they can't because they're not capable? Or whatever it is. So it is a choice, but then we make it's hard work, knowledge, intelligence sacrifice. There were things that have I honestly, you think back you're like, okay, the Krebs like everything is MCAT, the Kreb cycle, all this stuff is I don't even use it to this day. But there's a reason why we go through that, right, there's a reason for studying, critical thinking, the analysis. So it's a very special thing that we go through. So when you have other professions that say that they dumb it down is just such a slap in the face of what we go through to be where we are. And again, as I said, we make it - I can walk in the room, and I'm analyzing from head to toe From when I first in there, and we make it look easy, but that's called the 11 years of training that I've done. Unfortunately, there's no simple thing in medicine, in my opinion, I, I remember working in the ER and had an NP come up to me and say, 'Hey, Dr. Hanna, I just, you know, I can't get a good look at the ears, can you just double check.' And so and I go into the room and the girls like Kussmaul breathing like she can't even breathe, and she's like having it you know, she can't breathe, and I go, 'I'm not worried about the ear, we need to do - can you not see how she's breathing?. And that was the one patient she came and got me for. So imagine all the patients that I didn't see. And I have a panic attack every single day when I was working in that mindset. And it's not fair to the patients. It's not fair to them. It's not fair to anyone. And the problem is the administration and I don't know how to fix it. And it's very, very frustrating.
Rebekah Bernard MD 11:32
The profit-driven system idea by administrators that, you know, like you said, because you're good at what you do, because you've done it for so long, and you've worked so hard to achieve your skills, it does look easy to an observer who just says 'Well, somebody else should be able to do that - they don't realize what it took to get to that point
Dr. Sonal Patel 11:52
to kind of go on your training to like, I remember, when I was being trained, it's like you have to go into an ER, that's how they explained it to us. And you have to look at those 16, 17 patients, and you've got to figure out right, then they're in this spot, which one needs your attention, which can be a level one, whatever it is, but that's how you're trained, you're trained to walk into a situation and be like, Okay, this is not right. And sometimes people think it's like a gut thing. But it's really all the zero training. Yeah. And then you walk in, you're like, Okay, there's something that's nagging you about it. And one thing with medicine is like, you take your patients home, you take them, you're just like, you don't stop thinking about them.
Rebekah Bernard MD 12:33
So when you mentioned that, you know, you are we are trained to walk in and take control of a room. Does that also become a problem when women are perceived as being quote, bossy, bitchy, you know, things that men doctors often are not labeled as when you're really just going in there and taking control take care of patients,
Dr. Sonal Patel 12:55
you know, I just always look at it like I can deal with that afterward. Like, I'm not going to deal with that right here and there. And you can do whatever you need from me. And then I think with our like, everyone's track record, people know how you are type of deal. But I remember someone complaining about me, another nurse that I blatantly walked into the C section, and it was an OR and I was being all valiant and blah, blah, blah. And then my director was like, This doesn't even sound like you. I don't even know what you know, and you're just like, wait, I like I saved that baby.
Dr. JouJou Hanna 13:32
I've seen them do that to female physicians all the time. And I'm like, we're just here to take care of the future. So why are you talking and tattling about these things that didn't happen. But I'm five feet tall and working in the ER and I have paramedics that come in these guys and I get challenged every day. And it's frustrating because I know is like, I know you don't do that to my male colleagues.
Rebekah Bernard MD 13:55
Right? That happened to me the other day I called 911 for a patient that was orthostatic - an adult, but she was really unwell. But looking at her just sitting there without having the vitals and things like that you might not know but you know, I assessed her and she needed to go to the emergency room. So I called and the EMS people, you know, a troop of guys came through and the first group was very nice. And then the second group, I guess it was the in charge guy. And he looked at her and he said, 'she looks just fine. there isn't anything wrong with her.' And you're like, and I said, Well, and what bothered me was I've been doing this for 20 years, and I found myself questioning myself. I actually stopped for a minute and said, Well, maybe I'm wrong. And then I said well, she's orthostatic and check and he's like well, I don't believe it. And so he started taking her vitals and of course, it turned out that I was right. But I was actually really upset at myself that that actually made me stop for a minute and second guess. Have you ever felt that way?
Dr. JouJou Hanna 14:55
Absolutely. It makes you upset but that's what makes us good doctors. If we think we know everything all the time? That's when - that's when people die. But it's the way that it comes when a paramedic, like what whoever it is to come in like that? Absolutely, absolutely. I feel that way. I'm just like, they come in and then you go like, Did I do the right thing for that kid like, this happened a few times with me. And I'm like, You know what, no, obviously, I saw the kid I took care of this. That's why they looked better by the time they got there. And then I'm five feet tall, you know, people walking in, and it looks all intimidating. And especially when they say that in front of the patient,
Rebekah Bernard MD 15:29
I actually warned the patient ahead of time I said, I'm just gonna let you know that a bunch of people are going to come in, and most likely, they're going to challenge because this is how you always find. And so everything went well. But it was interesting.
Dr. JouJou Hanna 15:41
It's just very frustrating because I feel like I've not seen them do that to my male colleagues. And the 20 years I've done this, I just don't feel like I see them do that
Rebekah Bernard MD 15:49
I think you're probably right. So any final words that you would like to share with the audience?
Dr. Sonal Patel 15:54
Okay, so for the women physicians especially the ones that coming up, I have the privilege of teaching a lot at the DO school here locally, so I get to see them. First of all, what you're doing is amazing, okay, like, it's, it's just amazing. We recognize the sacrifices, we recognize what you're kind of going through, and we're gonna still fight for you, we're gonna fight for you. But you have to fight for yourself too. And that's how change is going to happen. And that's how you're going to be like, no, no, i, x, y, and z. And so when I talk to them openly about my own experiences, then it's like, oh, you can have kids and a husband, who is a trauma, ortho, and how does that work and the advice that I have given. So first, that would be a piece of advice, should be proud of who you are. And you're going to have all these battles and but we're right here behind you. Because we've been, we're continuing to battle for you and with you.
Rebekah Bernard MD 16:46
I love that, JouJou you have any other final words you'd like to share with women doctors listening?
Dr. JouJou Hanna 16:52
Yeah, I completely agree in the younger generation, it's like, I hope more and more women, you know, go into medicine and don't give up every day when even in my clinic and have cute little girls say it every day, we need more female doctors, because we need more female doctors, I was like you can do it, you can put your mind to anything. As a single mom, pediatrician, minority family from an immigrant, if I can do it, anyone can do it. So don't ever give up. Don't ever let anyone tell you that you can't do it. Because words can hurt. But it's it's just words. It's just words. So I encourage more female physicians and don't and it's okay to be a good mom and a good doctor, you can do both. I promise
Rebekah Bernard MD 17:29
Absolutely. Although, you know, realizing that we can't be perfect at everything, right. And it's okay to forgive yourself for not being all things to all people and being perfect in every way. We're just all doing the best that we can every day. And you guys are both amazing. You're an inspiration.
Dr. Sonal Patel 17:46
So I want to have one last thing. So I'm raising four boys. And I want them to know that Mommy can be a physician, Daddy can be a physician. And this is how it works. So when they have their spouses, whoever their spouses are, they recognize that it's a balance at home, to support each other. And that's, that's why I keep doing what I'm doing. I'm raising four boys, and I want them to see that. Mommy doesn't cook all the time. Dad does it too, you know, like little things like that.
Rebekah Bernard MD 18:16
Yeah, because we need men to be our allies. That was one of the things I was so proud because on that post that I was telling you about I did on my Facebook page, quite a few men physician weighed in and said, Thank you, we recognize you. And it meant a lot to me. So I am also talking to our men physician allies out there we see you and we thank you for helping us to be able to do the best that we can do because we need your help and your advocacy.
Thank you again to my guest, Dr. Sonal Patel and Dr. Joujou Hanna. If you'd like to learn more about this topic, I encourage you to get the book patients at risk the rise of the nurse practitioner and physician assistant in health care. It's available at Amazon and Barnes and noble.com. And if you're a physician and you'd like to learn more about supporting physician-led care for all patients and truth and transparency among healthcare practitioners, I encourage you to join our group. It's called physicians for patient protection. You can find us on our website physicians for patient protection.org Also, if you'd like to run an advertisement here on the patients at risk podcast, then please reach out you can connect with me on our website patientsatrisk.com. Thanks so much, and we'll see you on the next podcast.
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