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ASTRO Blog

ASTRO Blog

Lutheran Medical Center Becomes First to Earn APEx Reaccreditation

By Doriann Geller, ASTRO Communications

ASTRO’s APEx – Accreditation Program for Excellence® counts nearly 200 radiation oncology practices among those having earned the distinguished APEx badge since the program's inception in 2016. APEx recently granted its first reaccreditation in December 2020 to Lutheran Medical Center, located at the foothills of the Rocky Mountains in Wheat Ridge, Colorado. Lutheran Medical earned the distinction of being the first facility to become reaccredited after their first four-year cycle. Tyler Kemmis, MD, medical director of radiation oncology at Lutheran Medical, took time out of his day to talk about “Why APEx.”

“I know we were first in Colorado, only maybe sixth in the country for initial accreditation,” he said glowingly on a recent afternoon. “So, I guess it’s pretty neat that we’re first for reaccreditation.”

Lutheran Medical’s mottos include “Excellence: setting and surpassing high standards.” APEx accreditation, which demonstrates safe, high-quality care, validated their commitment to this value, Dr. Kemmis said. The accreditation process, which focuses on the entire radiation oncology team, allowed them to review and modify policies and procedures and to improve documentation. “I think what accreditation does, specifically ASTRO’s APEx, is it forces you to do a self-audit. It helped us modify some of our policies and procedures, update them, define them ― easily identifiable areas we were able to benefit.”

Dr. Kemmis mentioned that the team identified some deficiencies during the Self-Assessment, which is designed for success.We did not realize some deficiencies until we were sitting down and going through [the Self-Assessment],” he said. “We improved on them, even though they were potentially going to be disclosed at the site visit.” If they were called out, the Lutheran Medical team was prepared with a proactive response. “We could say, ‘Yes, we noticed that, and we've done this to improve it.’”

Lutheran Medical Center’s website describes their facility as a place where “Our patients and families are the center of every thought, communication and action that takes place in this healing space.” The APEx accreditation program evaluates the standard of care that addresses communication, not only among staff but specifically with patients. “Here at Lutheran, we really make sure that we, as radiation oncologists, are there for the entire spectrum of care, and communication is really central to that.”

The APEx accreditation process, while achievable, is known to be rigorous. Asked if that is a fair assessment, Dr. Kemmis concurred. “Yes, I think it’s fair. I won’t lie. It is no walk in the park by any means. Of course, when you go through that much work, there is a greater sense of accomplishment when you get there. Whether it’s an initial accreditation or specifically reaccreditation, the majority of the work is done on the front end and leading up to the site interview. It involves a lot of people putting a lot of work into it, [which] makes it more fulfilling when you do receive your accreditation or reaccreditation,” Dr. Kemmis observed.

“There were additional things that we never thought of, even during the review, [that] forced us to think critically. So, at that point in time you say, ‘Yes this maybe is something that we need to work on.’ Each part of the reaccreditation you can use as a learning experience,” he remarked.

Among the changes Lutheran Medical implemented as a result of the accreditation process was improvement in new staff onboarding. The radiation oncology department enjoys low staff turnover, a point of pride. However, the surveyor noticed that documentation of onboarding processes needed some attention. “We're fortunate that we really don't have a lot of staff turnover, and we didn't really have the opportunity to review some of our training processes and procedures for onboarding new staff,” Dr. Kemmis said. As a result, they have revamped some of those policies and procedures.

The four-year accreditation cycle provides generous time for facilities to continue to improve. During the first four-year cycle, Lutheran Medical used ASTRO accreditation as a framework for future improvements in developing new documentation for their system of radiation oncology departments, expanding the benefits of accreditation system-wide.

Dr. Kemmis stated that Lutheran Medical’s radiation oncology department considered other accrediting bodies, but they chose APEx. “I think it was the fact that, as a radiation oncologist, I felt more aligned with ASTRO. And when it was offered as a new accreditation, I think there was that allure that this was a new accreditation, that [it] would be exciting to be involved with.” The four-year reaccreditation, as opposed to three, was also a factor, he said. “It was all those factors put together.”

Would Dr. Kemmis recommend APEx accreditation to his radiation oncology colleagues? “Yes absolutely,” he responded. “I haven't gone through any accreditation other than ASTRO, but I've had a good experience with it so far, so I would.”

If you would like information on how your facility can become accredited by APEx, we invite you to contact an ASTRO team member at APExSupport@astro.org to schedule an online discussion. By this time next year, your facility could join Lutheran Medical in the family of APEx accredited facilities.

 

Posted: April 6, 2021 | 0 comments


Is it Really Best to "Just call me Jake"? The Importance of Consistent Introductions in a Bias-Laden World

By Christina Chapman, MD

In June 2019, I served as the discussant for an important abstract by Narjust Duma, MD, and colleagues presented at the ASCO Annual Meeting. In Dr. Duma’s study, a group of investigators watched videos of scientific presentations from two recent ASCO annual meetings and recorded whether speakers were introduced with a professional form of address (e.g., Dr. Last Name) or an informal address (e.g., speaker’s first name or Dr. First Name without last name). They found that women and Black individuals were less likely to be introduced with a professional form of address. They also found that men were more likely than women to introduce speakers informally. The abstract was subsequently published as a full length manuscript in the Journal of Clinical Oncology.1 Although the data on gender were published, the data on race were omitted from the final manuscript, which I discuss below. This research project was modeled after an earlier project that similarly demonstrated gender bias in speaker introductions at the Mayo Clinic’s Internal Medicine Grand Rounds. These studies add to the existing literature that demonstrates the pervasiveness of gender bias in medicine and biomedical research.

Christina Huang, MS, Fumiko Chino, MD, and colleagues performed a similar analysis focusing on recent ASTRO Annual Meetings. They did not find a statistically significant difference in speaker introductions on the basis of gender. However, their presentation prompted a series of conversations on Twitter during the 2020 ASTRO virtual Annual Meeting. Although they suggested that all speakers be introduced with a professional form of address, multiple male members conveyed opposing viewpoints. One was that formality in conference speaker introductions reinforces hierarchies that impair collegiality and free exchange of ideas. Another viewpoint was that calls for consistency are unnecessary in light of the study’s failure to demonstrate gender bias. One may wonder why such varied opinions exist on this topic. An examination of the existing evidence may shed light on why opinions differ strongly across gender and racial lines.

In general, people are less likely to support or see the need for formalized systems, rules or laws if they are treated justly without them. Those who are oppressed under current systems instead recognize that “honor systems” and informal structures often fail to produce justice in inequitable societies. In short, the marginalized clearly see the need for guardrails, while those who are centered may claim to be unaware that there is a dangerous cliff nearby. This cliff is well described in the literature, however, so it is incumbent upon everyone to recognize the bias, whether it directly affects them or not.

Although professional credentials are not the only factors that influence career success, they certainly help drive it. Furthermore, numerous studies have demonstrated racial, gender and other biases in the way that individuals with identical credentials are perceived. These facts demonstrate the dangers of informality in professional settings. Even if men and women are introduced informally at the same rates, the penalties are greater for women and the advantages are greater for men. When women’s credentials are not formally displayed, the audience is less likely to perceive them as a physicians or scientists. This does not hold true to the same extent for men, who are more likely to be perceived at the top of hierarchies or to possess advanced credentials regardless of their actual standing. When a male-presenting individual offers, “Just call me Jake,” it is somewhat disingenuous to think that this eliminates or substantially mitigates hierarchies, because he is still perceived to possess academic credentials and be perceived as a man, both of which elicit a certain level of respect in hierarchical and biased society.

To be clear, there are two types of hierarchies relevant here. They can be distinguished by whether they are publicly accepted as just or unjust. Most people will state publicly that racial or gender hierarchies are unjust while stating that hierarchies based on academic credentials or achievement are generally just if equitably implemented. For example, most departments would find it acceptable to deny an application for an academic radiation oncology faculty position from someone without training beyond a bachelor’s degree. Many conference attendees would also find it acceptable that scientific discussants are selected based on their training and content expertise. Without display of their formal credentials, however, women are perceived to be at lower levels of accepted hierarchies, leading to discrimination that is repackaged to make it appear justifiable (e.g., “Oh, I didn’t even realize she was a funded immunologist. I thought she was a student presenting her lab mentor’s research.”) Women then experience  additional discrimination when the unjust hierarchy of gender inequity is applied, as in the context of two people perceived to be students with identical credentials: “I thought that male student was more competent than the female student.”2

Simply put, informality, even if applied evenly, leads to inequality in an unjust world. Formality serves to mitigate the impact of gender and other biases. If individuals or groups want to reduce the impact of hierarchies on scientific progress, one high yield place to start is eliminating hierarchies that have no basis in science: those based on gender. Furthermore, it could serve the field well to challenge the notions underlying just hierarchies by recognizing a broader array of scientific methods and topics as legitimate and important (e.g., qualitative research, health equity research) and recognizing that junior members of the field can make groundbreaking contributions. Converting to informal forms of address without challenging these underlying beliefs is unlikely to amplify the voices that we need to hear more clearly to advance our field.

Finally, it would also serve the field and broader community well to consider intersectionality and other forms of bias in their own right. When the Duma et al. paper was published, the significant finding of bias in introductions against Black speakers was removed because race was not self-reported. Study team-assigned race was not actually a major limitation of the study, given that it still measures an important endpoint (i.e., how individuals perceived to be Black are treated). Furthermore, there is little evidence that there would have been high discordance between the study team assignments and self-report, so it also would have likely given a reasonable approximation of the impact on self-reported Black individuals. Instead, important science was lost, despite the tremendous effort on the part of the study team to efficiently investigate multiple forms of bias. Problems like this can be mitigated by eliminating the scientific hierarchies that downplay the expertise of health equity researchers and instead appropriately elevating them to reviewer and leadership positions in journals.

Solutions to minimize the impact of hierarchies on medicine and science must be definitive and not performative. Informal introductions will lead to failure to recognize excellent science and scientists, which will be further compounded by biases that exist when equivalent credentials are made explicit. Calls for equity from the marginalized should not be minimized by those who are often centered, lest we run the risk of slowing progress in a field that sorely needs it.

Join the Gender Equity community on the ROhub to continue the discussion on this important topic by answering this question: In addition to speaker or clinic introductions, where else do you think greater consistency should be implemented to advance equity?

Christina Chapman, MD, is a health equity researcher and radiation oncologist specializing in head and neck and lung cancer. She obtained her BA in Biomedical Engineering from the Johns Hopkins University, her MD from the University of Pennsylvania Perelman School of Medicine, and her MS in Health and Healthcare Research from the University of Michigan, where she also completed her radiation oncology residency training.

References

1. Duma N, Durani U, Woods CB, et al: Evaluating Unconscious Bias: Speaker Introductions at an International Oncology Conference. J Clin Oncol. 2019;37:3538-3545.

2. Moss-Racusin CA, Dovidio JF, Brescoll VL, et al: Science faculty’s subtle gender biases favor male students. Proceedings of the National Academy of Sciences. 2012;109:16474-16479.

Posted: March 24, 2021 | 1 comments


Practical Approaches to Leadership in Support of Equity, Diversity and Inclusion

By Jean M. Moran, PhD, and William Small Jr., MD, FASTRO

In a continued effort to encourage discussion around gender equity on the ROhub, we would like to share our perspectives on equity, diversity and inclusion (EDI) for women and underrepresented minority professionals. For decades, we as leaders have sought different ways to support the success of women and underrepresented minority professionals in radiation oncology.  At the root of many problems in medicine is a paucity of underrepresented minorities in the pipeline, specifically medical school. For women in medicine, this problem has largely been corrected by women applying, entering and graduating from medical school in similar proportions to men since 2003.1

Although medical student matriculation is an issue in many underrepresented demographics, the problem starts long before medical school. There are significant deficits in education for populations with lower socioeconomic status. To overcome this deficit, more professionals need to advocate for equity in educational opportunities. In addition, mentorship of elementary through high school students, especially for science, is a responsibility that we should all prioritize.

The Loyola University Stritch School of Medicine (SSOM) in Chicago believes in creating an environment that fosters equity, inclusion and excellence. SSOM has been the leader in matriculating DACA (Deferred Action for Childhood Arrivals, also known as DREAMer) students and is the only medical school in the country to have accepted DACA students for seven consecutive years. The university’s administration works closely with the Office of Diversity, Equity and Inclusion and regularly meets with medical student leaders of White Coats for Black Lives to further understand the challenges facing Black students and to establish paths for expansion of underrepresented students and faculty. In addition, the SSOM dean serves as the chief diversity officer, and the president of our university has created a new role of vice president of Institutional Diversity, Equity and Inclusion.

Once in medical or graduate school, recruitment of talented women and underrepresented minorities to radiation oncology and medical physics should be a major goal of all training programs. Many societies and institutions have developed summer fellowships specifically designed to expose underrepresented populations to our profession. Despite these efforts, exposure to our field can be a struggle, as radiation oncology is rarely given much time in the first two years of the curriculum in medical school. The American College of Radiology (ACR) is currently advocating for radiology to be a core medical student rotation, incorporating all the radiological specialties, including radiation oncology. Until such changes to the core curriculum occur, outreach to medical students for inclusion is crucial.

At Loyola, Dr. Small gives an hour-long lecture to second year medical students, which is often the first time they have been exposed to our specialty. Such advocacy efforts before and during medical school can inspire individuals to pursue careers in our field. Similarly, undergraduate students who may be potential recruits for medical physics programs may also be completely unaware of opportunities available through CAMPEP-accredited graduate or certificate programs to pursue our profession.

Within radiation oncology, chairs and other department leaders can model an open, learning mindset for addressing EDI. We are encouraged to see a growth in awareness of the need to address EDI within our field.2,3 One way to demonstrate a commitment is by allotting dedicated time as well as leadership positions in the department. At the University of Michigan’s Department of Radiation Oncology, Kelly Paradis, PhD, serves in a new senior leadership position as associate chair of Equity and Wellness. One active area this department-wide team oversees is ensuring equity in recruitment, by blinding applications, revising the wording of postings and being mindful of the interview structure. Dr. Moran held a clinical physics team meeting focused on lessons learned on implicit bias in the medical physics residency process4 prior to interviews by the team. Educational activities are scheduled with consideration of the availability of all employees to attend.

Leaders are able to support EDI for individual trainees as well. At the beginning of a career, we encourage leaders to explain and reinforce performance expectations while also taking time to understand the career goals of their new employees. Leaders are able to guide women and underrepresented groups in avoiding the well-known phenomenon of heavier committee service load. We both enjoy and are fueled by our relationships with mentees, whether formal or informal. Loyola University in Chicago has a formal program where faculty mentees meet at least twice per year with their primary faculty mentor, an institutional mentor and an outside mentor to report on progress. Leaders are also well positioned to seek and direct their employees to resources that support their goals for professional growth, whether they are departmental, institutional or national.

Another way leaders support employees is at critical intersections between their work and home lives, such as for the birth or adoption of a child. For individual employees, it is beneficial for the leader to direct the individual to institutional policies. At institutions that lack parental leave policies, leaders are uniquely situated to advocate for such policies and ensure support for employees. Leaders also help establish a team-focused culture that supports both women and men using the available benefits. Employees about to take parental leave are encouraged to list their active duties and projects then work together with their leader to identify which items require coverage during leave and which can be paused. Similarly, leaders should check in with the employee after leave to ensure that expectations are reasonable, and the employee should have the same opportunities for advancement as others. Unconscious and conscious biases need extra monitoring at this juncture so that assumptions are not made about an employee stepping back after the birth or adoption of a child.

Our final consideration is to encourage individuals to leverage resources that support their own success. For example, the University of Michigan Medical School has an independent three-year review for each faculty member to reflect upon their achievements and determine if any course corrections are needed to personal career paths. Other resources include the Association of American Medical Colleges (AAMC) workshops for early and mid-career women, the AAPM Medical Physics Leadership Academy and video and workshops from the National Center for Faculty Development & Diversity. Early career individuals are encouraged to apply for the different mentorship programs in ASTRO and AAPM.

We are excited to see more visible efforts in ASTRO, AAPM and other organizations to support EDI. We will continue to look for and act on ways to accelerate progress. Join us in this discussion: What would you like to see your department do to improve equity? What efforts in your department have been successful in improving gender and underrepresented population equity? Join this discussion on the ROhub.

 
Jean Moran, PhD, is professor and co-director of the Physics Division and associate chair of Clinical Physics in the Department of Radiation Oncology at the University of Michigan.
 
William Small Jr., MD, FASTRO, is director of the Cardinal Bernardin Cancer Center and chair of radiation oncology at Loyola University Medical Center.
 
References:
  1. https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019
  2. Holliday EB, Siker M, Chapman CH, Jagsi R, Bitterman DS, Ahmed AA, Winkfield K, Kelly M, Tarbell NJ, and Deville C.  Achieving gender equity in the radiation oncology physician workforce [published correction appears in Adv Radiat Oncol. 2018 Nov 02;4(1):210]. Adv Radiat Oncol. 2018;3(4):478-483. Published 2018 Oct 21. doi:10.1016/j.adro.2018.09.003
  3. Van Zyl M, Haynes EMK, Batchelar D, and Jakobi J. Examining gender diversity growth as a model for inclusion of all underrepresented persons in medical physics. Med Phys. 2020;47(12):5976-5985. doi:10.1002/mp.14524
  4. Hendrickson K, Juang T, Rodriques A, Burmeister J. Ethical violations and discriminatory behavior in the MedPhys Match. J Appl Clin Med Phys. 2017 Sep;18(5):336-350. doi: 10.1002/acm2.12135
 

Read previous ASTRO Blog posts from the Gender Equity Community:

Pandemic Health Care Worker and Parent: Considerate Teamwork Vital to Enduring (January 2021)

New Gender Equity Community opens in the ROhub (December 2020)

Posted: February 23, 2021 | 2 comments


What Will Your Legacy to Radiation Oncology Be?

By J. Frank Wilson, MD, FASTRO
ROI Trustee and Development Committee Co-chair

Making a legacy gift to the Radiation Oncology Institute (ROI), ASTRO’s Research Foundation, is a way for you to “give back” to your profession. You can plant a seed that will grow to support research that improves patient outcomes and enhances radiation oncology practice into the future. A legacy gift is one that you document now but will benefit the ROI in the future. Your legacy gift will help the best and brightest researchers in radiation oncology continue to advance the field and improve cancer care for years to come.

I am pleased to announce that Timothy Guertin, a former ROI Board member and retired Varian executive, has provided a generous challenge grant of $25,000 to encourage legacy gifts to the ROI in 2021. When you document a legacy gift of $2,500 or more to the ROI, $2,500 of the challenge grant from Mr. Guertin will be designated in your honor in recognition of your commitment to radiation oncology research.

This Legacy Challenge allows you to share your intent to include the ROI in your will or make a legacy gift to the ROI through another vehicle. Simply complete the planned giving intent form and submit it to the ROI. You will be recognized for your generosity today through the challenge grant, while investing in the future of radiation oncology research.

Theodore Lawrence, MD, PhD, FASTRO, is the first person to meet the ROI Legacy Challenge. A sum of $2,500 from the challenge grant has been designated in honor of Dr. Lawrence for his commitment. Fifteen years ago, Dr. Lawrence helped found the ROI and facilitated its growth from concept to creation to become a flourishing research foundation yielding results. Dr. Lawrence served on the ROI Board of Trustees from its beginning until December 2020, when he stepped down. His legacy gift has been one of his many acts of leadership.

We are excited to welcome Dr. Lawrence to the ROI Legacy Circle, the recognition group for those who make legacy gifts to the ROI. He joins me and my wife, Vera, along with Christopher Rose, MD, FASTRO, in making legacy gifts to help ensure that the ROI can continue to fulfill its mission to heighten the critical role of radiation therapy in the treatment of cancer well into the future. We hope you will consider making a legacy gift to the ROI in the way that best fits your estate plans.

Many legacy gifts are revocable, and you can change your mind later if your financial situation changes. These gifts include providing for the ROI in your will or naming the ROI as a beneficiary for your retirement plan, insurance policy or donor-advised fund. These gifts can be specific amounts or percentages and may be contingent on other considerations. Other legacy gifts that are irrevocable have significant tax benefits. Such gifts include Charitable Gift Annuities, Charitable Remainder Trusts and Charitable Lead Trusts, which can provide a stream of income for you or another individual now or in the future.

Making your future gifts with non-cash assets may be another consideration. If you have highly appreciated securities, using the stock to fund any of these gifts can result in tax savings. You can also make a gift of a fully paid life insurance policy that you, perhaps, no longer need. In that case, the ROI becomes the owner and the beneficiary of the life insurance policy, and you receive a tax deduction for the transfer of ownership. More information about each of these options is available on the ROI’s planned giving website.

When you meet the Legacy Challenge by informing the ROI of your intent, you will also become a member of the Legacy Circle and will be recognized on the ROI website, at the ROI booth at the ASTRO Annual Meeting and in publications, if you so choose. We encourage you to allow us to recognize you, because in doing so, you are encouraging others to follow your example. However, if you do not want your name to appear on recognition lists, you can choose to make your commitment anonymously.

Making a legacy gift to the ROI is a way to show your dedication to the future of radiation oncology.

If you have questions or need assistance, please contact Janet L. Hedrick by email or at 703-839-7340.

The information in this article is not intended as legal or tax advice. For such advice, please consult an attorney or tax advisor.

Posted: February 9, 2021 | 0 comments


Pandemic Health Care Worker and Parent: Considerate Teamwork Vital to Enduring

By Krisha J. Howell, MD, and Penny R. Anderson, MD

As health care providers pre-pandemic, we were all far too familiar with the 10-hour clinic days, parade of administrative documents, barrage of medical calls/emails/texts/pages inevitably delivered during “unplugged time” and the emergencies that pop up at 5:00 p.m. on a Friday. As parents, we each adapted as best we could with our own piecemeal childcare system to maintain the demands of burgeoning clinics and the needs of our family. Minor emergencies happened frequently: school lunches forgotten, pick-up times from sports practice missed. Then there was that one Christmas week when the family dog gulped down a box of chocolates ― that well-intended, beautifully gifted box of malt balls from Uncle Scott ― culminating into a 6:00 p.m. frenetic storm of family crisis and urgent childcare needs amid an on-going Tumor Board. But as unsatisfactory as it was, the system persisted. Conditioned from the moment of that first newborn cry, we gradually progressed into our own individual patchwork system of Dr. Mom/Dr. Dad.

In America, we profess a need for a robust infrastructure ― roads, utilities, communication systems are all worthy investments for the health of our economy. Yet it seems, as a culture, we remain married to the idea that the federal government only need to offer limited childcare assistance outside of the traditional kindergarten to high school model. Along with the nursing, therapy and administrative staff, women now constitute a large portion of our physicians and physicists. A more robust infrastructure would allow these women to make an even greater impact to our patients and our communities.

During the COVID-19 pandemic, we saw our health care workers report to work in the face of inadequate PPE, absent or under-resourced COVID testing and with the oncology cancer patient population quickly infiltrated by the disease. Not only were we consumed with our own safety but the probability of bringing the disease home to our families. One set of friends, both emergency physician parents, made matching living wills. Elsewhere, a physician mother quarantined at a hotel rather than go home to her family after an exposure.1

The pandemic exposed the lack of a countrywide childcare infrastructure. Old sources of support became unavailable, less accessible, or, for many, executed the removal of an elderly family member as caregiver out of concern for their vulnerability. Many health care workers now found themselves in the triple role of essential worker/babysitter/teacher. Each, in itself, would constitute a full-time position. In turn, the daily act of raising children now required a greater investment in time and effort. A 101F degree fever in a baby during the era of COVID translated into an automatic two-week home quarantine from daycare. Baby’s doctor visit meant one parent had to take time off from work to stay home with siblings, as only a single guardian and no siblings were allowed to accompany an underage patient.

In dual income families, the typical parental dynamics may have altered. Many women conceded that it was no longer possible to be all roles at once. In general, women are more likely to be in part-time employment, more likely to be the lower earner in straight couples and likely to already have the greater expectation of doing household chores and meeting child-rearing obligations. If both parents had the pressure of working, then it more often than not resulted in women leaving the workforce.2,3 Beyond this struggle, we do not even elaborate on those hurdles faced by single-parent households (9 out 10 headed by women) or those with separated households wherein child custody time may have been threatened by a parent’s role as a health care provider.

From a child’s perspective, understandably, the pandemic has caused a departure in their physical and social support. Their previous social outlets of friends, sports and school are not accessible or have been reimagined in a less intimate, virtual manner. Children of frontline health care workers have demonstrated increased anxiety and worrying. “The electronic media did come to their rescue during home confinement but not without its own drawback….”4 It is easy to imagine the paramount role a parent need play at this time as an accessible and reassuring figure to a child.5

A large-scale survey conducted by Athenahealth in 2017 found that the majority of physicians under age 44 were women.1 Given the onset of COVID in early 2020, it would make sense that this population would be especially vulnerable to the aforementioned stresses. And, indeed, a drop in publications by female authors was demonstrated during the pandemic period.5

At our department, we realized early on many of these consequences and how they could impact our physicians. And, beyond them, the dosimetrists, physicists, nurses and therapists would experience similar, if not worse, upheaval in their lives at home. We set out to increase communication and strive to optimize safety and support throughout the department. As with the majority of health care clinics, we quickly integrated virtual days. This reduced risk of transmission and gave many parents greater freedom when children needed at-home care. A “buddy” system was created to optimize coverage so as not to compromise patient care and protect against surprise physician absences due to emergencies. This facilitated collaborative efforts regarding consents, simulations and SBRTs. Fortunately, our center already had in place an on-site daycare, similar to what companies did during World War II.6 Holidays were matched to the clinic holiday schedule, and the hours mirrored that of the clinic hours to optimize effective care. Furthermore, we tried, and ultimately succeeded, to honor all requested vacations despite months of upheaval. To take advantage of time away, we strove to improve communication among long-standing professional silos so that an attending’s physical clinic closure could translate to staffing the exact number of required support staff. Thus, a nurse with children being home-schooled could make appropriate plans to be home. Male colleagues, who in the past would rarely if ever admit to needing help, now approached me with requests for cross-coverage due to family needs or consideration of a father’s help being needed at home. This has caused a visible stress in my colleagues, culminating in an evident need for an improved work-life integration. Hopefully, this will continue to manifest into the future in a way to facilitate consideration and willingness to collaborate with other colleagues.

I wonder, were there ― and are there ― other solutions employed elsewhere? Going forward, as the pandemic subsides, will this awareness abate? And, finally, are there opportunities here that we will want to carry forward beyond the pandemic? Join us in this discussion on the ROhub.
 

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Dr. Krisha Howell is an assistant professor and clinical director of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. She is actively involved in ASTRO as the Gender Equity Community Champion and in the American Association for Women Radiologists (AAWR) along with other virtual platforms promoting mentoring in the space of gender equity.


References:

  1. Dawar R, Rodriguez E. Chronicles of a Physician Mom in a Pandemic: When Doing It All Is No Longer Possible! Accessed January 25, 2021. https://connection.asco.org/blogs/chronicles-physician-mom-pandemic-when-doing-it-all-no-longer-possible
 
  1. Lewis H. Don’t Build Roads, Open Schools. The Atlantic. Accessed January 25, 2021. https://www.theatlantic.com/international/archive/2020/06/child-care-infrastructure-britain-boris-johnson/613672/
 
  1. Edwards K. Women Are Leaving the Labor Force in Record Numbers. The Rand Blog. Accessed January 25, 2021. https://www.rand.org/blog/2020/11/women-are-leaving-the-labor-force-in-record-numbers.html
 
  1. Mahajan C, Kapoor I, Prabhakar H. Psychological Effects of COVID-19 on Children of Health Care Workers. Accessed January 25, 2021. Anesth Analg. 2020;131(3):e169-e170. doi:10.1213/ANE.0000000000005034
 
  1. Andersen JP, et al. eLife. 2020;9:e58807. doi: 10.7554/eLife.58807
 
  1. North A. Vox. Elizabeth Warren made a crucial point at the Democratic convention: Child care is “infrastructure for families”. Accessed January 25, 2021. https://www.vox.com/2020/8/20/21376792/elizabeth-warren-dnc-convention-child-care-biden
 
 
 

 

Posted: January 26, 2021 | 0 comments