It is an honor to share a “Personal Story,” and it will be just that: very personal, and a story of my journey through this cultural shift, trying to put words around what the #HeForShe movement means to me. I emphasize the “personal” part of this given the trepidation of wading into socially and politically charged topics, knowing that I do not have answers for others, but hope that the perspectives shared here can enrich the conversations.

Having spent most of my life in Texas, I moved to Seattle, Washington, for my anesthesiology residency and pain medicine fellowship training. I was looking forward to a change of surroundings, but I had not expected that the cultural differences would be so stark. Among the differences observed, it was striking to note interactions between genders in professional settings: casual commentary and compliments that would be “expected” in Texas culture were considered egregiously offensive in the Seattle culture. Having been raised by a mother who fought for women’s rights and having joined her in marches to campaign for feminist ideals, I incorrectly assumed that I had enough insight to adequately appreciate current issues facing women. I now reflect on the contrasts of these simple, daily interactions while exploring issues of gender equity, which includes building appreciation for the influences of society on gender roles and expectations, and understanding the observed pay gap.

While the details, background, and data dive into the gender pay gap are out of scope for this writing, like many others, I wanted to understand this phenomenon. At first take, one would assume that such a pay gap, described as high as 27%, must be the product of abject and overt discrimination. However, having never witnessed anything so overt in my work environment, it was easy to be dismissive of this gap as being only the product of choice based on personal preference, and furthermore that this gap would not persist into fields like medicine. However, an observation came to light: though my institution boasts that more than 60% of its executive leadership roles are held by women, there was a pay disparity in my department that seemed related not only to part time status, but also academic position. I became curious about this imbalance, wanting to understand the influences on the individual choices of female physicians and also those made by women in other circumstances.

As part of this pursuit, I sought out the stories of my female colleagues, trying to frame their observations within my world. For example, how would it feel to be introduced as “the handsome Dr. Warren” for Grand Rounds? Not only is this confusing, but also demeaning, disrespectful, and draws focus to irrelevant (and in this case, obviously false) personal aspects that have no place in the professional and academic settings. This reflection serves to highlight that even well-intended commentary can have negative effects on people and contribute to everyday experiences of exclusion and barriers.

Dr. Tina Doshi, the Chair of the ASRA Women in Regional Anesthesia and Pain Medicine Special Interest Group, has enlightened us all about the imbalance of gender within our own specialty of Pain Medicine. While there can be base assumptions explaining the male predominance in the specialty of Urology, those assumption certainly do not apply to Pain Medicine. Having never seen male gender as a posted prerequisite for fellowship or employment in a physician group, I grew eager to understand the forces leading to this situation. Furthermore, scientific recognition of the benefits of diversity in patient care teams builds urgency in addressing this disparity.

The range of approaches to these related issues has been described by many writers, and it can feel overwhelming to consider the breadth of changes that would bring the full national and international cultural shift to create balance. One approach, which is useful for me, is to group them in to: 1) actions of individuals, 2) changes at institutional levels, and 3) shifts in societal culture. Although many of these changes are at the societal and institutional levels, the movement must begin with individuals of all genders. Thus, what #HeForShe means for me is that supporters will:

• Seek to understand the experiences of others, particularly those of women pursuing advancement in an environment of inequity – and as such, “walk in her shoes” as much as possible.
• Explore the factors which influence the choice of specialty, type of practice, academic promotion, public recognition, etc. and maintain curiosity about the “second shift” phenomenon that is dramatically imbalanced with a burden on female professionals.
• Speak up when witnessing discrimination, including everyday behaviors, well-intended or not, which bring focus to gender without value.
• Understand that our economy places a high price on time flexibility, and that this price is more commonly paid by women.
• Commit to sponsoring a female colleague in professional and/or academic endeavors.

Support your female and male colleagues alike who chose to take parental leave when bringing a new child into their lives.

Champion institutional changes that move to more supportive and equitable parental leave policies.

These actions can be taken by individuals of any gender to promote gender equity and build care teams with diversity. This is part of my commitment to supporting patients, colleagues, and the future of our specialty through #HeForShe. 

Daniel T. Warren, MD

Deputy Chief, Department of Anesthesiology

Section Head, Pain Clinic Services, Department of Anesthesiology