Paving the Pathway for Women in Family Medicine

Transcript

Emily Holwick: Welcome to Inside Family Medicine, where you hear from leaders and peers in your specialty while learning about new tools and resources. I'm your host, Emily Holwick, a member of Team AAFP.

Today we're speaking with Dr. Elizabeth Garrett, who began practicing medicine in a time when women family physicians were not common and spent her career encouraging women to choose family medicine. She's here today to discuss how she's seen the landscape change for women over the course of her career and what she hopes for the future of the specialty.

Dr. Garrett is a professor emerita of Family and Community Medicine at the University of Missouri School of Medicine. She served as president of the Missouri Academy of Family Physicians, president of the Society of Teachers of Family Medicine and its foundation, and was chair of the American Board of Family Medicine.

She's also a member of the Board of Curators of the Center for the History of Family Medicine and a past recipient of the AAFP's Thomas W. Johnson Award for Outstanding Contributions to Family Medicine Education.

Dr. Garrett earned her medical degree from the University of Missouri School of Medicine and completed her residency with University of Missouri Healthcare. After a few years of practice, she returned to the department and completed a two-year Robert Wood Johnson Foundation Fellowship, earning an MSPH. She remained on the faculty there for the rest of her career.

Thank you so much for joining us, Dr. Garrett.

Dr. Elizabeth Garrett: You're very welcome. It's a pleasure to be here.

Emily Holwick: I want to start by asking you why you chose family medicine as your specialty.

Dr. Elizabeth Garrett: I grew up in a small town by the name of Monett in southwest Missouri, and all the role models there were general practitioners in solo practice. There was actually a woman among that group, which was unusual at the time. I was very impressed by the scope of their practice and the excellent care they provided to families for decades.

So when I got to medical school, in the back of my head was being a family physician and nothing ever changed that. I knew I wanted to do women's health, including maternity care, but I wanted to see men. I knew I wanted to take care of children, but not exclusively. And I think the thing that really drew me to family medicine was the possibility of the relationships that I would have with my patients. And that proved to be absolutely true, that those relationships are what sustained me during challenging times and gave me my greatest joy.

Emily Holwick: Those relationships are certainly foundational to family medicine.

You have an impressive resume of teaching future family physicians, and specifically as we mentioned, encouraging women to choose careers in family medicine. What prompted you to choose teaching over full-time practice?

Choosing a career in family medicine education

Dr. Elizabeth Garrett: It's a great question.

Teaching was not on my radar at all. I was going to go back and join a practice probably in southwest Missouri, but several things happened along the way. Two of my residency classmates that we had talked about practicing together, both decided to stay and do the Robert Wood Johnson Fellowship, which was just a few years old in our department.

So I had a dilemma. I didn't just want to go join a practice on my own. So for a year I marked time by being an emergency room physician full-time, which definitely was not satisfying to me, as I knew it wouldn't be. I got a phone call and I ended up practicing for three years in Lebanon, New Hampshire, and being on the faculty of Dartmouth.

We were building a clinical practice with the hopes of starting a family medicine residency at the time. And at that time, I started teaching. I precepted students in my clinic. I lectured and taught at Dartmouth and I got involved in some research.

I realized I like teaching. I needed to know a lot more about research and they were starting the last class of the Robert Wood Johnson Fellowship.

So all those things combined to bring me back to Missouri to do the fellowship and never leave.

Emily Holwick: Why was it so important to you personally to help make sure that more women knew about family medicine and chose family medicine as their specialty?

Dr. Elizabeth Garrett: Well, I think just trying to encourage women in medicine from the beginning was an important part of it.

There just weren't many women role models when I was in medical school or residency in any specialty. So trying to get more women in, I think, was very important, for the women, but also for the men, for them to see women as role models. And then certainly, there weren't many women leaders at the time either.

So I think just getting women into medicine—and then family medicine was such a great fit; in the time that I chose, it was almost a counter-cultural movement of needing primary care—so as more women came, getting them into family medicine was a priority.

Emily Holwick: We are certainly lucky now here at the AAFP to have several women leaders on our board and also in our staff.

So what unique strengths would you say women bring to family medicine?

What evidence shows women bring to family medicine

Dr. Elizabeth Garrett: It’s nice when research bears out what your instincts are. And I think that women have different communication skills. They tend to spend more time with patients, have more empathy, and studies would show often have better health outcomes.

Women tend to follow guidelines more carefully, and when there's such a wealth of prevention guidelines and such, I think that can be very important.

Women's voices are important too. They, I think, advocate for, women's health, they advocate for other areas, research, and just bring a different perspective to the table.

So I think all that is really important. And the more diversity, I think the more inclusive we can be, fewer blind spots.

I do want to add that in my experience, the men who choose family medicine also have great compassion and empathy.

Emily Holwick: Yes, certainly. Absolutely.

I want to talk a little bit about mentorship as it relates to women in family medicine. I'm curious what role mentorship has played in your own career and what it means to you to be a mentor for so many female physicians.

Dr. Elizabeth Garrett: I think mentorship is kind of a curious concept. Most of my mentors, because of the time I was coming through, were men. There just weren't women around, there weren't women leaders, so I greatly benefited from those men.

Now looking back on it and understanding the concept of sponsorship, I am sure there were countless women and men who were sponsors for me advocating when I wasn't there, helping open doors for me. So I think I've clearly benefited from both those types of support.

And because I benefited so much from men, I'm convinced that women can also be important mentors and sponsors for men. And that's really important, too. By helping all of us, that benefits all of us.

Emily Holwick: Is there a particular story that stands out to you about a physician who you helped guide?

You don’t always know when you’re mentoring

Dr. Elizabeth Garrett: Oh, there's a lot of stories.

I guess a, a couple that come out is a very intense discussion I had sitting at a picnic table outside a Dairy Queen trying to convince someone to go into family medicine.

And then another conversation, less intense, but still very deep, at a billiards hall, with someone encouraging them to take a certain position, and that worked out extremely well for our discipline.

There were also, being on labor and delivery in the middle of the night, long hours was a great time to have important conversations with with residents and such.

But it's a curious concept because I don't think we always know when we're being mentors. I, when I hear back from former students or residents that say I was an important mentor to them, I'm commonly surprised and certainly humbled by that, because I just think teaching is an act of faith. You do the best you can, but you never really know when you're making that difference.

Emily Holwick: That's a really great thing for physicians who are listening, to remember that they may not even realize they're being a mentor, but they are someone who aspiring physicians or early career physicians are looking up to, and they are always serving as an example, even if they don't know it.

So it's so interesting to hear you say sometimes people come back to you later and say, “You were a mentor for me. You were that person.” You may not have even known at the time.

Dr. Elizabeth Garrett: And most of the time you don't hear anything at all. So you just put your work in, you try to do the best that you can, and I think the reverse is true, too.

I think those students and residents, I'm sure I have countless numbers that have no idea how proud I am of them. And that just not only of what they've achieved, but that I was at least along for part of their journey. So I think it works that way too.

But I think one thing is that we always are role modeling, and that was something I tried to remember too, that you can't not role model. So we're always doing that for our patients, for our learners, etc.

Emily Holwick: As you've taught and mentored aspiring physicians, have you come across any misconceptions or barriers that maybe discouraged women from entering the field, and how do you address those?

Dr. Elizabeth Garrett: Early on with my medical school classmates, there were many of them who didn't have two working parents. The mother was a traditional stay-at-home mother and they honestly didn't see how a woman could be both a wife, a mother and a physician.

I was able to share the story of my own family. My mom was a single parent of five of us. I was the youngest, and she worked all the time, and yet I couldn't have had a closer relationship with her. So I could share that. Then as the workforce started changing, I think that became a little bit easier as people saw more two working parents.

Certainly, having children coming through, that was something that just women weren't having them during residency. And now of course that's much more common.

And I think now you can point to so many examples of women who have been able to successfully combine relationships, families and careers, and in our own department, I can point to people where their children have entered family medicine. So I think those are great examples to be able to share.

Emily Holwick: Yeah, absolutely.

And so you've kind of touched on this, but how have you seen the landscape change for women in medicine, and specifically in family medicine, over the course of your career?

Expanding opportunities for women in family medicine

Dr. Elizabeth Garrett: Well, it's certainly gone from women being in the minority to, in some situations being almost 50% or even more of residency classes. So I think that that's a huge change. I think a good change.

We've gone from, again, personally, where I've spent most of my career at the University of Missouri to having had no women chairs to now having I think six women chairs. And our chief of staff is a woman from our department. The head of ambulatory care for the entire health care system is a woman from our department.

So I think that it's changed because now you see women in leadership roles all over—as you say, leadership in the Academy, deans of medical schools, chairs of important committees. So I think that that hopefully lets women see that anything is possible.

Emily Holwick: What does it mean to you just to see that progress and to see how many women are taking those leadership roles and how much the female workforce has increased in family medicine, because this is something that you've been working for throughout your whole career.

Dr. Elizabeth Garrett: It's so satisfying to me.

One of my research interests has been researching the first six women graduates from the University of Missouri, 1900 to 1908. And I remember when I was president of the Medical Alumni Association, it turned out I was going to be president during the 100th anniversary of that first woman graduate, so I proclaimed that there would be a year honoring these past women.

And later I heard that a senior alumni male had turned to another one and said, basically, “Give me a break. Have you ever met a woman who was as good as a man?” And those six women were incredible. And I think it just shows what women have had to overcome.

But not only that, the incredible work they did, the courage they showed, the barriers they broke during amazing challenges. So to see how far we've come just makes me feel like we're somehow carrying on what those early women did. And that gives me great satisfaction.

Emily Holwick: There's no doubt that some of the change that you've seen is thanks to your work and your commitment to bringing more women into the medical field.

I know, as we said, you've inspired and mentored so many women along the way, even if you didn't know at the time that you were mentoring them. So as we look ahead now, what are your hopes for the future of family medicine and women in the specialty?

Meeting the challenges of today and the future

Dr. Elizabeth Garrett: Well, there's, there's no doubt these are challenging times.

I retired before COVID when many doctor-patient relationships were challenged in ways that I think surprised everyone. What's happening now with the distrust of science and just everything around us are incredibly challenging.

My hope is that family medicine—and primary care, but family medicine especially, since we go where people live more than any other specialty—can get more value, can get more support, both financial and in other ways to help people do the job that they are so capable of doing in ways that are more doable for them, provide better balance and let them have more success.

I also hope that we can regain a trust in science and vaccines. But family medicine is here to stay, and there's no question that women in family medicine are here to stay and will help with all the challenges that lie ahead.

Emily Holwick: I wonder if you can just share some words of wisdom or advice for women who are considering family medicine today, or maybe they didn't know that they should consider family medicine.

What would you say to them?

5 tips for women considering family medicine

Dr. Elizabeth Garrett: Just have them talk to me.

Well, I thought you might ask that question, so I actually jotted down five areas of advice, I guess.

1.        First of all, just despite all the insane challenges today, I would choose medicine and family medicine again in a heartbeat. There's no doubt in my mind the relationships with my patients were incredibly satisfying, and I truly believe that I received more than I ever gave. They showed me courage. And kindness and grace that made all my problems seem very small in comparison.

2.        Second, never underestimate yourself and the power of your voice, your perspective, and your role modeling.

3.        Third, I think keeping in mind that personal and professional lives are arcs that are going to have different realities and challenges at different times. Don't try to do it all. But do pour yourself into what it is you choose. I gave a talk that surprised me when I was president of SDFM. It was during the SARS pandemic, and I told this room full of family medicine educators to do less—to do less to take care of themselves—but whatever they do, to try to do it even better.

4.        Fourth, to take care of yourself emotionally. Physically, get out in nature more. I personally would recommend that everybody become a bird watcher. I would just say that.

5.        And then the final one is to be kind to yourself and others. Always be ready to lend an ear and a helping hand, seek out mentors—and I will reveal that I'm a Harry Potter fan—and avoid Dementors. Avoid those people that suck the life out of you and bring only despair. So seek out that which makes you happy and, I guess, always have chocolate with you. So that would be my words of wisdom there.

Emily Holwick: I agree with that one, too. Those are all very valuable pieces of advice.

I can't thank you enough for joining us, and for sharing your passion for mentorship and for all the work that you've done to inspire and encourage future family physicians, and the work you continue to do.

And to our listeners, if you'd like to learn more about choosing family medicine or how the AAFP is working to support female physicians, we have links for you in the show notes.

If you enjoyed today's episode, let us know by dropping a line to aafpnews@aafp.org.

Be sure to share the episode with your followers on social media and tag the AAFP.