 Wonderful welcome everyone to the gender equity and ethics seminar series we're on our fifth. In the fall quarter and looking forward to hearing Dr wire speak today I'm going to announce her and introduce her and then we will look forward to four more three more virtual talks in November and then our next in person one will be in December so. Let me introduce Dr moyer Dr moyer and is the executive vice president and chief executive officer of the American College of traditions. She's board certified and internal medicine and infectious indeed, and she's been a cello of the ACP since 2007. She's also at the ACP honorary decade of the honorary designation that recognizes ongoing individual service and contributions to the practice of medicine. She has served on the ACP's Board of Regents, which manages the business and the affairs of ACP and is the main policy of the college. She chaired the ACP's Board of Governors and served as governor of ACP's Pennsylvania South. She currently serve in the board of directors for the Council of medical specialty societies and is the immediate past president. She's also serves as the immediate past chair of the board of directors of the primary care collaborative. Dr moyer is a member of women impact and is 2020 recipient of the American Medical Women's Association Elizabeth Blackwell award, as well as the recipient of the 2020 Lewis cat school of medicine at Temple University alumni achievement award. Priority becoming ACP EDP and CDO Dr moyer was a professor of medicine executive vice chair for education in the Department of medicine, and the internal medicine residency program director and assistant dean for graduate medical education at the Lewis cats school of medicine at Temple University. She was previously the co faculty advisor for Temple University School of medicines internal medicine interest group and for Temple University School of medicine student and educating about healthcare policy group. She received the temple University School of medicine women in medicine mentoring award in 2012. Dr moyer's research and scholarly activity interests and presentations have been in the areas of medical education. She has high value care, patient safety, professionalism and digital media, gender equity and HIV infectious disease. She received her bachelor of the arts degree biology and psychology from the University of Pennsylvania attended medical school at Temple University, and completed her internal medicine associate at Temple University and was chief president and clinical instructor there also. She went on to complete an infectious disease fellowship at Harbor UCLA medical center in California, and currently practices part time at Temple University internal medicine associate so welcome Dr moyer we're really looking forward to hearing your talk. Thank you for that introduction and I do say that those sorts of introductions get my imposter phenomenon going. I'm really sorry I couldn't be there with you in person, I have some commitments in Philadelphia with board meetings committee meetings, etc that but I really wish that you could be I could be there. So this is going to be about women leadership and the importance and how inexorably intertwined academic medicine is with national physician society leadership. And this is not forwarding. Hold on for a second let me stop my share and see if it will go now if not. This is the same problem we've been having an it glitch with our computers so it's not going to go. There we go. So here are my disclosures. Many of them you already heard. Here's my imposter phenomenon introduction I am a PG why 38 internal medicine infectious diseases physician who currently practices part part time, and I'm a recovering internal medicine program director Dean ACP Governor Regent. I'm in my seventh year as the executive vice president and CEO of ACP. So, we're really going to talk about what are some of the obstacles and what are some of the strategies. What are some of the actual interventions, where we can get to a more equitable arena. And, you know, I always like to reflect on where we've been and the continuum and this is the, the note from Watson and Rosalind. Thanks so much for your hard work on unlocking the secret to the helical structure of DNA. Great stuff has been very useful for us. So sorry to leave your name off the paper, we totally forgot, we are such scatterbrains. By the way, could you fill out the online catering order for our Nobel Prize celebration luncheon awesome sauce we may be Nobel winners, but we're just so bad with technology. Women in health care, whether it's you're on the front lines of care this is frequently how it feels and it still feels this way at times, we're doing everything we can to make him comfortable short of dressing up as male doctors. And I'm a big fan of clearing elephants out of a room I just had to have a couple of crucial conversations this morning, where we cleared the elephants out of the room. And I think that the pink elephant in the room around gender equity is that it's not a zero gang. When we have a more diverse, diverse, inclusive, accessible group of people that are at the leadership table that are making decisions, we all get more. And we know that whether it's healthcare or non healthcare business leadership for women, when women lead performance improves or collaboration, there's more innovation. And to quote breakdown barriers that hold women's back, it's not enough to spread awareness if we don't reinforce the people need and want to overcome their biases, we end up silently condoning the status quo silence in this arena does and condone the status quo and we know that gender equity improves so many parameters. When it comes to engaging women and engaging folks from other global majority but traditionally minoritized groups in medicine. I also know there is an intersectionality here, even though this talk is about gender, there is a lot of intersectionality that needs that needs to be pulled in here. Now I come from an organization the ACP is about 107 years old 1915 was when we started, and we have really been helping to lead the charge when it comes to organized physician medical groups. And finally, and internationally we were the first organization to speak up after what happened to George Floyd, and we have issued a commitment not just to be diverse inclusive accessible just, but to be actively anti racist. The leadership is no longer an option but an imperative you have to have men at your table, the people that are in the powerful positions need to be your allies your sponsors, and help you to get there. And Dr Carlos del Rio who I've gotten to know pretty well we've been doing a lot of American College of Physicians and our journal annals of internal medicine for COVID discussions, and he's done a lot of them for us. And he talks about shattering the glass ceiling is an urgent priority and we can expect women to do it by themselves. So, there is an imperative to get everyone to be all in on this. Now my story I just want to tell you, you know I I'm a big believer in telling stories. I was so poor on my pop pops farm in rural Pennsylvania. No one in my family was even in healthcare in fact no one in my immediate family even went to college, let alone medical school and became a physician. And I was, I think it was serendipitous that I was cared for when I was ill as a child with pneumonia in the hospital by a unique person in the medical arena of Berks County, Pennsylvania and that is a female pediatrician Dr Sandra Rowan, who recognized I think that I had potentially an interest in healthcare. And I seemed like a nice kid. And she I think she also knew that sometimes having contact with the healthcare system early on is what galvanizes in healthcare. And she encouraged me to strongly think about being a doctor and she was my pediatrician through the time I was 18. I also had a, a one of my teachers my high school, AP English teacher who was also really encouraging as were my science teachers. And it was, it was a challenging journey I went to Penn which was incredibly competitive. I got, got to find my peeps and my posse there that helped to get me through it. Went to medical school at Temple because I really believed in the mission of Temple School of Medicine caring for the largest underserved group in Philadelphia and stayed there for residency because of the mission and then did a fellowship out on the west coast at an L. Hospital. Once again, because of the mission I wanted to be, I didn't want to have to take, take care of worried well people really wanted to have impact with my care. I fell in love with medical education along the way, much to the chagrin of the ID researcher person that I was working with as a fellow, and ultimately went back to temple and took a job that was a combined job in internal medicine infectious diseases but really had sent the bulk of my clinical career, caring for people living with HIV and teaching. And it was in 2005 when I got tapped on the shoulder by then the ACP governor for the southeastern portion of Pennsylvania Pennsylvania has three ACP counselors and guy named Dr. Chuck Cutler general internal medicine physician he was the current governor. He nudged me to get more engaged in the, the Pennsylvania ACP chapter council. I went out and tried it on for a meeting and really enjoyed it. I also did it at a time that personally was better for me I was having a lot of challenges as many of us have integrating personal and professional life and really my network up until then the program director was with the Alliance of academic internal medicine and the association of program directors of internal medicine and thought of just putting something else in my portfolio for a long time was overwhelming. But in 2005 my kids were 16 and 12. And I decided to jump in and the next thing I knew Dr. Cutler and a few other folks, Chuck and a few other folks were tapping me on the shoulder to put my hat the ring for the election for the next governor. And again, I had to get over my imposter syndrome and, and really felt that I wasn't going to win. They put me up against the most connected physician in the Philadelphia area who ran this whole big network of practices at another health system. And I was shocked when they called me up and told me that I won. I truly did not believe it. Again, I, people tapped me on the shoulder sponsored me in my leadership trajectory with the ACP. And I, you know, went from the Board of Governors ran for chair of the Board of Governors was elected for that and then became a member of our fiduciary board which is the Board of Regents, it's akin to a Board of Trustees. Again, in 2015 Dr. Steve Weinberger who had been the CEO, there had only ever been white male CEOs for American College of Physicians announced that he was going to be stepping down and there would be a search. And it didn't even dawn on me to put to think about putting my hat in the ring. And once again I got nudged by both men and women to strongly consider this and at the time where I had to make this decision, my husband had been diagnosed with renal cell carcinoma. And, and it was a really difficult time personally, but I decided to go for it. And we know all the data around the confidence code that men will go for positions and promotions when they're 60% qualified, but women have to be well over 100% qualified. And I've gotten to meet a lot of amazing people along the way develop a lot of networks and and a lot of support. And the final thing I'm going to tell you is that at the time that I became CEO, which was September of 2016. In the exact same month, the Board of Governors, which is like our House of Delegates was meeting and our Council of Resident and fellow members brought a really important resolution to the college. And that was to expand the policy around women physicians and gender equity and compensation and advancement. And this was the paper that came from that and I got to be one of the authors of this paper I was the chair of the health policy committee originally and I as then the CEO, got to participate in the writing of this paper which really focused on physician compensation right it's more than salary it's, it's salary and every other sort of support that you need in your clinical administrative life. We expanded our policy around family and medical leave and I did some digging and found that within the my own organization at a staff level. I needed to change the parental policies as well. Leadership development bias training research on gender inequity and we have a lot of research there's a tsunami of data that Houston we have a problem, and then explicitly opposing harassment discrimination retaliation. And as you know policies can live on shelves and draw dust or they can be activated and executed on the ground floor and I'm going to go through some of that process with you. There are a couple of websites that we have that we're in the process of also revising around women in medicine and around diversity, equity and inclusion, but I'm going to also talk to you about what goes into that. We also at the same time as a national professional society just like an academic center has to adapt to generational expectations, expectations of diversity that the mission, the personal community the desired mentorship and input. And so one of the things that I have done as a CEO is I've totally uprooted the previous strategic planning process. And working with the team, the senior team around me, we came up with a much more integrated aligned cohesive strategic planning process, and our strategic priorities are for the one around the value professional identity of internal medicine physicians, 25% of the practicing docs, 25% of the trainees around membership growth and engagement around innovation and strategic alignment and then around diversity, equity and inclusion. So we have diverse needs and expectations of internal medicine physicians and we really needed to more effectively integrate and align resources and focus on the outcomes and make do this in a data driven way. And because healthcare is data driven and that's where we need to be. So our DEI focus this year after starting our journey initially with a DEI task force, then a DEI subcommittee of our governance committee and the reason why we put it there initially was the governance committee in the ACP structure is the committee of committees, they create all the rules of engagement for the organization. So we wanted it to be put there to make sure that it had the heft of the governance committee behind it it's akin to putting attaching it to your board, essentially. And then what we did was we rolled it into its own freestanding committee once we did all the groundwork and what we did was, we took that equity lens to our mission, our vision, our goals, and we are systematically going through everything that we do. We do internally as an $80 million organization with a little over 300 employees, everything we do with our leadership in our organization and the governance and then everything that we do with our chapters because we think it's really critical that we take a look and make sure that our leadership in our organization reflects our members our rank and file members, and ultimately the patients that they're caring for. So we've done a lot of work I'm not going to go through all of this in the diversity, equity and inclusion arena, looking at this Venn diagram of those three major groups where there is a lot of overlap. And, you know, professional societies need to work with academic centers, because we are intertwined in terms of leadership that we are looking for leaders who have made their mark in whatever they do and if they're in academics. And likewise promotion in academia and advancement in academia is frequently they're looked at also through the lens of what you have done for professional societies and what impact you have had. So, we are dismantling and equitable practices we're trying to promote inclusion and diversity of the healthcare workforce in addition to our own organization, embedding racial and social justice into professional society infrastructure, equipping healthcare providers to advance racial and social justice via education, and to address the social and structural drivers of health. And we have targeted DEI as one of our targeted philanthropic initiatives as we move forward, as well as our leadership and career development, which will also be very much focused on getting us to a better place. And for example, one of the first topics we're taking on clinically in an aligned strategic fashion across the college is the issues around weight management and caring for people with obesity. So women in medicine. So, even though there were a lot of 9000 women physicians by the end of the 19th century they were excluded wholly excluded from membership in medical organization so they started to form their own. And we saw at the same time the AMA which is 175 years old was formed in the 1870s and ACP in 1915. By 1937 there were only 57 women physician members of ACP. And the first one was elected to fellowship in 1920, but you can see this is really a glacial timeline in terms of when women started to reach and reach leadership in the college. It wasn't until 1979 that Harriet Dustin was the first woman elected to our board. And then 1989 when the Linda Hawes Clever was the first woman to chair the BOG. And we've had several women presidents we've had several women chairs of the board we had a landmark year during the pandemic when the president of ACP the chair of the board of the regents and the CEO were all women for the very very first time. Dr. Christine Lane was named as the first solo female editor in chief of Annals of Internal Medicine in 2009. And this is what the ACP Board of Governors looked like in 1982, you know, it was it was all predominantly white men, and we are moving in this continuum in terms of where we were in 87, and where we were 20 years later and our Board of Governors is now much more reflective. Now, unfortunately, other groups are not that much more reflective and some of you may recognize this picture of men, all white men, discussing a very crucial topic, which was women's health. This is the Freedom Caucus meeting in 2017 on the Hill. Where are the women? Well, I will use Dr. Julie Silvers famous analogy where all standing in line waiting for the back room, because the people that have created these structures have not taken into account the different needs of their biological needs, support needs, etc. for women in general, and women in health care in particular. We don't expect these women who are standing in this line to fix this problem on their own. What we really need is a major structural rehaul, a major structural reconstruction. And as much as I love Adam Grant's work and he presented this, you know, to his MBA students, you know, he was seeing under representation of women in leadership roles at Wharton. And, you know, he basically discussed the factors that held women back and despite doing that, there was no increase in the bump of MBA students who were women to apply for leadership positions. But then the next year he tried something different. And he did the one sentence experiment that basically telling people that they needed to do something about this. But this needs to be a combination of grassroots but really, really intentional deliberate structural change, because simply slapping the ladies, signing converting the men's room into the ladies restroom as was done at an AMWA meeting I was at a few years ago that is not going to suffice that is not going to be durable. And so, again, Dr. Julie Silver, I think really helped us with this to look at this through the lens that we look at what we do every day in science and that is that it really needs to be a data driven process. That's where you look at the important aspects of a just equitable, diverse, inclusive, accessible arena through the vision, mission and values and ethical code of conduct of your organization and report it out. Talk about what's causing the disparities do that PDSA cycle, implement the strategies track your outcomes adjust your strategies and report and publish your results. And there is an incredible role of academic societies and, and academic journals. Dr. Chin lies alone chin. The partnership of institutions medical societies and academic journals will be a pivotal step in ensuring systematic change that addresses gender equity within the full context of diversity, equity and inclusion. And what we had to do was do that to do that really long fall deliberate practice and look at every policy, every structure within our organization. We've all done a lot to forge external collaborations. We've developed affinity groups. I'm going to talk about what we did with our awards and master ship descriptions, and we're continuing to track and review the data and make the adjustments. And we're communicating coordinating and collaborating along the way. One of the things that we noticed were that there were very few women who were being recognized with master ship in the American College of Physician this is designated for about 50 to 60 folks every year. It's really the folks that are done amazing work in internal medicine. In 2007 to 2014 less than 10 women per year were nominated for MACP. And if we looked at the 2007 2008 year specifically only four out of the 80 MACP nominees were women. Every single one of them was selected. Now that's in contrast to 9% overall of MACPs. What we did was we did a deliberate practice peeking around corners looking to see who was overlooked, who was hidden in plain sight, and was more than deserving was not just deserving but these were people that have been overlooked for a very long time because of the affinity bias that you see when certain groups and in this case, majority of MACPs were white men, look to other white men for potential nominees. In 2019 and 2020, we had 87 MACP nominees who were women of the 27 women that were selected, 18 of the 27 were selected so that's two thirds that's compared to one third of the men. The third of our MACPs were women and we continue to work to again have that deliberate practice, but additionally, we also recognize and you probably recognize this for your own institution that your awards your honorific designations need to reflect your evolving values at your organization. And it's critical that you make sure that you are doing this in a mindful way. Senator Lane has a very, very diverse group of folks as deputy editors, associate editors, and the annuals editorial board, the publication committee for the annals of internal medicine. And it's, I found this really, really interesting. This was the gender disparity and citations in journals that was published about a year ago and this was a study that took a look at five original research journals. And from over the course of 2015 to 2018, and the ID the gender, and women wrote about 36% is the primary and 26% is the senior author. But basically what they found was articles written by women as both primary and senior authors had about half as many median citations as those written by men who were both primary and senior authors. And this really needs to us to take pause and to think about when we're writing articles again, are we casting a wide net about the citations that we're going to use. This is another fascinating story in terms of I cannot see I cannot be what I cannot see this is the proportion of women on the cardiovascular clinical trial investigators and leadership committees for those clinical trials. And the clinicians and probably the cardiovascular researchers here know, all those cardiology studies have those, you know, those cool acronym names like Jupiter and other things. But what they were finding is actually if you took a look at Negem, Gemma, and Lancet, and the black bar being no female investigators, and the green gray bar being no female physicians on the leadership committee. And that was between 40 and 60%. So, you know, pretty shocking, right, given that half of our patients that are cardiology friends are caring for our women. So if you look at what's happening in boards, we see that that, whoops, hold on for a second, that AMA has a reasonable balance ACOG American College of OBGYN has a fair amount of women on their boards American Psychiatric Association a little over 50% American Academy of Hospice and Palliative Medicine, also around the mid 50% tile. And. Oh my goodness, it's, it's getting stuck again. Let me just try something else. And okay, let's stop the share and go back and see if we can fix it. Luckily there's I have a lot of I'm very stubborn so I'm not going to let this get the best of me. So, and I'm really happy to say that our board has really undergone a transformation. And honestly, it's because there was again a deliberate practice in this. In 2010 2012 range the ACP had 48 board members now any of you who know, you know the data around this know that that's never a good idea. And to have so many folks on a board you're just not going to get things done. And what they tried to do was to actually take a look at the size of the board, and in it engineer diversity. So they basically have the size of our board at ACP. And we gave automatic age diversity because we gave a voting seat to the medical students to the trainees and to the career care the Council of Early Career Physician chairs. And that was really key in transforming our board. Now, here's a Dr. Silver's work also around the percentage of women presidents you can see there's a large number of national professional societies that as of 2017 had not had a single woman president, and then a handful of ones that are in the 10 to 20% range. And the ACP fall felt in that range and, you know, once again, we are all intertwined and leadership in natural professional societies is achieved by leadership in academic health care and other types of health care and we all know the data around women's affairs and deans being a little less than 20%. And when we even look at who the who are the deans, we know that the women deans were more prevalent in positions focusing on med ed, least prevalent in those positions focused on strategy, finance and governmental relations. And of course we know the inexorable zero of less than 1% of black women. And as Quinn Capers who I had the wonderful opportunity to actually interview on a fireside chat for ACP scientific met meeting that was held in your great city in April, stated, even if we ignore the preliminary data that in some women physicians have been shown to outperform men in terms of following evidence based guidelines. There's no rational explanation for why so many brilliant women are underpaid and under promoted in academia. And once again, this is not us versus them this is what can we learn from each other. And when we talk about what's happening, we know that over 50% of medical school classes are now women, but we're seeing the phenomenon of occupational segregation, trainees are continuing to distribute into specialties in ways that reinforce rather than mitigate pre existing gender imbalances. Women are going into pediatrics OBGYN psychiatry family medicine internal medicine. They're not going into our surgical areas to interventional cardiology and other procedurally oriented specialties. What we know is that women and underrepresented in medicine, underrepresented racial and ethnic groups are recruited evaluated advanced promoted mentored sponsored and compensated differently than those in the majority power holding groups. And this is for you and me graduate medical education practicing docs. And we also see this also in patients out at the biases in patient satisfaction data. And despite the National Academy's requirements that double IMC affiliated hospitals and healthcare orgs maintain a clearly written bill of rights and responsibilities communicating a zero tolerance policy for harassment towards healthcare practitioners. When Dr. Big Leonti pulled the data for 55 academic health centers, zero contained the recommended specific language. And then of course there's the whole wide world of social media. We know that women are suffering many, many more attacks on social media. So how are we going to get to a better place here. And I really do like the format of looking at this in a systematic data driven way. There's many, many metrics that we can look at. We can look at compensation. We can look at hiring and promotion, executive and departmental leadership. But you know what really has to start at the board level. The board has to say this is an important priority and help to set that mission and vision and goals for the organization. So we need our boards to look like the people that are in our organization and ultimately the patients that we're caring for. So I'm really happy to show you this slide. We have 25 members of our board right now, 18 are women, 11 are people of color, two are international medical grads. We have a little work to do there. Eight out of 25 are under the age of 50 and two out of 25 are openly gay. We also have marked geographic and practice setting diversity on our board. And once again, this just didn't happen because someone sprinkled some pixie dust on this. This was really the deliberate practice of finding those incredibly well qualified people that were getting over booked. Now, you may ask, well, where did your title come from? Well, it came from taking a look at the National Professional Physician Societies that are involved in the Council of Medical Specialty Societies, which is a group that was founded in 1965 by ACP and two other physician groups. And it now has over, now what, we just added two more. So it now has 50 physician professional societies covering over 800,000 of the about a million practicing physicians in the United States. 18 out of the 48 CEOs or executive directors are women, but not all these CEOs or executive directors are physicians. There are only nine of these 48 are physicians and three of nine are women. So Dr. Maureen Phipps, Dr. Patricia Turner, Maureen Phipps is the American College of OB-GYN. Patricia Turner, the relatively new CEO of the American College of Surgery and the CMSF CEO is a woman I am physician, Helen Burston, M-D-M-A-C-P, a new member of NAM. I know that Dr. Aurora, congratulations on finally getting inducted to NAM. I think you were elected in 2019. And congratulations and Dr. Burston is as well. So, and then there were four, there are four women physician CEOs of national physician professional societies and I got to actually meet with two of them in person last week when I was in DC, meeting with my staff and we were having some committee meetings. The Council of Medical Specialty Society Board is an 11 member board, eight out of 11 are women, four physicians, four non-physicians, two are women of color. The immediate press president, the current president are women and the president elect designee are all women. And here is our board of directors and that is Dr. Maureen Phipps and that is Dr. Patricia Turner. Helen's not on this picture. So, I think this is a great article and a friend of mine, Dr. Hustane, published this in the Philadelphia Business Journal in March of 2017, mentoring Monday, you know, how we can get diversity in the board room and it can boost Philly's economy. And what she looked at were actually the healthcare systems in Philadelphia. And she found that 80% of the healthcare professionals in the Philadelphia region are women, yet less than 20% of the healthcare institutional CEOs are women and less than 25% of hospital health system boards are comprised with women. And so it's leaky pipelines and sluggish middles and governance rules matter here. And many of the nonprofit boards are self-sustaining or closed, meaning they only do nominations from within. And at the same time, one out of five CEOs believe they had quote the right board members. So we really, again, talking about how we are all interconnected and how we need to work together on this. Now, a talk in all this wouldn't be finished unless we talked a little about equity in the time of COVID. And I know you're very well aware of this. And I can tell you, as the only infectious diseases CEO in the CMSS and of the major societies, and I didn't mention Dr. Eliza Chin or Dr. Elena Rios, who are AMWA and NHMA, because they're not in CMSS, but they are also women physician CEOs of physician professional societies, but they're not specialty societies. They are societies that encompass the umbrella group of all types of physicians. So we know that, you know, women, and I certainly have felt this as I got lots of questions throughout the pandemic, I continue to see people. And we know that 75% of healthcare professionals that were infected with COVID are women. And we know that these women are frequently disproportionately working in underserved communities. We know that for women, it really has been the third shift. And I want to commend Dr. Aurora and her team for presenting this originally at the Women in Medicine webinar about what we need to do to acknowledge all of the work that was done by folks to turn curricula that we're getting delivered face to face to virtual to think about how we're going to bridge fund people, how we're going to sort of stop the clock and capitalize the full spot spotlight on it in equities and of course this is the publication with the rubric that Dr. Aurora and her colleagues published in the Journal of Hospital Medicine in 2021. So as we think about the catalyzers that are going to get us all working together, we need to make sure we're performing the foundational work. I, we've done a lot of free consulting for other physician professional societies to help them on their journeys. Folks are at different spots and this continuum, but we all need to support each other and share. So we have done a lot around sharing our policies and procedures and how we went through this process and are continuing on this process, especially around the governance issues to remove implicit and explicit bias in all recruitment retention appointment promotion leadership educational advancement and other opportunity processes. Ensuring that our organization has very robust and accessible anti harassment and discrimination policies you know a lot of people it again there's a policy it's resting on a shelf. It's gathering dust, but it's not activated appropriately because it's not accessible or people are worried about consequences if they do activate that we need to have a zero tolerance for this we need to get granular. The thing that I would say that I speak with Amy Gottlieb a lot and we talked about this when she was in Philadelphia recently for a talk over at Penn is this is a critical organizational effort, and it needs to be empowered and funded and given appropriate authority appropriate to that. There should be a significant number of FTEs and a whole section on the org chart of an academic center, a healthcare system, a medical professional society that is dedicated specifically to this just equitable and diverse inclusive accessible organizational mission vision and value. It's got to have teeth and giving people responsibility without authority is not going to get them anywhere they need to have the power and sit in a place in your organization, where they need to do this critical work and have the staff to be able to help them and again to have the power to be able to have impact and to make changes and not just putting sort of lipstick on it and calling it calling it a day. Let's talk about how we're allocating and prioritizing financial and other critical supporting resources. This deliberate practice and transparent data collection cannot be emphasized enough, and then tracking the data and putting our dirty laundry out there for people to see. We're getting them know we are working on this we are, we are really committed to getting to a different place. We've also got to know what the elevator stories are, and we've got to be able to launch those elevator stories we are all better. If we get to adjust equitable, diverse, inclusive and accessible healthcare system, and we've got to be shouting that down and we've got to make people realize how critical this is. We've also got to know that other people are watching us, you know, the joint commission which ACP was one of the five founders of I just spoke with Dr. Perlin. The other day, you know, they they've got a lot of regulations around this, the double AMC, the ACG ME the state and local licensing boards health departments are all very, very concerned because they know that if you've got an environment that's mired with an environment that that is antithetical to being a safe high quality organization. So there is a big role for them I'm not going to go through all the rules and regulations that are there you can look at them on your own from double AMC from ACG ME from the joint commission. We are partnering with a lot of folks in this space, we are currently involved with the ACG ME equity matters initiative and this is a partnership that ACG ME has with CMSS. The other great thing about CMSS is this is where the organization of program directors association sits. So all of the residency and fellowship training programs in the US are part of the CMSS umbrella. And so we are working with ACG ME to move forward with that we're also working in conjunction with the AMA IHI American hospital association on the national initiative for health equity which is harmonizing healthcare organizations, individual practitioners there's still a lot of them out there I've got a lot of them as members, payers farmers at pharma and professional societies to work together we recently hosted a healthcare roundtable at ACP, where we talked about our efforts there were a lot of the stakeholders who fall mostly in the payer and pharma arena here and they are all really, really interested in in helping and in synergizing and syncing up. So it's all about leadership it's listening it's engaging others it's advocating acting amplifying developing yourself and others, elevating and lifting as you climb deliver and documenting respecting having radical empathy and transparency, being strategic, serving sharing, being inclusive intersectional and intentional. And the last job that I think I as a woman of a certain age, being a prepared professional disrupter. So that's an excellent suggestion miss Triggs perhaps one of the men here would like to make it. I know we've all felt this moment. And I remember the first time I sat at the division chief table at Temple, when I became the program director and I looked around and I realized I was the first woman and of course there was no chair at the table for me so I just pulled a chair and the other underrepresented folks off the rim get them at the table, get your elbows on the table and support others and you know I'll tell you that in my first year as CEO I did a lot of listening and learning. And I wanted to really understand the culture of the ACP I wanted to understand the culture of the organizations that we had the closest interactions with. I remember having this this similar scenario happen at a strategic planning meeting of a board that I was on not my board but a different board. And there was a woman sitting next to me and a man sitting on the other side of me they were both from the same organization. And they were talking about potential strategies for the organization and the woman talked about the importance of addressing the epidemic of professional dissatisfaction of brown out and burn out and how that organization really needed to think about having a major strategic goal in that arena. And she made her comment wasn't really acknowledged by the person who was leading it and then the man, Dr why Dr x made the comment Dr why basically paraphrased what she said. And it just he just saved the world with that comment I mean it was acknowledged. We, and we've all been in these situations and I decided to start being the professional disruptor at that point and I raised my hand and I said, they called on me and I said you know I thought that the idea that Dr x, the woman brought to this group is a phenomenal idea and for a strategic vision, and that Dr y built on in his follow up comments so I was able to convey the message that it was Dr x who came up with that idea, and Dr y expounded on it. Because I'm now at the point in my life where I guess because I am a woman of a certain age. And because I feel like I have a need to have that voice, I am. I am really taking a stand for others. Because remember she at the end of the day is someone's sister mother, daughter, wife, and there is always light if only we're brave enough to see it if only we're brave enough to be it. So with that, I am going to stop my share. And thank you for your attention. And I don't know Dr war and team what you want to do in terms of questions and thoughts. Yes, thank you so much about wonderful talk. I encourage people to put questions in the q amp a part I'm happy to read those out. I'll just start with, with this question I was really impressed when you put up the ACP all the leaders of women and the ACP over the years. And you noted the glacial pace that you know it took and I wondered if you could just comment on what it's really sped up that pace like towards the end it really you know with Christine. Yeah, let us say I wondered if it isn't having a woman leader at the top that speeds up the pace or what could other organizations do to. Yeah. Well I think it's, I think it's, you have to get everybody on the bus. I mean it's very clear that it was a lot of men who saw men in power in our organization and in other organizations, who those folks who are enlightened see the value of diversity, and bringing women to the table not to just take the notes and get coffee, but to really be engaged at the table. And I would say that you know I'm, I'm in my early 60s, and the majority of my sponsors and allies have been men. At the same time, I've had no problem actually asking for sponsorship and ally ship when I felt it was important to go after some. Some of it I've been nudged, but I've become increasingly more comfortable in that. So I think it was probably a combination of those first few women who were in the power I know a lot of them actually I serve on the ACP AMA delegation we have the biggest delegation in the AMA House of delegates we have 34 delegates with Dr. Donna sweet who is one of those first women with Dr. Mary Harold, who was one of those first women with Dr Sandra Abramson fry hopper, who was one of them so I suspect it was sort of that. Coming together of everyone in power and saying that this is really really important. And I'm sure they had to deal with a lot of people feeling threatened by that right we're, we all still see that. But I suspect it was sort of that perfect storm of folks coming together and recognizing and also taking a look at who was part of the organization and realizing more and more and more women were members of our organization and we needed to do something about that. You know, at the same time all politics are local right so you know and just like all of the national professional physician organizations are at different places on this continuum. I see the same phenomenon for my chapters because it's really the chapters are the grassroots, and they're the folks where we get the emerging leaders coming up through the ranks to have national and international leadership positions. So I very much see some chapters that are really really far ahead, and others that aren't quite there so what we're trying to do is take the lessons that we've learned to at the national international level, and to do and also to take sort of the best practices that we are seeing for these chapters to to be able to amplify them and diffuse them into the other chapters to work together to get to a better place. That's great yeah I have I have another question about chapters, but because I had another one you put up that slide there's a couple other comments and questions one was Dr Schwartz, who and just noted that Dr Christine castle was at in our section of this and I think now at the AB I am but also had some roles and ACP. So yeah she was the first woman president. Yeah. Yeah. So, Dr Schwartz wanted to highlight that and then Dr warra just said thank you for an amazing talk I'd be curious what your advice is for those that mid career who feel they're struggling there's been this new data that like the mid career is like the most challenging part of. Dr Lisa Lewis about this a lot you know she's an emergency medicine physician at Jefferson so she's local. So she and I chat about this a lot yeah because you know what you're seeing is this stagnation, and a lot of it is trying to integrate all the really hits you right when you're your mid career. And you know I think once again you've got to be deliberate about this you've got to you know do do a survey figure out what the barriers are. But when you do when you collect data, you need to do something about the results that you find. So I'll give you an example. Dr Lisa Bellini who's one of the faculty of Bearsteens over at Penn, who was the internal medicine program director at Penn when I was the internal medicine program director at Temple. So I got to know Dr Bellini really really well. And you know, so what the major issue that they were finding for mid career folks at their institution and this was physicians nurses pharmacists. Basic science faculty was the issue around dependent care, and the issue around lactation rooms, right something that is required by the Joint Commission and ACG ME and all of that. And it was the one of the biggest barriers for the women that were working there and people were cutting back on hours and thinking about leaving their careers. And what she did was she sort of tried to do this via method a and she wrote this up in the journal Women's Health into 2018, which is that she basically sent a memo out to all the division chiefs and department chairs and where there were, where people were working and said you got to find, you know, space for this. And this is a major, you know, burden for people it's beating burn out. And basically found that everyone responded and said, Well, you know, there's no space we don't have space. And then she decided to activate her posse, and she took somebody from the architect and the building. And from that division or department who was in a leadership position, a couple folks in the dean's office and she went and did a walkthrough of every clinical and basic science area at the Perelman School of Medicine and they were shocking, they were able to locate space for lactation rooms for all of the folks that were in a reasonable amount of walking distance were at quit or appropriately equipped, etc, etc. So what you know what I'm saying is you have to sort of really dig into the details and think about okay so and there's a lot of stuff that is feeding into that mid career stalling. And then you have to do something about it. And starting to solve those problems is going to help us to support the women in our healthcare practitioner workforce. Yeah, but I think you need to again be deliberate you need to not expect people to navigate this really challenging time when you're the busiest ever in your personal life. And you're also trying to advanced at the professional level, you have to be deliberate and you have to specifically target the needs of those folks and it's not just the women right. It's the men like we're having this discussion we created this gems alliance gender equity and medicine and science. It's an organization of organizations. And I'm a lot done, Danovic who is was it famer, who's done everything, every possible thing in academic medicine, internal medicine position, as well. You know, had this vision to pull together this group of folks and Amy got leaves on it she she represents the G whims Eliza chins on it from and Nancy specter from elams on it Helen burst in representing CMSS. Rachel Villanueva from NMA is on it, Rashma Jagsy, who's the new chair Brad on at Emory is on it she could Jane is on it and we're reaching out to academic health centers with. And there's four pillars to this and one of the pillars is mid career disruptions in addition to the one that I'm charged with fixing wish me luck. And it's working with academic centers to understand the needs around dependent care. I mean I think coven really hit us in the face in terms of we quick all of a sudden had, we're working from home and or had kids at home couldn't go to school. It's really sad to see how all of the health care institutions struggled with this, at the same time that you saw the community providers of dependent care, going out of business. Yeah, now. Yeah, some people did some innovative things they did the coven sitters in Minnesota I don't know if you heard about this program but the med students very quickly jumped in they recognize the nurses and the doctors needed to go to work. They were now learning from home, if they were first or second year, and they helped they all pulled together and created a system, but that's not sustainable we need to engineer in community partnerships with those caregivers in our communities. And even if I hear one more person say well we're not in the baby sitting business I'm like, oh yes you are. Everyone who works at your institution has a life they have dependence. They have these concerns and they're going to be much more engaged and much more productive and you're going to have a lot less turnover. If you deal with this. Our, we have a Department of Medicine women's committee. That's about 20 years old and the first thing that they worked on for 10 years was like dependent here on site and now the hospital has one and then one over on the university campus. And similarly the other things are, are women and peeds and surgery women's committees are banding together about this lactation and we're building a new hospital, a new cancer hospital and making sure there's like it's built in from the beginning not an afterthought and and then also I think Anna Volerman's on the college she's been advocating the paper about about just lactation policies for trainees and people coming back and so all the things you're all the things you're highlighting are definitely things of definite importance to us so I appreciate your your timely talk and your thoughtful talk. I think that we'll just since it's one o'clock at the hour we'll wrap up the kind of formal presentation and we'll stop the recording. And then sometimes we have the ethics fellows. I just wanted to ask some informal mentoring questions so be the arena wants to stop the recording.