Welcome to Our Voices, Our Future, the podcast
where we amplify the voices driving change and
equity within medicine and beyond. Brought to
you by the Gender Equity Task Force, a committee
of the American Medical Women's Association.
We're here to challenge norms, break barriers,
and ignite conversations that matter. I'm Megan
Etsy, and in each episode, we'll bring you candid
discussions with leaders, change makers, and
advocates working to create a more inclusive
and just world. No more silence, no more waiting.
You're listening to Our Voices, Our Future. Let's
get into it. Today we're welcoming Dr. Karen
Langer, who is an Ivy League trained MedPeds
physician coach who has helped over 500 women
doctors move beyond burnout, guilt, and overwork
into careers and lives that actually feel good
to live. Through her coaching and seeing the
accredited programs, she teaches physicians how
to renegotiate their time, energy, and worth,
both internally and institutionally. She's also
an ambassador for the Dr. Lorna Breen Heroes
Foundation and a passionate advocate for physician
mental health and gender equity in medicine.
Thank you for being with us today, Dr. Leitner.
Thanks for having me. So to start us off, could
you just share a bit about your journey in medicine,
what inspires you to become a physician, and
ultimately how that path kind of led you to founding
How to Feel Better for Women physicians? How
long do you have, Megan? I'll just keep it brief.
So I, my dad was a doctor and I wasn't one of
those people who thought I wanted to do it from
a super early age, but I just loved being able
to be kind and have empathy and compassionate
and care for others. That's really what drove
me into medicine. Plus I enjoyed science and
learning about the body. But I, so I, you know,
I found training to be pretty challenging and
I... I think it's really important to talk about
mental health issues related to people in training
because I don't think it's spoken about enough.
So I definitely had, let's say, untreated or
undertreated anxiety. And I had ADHD, which I
didn't know. And all of those things made me
really struggle internally with my experience
of going through training. I think I did fine,
but it did not feel good to me. And it really
led me to question if I wanted to go into medicine.
I finally got out and I got a wonderful job working
at a community health center doing primary care
med peds, which is really what I wanted to do.
And I also met my husband and had two children.
And so the first seven years in primary care
were just really challenging for me, progressively
more challenging. As I added children and cut
back on my time, I was doing sort of like a halftime
job with a full size panel and trying to take
care of my family. And I really felt like I was
drowning. And I was going through burnout, and
I didn't even know what that was. It wasn't like,
I don't think I heard that word. So I left my
job. And for the next seven years, I did a whole
bunch. I thought it was the job. And I also had
a lot of shame around my experience. I thought
I just couldn't handle it. And I just maybe wasn't
good enough. And then I was exposed to coaching.
And a lot of other interesting non -clinical
roles that I did, which we could talk about another
time. And it just helped me see that so many
of the reasons I burned out how to do with both
an imperfect system, but also some characteristics
that I possessed that I recognize now in so many
of my coaching clients that once we talk about
them, do you want to know what they are? Yeah,
of course. So perfectionism. people -pleasing,
learned helplessness, which is sort of not recognizing
where we do maybe have more agency within we
realize, being excessively self -critical, imposter
thinking, you know, all these things were the
perfect storm for me who wanted to be a do -gooder
and just be and excel at everything. it was impossible.
You can't. And so I felt like I was failing at
everything. And so I left. And so I don't want
people to go through that. So that's coaching
helped me reframe some of that narrative. And
now that's what I do with a lot of my clients.
Sounds amazing. Sounds like a painful but amazing
journey that you had to go through that to come
to this. But you're able to take what you went
through and turn it into light for other people.
I know that you talk about the invisible curriculum
of medicine. What are some of the unspoken lessons
that disproportionately affect women physicians,
and how do they show up in day -to -day clinical
life? Well, I think that there is a culture of
perfectionism. and infallibility. And we're sort
of taught don't fail instead of here's what you
do when you do fail. We're taught not to be vulnerable
when really we need to be vulnerable because
otherwise if you just take all those emotions
that you go through doing the challenging work
we do and you stuff it down and you never show
any of it and you just act like you got it all,
it takes a toll on you. So physicians and other
people in health care have really high rates
of untreated mental health. comorbid conditions,
anxiety, depression, suicidal ideation, substance
use disorders. And I think it's the hidden curriculum
is part of what drives that because we are message
we're supposed to be to help, not necessarily
that we should need help. And there's so much
stigma about getting that or admitting anything
less than just sort of this all knowing physician.
That's that's the biggest ones, I think. What
do you think? Yeah, no, I think that's good.
My question, though, is then when we're aware
of this hidden curriculum and all these things
that may affect us disproportionately, how do
we kind of come to not only realization, but
how do we learn to help ourselves? Yeah. Kind
of advocate for ourselves in these positions
that are really difficult to. Mm -hmm. Well,
I always think we start with looking at how we're
treating ourselves and talking to ourselves.
Like if the external messaging is just keep going,
work 100 hours, don't sleep all night, don't
go to the bathroom, don't eat, be universally
accessible. I think the system is so under -resourced
and so overburdened that you could work. like
24 hours a day, seven days a week and never stop.
The system is basically just like work yourself
to death. That's a real overgeneralization. But
if you don't set, if you use that inside your
own brain and you don't stop to eat for two minutes
and you don't go to the bathroom and you don't
say, you know what, I can't add on that one other
patient because then I don't get home and I don't
see my family and I don't get to take care of
myself. Like these are all small things that
we do have control over, but oftentimes we are
the ones keeping ourselves in this cycle of overworking
and under caretaking. It's not in any way blame.
It's sort of like it's expected of us. And we
don't want to disappoint anyone else. So what
I talk about so much is that it's not that you
care less or work less hard, but you have to
consider yourself in the equation somewhere.
And what I see my clients all doing is just I
can't not see that patient. What if my boss thinks
this? What if my colleagues think that? And it
leads to people going to work when they are physically
ill, too ill to work. Our judgment is really
impaired. I've had clients who had DVTs not wanting
to get help. I've had someone who is a surgeon
having pneumonia, but showing up to the OR. So
being in preterm labor and just being worried
about what our colleagues will think if we call
out. So it's like a over fear or maybe fear isn't
the right word, but over prioritizing the needs
of everyone else but ourselves. And we really
can take better care of ourselves than we do.
We can. We just have to accept all the guilt
and all the societal messaging that's like, no,
you don't matter. Just care about everyone else.
You have to reject that. It's not easy. Partially
reject it. It's just that we're so worried about
being perceived as selfish or selfish, that we
don't take care of ourselves at all. And so it's
very black and white. So we just have to find
the areas of gray. So to kind of sim off that
many women in medicine struggle with this internalized
perfectionism and that pressure to be good enough.
Can you speak on how that mindset develops and
how we can kind of begin to shift away from it?
Well, we tend to be like very high achieving
smart women. I'm speaking about the women I know,
which is many of them. And part of that perfectionism
leads us to like strive and excel. So we don't
wanna say, be mediocre, but we take it to an
extreme. And so the way that shows up, it's actually
like, the more perfectionist we are oftentimes,
like the worse we do. So I'll just give you a
little coaching example. It's like when I see
a patient and I think, oh, this is so complicated.
I really need to get this note so right. So I'm
just going to wait until I have, you know, two
hours to think about this patient. So I'm not
going to do it now. We want the note to be so
good that we don't do it now. And then we like
avoid because we're like we're like when am i
going to find the perfect two hours to do it
so we end up writing it you know significantly
later or in the middle of the night when we're
exhausted and the note is not better because
we've wanted it to be too perfect the note's
actually worse because it's two weeks later so
it's just sort of starting to notice like oh
you know perfect is the enemy of what is it perfect
is the enemy of done or something like that or
You know, like good enough is actually and sometimes
better than when we perfect because the note
I just write right when I saw the patient is
almost always better than the note I write three
weeks later when I'm trying to remember what
the heck we even spoke about because my brain
tells me it has to be perfect. So it's just it's
starting to realize how perfectionism there's
no such thing as perfect and sometimes the other
way i really get people thinking about this is
it's like do you want your notes to be perfect
and your life to be horrible or could the care
you give be exceptional but the notes you write
be decent and your life be more what you want
it sort of like you get to choose and what choices
do you want to make and do you like your reasons
yeah that's great i i think that that's a great
way to put it who needs do notes need to be exceptional
i mean quality of life Yeah, and then the other
thing is when we've made them like so detailed
and so perfect and we've punctuated everything,
I kind of joking my clients about and no disrespect
intended to the New England Journal of Medicine,
but like. The people reading your notes are also
overwhelmed and really busy and struggling to
just get through their day. So they don't want
to read an encyclopedia and a note. They want
the most important information for them to abstract
and like knowledge they need and move on and
care for the patient. So it's just this culture
of, you know, other people are going to read
my notes. They're going to think things about
me. We also have this a lot of fear about what
other people think about us, which is normal.
But sometimes we don't even realize that we are
just inventing a lot of it. with our own internal
negative monologue. And so just maybe I'm not
going to listen so much to that. Maybe that's
not what I want driving my behaviors. So speaking
about this late night writing notes and all of
these needs for perfection, they lead to burnout.
So this burnout in moral injury is often discussed
as a systemic issue, but it's also deeply personal.
How do you help your clients start to untangle
those forces in their own lives to reclaim their
sense of value? This is another one that's like
a longer conversation, but you know, I really
do believe that the system is the upstream driver
of burnout. That the system is, let's say, let's
just, because physicians oftentimes, we blame
ourselves. When I was going through a burnout,
I thought it was me. I just thought I couldn't
handle it. And I had a lot of shame around that.
And this is not intended to shame anybody because
most of us are working as hard as we can. And
it's not about how good we are. But there's excessive
demands for our time than we can provide. And
not only that, there's moral injury, which means
there's limits put on what we are. Let's say
forced to act in ways that don't align with our
own morals and values So like having limited
amount of time with patients and not being able
to prescribe the medications we want because
we have to you know prior authorizations and
all these little like deaths by a thousand cuts,
so so but within the system right like We can't
change the whole system today and we definitely
can't do it if we're burned out. So the way I
approach this with my clients is coaching is
where do you have agency? Yes, the system. Let's
blame it all on the system. Let's say the system
is horrible. Let's say even though there's a
lot of wonderful things about our health care
system in this country. But if it's not the system
that's going to change for you to feel better,
what can you do? What agency do you have? And
then it comes around to, well, what are the things
I'm doing? For sure, it's paperwork and how much
we're working. But part of what leads to burnout,
too, is this belief that I'm going to take care
of everyone but me. I'm going to. Have unlimited
access i'm gonna check my truck my you know i'm
gonna be i'm gonna be so afraid of like missing
something i'm just gonna work all the time and
i'm never gonna be present in my own life and
that's not sustainable for anyone so boundaries
i think boundaries meaning like what is and isn't
okay with you i'm going to have to say After
the third double book on my schedule like you
can't put anyone else on here that feels really
bad to us Like what are they gonna think what
are they gonna say what if my boss this what
that it's like so we just don't Protect ourselves
so boundaries for other people time boundaries
boundaries on our schedule, but also then for
ourselves we finally get home or Go on vacation
and we just we don't even use the coverage we
have or like I'm so worried My colleagues are
gonna you know, I'm the best person to handle
that So I'm gonna take phone calls on my vacation
a very little vacation I get and I'm gonna check
my inbox and I'm and so again We are we are violating
our own boundaries and it's it's leading us closer
and closer to burnout so I tell people like If
you want to be there for your patients because
you care about them so much, you have to dial
back. You have to take care of yourself, actually,
because if you overwork and over care and over
give, then you burn out and leave. And then they're
in no better. You know, then that's the worst
case scenario, which is pretty much what I did.
I don't want other people to do that. So it's
a reverse. It's sort of like, yes, you have to
worry about yourself, protect yourself, take
care of yourself. But in doing that, you are
taking care of them because you're going to still
be around to help them. And I had a client recently.
She's a subspecialist in a very male -dominated
field. And she had so much reluctance to let
go of things and just not respond to things.
So she was always working. And in the one week,
she finally didn't. We worked so hard. OK, I'm
just not going to. jump in to save everybody
or help everybody. She felt so much better the
next week when she actually went back to work.
She's like, I like my job so much better. I actually
felt so much better able to do it because I actually
rested. So again, it's like one of those errors.
I think if I work all the time, I'm going to
do a better job at my job. Maybe if I don't work
so hard, I'll be more present and more rested
and more able to do what's needed of me. But
we also have to advocate against, you know, just
the excessive hours of work and the inadequate
support and all these things. We have to ask
for what we need, which is not easy. Yeah. So
really, I feel like you have to fill your cup
before you pour into others, right? Like it's
so we say that and we preach that to other people.
But I think no one does. No one does. Well, because
it doesn't feel safe. Right. We're like, but
what is everyone going to think of me if I do
that? Yeah. Like, OK, but what if we all did
it? Then, you know, that's how we make change.
We have to humanize like I spend so much time
talking about. We are actually human beings who
need food and medical care and like maternity
leave. Why do we see ourselves as so different?
I was watching that. And personally, this morning,
I was like, you know, when I was like pre -med
or whatever, I looked up to doctors as if they
were these people who were like, superhuman and
just beyond, you know, and the more that the
closer I get to being a doctor, I realized, like,
these are actually humans, you know, we are just
as human as the next person. And yeah, we need
to take care of ourselves as well. Right? Yeah.
We make mistakes, just like anyone does. We drop
the ball, we screw things up. And it's like,
and then we apologize and we can move on. It's
so hard for us to admit to that. We don't we're
not really taught how to Manage that at least
I wasn't in my training. I don't know if you've
learned anything about what do you do when you've
made a mistake? What do you do if there is a
complaint or a lawsuit? Like how do you handle
that? We usually just think well, it's not gonna
happen to me because I'm that only happens like
bad doctors like no so I also tend to say like
They teach us do no harm. I wish they taught
us do no intentional harm Because we're gonna
do harm because that's just the nature of being
human Yeah. So then what? Like teach us how to
move past it and learn from it instead of just
beating ourselves up and like hiding under our
beds. Yeah. Yeah. I think that maybe another
player to the burnout is what is often written
and spoken about is the gender pay gap in medicine.
Not just as numbers that are an issue but a reflection
of deeper systemic inequities. What do you think
needs to change, both culturally, institutionally?
How do we address this thing that has gone on
for so long and is actually still prevalent today?
So I have some ideas. I don't have a solution.
I wish I did. But I mean, I think the movement
towards pay transparency is really huge. If no
one's looking at how many people are being paid,
then inevitably it shows up again and again and
again. And so there have been actions taken in
various states to promote full transparency.
And even laws, like I know in Massachusetts,
You're not allowed to ask someone what their
current salary is because we're just propagating,
you know underpayment from job to job to job.
So there are You know systemic things so someone
looking at how much people are paid people in
leadership like all those department chairs being
held accountable so like show like look at your
staff how much you're paying them. Are you taking
action to to move towards parity and equity right
and maybe you don't get your funding if you're
not doing that like that's for sure not happening
in many places and I think that would really
help on a systemic or structural level. The thing
that I. think is really interesting is that,
you know how the same way we were talking about
if burnout, if burnout is a systemic problem,
but there's a little bit of control that the
individual has, pay equity is a systemic problem,
but there really is power that the individual
has. And that's what I love helping my clients
do because if you don't even, first of all, if
you don't believe that pay inequity affects you.
Then you're not gonna do anything about it. And
a lot of women, we don't believe it. We think,
oh, but not where I work. They told me this contract
wasn't negotiable. And so one of the things I
do in my program is I give everyone MDMA data
so we can at least look at the facts. Like where
are you paid compared to your geographic and
what kind of. Practice setting are you in but
even with that even when I'm showing someone?
Okay, here we go. You're an amazing physician
You were paid in the tenth percentile for your
let's say you're an oncologist ten percentile
So ninety percent of oncologists working in the
same kind of place as you with the same Credentials
as you are getting paid more than you then suddenly
we're faced with like Well women aren't supposed
to ask for money we're not supposed to ask for
anything we might feel greedy we might look greedy
they might have thoughts about me they might
what are they gonna think about me and maybe
i don't care about money so much i'm not supposed
to care about money because i'm just you know
society tells women they're not capable of managing
money and there's been a lot of um historical
basis for that like we weren't even allowed to
have credit cards without our husband's co -signature
before 1974 until 1974. So it's only like the
last 50 years that women are even felt to be
capable of like having their own money without
a man supervising them. So all that filters into
our psyche. So what I see in my clients is they
don't actually know how much they're supposed
to be paid. They don't realize that it's a fair
market value for a role. they don't realize that
when you negotiate, you can do it in a collaborative
way. So you're not going to get fired for asking
for more. And that you're expected to ask for
more, that most places are not giving you their
best offer right off the table. So there's like
a whole, you need a different mindset when you
go to negotiate. You have to believe in yourself
and the imposter thinking. So many of us think,
well, I just, I'm not that great. So I just be
happy to have a job. And we always talk about,
you know, like you're J -Lo. Like you're daily
like you are the asset and you know you go from
residency where you're really not you know you're
underpaid you have no control you can't say anything
about your schedule or your vacation or what
rotations you do or how much you're made you
have no agency suddenly now you're looking at
your first job And you're still in the mindset,
oh, I should just take what they give me. I should
just take what's on the menu. And that's a huge
mistake, because even if you don't negotiate
$5 ,000 at your first job, you know this already.
But anyone listening who's like, wait, what?
What is she talking about? I'm supposed to ask
for more? I didn't know this. No one taught me
that. $5 ,000 for your first salary negotiation
translates into $500 ,000 over the course of
your career. But we have to take an action. And
then there's all this like, well, but. Sometimes
women are penalized or what if I don't get the
job? And there's a lot of fear, fear about being
perceived in a certain way and magical thinking
like I know what the person's thoughts are. I'm
trying to control that person's thoughts. I don't
want them to think this about me, so I'm not
gonna ask. It gets very confusing in our minds.
And I recently was even just coaching someone
and she said, well, we found out that the job
she was trying to take, we could see how much
the person who had had it previously was paid.
And they were offering her lower than that. And
so I was saying, well, the value for this role,
that's what they're paying for, the role, not
you. Not are you, Megan, blah, blah, blah. But
is this role worth this amount? She was like,
well, I'm worried if I ask for more, then I'm
going to have to do a better job. Like, I don't
want to put that kind of pressure on myself.
And I'm like, there's no. correlation between
how good a job you do and how much you get paid,
like when you're taking a job that's been offered
to you. And also, how would they even measure?
So it was just a very strange way of thinking
that, and someone else told me recently her contract
was coming up again, and she's like, I don't
think I'm that great sometimes, so I just don't
know if I should ask for more. Those thoughts
really hurt us. Who's talking about that? If
we don't change our mindset about our value and
then society is messaging to us that we are less
valuable because we're seeing white men and all
the pictures and all the hallways of our institutions
and then that we've been paid less and we're
getting first named and we're getting thought
that we're the nurse. And so all these things
contribute to why we don't embrace fully our
power and our agency and getting paid fairly.
I don't even know what your question was anymore,
but I'm just so passionate. There is stuff you,
the individual, can do. And if each of us does
the things that we can do, and I also just want
to mention that it's not even all the same for
all women, because if you're a woman of color,
the pay gap is even higher. So there are a lot
of societal and systemic factors influencing
what we can and can't ask for and if we're safe.
And I don't want to be sounding like it's our
fault that we're not paid more, because it's
definitely not our fault. But I also think we
have more agency than we realize if we just believed
in ourselves more or had someone else believing
in us. And that's what I love to do with my clients
because I just have infinite belief in them when
they don't have it in themselves. So to kind
of stem from that, there's often this fear of
advocating for ourselves, right? Or seen as selfish
or demanding. How do you reframe this idea? And
what tools do you recommend for women to kind
of advocate for themselves without this guilt
attached to it? Well, there's studies that show
that women are so much better at advocating for
other women or negotiating for other people than
they are for themselves. So a lot of times it's
just looking at, okay, what are you actually
thinking about this negotiation? Oh, interesting.
So you think that they will think you're greedy.
Well, here's all this evidence that shows that
that's not true, that most people do negotiate
a first offer, but also breaking down, how would
you even know if they thought that? Like they
might think you're greedy right now. Like we
don't read other people's thoughts. Are you greedy?
You know, and where does that idea come from?
Let's get so curious about why would you even
think that? So what we're saying, like if your
friend went to a job and they gave her, and I
showed you, this is the median salary for this
position. And they're offering significantly
less than that. And your friend asked for more.
Would you say to her, wow, that's so greedy?
And so much of the time when we think of it that
way, we're like, no, I would say you are amazing.
sure at least make what all the men or the other
people, the other candidates are making. So it's
just sort of noticing and having an awareness
of how you're thinking about things and seeing
if that helps you. But you also really need to
have a compelling why. when you're going to do
something scary like negotiate so it's like why
do you even want this money like what would what
are you going to do with it is this going to
help you retire is this going to fund your kids
education is this going to help you take care
of an aging parent like are we donating to charity
like what are we doing with this um and a lot
of it is just education i just think people haven't
been taught and they don't realize and we think
somehow that if i negotiate a higher starting
salary that it's coming out of the mouths of
patients somehow, right? So we don't even understand
the finances of how budgets are created. But
I think what you asked me was, how do I help
people not feel like advocating for themselves
is selfish? Maybe it is selfish. And maybe that's
OK sometimes. Who is going to be looking out
for you if it's not you? So I don't like that
word because it has a real negative connotation.
But I think it's sort of like we're so worried
about seeming full of ourselves and being arrogant
that we don't even allow ourselves to take any
pride in any of our accomplishments. Let's just
find a happy medium. You know, maybe it's selfish
light when you negotiate, but maybe you actually
deserve to be paid fairly for the work you do.
Maybe that. Yeah, I love that. So kind of to
just bring it all together, for women physicians,
especially those maybe early in their careers,
who are feeling overwhelmed, undervalued, or
unsure where to begin with themselves, what advice
would you offer as they start to reclaim their
time, voice, and worth overall? Well, this might
not be what you think I would say but I think
the most important lesson for us to start learning
from a really early age is self -compassion.
What does that mean? It's just how to be kind
to yourself and how to be there for yourself
because it is not an easy road to go into medicine
and we are, you know, exposed to a lot of traumatic,
you know, we experience a lot of trauma actually
in training and working with people who are so
sick and needy and if we If we're not careful,
our default is to just be super mean to ourselves.
Think we're the only ones going through what
we're going through. And the truth is, that's
not it at all. So self -compassion is like talking
yourself in a kind way like you would a friend.
And it doesn't mean just being a slacker and
being like, it's fine, you failed your boards,
it's totally fine, don't worry about it. It's
not fine, right? But what we tend to say is like,
you idiot, what's wrong with you? Why did you
do that? Everyone's gonna think you're so, you
shouldn't have even been a doctor, like no one's
gonna hire you and you're gonna live under a
bridge, right? So mean. Instead of, you know
what, you tried your best, well. hit the drawing
board again this is really important to you you
know there's lots of people that this happens
to too it's not just you this is part of being
human this goes back to the messy human part
of this talk it's like humans are messy and they
make mistakes and they fail sometimes and what
if that's okay so just starting to have that
kind of relationship with yourself it's not easy
even just to notice oh i'm i'm not being very
nice to myself when i say that i used to go through
my day being like I'm really bad at the exam.
My notes aren't as good as everyone else's. Like
I would just constantly, it was just like so
many mean things. And now I am much more aware
of that. And you can even say, you know, that's
not really very nice when you say that to me,
right? Ouch, that hurts when you tell me like,
I, I don't know. I should never have become a
surgeon. It's not nice. So how else do I want
to relate to myself so I help get myself through
the hardest parts? And how do I find my community?
How do I find other people? who are open to being
vulnerable and really talking about what it's
like to do what we do, because in my community,
so much of the time, people say, I thought it
was just me. I had no idea. I had no idea other
people felt insecure sometimes, even people who
are like head of departments. And I've been doing
it for 30 years. They still think sometimes maybe
I don't deserve to be here, or I feel like I'm
faking it. It's like, it's good to know. It's
not just us. It's human brains. Yeah, but it
all starts with somebody saying something, right?
Somebody has to say something first to get that
conversation started. Yeah. Well, thank you so
much, Dr. Lightner, for being here tonight. This
has been an incredible conversation. I've had
a great time. Me too. Thanks for having me. Yeah.
So that's a wrap on this episode of Our Voice
is Our Future. We hope today's conversation inspired
you, challenged you, and reminded you of the
power of raising your voice. The fight for equity
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Our Voices, Our Future.