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Arghavan Salles, MD, PhD

7 Sep, 17 tweets, 8 min read

https://twitter.com/LauraBukavinaMD/status/1430971005724409859

My point-by-point response to Dr. Klotz, who did us all a favor by putting his biased thinking out in the open.

Dear Dr. Klotz,

Thank you for demonstrating the challenging attitudes faced by women in medicine. Here are the flaws I see in your arguments.

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https://twitter.com/LauraBukavinaMD/status/1430971005724409859

#1. Perhaps instead of “ideological” lens you mean the authors have some kind of agenda? That agenda seems to be helping women have the same access to opportunities as do men.

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#2. People love to deny the existence of discrimination. This is especially true for those who are high up in the hierarchy because if you acknowledge widespread discrimination it may bring your own success into question.

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In reality, acknowledging there is discrimination doesn’t invalidate your success. It’s just an acknowledgment that you likely have had different and fewer obstacles than other people, in this case women.

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#3. I’m not sure what you mean about urology being “male-oriented.” Do you think it’s only appealing to/serving men? Both men and women have urologic problems. If the field is not welcoming to women, that is problematic for the field as a whole and especially for women patients.

#4. Your basic argument is that we should control for variables that demonstrate gender bias. For example, why are women less likely than men to be full professors in urology? Certainly the pipeline (interest in urology) is part of the problem.

journals.lww.com/annalsofsurger…

But even once women choose urology, other factors (including bias/discrimination) prevent them from getting promoted to professor. If you really want to examine this, your denominator should include the # of women who could have been part of the field but left.

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#5. Yes, I guess by choosing to be, for example, a woman urologist rather than just a urologist, women "choose" to make less money. Also the work women do is reimbursed at lower rates so compensation is often lower because of that.

ncbi.nlm.nih.gov/pmc/articles/P…

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#6. We all know the burden of childcare and housework often falls disproportionately on women. Maybe this societal expectation is what you meant by “personal choice?”

ncbi.nlm.nih.gov/pmc/articles/P…

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#7 and #8. Again, if you look only at the women who remained, you may not see disparities. But what about all the ones who left because they would not or could not tolerate discrimination, harassment, and bias? You have to account for them as well.

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#9. The myth of meritocracy is so damaging and actually allows discrimination to persist. Is it meritocracy when almost zero women are selected for society awards? Or when women’s research is less likely to be published and less likely to be cited?

nature.com/articles/d4158…
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#10. The whole pipeline argument again—if only we could get more women to go into urology, we would have more women in senior positions. Women have been >45% of med school classes since the late 1990s and we are still under-represented in academics and...

aamc.org/media/8661/dow…

...among chairs/deans.

#11 and #12. The old diversity/excellence tradeoff argument. Actually, there is no evidence that valuing diversity leads to worse quality. It just allows the excellent candidates who don’t look like you to actually get a shot.

forbes.com/sites/paologau…

#13. Blaming the women is a common strategy to avoid taking responsibility for your role in maintaining a system that undervalues and undercompensates women. None of us wants to admit complicity in a discriminatory system, but indeed we are all part of it.

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The sooner we admit that, the sooner we can change it.

In summary, I really appreciate you including so many flawed arguments in this letter so we could have the opportunity to confront them. Please keep writing!

Sincerely,
Arghavan Salles, MD, PhD

15/15

@UroGrrrl

cc @UroGrrrl @RenaMalikMD @kjdelay1 @AshleyGWinter @FutureDocs @LFiellin @JJcolemanMD @drnikkistamp @ShikhaJainMD

d'oh! Forgot to link to the original study (intentionally not linking to the letter):

europeanurology.com/article/S0302-…

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More from @arghavan_salles

Arghavan Salles, MD, PhD

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It's not every day your piece is front and center on the @TheLancet homepage!!

I was delighted to work with @reshmajagsi on this commentary covering what institutions should do to reverse the damage the pandemic has done to women's careers. 🧵

thelancet.com/action/showPdf…

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We have four major recommendations. "First, institutions must intentionally implement best practices to recruit, select, retain, and promote women..."

This would include criterion-based evaluations and transparency regarding roles and compensation.

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Arghavan Salles, MD, PhD

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“We care more about the crazy, insane members of Times Up Healthcare???”

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@jodikantor

Many of us resigned bc the organization clearly did not, despite its purported mission, prioritize survivors.

This piece, by @jodikantor, @arya_sundaram, @melenar, & @caranyt, is the latest in a series of articles about TU after the Cuomo debacle.

https://twitter.com/jodikantor/status/1429145448271552514?s=21

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In case you’ve missed them, here are some highlights.

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Arghavan Salles, MD, PhD

@arghavan_salles

2 Aug

Lately I've kept quiet on here about covid. There are amazing doctors and scientists tirelessly sharing the latest studies and policies, and my daily work is related more to bias and harassment than it is patient care. So I have been leaving that work to others.

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But I have been spending time with some amazing colleagues who are trying to educate the public over on Clubhouse. What I've seen in the last six months there has me concerned.

I'm not trying to be alarmist, but with infections rising across the country, I'm a bit down.

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Within the past week, I have heard chatter about the vaccine being "experimental," that it was developed too fast to be trusted, that "they" want to control our bodies.

(Who are "they," anyway?)

I have heard people be scared for their health and that of their children.

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Arghavan Salles, MD, PhD

@arghavan_salles

15 Apr

How do we talk things that are hard to talk about? Some musings.

I imagine that if I were a man, I would be upset about the way women and non-binary folks are treated in the workplace. I imagine I would want to speak up—that’s how I’m wired. But I might not know what to say.
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Being the type of person I am, I would probably read books such as She Said or Good and Mad to try to understand. And then I might start speaking up.

But what if someone tells me I’m speaking up in the wrong way?

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No, you shouldn’t MENTOR that woman, you should SPONSOR her! It’s not MATERNITY leave, it’s PARENTAL leave! You’re not babysitting your children, you’re taking care of them! They’re YOUR kids!

I would learn, sure. But I also might start to shy away from the conversation.

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Arghavan Salles, MD, PhD

@arghavan_salles

27 Mar

It’s been almost 2 years since I left my academic surgery job. In this time, I’ve become acutely aware of how much we have to PAY ($$) to build an academic career. I stopped submitting abstracts to meetings because I had no money to pay for going to them. When students…

1/

…asked to submit abstracts based on our work, it was heartbreaking to tell them that I couldn’t pay for them to go but that maybe we could try to find another way. (I made so little myself I couldn’t pay for them out of pocket).

When I got asked to give talks...

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...I could only do it if they were paying me. Of course, most societies don’t pay their own members to give talks, even when they’re invited opportunities. This is what I mean about paying, and many of you know this. You have to pay an annual membership fee...

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Arghavan Salles, MD, PhD

@arghavan_salles

10 Mar

@thoracicrad

Earlier this week I spoke at @thoracicrad about how biases affect our evaluations of performance. Here's the gist on how we measure "intelligence" and perceive others.

(I also talked about stereotypes but will save that for another day.)

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First of all, let's start with what intelligence is. There is a ton of variability, but this, from Howard Gardner, resonates with me.
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How do we measure intelligence? There are many many many tests. What I learned about human cognitive abilities in my PhD, though, was there's no one measurable "intelligence." There are instead measures, such as the ones on this slide, of specific skillsets.

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