Feb. 6, 2018

In December 2017, Stephanie Radu, M.D. Class of 2021, interviewed Esther Choo, M.D., M.P.H., associate professor of emergency medicine, OHSU School of Medicine, about her work as a physician and her path to becoming an advocate on issues of race and gender. These are highlights from their discussion.

SR: What do you think are the biggest misconceptions surrounding advocacy?

EC: Stepping back from specific issues, it's important to think about physician advocacy in general.

I think physicians often feel like they are not in a position to advocate for any of the issues that they are interested in. They often think they need to be experts first, or that it's too time consuming, or that they might not have a voice in all the noise and conversation surrounding issues.

I see myself as just a regular person, not a super expert, so I feel like the model I am trying to put forward is that you can advocate as a regular person doctor. Just by virtue of being a practicing clinician, having contact with patients, and seeing the ways that policy decisions play out in their lives — all that is enough.

SR: Can you speak about the current state of gender bias and disparities in medicine?

EC: I am surprised that I am actually an advocate on gender equity because I come from a strong place of "it's going to get better on its own."

I really believed that — it was the dialogue I was a part of, it was my gut feeling, and I went into a field that was predominantly male-driven with the idea that it really wasn't going to be a problem. I thought that I would always be treated equally, or at least that I would be treated on objective criteria like my knowledge, skill sets, and accomplishments.

I gradually observed both in my own and in my peers' careers that this is not true. Then I watched this same story from individual levels play out very consistently when we look at any data on this question. …

But, to really change these systems, we have to do it from within large groups. Women need to behave in a coordinated fashion, just like unions, and I think that is the only way that you can really move these established mountains. …

What we have to acknowledge is that there is a huge power differential between physicians and students. You, as students, have to get a job, and we have to recognize that speaking out directly when recognizing equities can be detrimental and harm you.

You can be labelled as a trouble-maker or complainer, you can get marked down in rotations; your academic careers can suffer, which affects your match, and then can affect your job. … We used to be advised on how to negotiate "like a man" — that is, really aggressively and constantly pushing while not taking no as an answer. It was then documented that actually that approach backfires. So there was a whole cycle where this really aggressive negotiating took place and it turned out that negotiation didn't work out for that whole generation of women.

Now we are looking at bringing in nuance to the advice we are giving; I think the best thing for women is to identify allies and advocates.

SR: Do you have any specific examples of obstacles that you overcame as a young professional, … and do you have any advice for us moving forward?

EC: I think my story is really just how I did a million things wrong and am still learning from them, rather than just having a few successes.

I really believed bad advice, such as "there will be a period of time having kids where you will be unproductive, but you can be productive after that." After having my second and third kid, I really realized that that did not need to be the case. …

There is a huge barrier in the advice that you get, which is one that you are both dysfunctional and a liability during your child-raising years. In reality, I believe the total opposite.

When I came back from maternity leave with twins, I did what everyone else did in their shifts — I was in the pit with critical patients, admitting and caring for sick patients, and taking care of a whole department all while feeding two humans, giving them breakfast, lunch, and dinner. And you know, no guy has ever done that.

I would walk out of the hospital with a huge bag of milk, having done a perfectly adequate shift and completing all documentation. I was productive in every sense of the word and I just felt so capable, like there should be a victory soundtrack. …

I really couldn't understand why the narrative was so backwards, because women can do all this and should just be getting a high five every day for just being at work the first year after your child is born. What women are doing is incredible and capable, so I want to flip the narrative and show how phenomenal they are at multitasking and seeing what the highest priorities are.

Women step it up, especially once they become mothers, in this way that you always do when you are challenged. Women always are able to reach down deep and find this resourcefulness and energy and I see women doing it in spades, over and over again. Women are powerfully driven by wanting to make the world a better place for their own kids. 

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Top photo: Esther Choo, M.D., M.P.H.
Bottom photo: Stephanie Radu, M.D. Class of 2021, is committed to understanding and becoming a voice on social justice issues. Here, she measures Sonoman Joe's blood pressure at the student-run Bridges Collaborative Care Clinic, a partnership between OHSU affiliated health professions students and the nonprofit Transition Projects.