Women have been involved in interventional radiology from the very beginning, and though their career paths, leadership opportunities and experiences differ, all women IRs have one commonality: They are practicing in a male-dominated field.
Historically, fewer than 10% of IRs have been women. In her new book, Save Lives, Enjoy Your Own, Barbara Nickel Hamilton, MD, brought together stories from physicians in male-dominated fields to stress the importance of discussing gender disparities with each other and with trainees. “If your desired field is a boy’s club,” Dr. Hamilton writes, “how do you figure out if you truly belong there?”
From navigating gendered comments to pay inequality, open discussions provide insight and guidance, both for women entering the field, as well as male colleagues who are in a position to create a more inclusive environment.
IR Quarterly compiled a panel of IRs at different stages of their careers—from retired luminaries to the next generation of IR—to discuss their experiences, reflect on the importance of encouraging prospective IRs and look at what comes next for the specialty.
Panelists
Janette D. Durham, MD, MBA, FSIR
Currently retired after 28 years of practice; previously, acting department chair and professor of medical imaging at the University of Arizona College of Medicine in Tucson, and a past president of SIR
M. Victoria Marx, MD, FSIR
Professor of clinical radiology, vice chair for education, and residency program director at the Keck School of Medicine of USC, and a past president of SIR
Barbara Nickel Hamilton, MD
Chief of IR at Desert Regional Medical Center in Palm Springs, California, incoming chair of radiology, past chair of the Women in IR Section and deputy editor of IR Quarterly
Allene S. Burdette, MD, FSIR
Assistant professor of radiology, surgery and medicine and program director for the IR residencies at Penn State Health, Hershey Medical Center
Lauren Park, MD
PGY-2 IR/DR-integrated resident
What inspired you to pursue a career in IR?
JD: I was lucky to be a radiology resident at Indiana University in the early ’80s. The program was a hotbed of IR led by Eugene Klatte, Robert Holden, Gary Becker and Ken Kopecky. At the time, Becker was working on the first publication of the Journal of Vascular and Interventional Radiology (JVIR). There was an energy being around the development of the specialty.
VM: I wanted to enjoy my job. I was initially in surgery, and I disliked the culture—not because it was antiwoman, but because no one seemed happy. In my experiences with IR I learned that it had some of the same qualities of surgery that I liked, such as creating short-term, good relationships with patients. So I asked the head of the department, “Do you like coming to work?” He said he loved his job, and I went for my residency in radiology, and then a year in IR.
BH: I entered medicine eager to learn about the inner workings of the human body, which was so mysterious to me. Then, in medical school, when I witnessed the magic of an image-guided procedure for the first time, I immediately felt compelled to become an IR. Since that initial exposure involved an IR cursing his way through a fistulagram, it only got more intriguing from there!
LP: I shadowed my mentor in IR during the first month of my first year in medical school. I was mesmerized by the minimally invasive procedures guided by clinical acumen and strong understanding of imaging. I couldn’t find a field more intellectually challenging and technologically advancing in modern-day medicine more than IR. It was a love at first sight.
Coming up, were many of your mentors women?
JD: I didn’t have any female mentors in my training program, but Anne C. Roberts, MD, FSIR, was just in front of me and Vicki Marx was behind me in the SIR leadership. My father had set up a lunch date with Katharine L. Krol, MD, FSIR, when I was a medical student and she was working in South Bend, Indiana, where I grew up. Kathy would reappear a few years later in the SIR leadership. These women provided wonderful role models, and so I never felt isolated in the field as a woman.
I think IR hasn’t had a glass ceiling issue, but rather a glass floor. In my time, I’ve seen women ascend to every leadership position, but our problem has historically been recruitment.
Victoria Marx, MD, FSIR
VM: There weren’t women above me during my fellowship because it was a small department, but since practicing, I have had a woman in every department I’ve ever worked in—which I don’t think has been most people’s experience. This companionship is something I’m very thankful for, and I also credit IR trailblazers like Jeanne M. LaBerge, MD, FSIR, who mentored me through my career and opened the door to many opportunities, as well as Anne Roberts.
BH: My first mentor was Judith Amorosa, MD, a chest radiologist at Rutgers Robert Wood Johnson. She took me under her wing and encouraged me to get involved in educational projects. While in my diagnostic residency, I was initially hesitant to declare my interest in IR because it was such a competitive environment, and despite taking three IR fellows a year, there hadn’t been a female fellow at the institution for over a decade. However, one of the IRs there, Ethan Prince, MD, encouraged me to pursue IR anyway.
AB: My mentors early in my career were the attendings who trained me during fellowship, which included Cheryl Walczak, MD, who provided a lot of insight about being an IR and was very encouraging. Although they did not train me, there were several women in Utah around the time I was there, which gave me the mistaken impression that women were not uncommon in IR. Not long after that, I learned that only 5–6% of IRs were women.
Were there many other women in your residency or fellowship?
VM: My diagnostic residency was approximately 50% women. However, when I began my IR fellowship—which we called angio, at the time—I was the only woman.
JD: Eugene Klatte, MD, FSIR, was chair at IU and took three female residents a year. This was similar to the percentage of women in my medical school class at the time (30%). I’m thankful to Klatte for giving women, who would struggle to find partnership track jobs in Indianapolis, an opportunity. At Massachusetts General Hospital, two of four fellows in my year were women, and I became aware of the many female legends preceding me in that training program, such as Arina Van Breda, MD, FSIR, and Anne Roberts being two. The high percentage of women was also not an accident, but rather a deliberate intervention to create equality.
BH: Our residency had one or two women per year, out of seven residents. That always struck me as very male-dominated. By the time I interviewed for my fellowship, I realized that standing out as a female in a sea of men was actually an asset—I was more memorable, given my inherent differences compared to the rest of the applicant pool!
AB: In my residency class of seven, three of us were women. During residency, I don’t believe that women ever made up over 50%. I completed my fellowship before the new IR training paradigm came to be, and it felt like fewer women were interested in IR at that time.
LP: Fortunately, my IR residency is composed of 50% female trainees. In a male-dominated field, Georgetown is truly leading by example in promoting an environment for the growth of future women in IR. I think it is not only about successful recruitment but the kind of respectful and encouraging environment that continues to draw smart, ambitious and kind women to our institution.
Have you ever experienced gender-based bias or resistance in your career? What happened?
JD: I was a product of the ’70s and ’80s when opportunities were generally plentiful for women, and I was oblivious to gender bias until I looked for a job in Colorado. There were few women radiologists in Denver private practices, and the questions I was asked during interviews would today be considered discriminatory or illegal. The community viewed me as a likely mammographer or nuclear medicine physician. I ended up at the University of Colorado instead because they offered me an IR position that matched my goals, and the environment was more welcoming—in part a result of seeing a few female faces on staff.
One learned to adapt to inappropriate comments about dress or not having a separate entry to the OR women’s locker room, and slowly lobbied for change. To me, it was of little importance as long as I could obtain a seat at the table—which I achieved. Women now would have no tolerance of these discriminatory practices.
VM: I’ve never encountered resistance—but I typically do what I want and tend to ignore people who may try to stand in my way. However, when I first began practicing, I was underpaid compared to my male peers. When I was recruited at USC alongside my husband, I was offered a salary far less than his. If I were a man, I feel I could have negotiated that.
BH: In a hundred small ways, verbal and nonverbal, I was told IR was not for women. But I had clues it was still possible: there were women in IR in the next state, and elsewhere in the country. So I went for it. It was a bit of a leap of faith.
AB: In residency, I was once told that I inject like a girl. I do inject like a girl, simply because my upper body strength does not match that of my male partners—I certainly couldn’t beat them arm wrestling. But if I didn’t accomplish what I set out to do, it was not because I was female, but because I wasn’t the strongest candidate for the position. If gender-based bias or resistance to my career choices occurred, I either did not observe it or I chose not to mind it. I focused on the people who told me that I could, not the people who told me that I couldn’t—if I chose to dwell on any attempts to prevent me from being the physician I wanted to be, I believe I would be mired in negativity and self-doubt. This would make it difficult, if not impossible, to move forward.
LP: During my short career, I have been well respected in multiple institutions, but I think microaggressions are more prevalent and an area we can improve as a specialty. There were some instances where I was the only female trainee during a procedure, during which male faculty and trainees would make distasteful comments about women. For a lot of students deciding on a career path, I think the common question that the trainees ask themselves is “are these people who I can continue to work with in my career?” For us to be more thoughtful of diversity and inclusion for the future of our specialty, I think we all need to start from our daily conversations and work environment.
How do you think the field has changed for women during your career, and what changes do you think still need to happen?
JD: Encouragingly there are more women in the field, but the challenge of attracting a diverse work force has evolved past gender. The politics and discriminatory behaviors in medical schools persist and are more limiting than what I encountered in my career. For IR to attract a diverse pool of candidates, medical schools need to be pressured to be inclusive both in their admissions process and their advancement of a diverse workforce, and educators need to be active in listening for inequities and addressing them when they surface.
In addition, predictable schedules, reasonable work hours, fair call responsibilities and family leave policies must be provided to attract strong trainees of both genders who are now balancing home and work life in a way that’s very different from in the past.
VM: I think IR hasn’t had a glass ceiling issue, but rather a glass floor. In my time, I’ve seen women ascend to every leadership position, but our problem has historically been recruitment. I also feel we need to encourage more women to submit papers, engage in research and serve as speakers, rather than pushing them toward education paths. These are the pathways to prominence in the field, and when women are invited to those tables, it opens up so many more opportunities.
BH: The advent of the IR/DR Residency is huge for our specialty, as well as the future of women in it. It seems this program attracts a lot more women than the traditional training pathway through DR. However, I think we still have a leaky pipeline. There are still biases and these women are still getting insidious messages, at the most impressionable and high-stakes stage of their medical career.
AB: With the arrival of the integrated IR residency and the focus on recruiting occurring during medical school, I see more women entering the field of IR—recent Matches have been yielding more interest from women. There is a stronger presence of women, in part because there are more of us to serve as mentors or be someone whom women choosing this specialty can identify with. It is helpful to have others you can feel comfortable discussing certain thoughts or ideas.
