Doctor, Doctor, and Leadership Redefiner

[music] Welcome to our voices, our future, and the podcast where we handle the voices, writing, changing 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 am Minu and Manani, and each episode will 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 or future, let's get into it. Today, we're welcoming two incredible physician leaders who are deeply engaged in advancing gender equity and helping reshape how we define leadership in medicine today. First, we're honored to welcome Dr. Hamani DeVetia, a dual-dually trained internal medicine and pediatrics physician, and the associate designated institutional official at Christiana Care, a leading academic medical center in Delaware. Dr. DeVetia is a champion of medical education, leadership development, and community advocacy. She's held multiple leadership roles in residency training and patient experience, and currently oversees accreditation, curriculum development, and physician training at the graduate medical level. She is a graduate of Leadership Delaware and the Health Management Academy's Physician Leadership Program, and she also serves as the clinical assistant professor at Sydney Kimmel Medical College and Philadelphia College of Oceopathic Medicine. Joining her, we have Dr. Valley condos, also a dual-dually trained internal medicine and pediatrics physician, who also serves as the co-chair of Delaware's ACPs, the chapters women and medicine committee alongside Dr. DeVetia. Since completing her year as chief resident, clinically Dr. condos serves as an academic med pit hospitalist at Christiana Care and Nemo's Children's Hospital. During and beyond residency, she has been passionate about physician well-being, and currently serves as the well-being lead for the division of pediatrics and Nemo's. She is also a clinical assistant professor at Philadelphia College of Oceopathic Medicine and Sydney Kimmel Medical College. In her role as the associate program director for the med pit residency at Christiana Care, as well as the director of the sub-eye program, she is passionate about leadership, mentorship, and medical education. Dr. DeVetia and Dr. Condos, both of you, thank you for joining us today. To start us off, I would love for you to begin by hearing from each of you how you define leadership in your own life right now, and how has that journey evolved over the years, and how has your idea of what makes a good leader changed over time. Thank you so much, Mindy, for having us. This is such an honor and really an incredible experience to be able to share our voices as we all shape our futures together. You know, the first time that I actually began to define leadership really formally was during my first leadership development experience as a third year resident. And prior to that, a leader to me was somebody that you always looked up to, somebody who had these values and behaviors that you aspired to emulate. But honestly, over the last 15 years, personally, I have sought multiple leadership development experiences, only to really refine that initial idealism. Leadership is an art and a science. It comprises very specific behaviors and skills that require practice, and it's founded and continual reflection and growth. Ultimately, I believe that it's about driving others to believe in a vision, their own capabilities, and motivating them to achieve those common goals. And it's funny, I define myself as a leader and I'm fortunate to be a leader in a workplace. I also see myself as a leader in the home, in my peer circles, in my community at times. And certainly I don't have formal roles in all those spaces. Would you consider a mother, a leader? Well, we do. But really, it's because we're using our values. My personally values are grit, grace, and interconnectedness. We're using certain specific skills, like emotional intelligence, like integrity, like communication, strategy. And ultimately, we're trying to bring people towards a common goal. Dr. Tobadia, that was so well said, you can't see my face, but I've been nodding along on every line of that statement. And just to further elaborate, you know, my initial definition of leadership is so far from where it is today, because initially it just seemed like I was looking up to those that seemed so far to reach that just we're in their field for years and years and got promoted. And just led with authority and with confidence. And as I progressed through residency and through attending hood, a couple key experiences really helped transform that definition for me. And actually one of those was similar exact course that Dr. Tobadia is talking about called lead our leadership excellence education for residents and fellows that actually our program director here at Koshanna Care Dr. Friedland created and that was the most impactful because I was able to see and hear. Leadership journeys of those that I felt I would never be able to talk to such as those are in the C-suite CEOs, for example, and those kind of those stories really helped bring it to ground level for me really helped validate that there is nothing extra special that those individuals have necessarily done to get there. But they were seen by somebody else the opportunities presented themselves they worked really hard and they are very passionate about what they do and they want others to see that vision and they want to be those aspirational role models to those around them. And that was fabulous. So as I have those experiences with lead are with our ACP women in medicine, annual retreats and being able to connect on a human level with those individuals and those leaders, it really helped me redefine leadership as one who is present, humble, able to create a shared vision, inspire those around them and under them to reach that vision. And really empowers all of their team members and that is absolutely seen in the workplace that is again seen in the home and really seen in every aspect. So just because there isn't a former formal leadership title does not mean you are not a leader. I love that reflection and appreciate that from both of you because I think you define leadership as more how we show up for others and often in ways that might not be immediately like visible, but I think that's really cool to especially for me to hear as this early in my journey, because you are people that I aspire to be like, so being able to talk to you like this and things like that, that's been really impactful and I really appreciate that. Can you share a moment of where you've witnessed like different types of leadership, especially like those quiet, like lead the power of the quiet leadership either in yourself or something else and how that's kind of influenced the culture that you pop around you. Absolutely, I can take this one so quiet leadership is truly powerful because I think it speaks to that leadership without a title right and so when I think of quiet leadership, I think of specific colleagues or residents that speak louder with their actions, then with their words. Those that really are putting in the work, those that are helping out their colleagues without being asked going the extra mile and naturally just aligning and realigning a group during times of conflict as we experience day in and day out, whether it's as big as COVID or small as just disagreeing on a patient case. And so that individual that is bringing us together and serving the group type of servant leadership is truly strengthening the culture of camaraderie and joy and fulfillment of that group as a whole. I think quiet leadership is really walking the walk, not just talking the talk as Dr condos mentioned and we see that quiet leadership does get noted does get appreciated and does get rewarded. I really love the term servant leader. I feel like that's I think something that's really very much a good mindset to have in like I think in medicine, but also just in general of leadership. My next question is kind of about I feel like many women don't see themselves as leaders like quote unquote until they have that formal title. So like how do we shift this narrative that we kind of have been talking about of that servant leadership, especially for those who are already kind of like developing or demonstrating those like the quiet every day leadership that we're talking about like because I feel like part of it's narrative part of it's how do you speak to yourself about it. So any advice on that and how you kind of help navigate yourself and like what you tell residents. Yeah, I think, you know, it is important to recognize that there is formal leadership and there is informal leadership and both are extremely important and oftentimes informal leadership can lead to formal leadership. So it is upon the choice of the individual, whether you want to remain in that informal leader capacity, or if you want to aspire towards more of those formal leadership roles. Ultimately leadership as a mindset, it does not have to have titles, but it requires those practice of consistent behaviors, those behaviors that Dr condos mentioned that I mentioned. It's about listening actively, it's about having creative ideas and speaking up towards those and it's really being that team player recognizing that we are motivated towards that same ultimate goal. I really think that, you know, we do as women have a tendency to build a narrative internally and structurally and societally there are narratives built around us as well. And it's thinking about how to whether you're a quiet leader or a more, you know, voice leader, whether you're a formal leader or informal leader, it's ultimately about figuring out who you are, what you want, and how you can work together with others to get there. You guys co lead a committee focus on gender equity, what barriers do you consistently see that prevent women from stepping into those leadership roles, and how do you think we can begin to kind of dismantle them. That is a great question and we are so grateful, you know, through the American College of Physicians for about the last decade we've had this opportunity to build our women and medicine committee together. What we've noted in those conversations that we've had with just in diverse array of humans is that barriers do exist. And unless we talk about them as we are in this moment, we won't necessarily be able to advance our own internal leadership and our collective leadership as a group. I like to sort of bucket them and certainly, you know, we could talk about a multitude of barriers, but I bucket them in maybe kind of three core domains. It's power, perception, and pragmatism. And we'll each expand on that a little bit and what what some of these barriers are, you know, power as we think about it historically medicine has been a male dominated profession. While we do know that medical school admissions are showing a higher rate of female matriculants almost up to 60% and now a female predominance, there are still decades of expectations and experiences that speak differently due to formal power and authority roles. So for example, about 25% of deans of medical schools and universities are females, about 30% of health care physician executives are females. And we also see that in general, there's about a 15 to 20% pay gap between the highest paid specialties in medicine as well between males and females. Now, it's it's not that we want to continue to focus on the divide, right, but it's really not how do we understand these power differentials, understand why they exist and begin to talk about them begin to ask key questions and begin to arm ourselves with information so that we can have more informed discussions and choices. And lastly, I'll say that power, you know, is is really about understanding that sometimes we have to dance the dance, but really it's about working together with our allies with our sponsors often that are men in leaders of all backgrounds in order to break some of these traditional mentalities and balance that power and balance. Absolutely. And like Dr. Davidia said, just being able to bring those to light or recognize them is already half the battle so that we can address them. And so, you know, a couple of things that come to mind for me, thinking about how our dynamics is as a woman may be. Um, really pursuing her aspirational goals of of her next promotion, for example, she may be seen as to power hungry or really a little bit too harsh, right, he's like leading with authority as opposed to a male in that same position that would really be recognized for how poised and how confident how well he's leading the team. And on the other end of that is, you know, women may be a little too softer seen as to issues more so leading with stories and not necessarily data and numbers, for example, and so some of those biases are a lot deeper than then we think. Just are intertwined in our day to day lives. And then one other one I'll bring up is, you know, just being in a meeting right and leader or not and a woman brings up a specific suggestion or a change, for example, and there's. It's kind of not recognized and we bring up the same topic and then people engage or say it's a great idea and. This is still happening like this year right and I don't think people necessarily are intentionally trying to grow that divide again, but it. It still happens and it happens right and so just bringing that to light a little bit with the power dynamics so that was that was kind of the first bucket of power and next we want to shift a little bit more into perception and perception. Is challenging because I think there's two areas of perception that will touch on one is self perception and the other is an exception right and and for. Internal perception or personal perception self perception and one of the biggest struggles I think that women have including myself very much so is imposter syndrome right I just is much widespread and in our communities and. I think that you know in a group of driven individuals that are physicians that want to be leaders that want to continue to aspire. We get this feeling where we're just not meeting the mark right constantly not meeting the market and should we be here and can I handle that next leadership opportunity that's presented itself and am I good enough and. I tend to question ourselves a lot about that feeling like we are not as capable and you know what I have found is helpful to combat that a little bit is really stop again and notice in the moment why am I comparing right why you feel like I'm not capable and notice it you don't necessarily have to answer it first. Yeah you're comparing why am I doing it and why am I negatively seeing myself and is that true is it reality or is it a false narrative that I'm telling myself right is it a story and really try to look at the facts there analyze the situation and see and if you can't figure out why you think you're capable maybe the best thing is to have a colleague a loved one who can tell your elevator speech to you. Actually you are this this you've accomplished all these amazing things that rattle off your CV in a minute they're right when you're showing that self perception I think we can really on rather ourselves and get pretty low and I think we need to really separate out fact from fiction that we're a narrative that we're telling ourselves. I would have to agree and say that you know I've had to do a significant amount of coaching work and thought belief work to change that mental narrative and the more that we speak about the mental narrative that exists both internally and externally the more we are able to empower each other to break those narratives down. You know when I work with a coach for example a lot of what we talk about is really thinking about what is it that I'm bringing what is it that I want you know what is it that I need to do from to get from here to there. And moving into that third piece which is the pragmatism the pragmatism is just that it's identifying facts figures feelings as well very so not alone I'm sort of forecasting predicting you know what you need to do to achieve success in a situation for example and actually women who receive training and being able to advocate effectively communicate lead from that practical standpoint. Carry their voice and larger circles with more effectiveness it does take however planning and preparation and it takes support and you know both Dr condos and I are very lucky that we have extremely supportive home environments we have extremely supportive work environments are colleagues that we work with our diverse teams and that is ultimately what drives that work life sustainability. I really love how both of you touched on support and how crucial that is in terms of like breaking that narrative in our brain of like sometimes we just need that reminder of like things that we know are true but in that moment we're not remembering them. But I think that's such an important crucial thing while we're navigating those like internal and external barriers like imposter syndrome the demands that are competing I feel like adding that space is really helpful and like in our like my next questions about how have spaces like m wall or lean in circles help to you grow not just professionally but also as people. Great question and I do think those are really crucial pillars to growth right growth in your career growth in your home life growth in all areas so I think there are specific types of support that you need right we need mentors we need mentors that are there different types of mentors for different areas in your lives. Not necessarily one mentor for all those some people may have that we also need sponsors right sponsors that are going to see you that are going to help you get to that next step that next opportunity to get you out there whether it's nationally whether it's locally regionally et cetera. And all those individuals all their those different supports in your lives your life are going to help you grow personally and professionally and will help you network and get you out of your comfort zone. I think we've been really fortunate through amwa through the ACP forum through lean in circles we've had some homegrown women medicine organizations as well that we've had the opportunity to create a forum to dialogue very much like we're dialoging. We've had an opportunity to discuss shared experiences and most importantly tangible tools right what are some evidence based tools that we can use to help ourselves promote each other and move towards reducing that inequity in that gender gap. And so for example at some of our women in medicine retreats we've been able to bring in experts on negotiation so that you understand you know how do you negotiate and how do you know what to ask for where do you identify data around salary differentials and then how do you go back into that conversation more prepared and pragmatic. We've had individuals come in and work with us on improv and we've done some acting experiences because we know that as a profession we have to be thinking on our feet pivoting at any time and really be able to bring that confidence which is a practice skill set and move into into that action. And certainly you know the more we get to share our voices together we learn from each other that is probably the most important thing because no two experiences are identical similarities that bring us together but it's those differences that allow us to leverage even stronger. So in terms of mentorship so does someone like going through is like a resident how do you find those mentors how do you ask people to be a mentor or I don't know sponsorship works the same way but any advice on that for people who are on my stage of our career. I think coming from somebody personally who does not have the skill of just walking into the room and networking maybe there may be that but most days I can't so I think taking small bites is where I started in my groups I could notice okay what are my interest and who is somebody that either has gotten there or has the skills to get there. And that's how it kind of came up with my first mentor second mentor and as I chat with them a little more informally and had a connection I don't know that I ever asked them to formally be my mentor you know one thing led to another that connection and as we had conversations and realized something else was an interest of mine they would be able to point someone else out for me to touch base with accept those different. It's goals and aspirations. That's how I started. I think that you know it does take work and the work is important to put in because the return on that investment is huge. I remember when I was probably at one of my first national conferences as a medical student actually the American Academy of Pediatrics and our first men pizza resident association and for conference. I thought okay these are all incredible people I want them all to be my mentors and I don't know how to ask that. Exactly. It's so natural it's so common you are not alone for thinking that over time I kind of learn to strategize and say I would love to have a mentor really for the personal aspects of what. And who is that female MedPete's position program director that is really focusing on how she balances her personal life with her professional life. We want that mentor who is that core academic mentor the one who's written a lot of papers to say how do I build a writing circle how do I submit my first proposal for a conference. I also think it's very important to have a distance mentor is an individual who is not at your institution is not maybe you're even seen interested specialty. But somebody who could sort of be that neutral perspective because you are going to be familiar and comfortable with the things in people you are familiar and comfortable with. Your distance mentor sort of sees things from a distance you reflect in a different way maybe challenge some of your suppositions and brings new insights and perspectives and distance mentors are really found by doing something like we're doing now individual is serendipitously me, but then you can you just stay in your circle because you actively build that relationship. And just to pick you back on that is that those individuals that you'll have in different areas of mentorship and the distance mentors. They don't have to all be strong female leaders right you made a different perspective of a strong male leader that is great out research because that's your you want to grow it right and so different individuals whether it's different genders different rules different specialties different locations. Also a really great purpose. You want to make a quick comment on sponsorship and you know there's a lot of literature that has been written around mentorship coaching and sponsorship and actually the American Medical Association has a really great toolkit on coaching and mentorship and sponsorship as well which you know individuals can should feel free to access. The key piece about sponsorship is that any point in time that you are in some type of semi formal or formal position. We all do that so seamlessly on the words when we become fourth year medical students and we see that third year medical student who might be on that inpatient experience for the first time right. We offer those insights we help them identify how to write that first soap note we talk about hey are you applying I'm in the application process now let me tell you what it's like. Take that model and transfer it at every stage of your life and when you get to that point of saying you know what I have a position that's vacant I want to sponsor the person that I believe is best qualified. It really deserves that opportunity that maybe somebody else won't see her but I do. I really love that I love that it's it feels like it's a little bit about intentionality and self reflection and destruction. But it's also about being genuine and just trying to connect with people and I think letting that guided a little bit and letting your inner like in reflection guide that a little bit as well. I think it's about showing up and trying a little bit is when I'm myself is summary of this wonderful advice I've just gotten. Today we've covered a lot already my next questions kind of trying to pivot a little bit more about being a little more personal and we kind of mentioned it already about work life integration and boundaries. Work life balance gets thrown around a lot but I feel like many of us feel like that's an impossible standard especially as women in medicine I feel like that's something we often struggle with even earlier stages. How do each of you kind of approach that work life integration and what's helped make it sustainable if at all or if you have a different way you approach it that also I feel like it would be cool to share. Yeah I have navigated this question over and over again so I'm so glad we're talking about it and honestly I don't think work life balance exists now this is me this is very personal. But I think you know what I strive now to do as a mother of two incredible boys as a community leader as a faith organization goer as a physician as a leader in medical education I strive for sustainability and you mentioned that word right. Exactly is it like how do you at your in your perspective you're probably thinking how do we make this career sustainable. Yes and that's what it is work life balance work life integration I think work life 3.0 is work life sustainability. And when I think about that I I ask myself the question yet can I listen in on a meeting while making dinner and feeding my children yes yes I can do it. And is that the best way for me to be mentally present in either domain not really and so I've had to make some calculated decisions I've had to set boundaries and I've had to really think about what it means to bring my full self to each effort sometimes that looks like asking you know my administrative team lead to block my schedule at 4 p.m. because you know I don't have a babysitter for the next couple of weeks and that means that I can't take in person meetings and then you get home and I will show up at home and my presence is needed at home and everybody around me knows that expectation. Sometimes it's saying that I have an opportunity to co partner with my esteemed colleague Dr. Condos with an incredible podcasting joy today and that's me telling my home life dinners on you guys I'm going to be out for the next 4 hours and ultimately you know what I'm what I'm getting at here is that it's the intentionality we spoke about earlier. It's not feeling guilty and it's really being tactical about looking at your priorities what matters in that moment and then really focusing in to build that experience to maximize that. I also really love that we're talking about this because it truly is a question that I don't know that I'll ever be able to fully answer get the perfect answer for but as we're juggling these multiple different aspects in our life different idols of who we are necessarily or who we want to be. It brings up an Instagram reel that multiple people have actually shared with me in different places and spaces so I thought it really illustrated this well and what it showed is that we're always juggling multiple balls at right and it is. You know the key is to discern which balls are rubber and will bounce back and which ones are glass and will shatter if you drop them and that is in that moment in that hour in that week in that month but the key there is is being able to discern right because your your goal in life is not to be perfect and carry all the balls at once. It is to be present and carry those that will shatter if you drop them and knowing that you can implement multiple tools to try to figure out which ones are glass. You and some are just intuitively glass and you know you are cannot them and others you really need to think strategically about which you have to commit to in that moment like Dr. Devati I was explaining but that shift in mindset will really give you the freedom to stop chasing perfection and start choosing presents. You really love that analogy I feel like I've heard the ball juggling analogy but not the taking the time to decide which one is rubber and which one is glass I feel like that's a big perspective shift of how you can view it. So like I really appreciate that analogy and the real that came into your life. And then we kind of mentioned boundaries in terms of boundaries of professionally boundaries personally and I feel like boundaries are essential especially in leadership but they're often part to set especially in medicine, especially in different aspects of medical medical training. What boundaries have you learned to protect over time and how has that kind of changed your relationship with work and leadership. That's a great question. Also one of those million dollar questions and boundaries is something that has always been difficult for me because I am still working and I think will forever be working on creating and upholding boundaries without guilt which is the key. One thing that's been helpful for me is having clear bidirectional communication between myself and the other party and set a boundary with right and not assuming their expectations of me or vice versa and really reminding myself that time is our most valuable asset and needs to be protected and so how I want to use that time needs to be determined by me. I believe by someone else and they external factors should not dictate how my time is spent. Now in reality right that is that is the goal. So how does how do you actually make that happen. I think is is based on almost analyzing every situation. So I have found that very exhausting and actually as I was listening to an audio book recently I loved a different framework that I would like to share and this framework is actually built around figuring out the emphatic yes so it's a lot easier for you to say no. And it's it this author was speaking about setting big hairy audacious goals something called be hags which is a term that was coined by Jim Collins and Jerry poras in their book built to last in the idea is if you set these big hairy audacious goals right your goals in the next like five years or 10 years that we actually tend to underestimate ourselves on. Then you will have this sharp vision and this commitment to get to that goal and so it's a lot easier for you to see all these other things as distractions from that goal. It's a lot easier for you to say no not today. Today I need to commit to writing that next chapter because I am going to write my book by April of 2026 and in order to do so I need to write a chapter a month. And I need to find it whereas if someone comes in and says oh but can you please help me you know mo my lawn you can get something but something that you would naturally want to say yes to because you're kind human being and you want to help others you know saying no is not that you are a mean individual or you don't care about that person but you really do have your large goals in mind and you are like emphatically saying yes to those and you are saturated so other things are much easier to say no to and that bad. It's a lot easier to say you know doctor condos I love that concept and I personally haven't heard of that term behag until you're defining it here today so I'm definitely going to take a moment to get the book built to last so that we know we keep on lasting. I love what one of my coaches doctor middle up church shared with me she's a physician who does wealth coaching for women and she asked me the question she said who is he money 14.0 And I think we spend so much time thinking of who we were of the past a decent amount of time thinking and maybe even worrying about who will be of the future. I don't have enough time thinking about who is the us 14.0 and what our our behags but if we do think about those goals we set them as ones that are bold able to then define our boundaries again out of strength and confidence and forward progress rather than guilt and feeling like we're letting ourselves in others down. I love that I love the framework I love the intentionality of it all I really appreciate your thoughts on that setting those kind of like boundaries and I feel like it is hard especially the guilt part and so I thank you for that and I feel like you both are navigating still demanding careers and meaningful leadership positions and opportunities if you had to mentor your younger self what's one truth one lesson you wish you would have known earlier. This one does evoke a little bit of emotion because there are a lot of things I would have said to my younger self the great part is we get to say those here and now to individuals to women who are a decade or maybe even more in this journey where we were maybe a decade ago. And I would just say be courageous be confident and be coached you know I personally spent way too many years inside my own head I wish I would have been able to speak up in forums where I was a minority I wish I might have been a little less afraid of failure so that I could see what possibilities exist. And I wish I could have been guided actively by certain professionals we are certainly guided in that medical space by our attendings and in really learning the clinical realm but I think it's important to be guided by other professionals to really understand and work through scenarios maybe do some visioning exercises. And think strategically about again who we are what are our values what do we bring to each experience and what do we intend to get out of every experience. So be courageous be confident I know that's like the worst feedback I used to get online you know more thanations evaluations like be more confident but it is true right but how do you be more confident it's to take that active step of being coached or being in these circles. Like the lean in circles and ACP women medicine and what so that we can really coach each other into that next 14.0 version of each of us absolutely and really like you said earlier get those practical tools on how to do that knowing that we show up more confident how to show more confident how to show more courageous and get that insight from your coaches and so. I think from my standpoint tactically that means giving yourself time to reflect and be intentional get clear about what your values are what your priorities are. Who you are which is a very difficult question to answer as I try to coach who you are not as defined by your rules but just who you are and who you want to be because if you don't allow yourself time to think about that and be intentional about that you will just keep going going going and then years will pass by right and you have these I wish I would have I wish I could have etc and I think every experience is. As important and timely etc but if I were to go back I would like to create that time that intentional time of reflection getting clear and really making the space to get courageous confident and coached. I think that's really important for us to hear when we are where we are now especially is like for theoretical students or residents as I feel like we're I think there are moments of our of like our curfews and career where there is time to think and reflect and have those things but sometimes it's a go go go I feel like like I think before medical school is one of those points like where do you want to be I think right now plan a residency for me is one of those points what do I want to be but I feel like in that in between it's go go go and I feel like I think I feel like what you guys have said of like taking that time even. Even in that go go go to give build space for yourself I think it's really important and I think it's something again like intentional you have to build space for and time for so I think it will be really useful for people like me who are listening to this podcast or in this stage of life to hear that. You know I just want to add a quick insight piece into that the ACGME offers the opportunity for residents to give feedback both around kind of core programmatic issues annually once a year's the ACGME program survey but they also have a well being survey where really you have the opportunity to think about you know how do we structurally create these environments where you have time to reflect and what's the data showing. And we've seen actually that the data shows that the number one question in need of really improvement is that I have enough time to think and reflect during my work experience. And ultimately that is a contributor towards emotional exhaustion which is one of the three facets that leads to burnout. Because you know leaders as educators as physicians as women together we should really think about how do we create that intentional time certainly do it on your own time and space when you can. So structurally systemically how do we also work together to create time for example during your clinic sessions you know do you create a little bit of admin time for the team to just have some time to journal and reflection. We have a forum here for narrative medicine and so do we create that time to reflect and think through a form of narrative medicine. It's really important and we know that the data says that we have less and less time to think and reflect but the time to do that even more so than ever is now. I really love that I think that perspective like structurally I think is also good for us to hear because I think we don't like we have less control of that as students and as residents and I feel like thinking about that and seeking that out I think is also something that we that we can do we can't create it right now but we can seek it out so I think that's really good for people to hear. My last question for our time today is what's one hope you carry for the next generation of women and medicine and what role do you see yourself playing in helping that hope become reality. It's a great question I will try to be so synced about this as I think we did address a lot of there's so many hopes that we have but I do think overall my hope is that we continue to see one another and to build each other up and not feel threatened by one another successes. And by we I mean the collective we write as like women leaders as physicians and also our very diverse work group right our colleagues that are not women that maybe are not leaders I think we find that support in each area and that mentorship that we talked about earlier in each area and really being able to bring to light. Those issues that continue to feed into gender inequity right and noticing them talking about them finding ways to normalize and not stigmatize that divide and maybe the larger mental load that we carry as a barrier for us excelling in our careers. I absolutely agree it's to not live in silos and fear but to live in a space of collaboration courageous conversations and critical changes. I really hope that we can together you know with all of our colleagues advocate for things such as parental leave workplace accommodations that enable individuals to choose to breastfeed if they want. For example really talk about going into practice with your counterparts who may not be female and saying hey you know what does your contract say and are we similar benefits and how do we help each other maximize our potential because we each are valued based on our skills and our experiences and not necessarily you know these gender definitions. And so really it's thinking about how we can come together as Dr condo said use spaces as this forum and others to create sounding boards and ultimately have a place where we feel free of judgment and shame but one that we can empower each other towards mutual acclaim. Thank you both for being here today I think this conversation is very enlightening for me and I hope for many of our leaders as well and hope for many of our listeners as well and leaders. And that's a wrap on this episode of our voices our future we hope today's conversation inspired you challenged you reminded you of the power of raising your voice the fight for equity doesn't stop here join us in the movement. Subscribe where we get your podcasts and if you love this episode share it with someone who needs to hear it today's story remind us that leadership takes many forms and we hope this episode sparks reflection and action. Until next time stable stable goal and keep the conversation going this is our voices for future. Thank you both for coming today and we hope to see you again tomorrow.