Equity and diversity bring new ideas, innovation and a richness that move progress forward. But some may think it’s a zero-sum game, that giving someone power takes it away from someone else. Emily Binstadt, MD, HealthPartners emergency medicine physician and director of simulation at Regions Hospital, talks about being a fierce advocate for women in medicine. She and hosts Kari Haley, MD, and Steven Jackson, MD, discuss setbacks and experiences, how feedback gets delivered differently for women versus men, and how talking openly and identifying issues can lead to positive changes away from what has long been considered “normal.”
Equity and diversity bring new ideas, innovation and a richness that move progress forward. But some may think it’s a zero-sum game, that giving someone power takes it away from someone else.
Emily Binstadt, MD, HealthPartners emergency medicine physician and director of simulation at Regions Hospital, talks about being a fierce advocate for women in medicine. She and hosts Kari Haley, MD, and Steven Jackson, MD, discuss setbacks and experiences, how feedback gets delivered differently for women versus men, and how talking openly and identifying issues can lead to positive changes away from what has long been considered “normal.”
Hosts: Kari Haley, MD, and Steven Jackson, MD
Guest: Emily Binstadt, MD
HealthPartners website: Off the Charts podcast
Got an idea? Have thoughts to share? We want to hear from you. Email us at offthecharts@healthpartners.com.
Kari Haley:
She's a rehab doctor from Chicago.
Steven Jackson:
She's an emergency medicine doctor from the Twin Cities.
Kari Haley:
Together we're examining the health equity emergency.
Steven Jackson:
Inviting voices for change without the cue cards.
Kari Haley:
I'm Dr. Kari Haley.
Steven Jackson:
I'm Dr. Steven Jackson.
Both, together:
And this is Off the Charts.
Steven Jackson:
Welcome to the show. I just want to say before we start, we appreciate all our listeners and all our support thus far, and we are excited to bring you as good a content as we can produce. It's been an exciting run and today will be no exception. We'll be talking to Dr. Emily Binstadt. She happens to be an attending physician in emergency medicine here at Regions Hospital, and she also wears a couple of hats, including the director of simulation, also in the emergency department. So welcome, Dr. Binstadt.
Emily Binstadt:
Thank you.
Steven Jackson:
So tell us a little bit about yourself. Anything you want us to know, even your deepest and darkest secrets.
Emily Binstadt:
Ooh, all right. Well, let's just lay it all out there then, I guess. So I grew up in Minnesota and have been in various places in the country for training and then ended up back here and living in my own hometown where I grew up, which is an interesting life trajectory. I have two kids who, if I had to choose the thing that's most important about me, that's them. But professionally also I'm interested in a lot of different parts of emergency medicine. I love being an educator, love hands-on learning and the interest I have in simulation. I also think that wilderness medicine is fabulous. And in the last few years I've become more and more interested in becoming more educated about issues of diversity, equity and inclusion in emergency medicine, medicine and society in general. My personal connection with that is being a woman in medicine, but certainly I think some of those experiences resonate with all sorts of different intersectional issues in medicine and in the world in general.
Kari Haley:
Emily, I've been able to know you well from the emergency department since we worked together there, and I know coming in as a new faculty, now six years ago, something like that, you're definitely one of the strong women in our department, who-
Emily Binstadt:
Aw.
Kari Haley:
... I knew would be a good advocate for the other women in the group. And I feel like our group, fortunately, we've hired a lot of women in the last six years and that's been really great to see. I'd like to hear a little bit of... Maybe share some experiences which you've had, especially maybe in medicine and even outside of medicine as a woman in society and the support or not, or lack thereof that you've had with these endeavors, and maybe why it's pushed you into being an advocate for her.
Emily Binstadt:
Yeah. So that's just off the top of my head. Some things that I think women in medicine deal with that maybe we don't always think about on the surface. I think historically women have certainly been less well represented as physicians. Fortunately, that has begun to change and med school application levels are equal basically at this point. There's still some disparities that we know about, gender disparities in certain specialties, the rates at which med students pursue different career paths and that's probably related to various things, but also I think across the board in medical specialties, we know that women are not achieving the same level of leadership or positions of authority or power that men are.
And just thinking back on my own experiences, I'll tell a story about when I was in residency. I recall signing up for a patient. So in emergency medicine, as soon as you're done taking care of one person, you try to go see the next person that's ready to be seen. And I signed up for a man with abdominal pain, and I can't even remember if I was a nurse or my residency colleague came to me seconds later and said, "Would you just take this patient instead? This is a woman. She needs a pelvic exam. She's requesting a female provider." And I was like, "Fine, sure, whatever." Unsign myself up for this guy with abdominal pain. Go do the pelvic exam.
Later my male colleague who signed up for that patient ended up having a very exciting case with a aneurysm that ruptured in the aorta, which is the big blood vessel in your belly, and went on to make a heroic save that he presented at various conferences later. And that should have been my patient, right? But instead I didn't get that experience because I got to do yet another extra pelvic exam. Now, should I have said, "No. I'm not the team player. I don't want to go do this pelvic exam. I don't respect this woman's wish to have a woman as a provider." All those things that forced you... Or not force you, but encourage you to be a nice person and do the right thing, are also the things that may give women who are in that same residency role an actually lived experience that's different from men that has reverberations and consequences potentially that are bigger than we might perceive in that moment.
Steven Jackson:
Yeah, and I definitely want to get to some problem-solving and maybe even talk about solutions because you're going to fix the world, like today. So stay tuned.
Emily Binstadt:
All right.
Steven Jackson:
But what are, in addition to an example like that, because, I mean, that's tough, and it's almost like a rock and a hard place. You don't want to miss out on this great case. I mean, obviously, it's unfortunate for the patient and the family, but from a medical standpoint, that's something that it's cool in the sense that you're learning, maybe it's rare, but you're also needed in the next room to do the exam. Are there other challenges that you faced where you find yourself in a rock and a hard place, and would possibly be almost prejudged or maybe not pre, maybe judged if you spoke up or spoke out?
Emily Binstadt:
Yeah, I mean, I guess I probably have a more vigorous response to overhearing women being asked to do pelvic exams in the emergency department now than maybe seems appropriate, even. And so I'm a pretty fierce advocate on that issue when I hear about it in our residency. But I think that's just an example of talking about some of those things that people may not realize the implications of some of the stereotypes that we put on women or men in the health care space is really the first step. Obviously patients can understand that when you tell that story and understand why maybe their slight preference for having a female provider in that setting may not actually be OK for women in medicine, and in that setting might be willing, if that story is explained, actually might be willing to have a male provider.
So I think there are lots of benefits that could just come from talking about this issue openly, and amazingly, that doesn't always happen. So I think providing forums for it to be discussed in a nonjudgmental way, clearly nobody is accusing anybody of doing anything bad in that scenario, but still, it has implications. So being sensitive about it is important. I think also the next step then is, how do you systematize issues that you can talk about and identify, and then take that to the next level of changing the system.
Steven Jackson:
So one of the things that I'm thinking about, because when I think about the fight for equality, fight for equity, and maybe we want to provide some definitions pretty soon about those, I think about, first, in order for somebody to think about solutions to a problem, they have to recognize it as a problem. Have you seen situations, or have you yourself been in situations where folks are looking at you sideways, like, "What are you talking about? This is normal. This is fine. You're emotional." I mean, what's been your experience with those kinds of things?
Emily Binstadt:
That's a great question. I think that, and Dr. Haley, you can weigh in on this, too, but-
Steven Jackson:
Please do.
Emily Binstadt:
... I feel like in the height of the Me Too movement pre-COVID, pre some of the race tensions and elevated awareness, there was this, I don't know, three to six months where this issue was kind of like, "Let's listen. Let's listen as the world." And it was so refreshing and great. And then I feel like that was the moment, and then other issues which rightly or wrongly superseded into the spotlight and the voice wasn't heard anymore on the gender spectrum.
Certainly other more... I won't say more important, because other intersectional issues maybe did come to the forefront and I think it's hard to say, "I had to do too many pelvic exams in residency is a more important thing than I'm being shot." So I think a lot of times those voices scaled back just because of what was happening with history, or I'm dying of a deadly disease. It just didn't feel appropriate to be talking about.
Steven Jackson:
That's a great point.
Emily Binstadt:
And I'm hoping now that some of that is, I don't know how to say, stabilized or evolving.
Kari Haley:
It's kind of been-
Steven Jackson:
Quieter.
Kari Haley:
I think that our society has made acknowledgements in that space now with more racial tensions and the disparities, and we know that they're there now. And I think that maybe moving to broaden that and apply it now that we have an open mind to it is a good spot maybe to start talking about gender a little bit more again, because it's still there.
Emily Binstadt:
And so trying to just amplify that voice and figuring out how to gain that platform back a little bit is an interesting question I think going forward in the next couple of months to years.
Steven Jackson:
And I think also, too, if you think about it, I mean, and I know we're talking about gender equity and gender equality today, but when you think about the murder of George Floyd, obviously that was... I mean, what can you say? That's an event that'll be in history books, somebody's history books, and it really changed the face of what equality inequity looks like, at least in this generation. Obviously you have the civil rights movement and you can look at history and the different milestones that occurred, but that was definitely a milestone nationally and even internationally. And it changed policies, it changed conversations. And for lack of better terms, it kind of primed the pump to the point where, OK, first couple of months I'm uncomfortable talking about race, but now we're talking about it because we need to. And it seems like it would make it easier for other very important issues to also move to the forefront now that we're uncomfortable, we might as well-
Emily Binstadt:
Might as well go there. Yeah.
Steven Jackson:
I mean, that's what I'm saying. So I just find that interesting.
Emily Binstadt:
Yeah, I definitely think that my personal journey with this whole discussion started with that exact event. I was very engaged with the gender side of things before that because that was personally relevant to me. But having George Floyd murdered here in the city we live in certainly prompted me to want to explore my own understanding and what I could do to be a part of making the world I live in better from that standpoint. And so-
Steven Jackson:
Absolutely.
Emily Binstadt:
... it is amazing how much though all of those issues intertwine and hopefully how redirecting the mic back to all the different people that need to have a voice is the way forward.
Steven Jackson:
Yeah, I love it.
Kari Haley:
Yeah, and I know, Steve, you mentioned earlier, too, thinking about the setbacks or things that we've maybe experienced as women. I know we've talked within the emergency department ourselves and about feedback for people. So feedback for women is different than feedback for men, which can 100% affect training in any sort of job, or ultimately then who you become as a trained professional within your trade. But that's something that we've specifically talked about, not using the terms "they're nice", or "they're aggressive", or...
Steven Jackson:
Right, right.
Kari Haley:
... smile more.
Emily Binstadt:
Right. Be confident. That's my favorite.
Kari Haley:
Yes, be confident.
Emily Binstadt:
Like you're supposed to act like something you're not, right? And it sort of implies that you're not actually confident or not knowledgeable of what you... Anyway, but at-
Steven Jackson:
Interesting.
Emily Binstadt:
... some point in training, everybody's not confident about something, and to act that way when you're not is probably not a great plan. Anyway, that's a pet peeve of mine.
Steven Jackson:
Actually... And I just got educated, in full transparency, because I have given that feedback and very well intended, but you want people to be confident, but you can't be confident by just saying it. You have to grow into that. It's like I say, I'm here to be educated myself. Interesting. There's something. Go ahead, go ahead.
Kari Haley:
Oh, no, I think that's a really great example because it's with all good intentions. People want you to go into a room and use your big voice and command the room and have all this knowledge and you should be sharing it, but why are you not? Why are we not perceiving you as confident is probably the things to think about a little bit more for the actual feedback to help improve.
Emily Binstadt:
Yeah. The number of female trainees that have been told they need to lower the decibel of their voice, like, "Speak at a lower voice," when they're trying to be in charge of a leadership situation in the... I mean that's-
Steven Jackson:
Interesting.
Emily Binstadt:
... a little concerning to me, that that's probably more in the receiver of the vocal range than in the person whose ideas are being expressed. Yeah.
Steven Jackson:
I feel like we're uncovering some things because, in the same vein, if you think about it, first of all, I think the fight against racism, the fight for equity, and not just equity regarding race, but also gender and... etc., etc. You're trying to level the playing field to the point where everyone has an equal chance to be successful, whatever success is. So I think about the whole construct of what normal is. For example, people refer to me as a Black doctor. Well, why can't you refer to me as a doctor? Because "normal" isn't a Black doctor. Normal, historically, has been a white male doctor, right? So really challenging what normal is. So then, who tells us that confidence expressed with a deep voice and a commanding presence is normal? Confidence can be very soft-spoken and quiet, but you can know more than everybody in the room. So I feel like we're scratching the surface in terms of challenging what normal is.
Emily Binstadt:
And it's even more interesting that when you do studies of how nurses perceive doctors, the way that nurses prefer to work with people who are collegial and more traditionally feminine, yet those leadership situations sometimes are still problematic. So-
Steven Jackson:
Interesting.
Emily Binstadt:
... from the nursing feedback we've gotten, we should be training men to act more traditionally like women, except maybe in those leadership situations, which is just challenging for a resident in training to take that all in and still being validated as showing up as your true self and feeling like you belong at the end of the day. And I think you touched on defining some of those terms we throw around, diversity, equity, inclusion, and what do those things mean? Because sometimes I think they all get lumped in one big pile, which isn't quite fair or the right thing, probably. So I don't know if we want to untangle some of those. Oh, look at you.
Kari Haley:
Steve has a visual pulled up here.
Steven Jackson:
Well, I'm so glad you asked Dr. Binstadt and Dr. Haley. So it says here, and I actually shared this on my LinkedIn page. It says, "Equality is everyone getting a pair of shoes. Diversity is everyone getting a different pair of shoes. Equity is everyone getting a pair of shoes that fit. Acceptance is understanding we all wear different kinds of shoes. And finally, belonging is wearing the shoes you want without fear of judgment." So, I think, and obviously there are many other definitions and different ways to present that, but at the end of the day, I think we all want similar things.
We want to be accepted. We want to walk without being judged. We want to be who our true selves are without feeling like we have to be someone else to be accepted. And if that's our foundation, then why should equity be such a big fight? Because this is what we "all want," but there's resistance. There's the, "Why are we talking about this at work? And why are we still talking about this?" Things are, as you said, stable, or things are quieter and I know exactly what you meant, doctor, but why are we still getting that resistance? What are people holding onto? And I think the answer is they're holding onto normal.
Emily Binstadt:
Yeah. The question is whether that's also-
Steven Jackson:
Boom, all right, sorry.
Emily Binstadt:
... normal, and whether the question is that that's also power, right?
Steven Jackson:
Yes.
Emily Binstadt:
So it's really hard to give power up once you have it. It feels pretty good to be in charge and be heard and all that good stuff. And it's hard to give that away. And I think that's something where if you see that as a zero-sum game where once you give it away you lose, that's the fear in embracing some of these new ideas of the non-normal. And I think the thing I would say to push back on that is that it isn't a zero-sum game, and diversity actually brings richness and new ideas and innovation-
Steven Jackson:
Innovation. That's right.
Emily Binstadt:
... and amazing progress forward in so many different domains that we've seen again and again, whether that's the business world or the health care, that it really isn't a zero-sum game. And the more we can make it equitable, meaning some people breastfeed and others don't, but they probably still want to be able to come to work and do their job, that kind of thing, versus this sense of inclusion, like everybody's voice getting heard so that you actually feel like you belong and you can bring your diverse perspectives to the table and be heard because sometimes you do bring them and if you're just not heard, well, that isn't going to go anywhere. So those things are actually making everybody's lives richer when we can make the environment that people are living in better. So I think that's the same lens I apply to gender, is that sometimes I think it's scary for people to move away from normal, but generally every program or systematic change that's been made to accommodate gender differences makes life better for everybody in the workplace. So, that's kind of the-
Steven Jackson:
That's a great point.
Emily Binstadt:
... take home that I would encourage people to-
Kari Haley:
Instead of thinking about as the maternal leave, we're thinking about parenting leave, and that just brings richness to a male or a dad's life.
Steven Jackson:
Thank you, ladies.
Kari Haley:
And it came from women who needed to be home with their infant because they are their sole source of food and comfort for a good period of time. And I agree 100% that if we can try to think about it more on that lens of we're learning from each other, building on things from each other and taking characteristics that are beneficial for everyone, bringing that more towards equity versus the equality of, "Well, you can also have this position, too."
Emily Binstadt:
Exactly.
Steven Jackson:
So when we think about, dare I say solutions, and especially in the context of equity, this is a health equity podcast and we're talking about health equity in the context of gender equity. What does that look like? So what does it look like in the context of gender where everybody has a pair of shoes that actually fit? Can you think of any examples? Maybe even experiences where you wish that shoe fit a little better?
Emily Binstadt:
I guess I've done some work recently with the Society for Academic Emergency Medicine, which is one of our National Specialty Societies, and they began a committee on equity and inclusion. And I, right around the time of George Floyd's murder, signed up because I decided I needed to know more about this space and be more involved. And as a part of that group, I found an extremely welcoming, encouraging place where I was heard in ways that I maybe haven't been in other scenarios for a while, and it felt really good. And honestly, I feel like we've made pretty cool progress with some projects in that space because of it.
But I think that sometimes having organizations that are dedicated and expressing that formally mission to focus on DEI can help move that needle because they're offering a space to be heard and also to develop concrete projects that can help move systems, right? We all need the chance to talk and offload, share common experiences, and that's super healthy, especially for whatever affinity group you belong to, just to be able to be a part of people with shared experiences.
Steven Jackson:
Absolutely.
Emily Binstadt:
But then the next step is taking it beyond that into, how do you get others that may have more traditional, historical, hierarchical power or are heard more? How do you get that, like I said, passing the mic to the person that needs to be heard? How do you get that to happen, and what are those systemic changes that we are talking about with our residents, with our faculty, at the institution level? How are we reviewing policies about who gets promoted and who gets titles and who gets salaried based on the jobs they're doing at work. Who gets awards? All of that stuff is rife with disparity, unfortunately, if you go back and look at it.
But the first step is looking at it, first of all. Being OK with going through the data and saying, "Wow, when we look back at this, not only are the people whose pictures are on the wall from 1930, all white men, but the people still getting the awards today still fall in that category, so what's going on here?" And then talking about it and then making that a thing that's OK to talk about and then troubleshooting why. And then maybe even talking about what are those criteria and how can we change them so that everybody's voice gets heard.
Kari Haley:
And thinking, too-
Steven Jackson:
Beautiful.
Kari Haley:
... along those lines thinking about solutions, I was hearing a little bit more about the mentorship versus the sponsorship, and I think sponsorship along those lines, like finding someone who is maybe closer to that traditional normal who is your mentor, but encouraging them or providing a way for them to learn how to be a sponsor, meaning more that they are able to advocate for you and say, "Oh, I'm not going to do this talk. I want so-and-so to do this talk," who would traditionally not have necessarily been approached to do it. So getting faces out there, getting voices out there from people who maybe traditionally have been closer to that normal, I think would be huge for moving towards a solution.
Emily Binstadt:
Yes. There's some really interesting data along those lines where people that are in formal mentorship programs and who get mentored by people that are "normal," basically white men, have substantially higher rates of achievement than those that are in informal mentoring relationships, maybe with people that are more part of their affinity groups, which is fascinating, but totally speaks to what you were just talking about.
Steven Jackson:
Well, mentorship is definitely one of the arms when it comes to solutions regarding this. I mean, I think about related but kind of not, you look at the hiring of NFL coaches and they talk about hiring trees, and so-and-so who's the new coach of this team came from so-and-so's tree. Well, what if I wasn't part of the tree? Then I might not get that job, or I might not even get that interview. And so mentorship and having a network of folks that can bring you up and show you the ropes, I think that's another way that the shoe can fit because it can level the playing field, because if I'm coming to the table and I don't have a mentor and everybody that is applying for that same job has a few mentors, then that's an instant disadvantage. Other things, and now, these are your solutions, OK?
I'm not taking any credit for it. So it sounds like the first thing we need to do is to make it OK. So make it OK to be uncomfortable. Make it OK to have open and honest, uncomfortable dare I say discussions about things that need to be talked about. Then it sounds like we need to almost incorporate what we learn in those conversations into systems. So a tax system such as including it in an annual plan, or making it part of a mission or a vision. And then after that, setting the standard. So if your mission is gender equality and gender equity, then that should be the expectation. And so that will affect who you hire and how you hire. Now you can apply that to any disparity. Boom. We just saved the world. Thank you. You've heard it here, folks. Wow. This has been awesome.
Emily Binstadt:
Yeah, Thanks so much.
Steven Jackson:
I've learned a lot. And what I appreciate, going back to something you literally just said two minutes ago is that, being a part of an organization or having an organization who, in so many words, they put their money where their mouth is. In other words, they're not just talking about equity, not just talking about inclusion, but they're looking at policies. They're looking at how we can leverage any influence or clout we have to make things better for everybody, because just like the thing you guys talked about in terms of maternal leave, well that's helped dads out, too. And so it stands to reason, the more we focus on the issues is not just going to help the "specific group". It's going to help us all, so why don't we get together and make it better?
Emily Binstadt:
Another thing that I think I'd love to see going forward is not only institutional policies at the highest levels of the institution, written policies and considered and really heartfelt, but maybe also down at the departmental level or the more day-to-day operations level. Making that a part-
Steven Jackson:
Good point.
Emily Binstadt:
... of every single discussion is where the rubber meets the road in effectual change rather than aspirational change.
Steven Jackson:
That's a mic drop there. I don't even want to add to it.
Kari Haley:
I think we've got to end with it. We've got to end with it.
Steven Jackson:
Wow. Thank you so much for your time.
Emily Binstadt:
Oh, thank you for having me.
Steven Jackson:
Our listeners are more educated and a little better for tuning in today, so thanks Dr. Binstadt.
Emily Binstadt:
Thank you.
Kari Haley:
Thanks everybody.
Steven Jackson:
Off the Charts is a production of HealthPartners and Park Nicollet.
Kari Haley:
It is recorded by Jimmy Bellamy, with creative by Peggy Arnson, Tina Long, Tim Myers and Jeff Jondahl.
Steven Jackson:
Production services provided by Matriarch Digital Media.
Kari Haley:
Our theme music is by Ryan Ike.