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Ep. 128 - LiveWell Talk On...Medicine: Color, Culture and Equity Pt. 5 (Dr. Niyati Sharma)

episode 128

Ep. 128 - LiveWell Talk On...Medicine: Color, Culture and Equity Pt. 5

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Niyati Sharma, physician, St. Luke's Wound & Hyperbaric Center

Dr. Arnold:
This is LiveWell Talk On…Medicine, Color, Culture and Equity. I'm Dr. Dustin Arnold, chief medical officer at St. Luke's Hospital. Today's podcast is another installment in our mini-series where we discuss topics related to diversity, equity, and inclusion. Returning to the podcast today is Dr. Niyati Sharma, medical director at UnityPoint Clinic Wound and Hyperbaric Center. She's also a member of the medical staff and cares for patients on the hospitalist service. And I'd like to share her journey of becoming a doctor and discuss women in medicine. Welcome back.

Dr. Sharma:
Thank you for having me again, Dr. Arnold.

Dr. Arnold:
You know, we've done this color, culture, and equity and addressed racial disparities. We've addressed the disparity of men of color wearing white coats and what that challenges have. But another challenge, I think, and this is not to be misogynistic, but I think being a woman and being a doctor is really hard. I don't know about your household—I guess I know your husband very well, so I probably know the answer to this—but mom is never off duty. You know, when kids get sick, the first thing they say is mom, they never say dad. Now when they're teenagers and they want money, they will go to their dad first. So the mom is never off duty. I know you have two beautiful children, so can you share the story of how you became a doctor and some of the challenges you faced as being a woman, as well as a mother?

Dr. Sharma:
Yes, absolutely. Thank you for doing this series, Dr. Arnold. I'm really glad that more and more organizations are recognizing this and addressing this. And now I'm lucky to be a part of UnityPoint, where you know, they have always looked at the female physicians and given chances and opportunities. But yes, it is, as you said, difficult for women physicians in general. For me, I'm from a small town in India, but I was lucky to have both my parents as physicians. So, you know, I was exposed to this profession at a very young age. We used to have—our first floor was the mini hospital that my parents ran and the second floor was where we lived. So it was basically a part of our life. But then my own interest in biology and human body, which until today doesn't stop to amaze me, was the main push when I entered into this field. Also the patient satisfaction that you get from it. I was seeing my parents get that, and that was a big push for me to get into it. We all have challenges as physicians. You know, you yourself and all other physicians. And similarly, I did my share of the hard work that I did. My story about challenges about becoming a physician in America coming from India, it actually relates to lots and lots of immigrant doctors who've faced similar situations. Coming from India, doing my basic medical school training in India, and then coming here and learning, not just the content of medicine, but the way to practice medicine, which is completely different, which is beautiful here. Wonderful. But it's different. It's something that was the first challenge for me to learn how to modify the practice ways and do it the way it's done here.

Not just that. Actually understanding the community and getting in and knowing what's important for people here, understanding history. Getting to know who are the superstars? What movies are common here? What sports people are into. You know, leaving behind the cricket and getting into football. Although it's not exactly medicine, but you can't leave these things behind. You still have to understand the community, the culture. And I think that's the best way to practice medicine. That's how you know your people, you know your patients and you make a connection.

Dr. Arnold:
Absolutely.

Dr. Sharma:
So, you know, something from very basic from driving over there is so much different than driving over here. But all of that and then seeing community culture. And then, you know, language. English is our second language. All our education was done in English. But what's prevalent in India is more British English and here the accent was different. So to understand that, to get used to that, and then making sure the people who I'm talking to, my patients are understanding what I'm saying. That's a little bit of a challenge. I still hear some patients coming back and saying that we really couldn't understand this. We really couldn't understand that doctor who had this accent. And little things, but they get challenging when it's happening every day. There are visa technicalities, which lots and lots of immigrants go through. And it poses a barrier. In a lot of the different stages of our lives, it's just hard to make good progress with the technicalities still there. Even like traveling back to my country, going back there and then coming back, even being legal immigrants, working hard, there's still a little bit of uncertainty. Like, are we going to get back here on time? Are there going to be any problems? You know, will everything go okay? Will I get my visa things done on time? So all these problems just get together and they become one big challenge. I'm always, I'm lucky to have my in-laws stay with us and help us out. But families who are working, you know, if a husband and wife both are working physicians—to get that support that, you know, the family support is not there. And in fact, right now with COVID my family's in India to just stay here and just worry about them. Not being able to even meet with them, you know, a lot of people didn't with COVID. But just being so far, just across the earth on the other side, that's just another challenge that we face.

So we have to work hard to build that first connection with the patient. And also many times, I hear these questions, where are you from? Where's your origin? What country are you from? What's your mother tongue? What's your language? What's your religion? And I understand most of these questions come out of curiosity. But sometimes they can make people feel differently. And Dr. Arnold, despite all of this, I never questioned myself to be a physician practicing in the U.S. You know, that was my dream. And here I am, and I would just say, different skin colors, different cultures, different backgrounds, different accents, but really we're all working on the same purpose, working on improving the health of our society, our people. So as long as the society is welcoming, we keep giving our best.

Dr. Arnold:
You know, two things to follow up to your commentary. One, the visa system does not take in consideration, in my opinion, at all the value that physicians from other countries bring to our communities. That has been an eye-opening experience, that uncertainty you talk about. I mean, I'm an American citizen. I work at the same hospital I was born in, you know. So I never had that uncertainty. And you know, having ran the hospital's program and all the friends I've made over my 25 years, I've had physicians that just, you know, really get jerked around by the visa system. And it's just not fair on several levels. The next is that, it's totally a Midwestern thing that, you know, if you go in and introduce yourself as Dr. Sharma. People, particularly the agriculture and the older people around here, particularly in Eastern Iowa, but they'll say to you: do you know, Dr. Sharma from Minneapolis? You know, they want to connect with you. And once they connect with you then, okay, she knows so-and-so and therefore now we're connected. It is totally a Midwestern thing. And sometimes people are taken back by it. Like, why would I know—just because my last name's Sharma doesn't mean I know that doctor. And I did it one time too—I had a friend that when I worked in research whose last name was Patel. So that was me to this other doctor, and I said, oh, do you know so-and-so Patel? And, you know, come to find out that Patel is much like Smith. So I've even done it myself, I think it's kind of funny. But tell me about being a mom and being a doctor. What are the challenges that you experienced from there? Because, like I said, mom is never off duty. Dads get off duty, moms never get off duty.

Dr. Sharma:
Yes, that's true. And there are many different challenges that come along with that. First of all, just the thought of being a mom and being pregnant and caring that during your initial career, like during the residency, and then as I started working, that's a challenge in itself. Because sometimes it's perceived as, or maybe some women perceive that it can be a threat to their career. So sometimes women end up delaying their pregnancies, which is not good because there's so many years of training and schooling already. And then you get to the stage where you're starting to work as a physician, and then you're scared that it's going to affect how—first of all, you won't have enough time to care for your baby. And then secondly, how we will be perceived at the workplace if you're taking time off. That's one thing, then yes constantly, you know, every morning I'm having to think about what we are packing for lunch and who's going to pick up kids. Who's going to drop them to school. Oh, it's a day off today. Now who's more responsible to take a day off with them. So it's a constant struggle. Bringing up kids is not easy for anybody, but I've realized that being a working mom and a physician mom, if I didn't have all the support that I have, which I'm lucky with my husband, my in-laws, and my neighbors to tell you the truth. When my in-laws are not there, I rely on my neighbors a lot. And that's, Iowa, as a community and neighborhood has given me a lot. So yes, it's hard. There's always a guilt. The mom guilt, you know, you go into leadership roles and you go into get immersed into your profession, and then you have a guilt that I'm not doing enough for my kids. That's always there.

Dr. Arnold:
Well, I happen to know that you're a wonderful mother and you have beautiful children. Two beautiful dogs now, right?

Dr. Sharma:
Yeah. Yes, I have two fur babies too.

Dr. Arnold:
Yes. You know, one of the darker sides of medicine perhaps, or patient care, is particularly for foreign physicians. I've had to intervene where, you know, the patient says, well, I don't want a foreigner to take care of me. And that happens. It does not happen very often, but it does happen. And usually when I intervene, I'm like, you know, you've got to be crazy. This doctor is one of the best doctors that I know and very well trained. And it's really from bigotry, I think. I've never had a patient that was discerning do that. You know, but it is disappointing. Have you ever had that experience, where patients are like, well, I can't see you because you're a foreigner.

Dr. Sharma:
I've had my nurses alert me to just be prepared going in the room. I've had some patients, you know, show me the dislike. But ultimately, going back to forming that connection, and I think if when we're seeing them the first time, it is definitely challenging. But if you find a little bit of commonality, and if we try to work around what really the patient's culture is and background is, and ignore some of that initial. Which is tough, which can sometimes just get you right there, but ignore first the initial thing, I think you can still manage to build a good relationship.

Dr. Arnold:
You know, the listeners should know that all patients love Dr. Sharma.

Dr. Sharma:
That must not be true.

Dr. Arnold:
No, that is true. But in regards to—our world's a little bit different. We're both hospitalists. And so you get your salary and you work your hours and your shifts and that. But, you know, they do see a discrepancy in payment, or earning between men and women. And I know healthcare is one of those. And I've always kind of felt, it's kind of like you said, it's part of the, you take that time off, you take your maternity leave and that can impair your ability to move along in the system. But, it does happen. What are some of your thoughts of why there may be these discrepancies in earnings between physicians, male physicians and female physicians?

Dr. Sharma:
Well, I think—I'll start with this. There are a lot of capable women. There's no shortage of capable women workforce in medicine. There's actually increasing, and better number of female representation in the medical schools and the training programs. But then the women don't go to the higher stages, the high profile ranks, the higher academic places. They, you know, there's less women who become the deans or the department heads and very less women who become CEOs and COOs. So that will impact the salary, that will impact the payment and all. And definitely women as physicians. Women end up taking more time off their work. If they are completely immersed into their work and not taking time off, they sometimes can be perceived as neglecting their families, which most of the women with families and children cannot take that. So, they end up taking more time for for kids. If they have a sick kid, usually it's the mom taking time off and women taking time off. Again, the pregnancies and childcare after that definitely affects that too. And beyond all of that, there are still discrepancies there between men and women in relation to the pay in general.

Dr. Arnold:
Yeah. To me it's mind boggling, because we've always had women on the medical staff that have contributed and it's disappointing on some levels actually. Just St. Luke's, I had them look this up for me today, we have 218 female physicians and 197 male physicians on the medical staff. And then if you add in ARNPs and PAs. So obviously ARNPs are predominantly women, but a total of 311 female clinicians and 215 male clinicians. So it's quite a gap there when you add in the allied health providers. But a gap that we're obviously proud of because they get the job done on a regular basis. Well, Dr. Sharma it is always a pleasure to talk to you. And I want to thank you for joining me and sharing your story today. You're a wonderful physician and a good friend. Again, this is Dr. Sharma, medical director at UnityPoint Wound and Hyperbaric Center. Be sure to join us again next month for the next installment of our mini-series, medicine, color, culture, and equity. Thank you for listening to LiveWell Talk On, if you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.