Well, it is my pleasure to welcome you to San Diego and Heart Rhythm 2025, the 46th annual meeting of the Heart Rhythm Society. If you have not already done so, please download the HRS 2025 mobile app from your preferred app store. This is how you can participate in live Q&A during sessions, and we will have Q&A, so please participate. Get ready. To download, please scan the QR code on the screen to access this session's Q&A. When using the mobile app, log in with your HRS credentials. Please note that visual reproduction of Heart Rhythm 2025, either by video or still photography, is strictly prohibited. And we will report you. So our first speaker today in this session, which is about women in pediatric and congenital electrophysiology, why is there still a gap, pun intended. Our first speaker is Dr. Molly Shaw, and she will be giving a talk on what do we know about the current state of the gender gap in pediatric cardiology and EP. Good afternoon, everyone. And my esteemed chairwomen, thank you for the kind introduction. So my charge is to talk about the current state of the gender gap in pediatric cardiology and EP. All right, so in order to talk about the present, it is imperative to talk about the past. The first female physician recorded in history was Agnatis. Agnatis could only practice medicine by cutting her hair and impersonating herself as a man. And when she was discovered, she was sentenced to death for breaking the law. Her female patients then rallied behind her, threatening to end their own lives until the Athenian judges lifted her sentence. And she was then able to continue to practice medicine. Fast forward to the 19th century, when Elizabeth Blackwell became the first woman in the United States to receive a medical degree. And slowly but surely, other women followed, enduring poverty, the same deep-seated stereotypes and discrimination. But they went on to build hospitals, win a Nobel Prize, lead a medical school, and dramatically improve the health of millions. While at the same time, the hallowed Journal of Medicine, now known as the New England Journal of Medicine, continued to publish articles about the smaller brain size of women compared to men, and linking it to lower intelligence. And asserting that their weaker physique and physiological conditions during a portion of every month disqualifies them from practicing medicine. So when the question is asked, why is there a gender gap? The complicated answer is that we have a millennia of implicit bias, prejudice, and stereotypes to recover from. It was only in 2017 that there was gender parity in the United States medical schools. Canada achieved this two decades prior. Let's now again fast forward to the current state of gender gaps in our field. Thanks to the heavy lifting done by many women that have generated substantial hard data about gender disparity in the workforce, fellowship training, academic leadership, compensation, conferences, panels, authorship, and clinical trials. Looking at women representation in different stages of training from pediatrics to pediatric cardiology and pediatric EP, we are fortunate to start out with a pretty robust pipeline with 70% of pediatric residents being women, and currently 53% to 54% categorical pediatric cardiology fellows being women. Now 60% of cardiology fellows choose a subspecialty fellowship, and most women do choose to go into a non-invasive branch. But 9% go into electrophysiology, and almost a third are women. Looking specifically at pediatric EP fellowships in the United States, of the 65 fellows trained in the most recent seven fiscal years, 34% were women, and the trend seems to be holding if not getting better. Looking at EP faculty at training programs, 9 of 12 programs had at least one female EP faculty, but three programs had none, and I will not cite them. However, I do want to put in a plug for Stanford. While the numbers are small, the observation is that Stanford probably has trained the most female EP fellows in the last few years. Well-deserved applause. This also reflects in the current workforce of practicing pediatric electrophysiologists in the United States, with 35% being women, and this number is important because we have not had a further leak in the pipeline with women dropping out of EP after completing their fellowship, which is actually seen in adult electrophysiology. About 13% of graduating fellows are women, but there are only 6% or 9% practicing electrophysiologists. So we have held this pipeline. However, representation of women in leadership roles is less, with 39% subspecialty directors, 25% of endowed chairs, and 16% of division directors being women. Now, the disparity exists in the promotion process as well. Women are less likely to get promoted to associate and full professor, and when they do, it takes longer than men. Specifically in pediatric cardiology, only 27% of women were full professors at the time of this survey, which was only a couple of years ago. And they're less likely to be appointed as department chairs. Now, there's an abundance of data that show that there are no medical specialties in which women earn the same or more than men. Relative to pediatric cardiology, the starting salary, the year 10 salary, and mean annual salary growth rate is much lower than men. And the data are similar or worse in our allied specialties. CT surgery women actually get paid less than assistant professors of general surgery. We are the only pediatric cardiology subspecialty to have generated salary disparity data for full-time electrophysiologists, and not surprisingly, the median annual salaries for females are lower than males. Female EPs are less likely to be in the top 45% of earners, and this difference persisted after adjustment for academic rank and years in practice. On average, women EPs, pediatric EPs, earn $0.78 on the dollar compared to male counterparts of equal rank and experience for doing the same work. All right, that was a lot of published data and helpful, but what about the soft data, the elephants in the room? Let's start with the confidence gap. Well, outside medicine, when asked, and this was a UK survey, if you could win a point of Serena Williams while playing your best game of tennis, one in eight men or 12% said yes, and only 3% thought they could take a point off the 23 times Grand Slam winner. The Matilda effect, where scientific achievements of women are often overlooked, underappreciated, or even attributed to male colleagues, where leadership sessions are almost exclusively mannels, and wellness and DEI sessions are relegated to women speakers, and scientific sessions on ablations and devices have almost exclusive male faculty, even when women perform the same procedures with equal or more technical expertise. Or the presidential gender gaps in professional societies. Hayses has had eight female presidents since 1988. In fact, there was a gap of 20 years with no women presidents. What the hell were people doing? But in the last 10 years, there have been four more women presidents, and at least two in the pipeline. So finally, there are many opportunities and solutions to close the gender gap at multiple levels, which include institutions, policies, professional societies, editorial and industry boards, and clinical trials. But I think the three most important tools are the individual responsibility to speak up and speak out. To have strong allies, both male and female, committed to closing the gap. And an intentional plan to perpetuate female leadership. So for all the women leaders out there, I urge you to start thinking today about the next woman you will hand over your reins to tomorrow. Thank you very much. Thank you so much, Molly. That was great. We're going to have lots of time at the end for discussion, so we'll just move through our speakers for now. And our next speaker is Cheyenne Beach, who comes to us from Yale University, who will speak to us on Important Lessons I Learned as a Junior Woman. Well, this is loading, I'll say hi. Thank you to the organizers. Thank you to both of you for having this session and for inviting me to participate in it. So my task is to talk about lessons I learned as a junior woman in EP. And really my disclosure is that I know my experience, but I have no idea how much of my experience is due to my being a woman or not. I've thought about this a lot, and I can only make so much of it. So I'll tell you about my experience here. So a few slides on my background. I have five minutes to talk, so I'm gonna try to go through this quickly. I'm the middle of three girls. So I grew up in a family of many women. I also have many female cousins. And so I have to say that being a female, it never really occurred to me that I might not have the same opportunities that other people did. I was always told by my parents, as I'm sure many people in this room were, that I could do anything if I set my mind to it. And I truly believed that. I always have believed that about myself. So as many of us did, I went through my training pathway, very confident in my achievements. And I landed in Pittsburgh for my pediatrics residency and my pediatric cardiology fellowship. And I feel very lucky to have been there. So I was exposed to EP first with Dr. Gaurav Arora and Dr. Lee Bierman. And I cannot help but mention these two women on this slide who have meant a lot to me. This is Dr. Jackie Kreutzer and Dr. Sarah Trucco, who were our cath attendings in Pittsburgh. So we only had female cath attendings in Pittsburgh. And it, mostly when I was a junior attending, was when I realized the effect that they had had on me. And when I really thought, what would they do? Or I directly asked them, what would they do? So these two women, not electrophysiologists, are very special to me. When I was deciding to do EP, I was fully supported. Gaurav and Lee were 100% supportive of this. Other people who have thought about going into EP, some of whom did, some of whom didn't, have said it's hard to get into an EP fellowship program. It is, but that's okay. There aren't enough jobs in EP. EP doesn't allow enough flexibility. Those days are really long. And then you're not weird enough is something that some people hear. And I give a lot of credit to my mentors who told me that none of that matters. Like, we've been talking about recently, if you really wanna do EP, you can do EP. And if you don't wanna do EP, we don't need you in this field. So we had a lot of people. If you love it, you can do it. Then I landed in Michigan for my EP fellowship, again, feeling very lucky to have been there. So I learned from these amazing mentors. And as I was thinking about this, I realized that Brynn and Stacey Kayser, who was the other nurse practitioner at Michigan when I was there, really should be on this slide because I learned a great deal from them and still do. So my fellowship was wonderful. Again, it never really occurred to me that I might be treated differently as a female. It didn't even cross my mind. And then when I landed my current job, so I'm still in what was my first job at Yale, where there wasn't another electrophysiologist. And so I took on this task of restarting a pediatric and congenital electrophysiology program. And I was terrified. I made this decision to be closer to my family and to have a good job for my husband. And I was very happy about having made that decision. There wasn't a second guessing about that, but I was terrified. And this group of people here, including Brynn and Stacey, told me to trust my training. And I told myself that so many times during my first year of being an attending. They told me to use my resources, which I'll talk about in a moment. And then when a few people who didn't know me cast doubt on my decision to choose the program at Yale that I had chosen, Marty LePage said to me, they don't know you, I know you. And I can tell you, I can give you advice, I know you. And so that, I'm sure he does not remember telling me that, but that comment that he made to me was really special. So lesson one, I have seven lessons to go through. I'll be quick. Lesson one is to be open-minded. So I landed at Yale, as I mentioned, and I realized that while I did not have things that other people had, and while I was jealous of other people who had amazing senior pediatric EP mentors where they were, I had things at Yale that I could take advantage of. This is Eric Grubman feeding me a slushie during a long case when I needed a break. He really has been a clinical sponsor for me. And then Rachel Lampert, who isn't included on this slide, she's been an academic mentor for me. And I realized that I had an amazing adult electrophysiology program at Yale. And I have an amazing adult congenital clinical practice at Yale. And so I could fall back and gain experiences from what I did have, even though it looked different from what I had been exposed to during my training. Lesson two is to reach out and make connections. So I have presented this case. This is a patient with Tango II deficiency disorder, which was the scariest clinical thing I've ever seen. And I suddenly realized I had no idea what to do. I had amazing training, but I did not know what to do. So I did my PubMed search and found the only paper about a patient with Tango II deficiency disorder and arrhythmias, and I saw Christina Miyake's name on this. So I just called Christina Miyake. I think I asked Yuki for her phone number. So I called Christina, who probably called me right back, talked me through this whole thing, and Christina and I have developed a relationship since then. And so this ability to suck it up and make a phone call, even though it was a little bit intimidating, has meant a lot to me. And I've had to repeat that, remind myself of that over the years. Lesson three is pretty simple. Ask for what you want and need. It seems so simple, but if you don't ask for it, you're not gonna get it. About six months into my first year as an attending, I realized that I did not have any space in my schedule to do general pediatric cardiology. I could not do my clinic anymore. So I asked my section chief if I could stop doing general pediatric cardiology, and he said, sure, on the spot, right then. And he identified who he had available to give my clinic to. And within a month, the templates were all changed and I no longer had a general pediatric cardiology clinic. Not everything works out that great, but that was a really eye-opening moment to me. Lesson four, which I stole from Dr. Ed Walsh, is that there's no shame in a recurrence. This is a patient of mine who had had fetal SVT. This is SVT caught on a Holter monitor. When she was two, she had had so many breakthrough arrhythmias even on amiodarone plus beta-blockade, which was getting in the way of childcare plans and all that. So we decided to take her to the lab. She had PJRT, mid-septal, I did this with cryo. This is three point something seconds when I had beautiful termination of tachycardia, no evidence of continuation of pathway conduction, and then it recurred within a week. And this was one in a two-year-old when I was in my first two years of being and attending that I just did not feel comfortable doing this second procedure. So I called Dr. Walsh, who kindly invited me to join him in the lab in Boston. And I must have said something along the lines of how I felt bad that I was there with the recurrence and I didn't even have the guts to repeat it one time myself. And he just looked at me and said, Cheyenne, there's no shame in a recurrence. There is some shame in being overly aggressive and causing harm to a patient, but there's no shame in a recurrence. Lesson five that I could talk about for a very long time, although it's a little hard for me to talk about, is that pregnancy can be very challenging. I was thinking about this as Dr. Shaw was presenting her slides, that I always had thought that I am totally as physically capable as a man. And this was the moment when I realized that it was a little bit different for a short period of time. And so it's okay. Again, I could talk about this for a long time, but I'll keep it as that's okay. Within reason, we don't want it to be that hard or it's not worth it if we push ourselves beyond what our bodies can do. We should give ourselves grace. We can meet with our radiation safety teams because actually this is a very manageable thing to handle, pregnancy, when you're exposed to radiation, but you have a radiation safety team at your hospital that you can talk with. And this is when I needed to start telling myself these lessons. It's when I really had to focus on what was important, what I wanted, what would make me happy. And I started really leaning to others for support and advice. Lesson six is to do things that make you feel like you. Someone once said to me, have friends who don't make, it's not that they should make you feel good, they should make you feel like you. And there was something about that comment that really resonated with me. So I say, consider others' opinions, but feel free to let them go. The whole you should do this or you shouldn't do this can be, it can feel heavy and there's no need for that. Spend time, like I just said, spend time with people who make you feel like you. And then lesson seven, as I'm now telling you what your goal should be. Your goal is happiness. I feel so strongly about this. I made a comment at a women in EP luncheon a year or two ago about how when I was interviewing for my job, somebody asked me what I wanted in 10 years. And I said something like, I wanna grow the program 200%, something like that. I don't know. And now my goal is different. My goal is that I want to be happy. And I've realized that this looks different for everyone and it looks different for me, even on a day to day basis, but definitely on a every five year to every five year basis. And I think we should reassess this regularly. And I'll say I haven't entirely figured this out. And so I'm really looking at Dr. Dubin to tell me then what to do. Tell me how to figure that out. So in summary, I think what I learned as a junior woman in EP is that we should be open minded, reach out and make connections, ask for what you want and need. There's no shame in a recurrence, that pregnancy can be very challenging and we need to accept that. Do things that make you feel like you and that your goal is happiness. Thank you. Thank you very much. You're welcome. Thank you. And now I have the honor of introducing Dr. Ann Dubin from Stanford. And she will talk about advice for my younger self as a woman in EP. Thank you, Kara. Thank you to the organizers. And this is my second gray hair talk. It hurts, but I'm starting to get used to it and it's okay. Basically, I'm gonna start this with a disclaimer that these are my opinions. They're not anything scientific or written or anything out there. You can disagree with me all you want. Let's have a nice debate about it. I think it could be interesting. But these are just opinions. And second, my apologies to everybody who came through our fellowship because men and women, you've heard me say a lot of these things many times. So just stick with me because I know you know these already. Okay, so the first thing that I would say when I'm talking to my younger self is you have to start getting a little bit more comfortable with the work-life detente. And I'm gonna call it detente instead of balance because in some ways, it's always a war. As I've told many people, when you're home, you feel you should be at work. When you're at work, you feel you should be at home. You just have to get comfortable in that feeling of uncomfortableness, so to speak. And I think you have to be realistic. If you look, Martha's up here. And I remember back in 1998, this is when this actual clip was shown on the Oprah Show. I still remember this. It was some Christmas show or something. And Martha was talking about this wonderful Christmas tree that she made out of plate-sized chocolate chip cookies. And I was psyched. I had, now mind you, I had a three-year-old and a six-month-old at home. But I was set to make these plate-sized chocolate chip cookies, 450 of them to be exact, and then put them up on a tree. And then as the weekend came closer and I was getting, I burst into tears, probably partly hormonal, et cetera. And I was hysterical thinking I was never gonna be a great mother or a great wife because I wasn't making this damn Christmas tree. And excuse my swearing here. And then I took a step back and I started thinking about this and thinking about how all of the women I knew, on some level or other, maybe not Martha's Christmas tree, but in some level or another, were having these feelings of inadequacy because they weren't doing things like this. And instead they were taking care of patients, maybe a good thing to be doing. And so I think it's always important to start out any conversation with, especially young women, most young men don't wanna be Martha, but if you do, this will go for you as well, you don't have to be Martha. You should farm out the stuff that you don't want to do. We are in medicine. Medicine tends to be a place where there is some disposable income. Have people do the stuff you don't wanna be doing so that you can do the stuff you wanna do at home. I like to think of it as family time versus chore time. My husband was actually the person who said to me, the kids are not gonna remember you keeping a spotless house or having the laundry done every week. They're gonna remember the times you go to the soccer game or that you're sitting there playing on the floor with them. I think that's really important to take a step back and think about, that you don't have to be the perfect housewife or the house husband. And as I said, I'm trying to open this up because I think it's true across the board. And it's really probably important, especially as a woman, for your family to see you as a role model and to really stop apologizing for your career. I think it's important for my kids and they to this day, and I'm really proud to say that they're both following in our footsteps and becoming physicians, to see this as the right thing to be doing that they didn't miss out. So that's number one. Number two, when you think about women in medicine, there's always the, but women are too emotional. And women are always having all these issues. And yes, you're gonna be called emotional. I've been called emotional since day one in this field. Just don't let it bother you, just suck it up. Because it's gonna happen. If you look at it, actually women are described as pushy, bossy, emotional across the board, especially, and a great example is there was a Fortune 500 study that was done of looking at women's performance reviews, and women were often, in 70% of the cases, described as having negative personality traits, specifically bossiness and being stubborn, whereas men were thought of as being confident and assertive. It's gonna happen, it's just the way it is. You put up, you understand that this is coming. Now how do you react to it is the important thing. And I think that in figuring out how to advocate for yourself, I think we have to start out with the premise that Disney is done as dirty. I grew up in the generation of Disney princesses where they were meek and mild, waiting for their prince to come save them, and they didn't, they were very humble, that ain't life. And so we have to break that model. And it's ingrained in a lot of us, because this is really, from ages two, three, four, five, what's been there. So we have to fight against that. It's important to advocate for yourself and don't let any of this negative criticism muzzle you. You have an opinion, you speak it. Now there are different ways of speaking this opinion, and I think it's important that we understand our tone when we're talking. We tend to be a little bit concise and direct when we're speaking. You can't kind of be, you can't, you have to be, I'm gonna just say concise and direct. It's probably the best way of putting it. I'm gonna try and be concise and direct in my talking about this today. And it is fine to bring up issues, I think this is the other important thing, fine to bring up issues and problems, but you can't just come in and bring up an issue and a problem without having thought through a solution. May not be the right solution, but you need to have some idea of what to do about the problem. Just coming in and complaining, people are gonna turn you off. You really need to have thought through at least the problem in such an extent that you can have an idea of what to do with it. Negotiating, this has been brought up before, I think in Molly's talk a little bit as well. It's fascinating, only 46% of women negotiate salary as opposed to over 55% of men. And when negotiating, we tend to negotiate for 30% less. You need to know your worth and you need to believe in your worth. The AAMC can give you median salaries for your type of cardiology for an invasive cardiologist in all different areas of the country. I'm sorry for international folks, I don't have that information for you, but I know in the US we can do that. They give you this for a nominal fee, it is worth knowing. It's important to have that information. It's also important, and I tell all of our trainees this, that you don't just look at salary as a number and what your salary itself is. You need to be thinking of everything else that goes into your fulfillment and satisfaction with your job. It can include things like personal development leave, it can include things like bonuses, it can include things like research resources. You have to look at the whole big picture. And yes, there are many places that can't necessarily give you salary, but they can give you other things. And you should be ready with what else you're gonna need, and as my mentor told me, but you need to be successful. You have to think of it in those lights rather than in I just want it because I think I'm worth it. That's not usually the best way of getting what you need here. And it's really important to talk with your mentors before you start negotiating. Okay, moving on, imposter syndrome. And this is something I feel very strongly about that it's come across to me in the last few years. I think it's really important to acknowledge we all at some point in our careers have imposter syndrome. Everybody gets it, okay? And you have to recognize that you are your number one critic, you're gonna be your worst critic in this, and you're gonna think you're doing a much worse job that anybody around you is. And this is the time you lean on your mentors, you lean on your network of folks that you depend upon, you focus on growth and learning, and you can't be afraid to do something that's out of your wheelhouse. It's important, that's how you grow and that's how you learn and that's how you develop. You have to kind of take chances. And when you take chances, you're gonna fail sometimes. It happens, we all fail. There's no question about it, and I think the important thing about failing is you need to be honest and transparent when you do fail. You have to take a really hard look at why you failed and look at what you can do to change that situation so that you can learn from your mistakes. And that's probably one of the more important things that I've learned. And finally, I think we have to think we are all not islands, okay? If you're going through something career-wise, home-wise, chances are many of us have already gone through it and understand what the issues are. I have to say I've been blessed with a really rewarding career in pediatric EP, and the bulk of it I really owe to my mentors, those who've gone before me, as well as my peer mentors. And I really appreciate it. So don't hesitate to reach out, and I think as Cheyenne said really nicely, maybe even somebody you don't know, but you just kind of admire, people are really willing to talk and are really willing to remember when they were in the same scenarios that you are. And I don't think it stops, again, just because I have gray hair now, I do find times I'm like, oh, I gotta ask how somebody would handle this scenario. I call my mentors, I call my friends often to ask their advice, and I think that's important that we stay connected that way. And that's what I got. Thank you very much. Thank you. It's my pleasure to now introduce my mentor, Charlie Verul from Children's National, who is going to talk to us about his perspective as a male ally in closing the gender gap. Okay. Well, thanks to HRS and the committee for inviting me to this talk. I gave a similar talk at the Women in Paces meeting about seven years ago, only women in the audience, and it was very intimidating. So I'm pleased to see that there's men and women in the audience today, and we'll update it. But I had to start with the same slide because this was from a magazine article about 50 years ago. So a long time ago, but 50 years ago, they're talking about women coming a long way because they can smoke thinner cigarettes, not the fat cigarettes that men smoke. So hopefully the 50 years since then, we've seen more progress than that. And I also showed this slide, which was from a PD Rhythm meeting, and I made the inappropriate comment that there's not even enough women to make a Women of EP calendar, right? There's not 12 women at the meeting, right? And at the same meeting, look at all the men at this PD Rhythm pediatric EP meeting. So there's a big disparity there, and that's what I'm going to try to talk about a little bit in the five minutes. Men have to put up signs when they work. Women just work. And I think at that last meeting, I bought this book, and I think I gave it to Molly at the end, about how to be successful without hurting men's feelings, the non-threatening leadership strategies for women, and I thought it was pretty helpful. So we're going to talk a little bit about how I can advocate for pediatric female electrophysiologists And I only have a few minutes, so I'm going to use the David Letterman style and do the top ten ways to help resolve the gender gap. And the first one I think is important, and it's advocating for equal pay policies. It seems so obvious, but it isn't. I know when I got to my institution as chief, there was a disparity in pay at equal levels, as Molly showed the actual data. So I knew, I predicted you were going to show that, so this is going to be more qualitative than quantitative, but basically guidance for what we can do as men in the audience, and men in leadership positions advocating for or implementing pay structures that ensure equal compensation for equal work and addressing the salary discrepancies. Number two is mentorship and sponsorship. Men can mentor and sponsor female physicians, helping navigate career advancement, leadership roles, and access opportunities. Mentorship is more active than mentorship and can influence promotion and salary increases. Number eight, challenge unconscious bias. I think I used the same slide as you did, Molly, but it's an important point. Men can recognize and challenge their own biases and encourage others to do the same. This might include confronting stereotypes that impact the recognition and value of women's contributions and addressing biases in hiring and evaluation. Number seven, support flexible work policies. Men can advocate for policies that support work-life balance, such as paid family leave, flexible hours, job sharing. These policies can help reduce the burden on women and men, especially in the context of childbearing, which has historically led to career interruptions and lower salaries, what has been called the mommy penalty, not my quote. Number six, be allies in salary negotiations. And alluded to this, men can support female colleagues during negotiations by offering advice or standing in solidarity, sharing negotiation tactics or strategies to help close the pay gap. This is from a textbook on physician negotiations that was written 22 years ago now. And the impact, you can probably double that and make it $15 million, is the impact on negotiating and being a good negotiator. Number five, promote leadership, gender diversity. Men can advocate for more women in leadership roles in hospitals, societies, and academic institutions. So here are my current bosses, maybe Sherwin and Ansong. And PACE has, again, Molly showed this, PACE has started quite early with their presidents, and we continue to increase the number of females on the PACE's executive committee, including several here on the podium. Number four, foster inclusive workplace culture. Creating a culture where all employees feel respected, valued, and heard is critical in reducing gender-based disparities so men can foster a culture of inclusion where all are treated equally. Number three, use platforms for advocacy. Men in medicine have platforms in leadership and academia or other public-facing roles, such as this one, you can use their influence to raise awareness about the gender pay gap. Number two, don't make assumptions. Men in leadership positions should not assume that all women in the physician workforce will be childbearing and or child-rearing primary caretakers. And number one, so by engaging in these top ten priorities, men can help create a more equitable environment where women in pediatric EP are recognized as leaders and superstars, promoted and compensated fairly for their work and contributions, and the gender gap in physician salaries can be narrowed and hopefully equalized. So my mentors, Vicky Vetter, Cricket Seidman, helped teach me the way. And then my top ten superstar mentees, sorry if you're not on here, anybody can name all ten of them, I'll buy them a glass of wine. But it's good to have mentees and mentors that can be superstars. And it takes a perfect balancing act, doing all the things that you do, and again, all of you alluded to the whole work-life balance and the guilt of balancing work at home and at work, and it takes a perfect balancing act. Nadia Comaneci got the perfect ten in the Olympics, so I'll be the third one to show this picture. But thank you to all the women of Pediatric Electrophysiology. The same conference that I showed my first slide with only nine women, now has a room full of women at the same pediatric EP meeting. Thank you all. Thank you all so very much. I'll just encourage people to use the app if they want to put in any questions, or feel free to come up to the microphone. I'll just start off the conversation. lead when you're eight and a half months pregnant your IVC doesn't expand anymore and I think that for a lot of women it's also very hard to say I'm actually gonna faint if I put that lead on again and and you feel less than comfortable. And I'm just wondering, you can't reach the table. Your belly is in the way. And speaking to your radiation safety team is great advice. I had wonderful support so that I felt very, very safe until I couldn't reach the table. But it's something that we don't talk about a lot, and I would love to hear from women up here or out there about that experience and whether they felt they were able to be honest about what that experience was like. I'll start off, because to your point of not being able to reach a table, I was 36 weeks pregnant and doing a lead extraction on a 16-year-old drug user who had infected leads, but the leads had been in there for 12 years. And I actually went into labor. Ah! I got it. I want to actually make a really important comment. I don't know if Tammy Sweeten is in the audience. Tammy is our EP tech or specialist at CHOP for 30 years. And she saw what was happening because I kept having to sit down, but I had to get the leads out because the patient was, frankly, septic, had high LFTs, high creatinine. But she pulled me aside and she said, Molly, you've never had a child before, and you've got to get out of here as soon as you can because in a few moments the most important thing in your life is going to happen, and you still don't know what it is. And I think that just brought it all together that I was not just an electrophysiologist taking care of this patient who was dying, but there was a life to come. We have people at the microphone. say after your comment, Molly, but just wanted to say, Ann, I was pregnant and in labor apparently and didn't, and Ann turned to me and she said, I think you're in labor. And I said, no, I'm not. And I kept ablating. Do you remember that? I remember that. Had my first baby that night. So thank you, Ann. I'm actually super nervous about what I'm going to say. And so on the comment of women being emotional, I think that it is unacceptable to accept that anymore. I did not find that this talk was radical enough for me. I understand that we are an extremely diverse group of humans in this room. I'm so happy to see as many Y chromosomes are in here as compared to seven or eight years ago, right? So within the past decade, I have seen change. I would like to continue to put myself on the envelope pushing side and often find myself very scared of doing that. And you all, many of you know me, and I think I sound very strange right now. And so I think you probably also can tell how I feel about this right now, but I wrote a couple notes. So back just to the emotional part, I think we've seen in the media and we've seen in the people around us that everyone is emotional. And I am not willing to accept it anymore. And I would like to see myself in the place where I can say, no, actually, I'm not being emotional. I'm actually being normal. And this is what I need from you. So Cheyenne, you know, you had said asking for what we need, and I think that can be in any setting. And so I would like to lean in to that. And I would like to call the men in the room to work with us to change the system and say, I also have feelings. I think we've also done a disservice to the men in our lives by creating a culture with a lack of feeling and creating this dichotomy. And I think that's unhealthy for all genders. And the other thing I saw from all of you is the using of the network. And one of the things that made it possible for me to get up here and be nervous right now is because Carol's sitting right next to me. And so using our network to say the hard things to the people in front of us who are either directly or indirectly harming us and our colleagues. And that means not tone policing ourselves and not changing our delivery to accommodate someone else in a way that other genders would not be asked to. I do agree that there is a level of discourse and civility that we should all give each other out of respect for our humanity. But I think that should be a level playing field. I think we're in a time where men in power are trying extra hard to control our lives and our bodies. And I'm unwilling, and as I said, I'm unwilling to change my behavior or words in a way that another gender would not be asked to. I do not want to give an inch of the progress that has been made by my forebears, the women and non-binary and LGBT folks who have gone before me. I do not want to go backwards on what has been done. And I want to only go forward. And it is going to be harder now. And so I think, in fact, we should meet the moment and actively continue to push for this equality because a rising tide, I think, does lift all boats. And so that's what I have to say. Thanks. I'd just like to respond to that because it's incredibly important and there is this assumption that But there have been studies that have looked at outcomes of... And maybe being female isn't such a disadvantage. Maybe those characteristics make us good doctors and maybe as a community, all of us need to be choosing that more. I see. I also think emotions can be powerful and can be used as an advantage. As a prior division chief, if someone started crying, I was probably more likely to do what they were asking for. So I think the emotions, right? I think so, no. I can say it now that I'm not the chief anymore. There's plenty of people crying. Yeah, that was one of the things. And the other thing, shoot, now I've already lost my track. So go ahead, Anne, and I'll think of it after. Okay, I'm going just because I'm a contrarian and you all know I'm a contrarian. I'm gonna push back a little bit. Emotions are important. I think there are multiple studies that have shown that women are better doctors, or have better outcomes. They're not better doctors. That's not a fair thing for me to say. Have better outcomes than men do. But I think one of the things my cynical self will say is you have to have multiple tools in your toolbox when you are trying to get your point across or trying to get things done. And sometimes I think you need to be able to craft your, not change your message, but craft your message in such a way that you can get it across to your audience. And I think that's something that's really important as well to take into consideration. I think, I'm not saying your message should be different. I'm saying the way you deliver it may need to be different in order to get your point across. Well, maybe both things can be true, right? That doesn't mean that. can be positive or negative depending on how they're, right, and so someone may say, oh, she's really bitchy, and the same attributes for a man knows he's really assertive, right? And so it's, you have to be very cognizant of how Although that rule in general does go for for all genders and and yes it's received differently so I I do agree that with these thoughts but people in general should be aware of the room and the tone and how they're they're asking for the things that they want and need. Hi Jeanette Strasburger from Milwaukee I just wanted to just bring up the the need in my opinion for looking at the later stage women in academics and promoting ways in which we can assess the de-escalation of our careers over time and I think many of us choose to do more research during the later stages of our careers and I think many of us by not being in positions of power are less able to to defend sort of the position so I'm lucky because I have tenure but but I mean I think it is an area where we are looking at the escalation and the promotion of women but I think we also need to look at the the later stages in women's careers and see if there is any areas of gender pay gap and I I was three years into my R01 and I was already being asked how I was going to get that next R01 to cover my salary and so I think there are ways that we could define what we're doing in later stages too. Thank you. We do have a question online as well or from the Q&A. Do more prestigious institutions pay less than less prestigious institutions and do women more preferentially go to these prestigious institutions? Define prestige. Before we address the question I'm gonna address the bias in that question. This person may be looking for reasons for the pay disparities and I think it's important to be careful when we try to explain away the gap. all of the research in all of the fields of all of the gender gaps in all of the institutions show that those are simply not the case. So I'd be interested to hear from our prestigious leaders if if they feel that there's a difference but I just wanted to kind of highlight the thought process behind questioning the data. Yeah, I don't think it matters how prestigious. They are. Within that institution, it should be equal. It doesn't matter. And if you are compensated less to choose to do that, to go to a more prestigious institution, that may be, but it doesn't matter. It's not an excuse for why women are paid less. And just to whoever asked that question, again, I'm not sure what prestige means, but the survey that PACES did, the only data collected was everyone working full-time. So, as you said, in other surveys, what's come out is, well, the gap gets smaller and smaller when you adjust for part-time work and all the other characteristics. But here, we compared apples to apples. This is probably the only survey where it's apples to apples. Same rank, same years of experience. And I apologize to the person... Interesting, interesting session. This is probably just gonna turn into more of a comment slash rant than a question, but I'll work on it. We're not a prestigious institution, just in case people were wondering, but you know, I feel like we're having a very far downstream conversation. I mean, when we when we even talked about this to Molly, she was like, why are we still having this conversation? And as a father of two daughters, I consider myself sort of an honorary feminist, and you know, we mostly talk about just people raise boys poorly, and boys are assholes, and they grow into asshole men, and I'm just curious, there's so much emphasis on certain types of conversation. For example, in our institution, we talk a lot about indigenous and DEI and things like that, and I appreciate that a lot of this may be very tone-deaf, given what has been happening here politically in the last few months, but are there conversations at any of your institutions that talk about, you know, speaking up when you see, you know, women, you know, when you see gender discrimination? Like, is there anything proactive happening at any of your prestigious institutions? Because I certainly, I see very little happening, and, and, and so I don't, I don't know that we're actually doing anything to fix anything. I don't think I'm at a prestigious institution, ranked a solid number 17, so we'll ask for a higher ranking. When a woman was leading our institution, we were a solid number one, but we are 17 now. We can talk a long time about that ranking, by the way. I mean, I will say at our institution, we did have a big movement to have training in implicit bias and gender bias. They've had all different topics of various implicit bias, and there was a lot of conversation when those, when that kind of movement was going about, and it was really interesting when we did the gender bias training. I think a lot of us women, kind of like Cheyenne, where we didn't really think about how did the whole gender thing impact us, I think it actually opened our eyes to a lot of things that maybe we didn't even realize were, was going on in the background, and I think once we heard that, every time we were in conferences or other places where it happens, we couldn't unsee it anymore. Things like how often do women speak up in conferences versus men? How are women addressed and introduced at conferences compared to men? All of those things that are just not done out of malice or ill intent or people thinking less of women, it just, it's just implicit bias. It just happens, and I think until there's more recognition of it happening, it's not going to change, and for me, that was a huge kind of light bulb when I went through that training, and all of a sudden, I couldn't unhear it. I hear it everywhere now, and so I, I try my hardest to not have that, not myself have implicit bias, which obviously it happens because that's why it's called implicit, but I also try to, in times where I feel like I can say something to raise awareness, I try, and I think that's been kind of my way of contributing to this and to kind of help make a change because I think we all agree we all want to change, right? All of us, men, women, everybody, and then the question is just how do we do that, and how do we recognize when is it happening, and how can we move the needle? And I'll add to that that the bias comes from everybody, from men and women also, so there have been really clear data showing that women show the same thing, and women also are less likely to introduce women as doctor. It's really interesting when you look at that. And also things like, you know, I mean, I'm sure from a generational standpoint, too, what all of our amazing mentors have done to pave the way for us, things that, you know, had to be kind of just swallowed and just kind of grit and bear it, whereas now, you know, it's we can kind of stand up and say something about it, but it wasn't, you know, normal to do that back then. It's interesting because I think, Susan, you had, we were talking about one thing or another, and I had kind of pointed something out, and you were kind of like, oh, that was just kind of the norm for us when we were going through all this, and so it's an interesting to see your perspective on how things have changed. Thank you. I think we have time for one more question. Thank you. Libby from Children's National. Kind of one thing from Shu's question of what are we doing. Our hospital has been kind of for a number of years now really vocally talking about these issues and raising awareness. One thing that ties into what Cheyenne, one of her amazing points, was asking for what you need on this subject. One of my colleagues who's not a cardiologist, but a male colleague who is kind of a bit of a repeat offender in saying things that are not taken well by people, I have approached him one-on-one and have just kind of sucked up any fear or anything and just talked to him about, okay, what happened today, that was a really good example of what we can't tolerate and this is how it sounds. And he's like, what do you want me to do? I want you to stop doing that. And he said, well, I don't realize I'm doing it. And so he asked me basically what do I want him to do. I said I'm happy to keep telling you this and calling you out if that's okay, but tell me how is the best time to do it. Do you want me to approach you after and say that example was bad? And he actually said, no, I need you the way I learn is I need you to call it out in the moment. And so I just said, do you mean in the middle of conference, in the middle of rounds, in front of a crowd? And he said, yes, that's how I learn. And so I am doing that awkwardly now when it's not my place to jump in and say, excuse me. And so I think asking for what we need, but also asking other people how we can help them and what they need to learn to change the ways of communication. Is it working? Well, I'm a little busy, so I'm not on conference all the time. So I haven't had many opportunities. It will be interesting to see if it works. She's going to put the shock collar on him. We need to get you a big eggplant. Hold up the eggplant. But I would say have the conversations, and they're awkward, but have the conversations one-on-one when you do witness something or if you feel comfortable in the moment saying, actually, you can't make that joke. And I've done that with a colleague, too, and he stopped because I heard a trainee next to me kind of make this little gasp when they made what they thought was a joke. And I said, actually, that's not appropriate. And in that moment, he goes, oh, really? And, you know, didn't realize it. So finding a way to maybe be light, maybe in the moment make a joke, or maybe take it after the fact and do it privately, but have those awkward conversations of just saying how things are coming across. All right. Well, unfortunately, we are out of time and really don't want to say that because this is a great conversation, and actually having the conversation is the first step. Talking about it, calling people out, helping them to learn, helping each other to learn is what we need to do. So many thanks to the organizers for putting this session on, and many thanks to all of you for coming to a session that might not feel entirely comfortable to all of you. And thank you for helping all of us make this a better community. Beth, may I just actually want to give a shout-out to Shu. Many people give me credit for studying women in paces, but I want to give the credit to Shu. I don't know if he remembers this, but when Shu was the president, and I was actually VP of Research, and I sort of, you know, paces was not in the black at that time. Finances were really bad. And I pushed forward this idea to Shu that, hey, we want to do a women in paces. And I remember the executive committee was like, what, like more money? And Shu was like, go for it. And so thank you, Shu. Thank you. Thank you all.

gender gap

pediatric electrophysiology

congenital electrophysiology

gender disparities

implicit biases

mentorship

leadership roles

salary comparisons

inclusive workplace

imposter syndrome