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We sit down with Alopi Patel, an anesthesiologist and interventional pain physician, to explore the gender-based inequities women face in their careers. Inspired by the metaphor of flamingos losing their pink during times of adversity, we delve into the personal, professional, and physical challenges women navigate throughout their lives. Alopi shares insights on how these challenges impact female physicians and offers solutions to create a more equitable and supportive work environment.
Alopi Patel is an anesthesiologist and interventional pain physician.
She discusses the KevinMD article, “The progression of women’s health issues in the workplace from menstruation to menopause.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Alopi Patel. She’s an anesthesiologist and interventional pain physician. Today’s KevinMD article is “The Progression of Women’s Health Issues in the Workplace from Menstruation to Menopause.” Alopi, welcome to the show.
Alopi Patel: Thank you so much for having me. I’m looking forward to talking.
Kevin Pho: So let’s start by briefly sharing your story and journey.
Alopi Patel: So, I am an anesthesiologist and an interventional pain physician, which is a mouthful, but after anesthesia residency, we can do different types of fellowships. I chose something that was a bit office-based, which is interventional pain medicine. And my journey involves still practicing both aspects of anesthesiology and interventional pain medicine. When I started practicing interventional pain, I noticed that a lot of women’s pain conditions, such as pelvic pain, migraines, fibromyalgia—a lot of these conditions were stigmatized. Women were having, and men actually, for pelvic pain, were having a hard time connecting with physicians to treat and manage their pelvic pain.
So, as I became a young attending in New York, I really took it upon myself to really focus on that, learn more about these conditions, advocate for treatment, and, in the process, kind of just one door led to another, and I’ve become a women’s health advocate and pelvic pain educator for people to feel—clinicians to feel more comfortable treating pelvic pain.
Kevin Pho: And when you said that pelvic pain was stigmatized, when these patients went to other physicians, what kind of responses were they getting?
Alopi Patel: Oftentimes, a lot of these patients are told that their pain is just—have you tried breathing exercises? Have you tried drinking wine or just relaxing? And this is for men and women. A lot of these pain conditions, and I might even say that male patients with pelvic pain are probably stigmatized even a bit more because they feel demasculinated. But I think that patients are mostly told that their pain might not be real, they’re too stressed, they’re too depressed, you know, try an anxiety medication, or we just don’t know enough about it to treat it, or I don’t know enough about it to treat it, and these are patient referrals coming from urology, gynecology, colorectal—like people that we would think would treat pelvic pain often didn’t know what else to do because there could be so many reasons, right? And we know that pelvic pain is multifactorial. So a lot of these patients were just kind of shifted around the health care system, unfortunately.
Kevin Pho: And I know that this isn’t the topic of today’s podcast, but speaking from the perspective of an interventional pain physician, you’re saying that there are therapeutic options for chronic pelvic pain?
Alopi Patel: Absolutely. Absolutely. And as pain physicians, we are experts in muscles, nerves, and bone. And that’s how I break it down for my patients—that, you know, if there’s a muscular component, nerve component, if there’s a bony component, we can help identify and manage that aspect. Even if there’s a visceral component, we might need to collaborate with our referring physicians, but other stuff that might be happening secondary to that, we also can help manage in terms of suppositories, injections, and physical therapy.
Kevin Pho: All right. Maybe we’ll have you come back on the podcast to talk about that. Today’s KevinMD article is “The Progression of Women’s Health Issues in the Workplace.” So what led you to write this article in the first place? And then you could talk about the article itself.
Alopi Patel: Sure. So, lived experiences, right? We’re all a combination of our lived experiences. And as a women’s health advocate, I was advocating for my women patients in terms of getting treatments and managing their care. And I also was pregnant about five years ago, went through COVID, another pregnancy, and have lived these experiences of being a woman physician with my own pain conditions and pregnancies in the workplace. And I realized that a lot of the workplace culture is not set up for women in the workplace in terms of lactation, menstrual pain, and even menopause. A lot of these topics are now getting some attention in the social media sphere, but the workplace in general—you know, not many people feel comfortable hearing the word lactation or menstruation or menopause in the workplace.
But I kind of come from the philosophy of, we all have so much potential in terms of not just women physicians, but also men physicians. If we’re supported, whether that’s physically, personally, professionally—if we’re supported, we can really thrive. And I feel that women are showing up in different spheres of medicine and all across different specters of the economy. And if we’re supported in a unique biological journey that we face in different ways—menstruation, menopause, pregnancy, lactation—if we’re supported in that journey, we can push the boundaries even more and really grow not just in our careers, but in different ways. So that’s what this article kind of led to, that, you know, if women are supported in the workplace as physicians, our potential is limitless.
Kevin Pho: So tell us a story—and it could be your own story—when you were pregnant about how the medical workspace was not conducive to women.
Alopi Patel: Absolutely. I mean, you know, as physicians, we train most of our—you know, our youth or twenties—while our friends are done with college and their grad programs, are out in real-life jobs and working, we’re still hustling, right? In medical school, in residency. And I finished residency at the age of 30, so it’s like now you’re in your thirties, and suddenly you’re done with residency, and you’re trying to be a young attending and build a career, and suddenly you’re supposed to also think about your reproductive health. Do I want children? How am I going to take care of my children? What are my hours like? So I feel like it just goes by so quickly, and things like infertility and reproductive challenges are faced in that process. So I feel, as a woman, it was something that really struck me, that we have these lived experiences, and then suddenly we’re in our thirties, and no one really talks about the challenges we have faced until we got there.
Kevin Pho: And do you feel that the fact that a lot of medical settings are not conducive to women physicians—does that influence the choice of specialty some women choose with reproductive health in mind?
Alopi Patel: Absolutely. Right. So, in general, like I said, we have the reproductive timeline, but also workplaces that may not have access to lactation support, or the hours might be challenging. So, if you’re in something like trauma surgery, you can’t plan around lactation because you might be in the operating room. So, absolutely. I think many women weren’t thinking about these things before, especially when I was in medical school. I liked anesthesiology, and that’s why I chose it. I wasn’t thinking about, well, I’m going to be a mom one day, or I’m going to, you know, have my own health issues one day. But I think now women in medical school are a bit more progressive, and they are thinking about these things—that I do want to have a successful career and be a mother, and they don’t need to be mutually exclusive with each other. I want to be the best trauma surgeon and breastfeed my infant for a year. And it, again, doesn’t have to be mutually exclusive, and they’re creating opportunities within those fields.
The American Academy of Surgeons recently also put out a lactation statement in terms of how to support women surgeons so they can not just do their job but also be supported to continue lactation, to support their children. So, before, I think it did affect a lot of women in terms of—they thought they can’t be the best surgeon if they’re also going to want children, or they can’t be the best mom because they want to do a certain type of specialty. And things like interventional radiology or interventional pain also have a lot of fluoro, so that was something that we used to think about a lot. But again, we’re learning more about the safety of radiation if you’re double-leaded and whatnot. So, I felt comfortable—I mean, relatively comfortable double-leading while pregnant to successfully have my two pregnancies to continue practicing, essentially.
Kevin Pho: So it’s great that we’re getting that recognition, and there are some professional medical societies that are producing these guidelines. Are you seeing those guidelines trickle down to individual hospitals? Are we seeing the practical results of those guidelines over the past few years?
Alopi Patel: Yes, absolutely. And I know it may vary based on geographic location or hospital location, but I have seen it in my progression of my career in terms of lactation pods. You know, lactation pods are becoming more prevalent. We have one in our hospital lobby as well. We are having more receptive workplace policies because we’re speaking about these things—that I want to be the best physician, but I also want to not be penalized if I choose to work from home because my child is sick, and they’re in the background, just need to be monitored. But I can still do telemedicine or take, you know, meetings if needed. So the conversation has been changing, and workplace policies have been changing, but we do have a long way to go. And part of my advocacy work is to, yes, create awareness for women’s health issues in the workplace, but also for all of us because as parents, we also need flexibility. So even if a parent, like a father, needs to take time off work to be able to support their child or their spouse, that should also not be penalized. And these are things that historically or traditionally were not a part of the norm in medicine.
Kevin Pho: So I want to touch upon some specific points that you brought up in your article. One of them is the so-called motherhood penalty that can affect women in leadership roles. So what is that? And talk more about what that is.
Alopi Patel: Sure. So, the motherhood penalty is a term that kind of has come across in literature that women are unintentionally sort of stigmatized or potentially penalized for taking time away to spend with their kids or taking a maternity leave that might be longer than somebody may like, or just leaning out or leaning back in their career because their kids may be young or there might be health issues for their children, and they’re taking a step back. And then, when they are ready to take more of a leadership role or take on more responsibilities, they’re penalized for, well, you may not be as committed to your work as Dr. So-and-so because he did not take off that time and he was able to show up to all those meetings that you had to miss. So, it’s a penalty that is unconsciously made when women decide to lean back in their career.
Kevin Pho: And what are some of the solutions to this? What are some ways women can still pursue leadership roles even after they have to take time off for family?
Alopi Patel: So, I think awareness is key in terms of educating our colleagues that we are not any less committed to our careers or any less committed to our patients or just being a physician in general. If we decide to take time off, we can be a good physician and a good parent. So awareness and support from our colleagues, those mentors, those advocates, those sponsors play a key role in creating that leadership opportunity to continue the pipeline. The leadership pipeline, as we know, needs to be fixed and continue to be propelled forward. Once we get more women into senior leadership positions, we can continue retaining women in that middle management, so to speak, sort of zone, which is where we lose a lot of women, right? In the first six years after residency, up to 40 percent of women either quit medicine completely or go part-time. It’s those periods, those middle periods, when women are balancing their growing careers and their young families that we need to really tighten up that pipeline and support women in that so they can continue on to those senior leadership positions. And then, again, advocate for women who are younger in their career.
Kevin Pho: Another point that you brought up in your article was menstrual health. You wrote that only 19 percent of women feel supported for menstrual-related issues in the workplace. Tell us what kind of changes you think are necessary to better support this issue.
Alopi Patel: That’s a great question, and, you know, I applaud you for asking it because not many people feel comfortable speaking about it. It’s a very stigmatized topic that is finally, I think, some people feel comfortable speaking up about or even on social media. But menstruation affects every female that is born with a uterus, and we live in those periods of our life—no pun intended—for the majority of our working years, right? So twenties all the way to our fifties are the majority of our working years. And ninety percent of women will experience some sort of menstrual pain, and a good portion of that—forty percent, I believe, is the number that Deloitte put out—forty percent of them state that they have debilitating pain that prevents them from working to their full capacity.
But what if we don’t enforce presenteeism, that they have to be at work in this capacity, and we allow for allowances of, “I’m going to work from home today” and not be penalized? In medicine, it’s a little bit more challenging to create effective solutions because we do need to be in person oftentimes to do procedures and whatnot. But for certain careers that allow telemedicine or a hybrid option, maybe this is—you don’t have to get in your car and commute two hours because that might make your pain worse. Maybe you have the option to do telemedicine, or you don’t need to be in the office taking meetings, and you can take a hybrid option and take meetings from home. Making allowances in the sense of sometimes, as an anesthesiologist, I’ve had to push tons of stretchers and help move and lift tons of patients over the years that it hurts, you know, in your back for multiple different reasons, and you’re already in pain to begin with. Maybe asking for support and feeling comfortable asking for support, saying, “Hey, do you mind helping with this? I’m just going to, you know, need a little bit more help today,” sort of thing. And destigmatizing it by being able to speak up about it, ask for help, and then be supported beyond it.
Kevin Pho: And in fact, are you seeing things like that happening and when talking to your colleagues and in other medical institutions?
Alopi Patel: No, not yet. This is something that is relatively new still. So McKinsey, Deloitte, and the Lean In organization have been some of the international organizations that have been looking at women’s health issues in the corporate world in terms of things like menstruation, the impact of menstruation, menopause, and all of that. In the hospital system, we’re still limited to women’s health being lactation or pregnancy or occupational hazards from radiation. We’re not really talking about menopause in the workplace. We’re not really talking about menstruation in the workplace, which is ironic because it’s a health care setting.
So, we’re not seeing much really about that yet. But ironically, this weekend, we have the annual Society of Anesthesiology conference. And for the first time ever, we are going to talk about things like menopause in the workplace, how to effectively advocate for yourself for fertility treatments from your employer. We’re talking about lactation. We’re talking about radiation exposure, gender inequities in terms of physical constraints and whatnot. So yes, we’re starting to talk about it. Is there research in the medical field? Pretty much minimal.
Kevin Pho: The last thing I want to talk about is burnout. You mentioned that studies show that women face higher burnout rates than men, often due to the dual pressures of personal and professional responsibilities. Again, what are some things that medical institutions can do to address that burnout disparity?
Alopi Patel: So that’s a great question. I think everybody across the health care system in terms of nurses, physicians, PAs, are experiencing some sort of burnout. We’re all human behind those white coats. We are spouses, parents, children, and we wear so many roles outside of just being a health care provider. So I think just seeing the human behind the white coats—that we are not just a clinician, we are also wearing all these other hats, and this is for men and women. So being able to humanize them and just be a bit more empathetic in terms of this punitive sort of mentality of “If you take time off, you’re not being a team player,” or “If you take time off, you’re hurting other people around you.”
Understanding that health is wealth, so to speak, but also a healthy clinician leads to better outcomes. There’s increased retention of those physicians as well. And women, especially—there’s data to show that women are more likely to face anxiety, burnout, and depression. And if we’re able to support women during those times of challenge, we’re more likely to retain them in the workforce in the long run. And again, more data coming out on this from these international companies like McKinsey that are saying that if women are supported in the workplace, we have the possibility to increase GDP by 1 trillion by the year 2040. Lots of numbers that they’ve turned out looking at supporting women in the workplace retains women in the workplace, decreases burnout, increases wellness, and overall increases women’s health and wellness, which is what we should care about. But financially, it also makes sense.
Kevin Pho: A lot of things that we’ve been talking about today are top-down solutions. What are some ways that women can advocate for these issues? What kind of advice do you have for them?
Alopi Patel: That’s a great question. And I think we turn to the women around us. We support one another. It’s that pipeline effect again. So starting with addressing each other and knowing that we’re facing this shared experience, creating those collaborations of supporting one another, and then advocating. I’m done with my lactation journey, but if I see another resident or physician facing challenges in their lactation journey, I, as a person who’s a bit more senior to them, can help advocate for them. I have young children, and I’m balancing, you know, my career and my young children. And there are women ahead of me who have become mentors and sponsors who are able to support me in that way and say, “This is a temporary period of life, but, you know, let’s do this, let’s do that and work around it.”
So creating that pipeline, supporting each other, advocating for each other in the workplace, and then creating a positive environment, which is much easier said than done in terms of toxic workplace culture. I think health care has changed a lot in terms of its workplace culture, but starting ground up in that sense and being the change that we wish to see in the workplace.
Kevin Pho: We’re talking to Alopi Patel. She’s an anesthesiologist and an interventional pain physician. Today’s KevinMD article is “The Progression of Women’s Health Issues in the Workplace.” Alopi, we’ll end with some of your take-home messages to the KevinMD audience.
Alopi Patel: For me, the take-home message is that we are all more than just clinicians; we are all more than just physicians; we are all humans. Let’s humanize each other in health care, humanize each other behind the white coat. We are not just physicians; we are also parents, we are also spouses, we are caregivers, we are daughters, we are sons, and let’s look at each other with a bit more empathy and support each other to hopefully reduce burnout and retain all of us in this beautiful field of medicine.
Kevin Pho: Well, thank you so much for coming on the show and sharing your perspective and insight.
Alopi Patel: Thank you for having me.
