Equity can be a complex topic. As emergency medicine physician Emily Binstadt has observed throughout her career, opportunities to make change or move conversations forward can be lost, not just because of the status quo but in service of genuinely good things.

Dr. Binstadt, who also serves as director of simulation at Regions Hospital, has seen these situations as far back as residency and as recently as the COVID-19 pandemic. During the height of the Me Too movement, there was a lot of attention on gender equity in all aspects of society, including the medical community. But then the pandemic arrived. Between that and the death of George Floyd, the attention of the general population moved away from gender equity and towards conversations that, completely understandably, were more pressing.

It's a large-scale example, but similar dynamics can be seen in multiple other examples Dr. Binstadt brings up. In this episode of Off the Charts, Dr. Binstadt helps us frame gender equity within the larger equity conversation and outlines what care providers can do to make changes within their institutions. Listen to the episode or read the transcript.

Facing uncomfortable implications

The first step toward change is making space for conversation, even when the conversation isn’t comfortable. Dr. Binstadt cites an example from residency that’s common amongst female providers: despite being an emergency medicine specialist, she was asked to do a lot of pelvic exams for women who requested a female provider. She points out that those patients deserved to have their preferences honored, but helping them meant that she wasn’t helping patients who were relevant to her specialty. She missed opportunities to gain experience that could have informed her career in many different ways.

The solution to this issue probably isn’t as simple as informing patients of these kinds of dynamics – again, people deserve to get care in ways they’re comfortable with. But without open and honest conversation about these dynamics, they’ll only continue. Talking about them, on both the patient side and the provider side, is the only way to make people aware of them and to start moving towards something different.

Making space means changing expectations

The pelvic exam example illustrates more than the importance of conversations – it also illustrates how expectations shape medical spaces. As another example, Dr. Binstadt and our host Dr. Kari Haley highlight feedback female providers get on the affect they present at work: they’re encouraged to be “confident” even when they don’t feel it to be true, and they’re encouraged to speak in lower vocal registers when working with patients. At the same time, our host Dr. Steven Jackson notes that he's frequently referred to as a “Black doctor,” as opposed to simply “a doctor.”

These kinds of comments are based in history. For a long time, medical experts have been white men, and they’ve been treated as total authorities in their spaces. What we see now is that expectations rooted in that history clash with who’s actually doing the work: women, people of color, people of varying degrees of experience. If we want the medical workplace to be more equitable, we have to allow people to show up as their whole, true selves, and treat that as the norm.

Power is not a zero-sum game

The final big point of discussion on this episode is that power has to be shared. Dr. Binstadt points out that while applications to medical schools are now fairly evenly split between men and women, leadership and higher-level positions still aren’t. If the people in those positions don’t participate in making change, it’s going to be a lot harder to accomplish.

What this participation looks like could take a number of different forms. Dr. Haley sees potential in shifting the mentorship dynamic of the medical field to one of sponsorship, in which mentors use their authority to get more diverse voices and perspectives into spaces they otherwise might not. It doesn’t mean the mentor gives up their power, but rather that they use it to help others build theirs.

Dr. Binstadt believes that sharing power like this benefits everyone. Having more diverse experience and perspectives in medical spaces means more collective knowledge and better care for more people. What’s more, making spaces more equitable doesn’t only benefit one group. As an example, Dr. Haley points out that it was the advent of maternal leave that eventually allowed us to make parental leave a norm.

There’s still a lot of work to be done to make the field of medicine as equitable as it can be. But as Dr. Binstadt shows us, we know what has to happen. We have to be open and honest about everyone’s experiences and make space for them at every level, from policy to daily operations. To hear more from Dr. Binstadt, listen to this episode of Off the Charts.