Hello and welcome to The Premed Years, where we believe that collaboration, not competition, is key to your success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician.
We are part of the Med Ed Media network, where you can find us at www.MedEdMedia.com.
February 3rd is a famous birthday for a famous physician. Elizabeth Blackwell is known as the first female physician in the United States, the first woman to get a medical degree in the United States. She's British born and came here to the US to get her medical degree, and her birthday is February 3rd. Therefore, February 3rd is celebrated as National Women Physician Day.
Dr. Jean Robey, a Nephrologist who practices in Surprize, AZ, joins today’s discussion as we discuss women in medicine. Male or female, this information is very important and I hope if you are on this journey as a female physician or female premed and you've been doubting yourself and your abilities, you will learn a great deal from this episode. Male physicians play a huge role in the world of supporting female physicians; there is also a huge role that female physicians play to support themselves, and to support male physicians. We are all in this together.
(1:45) Dr. Robey’s Background and Interest in Medicine
As a young child at just six years old, Dr. Robey knew that she wanted to be in medicine. Like most children who are asked what they wanted to be when they grew up with broad interests, architecture, accounting, even being a novel writer appealed to her. However, it just didn’t have enough human contact to be a lifelong interest and therefore she always came back to being a doctor.
Dr. Robey considered herself a traditional student, going through the flow from high school to med school, feeling as though it was a race to get to an end point because that is what everyone was doing at the time. In retrospect, she learned at the end of med school that she had been running one race her entire life, and that was to get to that doctorate. When she made up her mind for one thing, it was nonstop until she got to that one thing.
(6:00) Taking Diversions along the Journey
There's a lot to be said about stopping and looking around, and there's a lot to be said about taking side trips, and there's a lot to be said about what happens when you finally get to that mark. Dr. Robey recalls a close friend saying to her, ‘I'm really eager to see what happens when you hit that peak again.' Suddenly she didn't have a peak to climb but instead of getting anxious, she sat said to herself, ‘I'm where I want to be, and this is what I want to do.' Now that she is raising children whom are very driven, she finds herself saying to them to slow down, take their time, we all get there and when you do you have to be happy about how you got there.
Dr. Robey recalls a childhood memory of when, in high school, she told her father that all she wanted to do was read books. Being a highly driven individual, her father thought this was very peculiar. She further explained that there were books she wanted to read that she knew she wouldn’t have the opportunity to read again. So that year in high school she just took photography, drama and read novels. Dr Joyce admits it was one of the best decisions she ever made — to stop everything and be age-appropriate. She proclaims we just have to be wise enough to know that the rat race is going to always be there and you just have to appease yourself but realize that you do have to stop in your own way and smell the roses. She hopes her kids will get enough going forward, but “kind of stroll around a little bit”.
(14:20) Biggest Challenge as a Young Female in Medicine
Dr. Robey applied and was awarded a scholarship through the Flynn Foundation, whose initiative is to keep bright students in the state of Arizona. The scholarship was an amazing opportunity because it not only paid for college tuition, but it provided stipends to spend summers abroad. She attended University of Arizona, and did more than just study and hyper- focus; she took summers to have enriching experiences, and part of that was study things like medical ethics, which really helped her to understand not just medicine, but medical humanity. In taking that journey, she applied again for a six-year program at a state institution and ended up getting a dean's scholarship. As she stated, ‘in gambling my six year program I got back a lifetime program’.
The entire idea of being a female going along the journey never occurred to her that it was going to be a barrier but when it did, it was never blatant but happened it little pieces. At a retreat she was once asked what she thought the handicap was for being a female and she at first was confused at the question but then realized the first implication was that the rest of the world thought she had a handicap being a woman.
But it wasn’t a handicap at all. She turned this social expectation into a cial disadvantage by replying, ‘if you think I have a handicap, then I've got you right where I want you! Because now I can always over-achieve, I can always exceed your expectations, I'm going to look like so awesome because you just thought I was disabled!' From then on the posture changed dramatically. The bar is low that anything women physicians do is going to shock, and surprise, and awe everyone around them. And if you walk into a situation knowing that you've already won, then once again, the road is wide open. It became nothing but proving everyone wrong from that day.
Dr. Robey concludes there was no way around avoiding the broad topic of sexism when having a conversation about women in medicine, particularly physician women in medicine. It is therefore essential, she says, “that women have other women mentors, and those women mentors say, ‘I represent for you the reality that could be, the realization that could be, the attitude, the perspective that could be.' Like I'm telling you I exist and I never ran into any encounter of difference. And here I am, I act as if I'm not different, I believe I'm not different, therefore you could as well adopt this stance. And when you engage other people and they're trying to push on you a reality that there's a difference, you may push back and say there is not a difference. And for those things that are different, I can tell you how to navigate them”.
(25:30) Differences among Men and Women
Dr. Robey feels that whenever people want to talk about this topic, and what really is different, women get very sensitive because they feel as if they are being segregated or put down. However, Dr. Robey says we don't have to put anyone down to raise someone up; it is not a “pulley system”. We need to get rid of that assumption that one going up means one going down. Additionally, if we’re discussing how to bolster the differences and accept the differences, then we have to just be realistic about what those are, such as biological and sociological differences. We should continually talk about these differences because that's how we can create an environment that's woman-friendly and woman-strong, rather than just being always ashamed to be a woman and always acting as if men are accommodating or tolerating women.
(31:10) Current Challenges Facing Female Physicians
Supporting one another and supporting the concept of women in medicine, Dr. Robey suggests, is the biggest challenge facing female physicians. Recently, an interesting group of studies or observations have been put out to really ask the question about the possible value and contribution women have in medicine and understanding what that means to one another, and for men and women.
In the latter part of December, JAMA (Journal of American Medical Association), which is an established journal for medicine, published an article on a reflection on outcomes. In these outcomes cross-sectional evaluation, they looked at what happens if you look at men and women physicians and if they treat patients (they used Medicare as the subset of patients as that's an easy database). They looked at their admissions, their mortality and their readmissions and theorized is there a difference? Is it equal? They took over a million and a half admissions, and a million and a half readmissions, and the outcome was women did better than men. Women physicians did better than male physicians. There are all sorts of stipulations about what that means and why that would be, but there might be attributes that women bring to medicine that bring out better outcomes based on those attributes.
(39:40) Advice to Lift Women up in Medicine
Dr. Robey states that whether or not you are male or female, when you go into this profession, you need to have support and resources. No matter what your situation, medical training and medical education is hard and it's necessary to be hard because that's how you're going to grow into authority. In this profession, you have to wise, and in gaining wisdom must spend time and focus.
In different life experiences we all have something to offer because hands down you're going to care for someone that looks like you, is living like you, had a history like you and you can relate. Because that's really what medicine is about– compassion, empathy and relating. If you can't relate because you've never been hurt and you've never had trials and tribulations, you've never had challenges, you've never had families, children, death and dying, then you don't have a whole lot to offer in terms of authority in medical caretaking. There's room for all of it, but medicine itself is such an arduous journey that you have to be prepared and then the institutions themselves have to be prepared.
(47:40) Men Supporting Women Physicians
When Dr. Robey looks at men supporting women, she thinks they've got to think of the women as their sisters and their mothers because they are not the same as their brothers but they are worthy of their respect and support. And only by looking at them as sisters and mothers and wives, can they say, ‘You know I want for you what's good for you. Even though it's different than what I need right now.' Dr. Robey concludes that women need that time, space, permission and understanding. Men can provide that to them if they frame their relationships with their female colleagues as if they're dealing with their mother, or their own sister, or their own wives.
(53:00) National Woman Physician’s Day
National Women Physician's Day, Dr. Robey thinks, became a movement when we began to realize that we were under-represented and not really understood even amongst each other. The National Women's Physician Day was born of this idea that we need to unite, we need to have more similarities than differences, we need to be proud of who we are and what we're trying to, and our worth, and our sacrifices, and our common- our more common struggles.
This isn't supposed to downplay male physicians, it's not supposed to downplay other females in medicine like nurses, social workers, CRNAs, nurse practitioners or PAs. It's really meant to just celebrate this one profession, female physicians and to help open the discussion about what females might need that are particular to being females in this profession. The intention is not to negate other professions or other working women. Currently, the discussion is getting really interesting because we want to know can we all be more something, and can society gain something from that? Dr. Robey feels it's going to keep gaining momentum in a way that can extract from being female and being a physician, goodness for society.
(56:00) Words of Wisdom to the Struggling Premed
Dr. Robley looks at her daughter thinks, ‘What good did I do you? All the while I was doing good for others, or maybe if me would say good for myself, what good did I do you?' Her daughter knows that she can contribute, that there are no barriers in her contribution and should she choose medicine then she knows what it looks once she gets there, and who she should surround herself with to support her. To that end, her son knows what he needs to do to support someone like her or her daughter, and he knows what benefit it is to society to have a female in this position.
Her advice for women considering this profession should ask themselves if they want to do this, then do it–whether or not they are male or female. For those women that want to challenge this and do it, Dr. Robey says to go for it, see what it takes and you have resources and support . You will have women and men who support you and then you won’t have to ask yourself, ‘Why am I disabled?' You're not, you're able, go ahead.
Links and Other Resources:
- JAMA (Journal of American Medical Association)
(Dr. Robey was on episode 6 discussing about being a private practice nephrologist).
- National Women Physician Day (use the hashtag #NWPD on February 3rd to get the latest updates)
- Elizabeth Blackwell (use the hashtag #iamblackwell to celebrate the first female doctor)
Dr. Ryan Gray: The Premed Years, session number 219.
Hello and welcome to The Premed Years, where we believe that collaboration, not competition, is key to your success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician.
February 3rd is a famous birthday for a famous physician. Elizabeth Blackwell is known as the first female physician in the United States, the first woman to get a medical degree in the United States. She's British born and came here to the US to get her medical degree, and her birthday is February 3rd. February 3rd is celebrated as National Women Physician Day, and that's what we're going to talk about today. Not necessarily the day itself, but women in medicine. This discussion though isn't just for women, it's for men as well because as men we play a huge role in the world of female physician, and there's a huge role that we play to support them, and there's a huge role that female physicians play to support themselves, and to support male physicians. We are all in this together. So male or female, or whatever you associate as, you need to listen to this episode.
Jean, welcome to The Premed Years, thanks for joining me.
Dr. Jean Robey: Oh thanks so much for having me back.
Dr. Ryan Gray: When did you know you wanted to be a doctor?
Dr. Robey’s Background and Interest in Medicine
Dr. Jean Robey: I knew when I was really, really little. I was like six years old and I just knew that that's what I had to do. So I think a lot of children are asked kind of what you want to be when you grow up, and then they go exploring what that means and stuff like that. So it's not uncommon for kids to have kinds of a dream their entire life, right? More interesting like what did I want to be instead? There were a couple times when I wanted to be an architect, or an accountant, or a novel writer or something, but it always kind of came back to being a doctor.
Dr. Ryan Gray: Were those ever serious considerations, or those were just like, ‘Maybe this,' and then you just popped right back into medicine?
Dr. Jean Robey: Well it's because I like numbers a lot, and of course that came out in going into nephrology eventually, right? But what I liked about numbers was that it was really exact, and you could be right. And I know now that I really want to have a black and a white, and I'm a very concrete thinker, so that was the appeal. So every time- you know as kids you really don't know what your job options are, so anytime I met someone I was like, ‘Oh I kind of like that, I kind of like that you've got that black and that white.' And it's funny now because what I do has so very little black and white except for the numbers, but that's why I got interested in that sort of thing, was because somebody would introduce me and say, ‘Oh did you know you could build a building? Or did you know you could sit around and crunch a bunch of numbers?' You know so I was always like the treasurer of every club or something. So that's why I would even say I was interested in those things, but eventually it just didn't have enough human contact to be lifelong interest.
Dr. Ryan Gray: Was your journey- once you had that interest in knowledge that, ‘Okay I'm going to be a doctor,' were you a pretty traditional student going from undergrad to medical school?
Dr. Jean Robey: Yeah I was. I mean I'm the quintessential, you just get into the flow, like the prefab factory, and you go straight through. I mean you go through high school, and you're building your resume, and you get out of high school maybe even early, and then you go through college with your premed major, and you blow through that with your research, and your quasi papers, and things like that. And then you do your travelling, and your volunteering, and you're single, and you're in your twenties, and you pop out of college and go right to med school. There's nothing in between. You didn't take a year off to do any exploring, or get a different job, and you didn't do anything nontraditional, not at all. Like you weren't an English major, you didn't go to Spain for a year, you certainly didn't get married, and you had no kids. You just were single, and you showed up to med school and said, ‘Marry me?' and med school said, ‘Okay,' and then you just married medicine for the next ten years or so.
Dr. Ryan Gray: What was the hardest- go ahead.
Dr. Jean Robey: So it's not fair in some ways to talk about women in medicine because I just did what everybody does at the time, just go through, and you're twenty, and now you're in med school, you know?
Dr. Ryan Gray: Was that because that's what you thought you had to do, or you just didn't know any different?
Dr. Jean Robey: That's a great question. So I'm six and I'm thinking I'm going to be a doctor, and people just looked at me at this declaration and thought, ‘Okay so you're going to be a doctor, and then what?' I'm like, ‘And then what? That's the plan.' So it was a race to get to an end point, right? And so in my yearbook for medical school, we're given an opportunity to put in our page, what it is and what we learned. I learned at the end of med school that I had been running one race my entire life, and that was to get to that doctorate. So it was because I was just fashioned that way. When I made my mind up for one thing, it was nonstop until I got to that one thing.
Taking Diversions along the Journey
Dr. Ryan Gray: Do you wish you would have taken some diversions?
Dr. Jean Robey: That's a really awesome question, and so now I'm raising my kids, and I'm looking at what happens when you run as fast as you can, and you finally get to where it is that you thought you were headed? And yeah there's a lot to be said about stopping and looking around, and there's a lot to be said about taking side trips, and there's a lot to be said about what happens when you finally get to that mark. And one of my really great friends, he's quite wise, he said, ‘I'm really eager to see what happens when you hit that peak again.' Because for a lot of mountain climbers that means looking for new peaks, right? And he thought I'd sort of freak out and go schizophrenic because I suddenly didn't have a peak to climb. And I think you have to mature with it and say, ‘I'm where I want to be, and this is what I want to do.' So we talked a little bit about appreciating the view and everything. But now that I'm raising children, and my kids are very driven, that's sort of somewhat genetic but also environmental, and I try to actually put brakes on them sometimes and say, ‘You know what? Just try and slow down, take your time, we all get there and when you do you have to be happy about how you got there.' But I will tell you there have been a couple of times that I had enough wisdom thankfully to know when to stop myself. So when I was in high school, I was able to graduate in two years, but- and then I went for this interview for a six year med program, so everything was just as fast as it could be. And I got my acceptance letter to that program, and I was at that time just turned fifteen, and I told my father, I said, ‘I don't want to leave high school.' And he was like, ‘What do you mean you don't want to leave high school?' And I said, ‘I don't know, I just want to stay.' And here's my rationale, it was kind of stupid at the time but I said, ‘I just want to read books.' And he was like, ‘What are you talking about?' So highly driven, highly driven environment, and he looks at me like that's the most absurd reason ever. And I'm thinking, ‘Well Dad I want to explain this to you. There are books I want to read that I know I won't get a chance to read again. There are books for children, and I miss the opportunity to read this book, I'll never go back to read them.' And he's thinking, ‘That's absurd, you're just going to hang out and read a bunch of books for a year?' And I thought, ‘Yeah that's the plan.' So that year in high school was a funny year, like I just took photography, I did drama, and I read a bunch of books like Huckleberry Finn, and Tom Sawyer, and Catcher in the Rye. Things that I think usually are young adult books. And it was one of the best decisions I ever made was just to stop everything and be age appropriate. And I think when I look at my kids and stuff I think, ‘Just enjoy your childhood, just enjoy your time, because pretty soon you can't- it's not like you're twenty and you can justify going back and running around in a park and playing on a swing necessarily. So I said just do this for now, because that's age appropriate, and the rest of the stuff will sort of fall in place, and catch up with you, and you'll be less dyssynchronous. So I think I do regret not being able to slow down more, but there in it lies my nature. I just- I couldn't have taken another year, I mean that was my compromise and I was comfortable with that. So I think we just have to be wise enough to know that the rat race is going to always be there, and you just have to appease yourself but realize that you do have to stop in your own way and smell the roses. So hopefully my kids will get enough going forward, but kind of stroll around a little bit.
Dr. Ryan Gray: Your kids are obviously in a situation where they have a parent who's a physician, and so you assume there's some financial stability there. Were you driven because you came from a household that didn't have stability, and so you were trying to get that stability? Or is it just something in you?
Dr. Jean Robey: Well that's a question I grapple with all the time, right? Because my parents were refugees, they came here with nothing but a lot of drive, they're intelligent people, and they did sort of unorthodox things. So as refugees they did a lot of laboring jobs and things like that, but very uncharacteristically in their thirties and with children back in the early eighties, they went back and got college degrees. So hardly ever would you see that in just mainstream America, let alone people who barely speak English, to get into colleges. And so both of them actually ended up graduating in four years from the university Louisiana State University. And I remember my father, very practical man, great with numbers as well, opening the newspaper one late night and just looking for what kinds of jobs were hiring, and then deciding okay there were enough red circles around computer programming. And that was how he declared his major. He just did it because of practicality. And then his design was he would go through a class, and then my mother would go through the class, and at the same time they were either working nights, or working days, and then raising two kids at the time. So we were latchkey kids back before that actually had a name, and we just made it work. And people talk all the time about if that drove me to excel, and I'm not quite sure. Like I think- because my parents ended up having five kids, and we're all very accomplished people and stuff, but we're all different personalities. And if we look at each other as far as who's going to take care of who, and did we do this to take care of our family, our parents, or to create more comfort for ourselves or whatever, I think America is this wealth of opportunity, and we were just designed to take opportunities. There wasn't anything going to hold us back, and we were told in one way or another that we were good enough, and we could do everything that anybody else could do, and so we just drove as fast as we could in any direction we wanted, and got there. Meanwhile my kids, they're comfortable, and so there isn't necessarily this thing to rise above, or this thing to create for themselves. They already have a comfortable life. But they do have honor, and they constantly are told they own none of what they see. Like you have nothing, and you've just got to start your own manifest destiny. So I think my children- it's funny because I tell people all the time that I have to create artificial barriers, and my mother also like one time or another will question like, ‘Why are you doing these weird obstacles?' And I'll say, ‘Because Mom, I have to create impetus. You know they can't rise above nothing, they have to rise above desire, and rise above convenience, and rise above short-sightedness.' And so I have to create as a parent challenges for them, and delay gratification for them, and expectation for them. And so they don't- they're not allowed to be comfortable even though they are comfortable. They need to prove themselves in their own time, and I think it's good enough. There's no obscene amount of pressure on them to achieve, there was never for us either, but I think they have it in them to want to better the world, and position themselves to better the world, and I think that's a much better goal in life than anything specific. Like they're not asked to have job security necessarily for money but they need productivity, and they need job security for sake of security.
Biggest Challenge as a Young Female in Medicine
Dr. Ryan Gray: Yeah that makes sense. What was the hardest part as you went through your journey at such a young age- going to a six year MD program, or BSMD program, what was the hardest part on that journey being such a young student and being a female?
Dr. Jean Robey: Well for clarification, I got accepted into that program but I turned it down, and it was like the most stressful thing my father ever could experience. Because you know how hard it is to get in a program, and then to turn it down, the idea is that you'll never get another chance, right? So we just gambled it when I did that, and what ended up happening was- so I stayed that extra year in high school, and then when I was applying then for colleges and scholarships and stuff like that, there's a really amazing scholarship here in Arizona called the Flynn Scholarship, and the Flynn Foundation actually- its initiative is to keep bright students in the state of Arizona. And so I applied for that scholarship and that scholarship is an amazing opportunity because it not only provides college tuition, it did something different. It allowed me a stipend for two summer abroads, or summer enrichment courses, or something. So it actually forces people to be not so one-sided. So I got that scholarship and stayed in Arizona and went to U of A, and did more than just study and hyper focus. I actually took summers to do things that were enriching, and part of that was study things like medical ethics, and so that really helped me to understand not just medicine but medical humanity. And then in doing that journey, I applied again to a state institution and ended up getting a dean's scholarship. So for gambling my six year program I got back a lifetime program and I was well endowed moving through. So I don't have the same end picture of like high debt and stuff like that because I had a lot of scholarships, and so that changes also sort of my perspective. But I will tell you the whole idea of being a female going into this journey, it never really even dawned on me that it was going to be some sort of barrier or problem until- and it comes in like little pieces. I don't know why it's never so blatant but it comes in little secret pieces, and the first little secret piece was we went to a retreat- so before we started medical school they kind of round up all the students and they take them on a retreat because now they're 150 people that are supposed to spend a lot of time with each other, right? So they send us off to this retreat, we spend the weekend together, and we break out in little groups, and the little groups have discussions and stuff. So my group broke off and it was eight people, and it was evenly divided, and U of A's medical school is pretty nontraditional so at the time there was equal number of men and women, but also there was this group of nontraditionals. I mean like families with kids, second careers; I mean that stuff was still kind of a novel like ‘let's see what this does' kind of thing. So we had a lot of those differences in life, it wasn't just all ‘Hi I'm twenty, I'm single, I've got no kids and I'm blowing through high school, college, and now I'm in med school' kind of thing. So we all break off in these groups. So they're asking us these probing questions to get us to think about what being a doctor is going to be like. Because all of a sudden a large majority of us don't have any life experiences and we're about to try to be authoritative. So they want us to get an idea that, hey you really don't know much, but you're going to have to figure it all out, or at least be open to understanding it so that when you meet the person that is three times your age, that you don't sound like a punk kid, right? So they ask me, they say, ‘What do you think the handicap is for being a female?' And I'm thinking- I'm thinking, ‘What?' Like I misunderstood the question, right? And I'm thinking, ‘I don't know what you mean. Like what are you talking about?' And that's when I finally get the first implication that the rest of the world thinks I'm handicapped, right? So I'm thinking, ‘Oh I get it, you think I'm disabled.' Well the funny thing is, is if you think I'm disabled then I've got you right where I want you. Because now I can always over-achieve, I can always exceed your expectation, I'm going to look like awesome because you just thought I was disabled.' So the whole group just is like shocked because it never dawned on them that this social expectation would actually be a social disadvantage. Because all of a sudden I just have to be average to be awesome, and if I'm awesome I'm going to walk on water. You know? Like so at that point I thought it's never going to be a problem to be a woman because the bar is set so low that we're going to easily blow this out of the water, you know? Like we've got this, right? So from then on the posture changed dramatically. At that point what can't we do? The bar is so low that anything we do is going to shock, and surprise, and awe everyone around us. And if you walk into a situation knowing that you've already won, then once again, I mean the road is wide open. So it's been nothing but proving everyone wrong from that day, right?
Dr. Ryan Gray: So I have this sense that this is who you are, and you're proving everybody wrong, and just plowing through everything. But what does a female out there that's on this journey and trying to figure it out who doesn't have that drive and motivation that finishes high school in two years, and everything else, and she's met with this sort of question and pushback from a surgeon who's like, ‘What do you mean you want to be a doctor? You need to go have kids.' What are they supposed to do?
Dr. Jean Robey: Right. So here's the thing, there was no way around it. Like if we were going to have a conversation about women in medicine, particularly physician women in medicine, we were not going to be able to avoid the much broader topic of sexism, right? And so when you present me with a girl who has this impression that she can't, two things come to mind. One, who told you that, and when? And recently in the Atlantic, like literally today, came out an article talking about when little boys and little girls decide that they can't. And as it turns out, it's quite pivotable. So at five years of age, they seem to have gender equality. So what they did was these sociologists took a bunch of kids and they told them a story; a story about someone who was brilliant, did an amazing thing, had an amazing achievement, was really accomplished. And then they showed them four pictures, two of women and two of men. And they said, ‘Who do you think I'm describing?' And in the five year old group they equally picked men and women, and it tended to be that boys picked boys and girls picked girls. Fascinating, right? So the girl at the age of five already can see a woman doing that. Now then they did it for six year olds, and what happened was it changed. So suddenly the group of six year olds- so they're not controlled subjects for themselves, but this group of six year olds were asked- done the same experiment, asked ‘Who do you think I'm talking about?' The boys continued to pick boys, but the girls started to pick boys in the picture. So there's a concern that somewhere between five and six, little girls are being told anything that requires you to be smart, and driven, and accomplished, and have a brilliant new idea must imply you're a male. So when you ask me, ‘Are you different somehow? Is it just your innate personality?' I think I was never told that there was a difference, and that's what I'm telling you. I wasn't told until someone asked me what's the problem with there being a difference. So we have to talk about when we tell kids this. But now you're talking about- okay so we're dealing with an adult, a young adult, who for whatever reason in whatever way, because we don't really know, it's intangible how they were told they were different. And now they're walking into it and they're believing they're different. Okay? What do we tell that person to tell them they're not different, and to help them to fight the social order around them that says they're different, and to survive. Okay well set aside the notion that there are some differences, and we can talk about that because there are legitimately some differences, and that we need to sort of support and be honest about that. But for that person that has been told, and is under the impression they're different, and is now subjected to that affirmation, it takes someone like me to exist and to affirm the opposite. That's what happens. So when we talk about who we look and see around us, like when we're practicing, it is so essential that we see women, and that we have other women mentors, and we have those women mentors that say, ‘I represent for you the reality that could be, the realization that could be, the attitude, the perspective that could be.' Like I'm telling you I exist and I never ran into any encounter of difference. And here I am, I act as if I'm not different, I believe I'm not different, therefore you could as well adopt this stance. And when you engage other people and they're trying to push on you a reality that there's a difference, you may push back and say there is not a difference. And for those things that are different, I can tell you how to navigate them.
Differences among Men and Women
Dr. Ryan Gray: Yeah what is different? Talk about those.
Dr. Jean Robey: Well so that's really fascinating too, right? Because whenever you want to talk about this topic, and you want to talk about what really is different, people get really sensitive. They get very sensitive because they feel as if you're trying to do something, like you're trying to segregate or put down. But remember I don't have to put anyone down to raise someone up, that's not necessary.
Dr. Ryan Gray: That's a very big discussion in this country right now.
Dr. Jean Robey: Yeah there's not some weird pulley system here, you know? So I can certainly talk about somebody and raise them up, and it doesn't- should not subtract from someone else. I'm not talking about therefore this other thing. So we need to get rid of that assumption that one going up means one going down. But the other thing is, is if I'm talking about how you can bolster the differences and accept the differences, then we have to just be realistic about what those differences are. Okay so the way I look about it is there are biological differences, okay? There just are. And that biology does translate into sociology, but that biological difference means I have things that my body goes through every month. You tell me what a man's body goes through on a cyclical basis every month that's in any way like the same. Then we can say apples and apples. But there are apples and oranges because every month there are ten days that I am different than myself, okay? So people want to say that I've just- I don't know, accepted a lesser- I've somehow demoted myself, or I'm compared to a man who doesn't have to have these biological cycles that I'm lesser. And it's not, I'm not even talking about that because I can more than account for the ten days, okay? I'm fine, better than average. But there are ten days when I'm lesser than myself, okay? And that's my own personal admittance, but those ten days are very hormonally driven and they are a problem sometimes because I'm just- to be very frank, I'm just walking down the hallway, and all of a sudden I start bleeding. It is an incredible inconvenience. I'm just going, ‘Aw geez.' I've got to stop what I'm doing, and I've got to go address myself. But I say it that frankly because when's a guy going to be walking down the hallway and then- aw geez. He's just not, right? And it's not like therefore the guy is bad or therefore the guy is better, it's just a reality, accept it.
Dr. Ryan Gray: It's biology. It's all it is.
Dr. Jean Robey: Yeah I mean unless you don't have a uterus and ovaries or something, you're not going to- you're going to have that ‘aw geez' moment. It happens, now you have to deal with it. Well now along the lines of that, biologically when I enter a relationship and I'm heterosexual, or I'm not heterosexual but I want to have a baby, I'm the one. It's not like I look at my husband and go, ‘Hey is it going to be you or me?' You know? I mean it's not like you take a vote, it's not like we drew straws. You know? If I'm in a homosexual relationship, and we decide to have a baby, maybe one of the two of us can have a choice but for the most part it's going to be the female, right? So the female is going to carry this baby, and that itself is a very demanding, very draining, very responsible event and it's not like it's one day or one week, it's ten months of your life and then afterwards with the postpartum. So I'm mentioning it because as we're going through medicine, and we hit that reality, and we hit that point in our life, I think it becomes something that we have to account for. You're in the middle of your career. Many women used to just not in order to equate themselves with their male counterparts. They would just decide not to have children, not to get married, and now they were trying to like equate themselves. But I mean that doesn't happen necessarily predominantly anymore, although some people may grapple with it. They would say, ‘I'm not going to have kids now. I'm not going to have kids under these terms. I'm not going to have kids because I want to do this sub-specialty and they're not going to appreciate that.' So you've changed your options in one arena because you've chosen medicine, and that's not a hospitable environment. You know? The environment that allows you to continue your biological and your personal destiny outside of your profession should be the one that's ‘equal but not equal,' right? So I talk about these differences because that's how we can create an environment that's woman-friendly and woman-strong rather than just being always ashamed to be a woman, and always acting as if they're accommodating women or tolerating women. You know?
Current Challenges Facing Female Physicians
Dr. Ryan Gray: What is the biggest challenge now that you're out in practice? And you're obviously a huge advocate for women physicians, and mom physicians, and we're talking all about this because of National Woman Physician's Day on February 3rd. What is the biggest challenge facing female physicians?
Dr. Jean Robey: Supporting one another and supporting the concept of women in medicine. And so here lately a really interesting group of studies or observations have been put out to really ask the question about the possible value and contribution women have in medicine, and understanding what that means to one another, and for men and women. You know? So latter part of December, JAMA which is an established journal for medicine- Journal of American Medical Association published an article, and this article was actually a reflection on outcomes, and people love that because they want to know okay does it make a difference? Did it help? So in this outcomes cross-sectional evaluation, they looked at- what happens if you look at men and women physicians, and if they treat patients- and they took the subset of Medicare patients, because that's an easy database. So these patients are 65 and over, right? So they said, ‘Okay if I take this subset of 65 and over patients, and I look at their admissions, their mortality, and their readmissions, what do we see? Is there a difference? Is it equal?' So they took over a million and a half admissions, and a million and a half readmissions, and the average- the mean age was eighty so these are older patients, and they looked to see how were outcomes? And as it turns out, women did better than men. Women physicians did better than male physicians. And there's all sorts of stipulations about what that means, and why that would be, but the point is, is there might be attributes that women bring to medicine that bring out better outcomes based on those attributes. And there's no shame in mentioning what these differences are. They tend to be very common understandings of how women are. I mean they end up being talked about as stereotypes, but women tend to talk more, they tend to explore more like deeply into things, they tend to be more parental when it comes to kinds of caregiving issues in medicine, and they tend to want to involve more people so it's not a one-to-one transaction, it's more like okay, who's on your team, and then you address the team. So these attributes, which if you want but I hope you don't, are sexist attributes. They are just sort of our makeup, it's how we communicate and navigate and understand and think. These attributes may actually benefit the social order when it comes to things like medicine, especially as we get older. Perhaps that's the stipulation, we don't know because we've never done this study in twenty to sixty year olds or pediatrics. But the reason I bring it up is because therein lies potentially some conviction and validation that women belong in medicine, and society could benefit from us in medicine. But when we look at women even talking to other women- because I was there, I was there. Remember I was single without kids and I was young, and I was in an institution that was becoming nontraditional, and in their nontraditional admittance they had women that were moms, and men and women who had second careers, and single moms. And I looked at those people like they were the weakest link, right? Because they had obligations, and they had responsibilities, and that was me in my naivety. And even in my training I had a fellow intern who already had one kid and she dared to get pregnant during her internship. And I was newly married but I was not going to have kids, this was not the best time for that, there was no time for that kind of thing because I was married to medicine. Okay now I look back and I think, ‘I should have never looked at that woman that way. I should have never given less support, even though my circumstances didn't demand understanding in that way.' And so it's interesting when I see comments from other women that says, ‘I'm not going to have kids. I'm not married, so why should I owe you anything?' Because that gives males the ability to say, ‘I will never, ever have kids. So it goes double for me.'
Dr. Ryan Gray: What drives that from women?
Dr. Jean Robey: You know here's where it gets controversial again. I believe there is a circle- a secret circle, and this shelters sexism because there's a secret circle. And I've described this secret circle because I recognize that in some ways I go in and out of the circle, okay? Because I'll be around males, and I've been permitted to be around males, I've been accepted. I talk like them, I think like them, and I'm speaking in general. I'm direct, I'm forthright, I might have more male attributes. And so in this circle there's us and there's them, right? And we feel good about that, there's us and there's them. And then I realize who they're talking about, and it could be me. Not them, but it could be me, you see? So they're talking about another woman because of something a woman is doing, I happen to be on this side of the conversation so I'm in the secret circle, so now I'm part of the conversation that's talking about that woman, but guess what? I could walk over there and be that woman, or be aligned with that women. So suddenly I'm realizing that my safety, my security, my identification with this circle is allowing and perpetuating sexism within our workforce. So when you ask me what drives women to be not supportive of other women, it's because it's almost like they're conned into thinking they belong to a fraternity, a special order. Now let me tell you about sexism in a very, very simple way. Look at two plates. This is my plate, I'm a woman. This is your plate, you're a man. You come in and you can pick which plate you want. I'm going to tell you a majority of the people are going to pick the man's plate because the man has something you want. And it's the same argument you can make about racism. If you have two plates, and you ask someone to pick would you want this plate or this plate? And they say, ‘Actually I prefer this plate.' Well why? There must be something about that plate that has an advantage. So when you look at a situation where women believe they have the other plate, and that they would pick that plate, then they're not going to want the other plate. I don't want her ostracism. I don't want her situation. I don't want her weakness. I don't want her lack of availability or needs above the average that's inconveniencing everybody else. And so they misalign themselves with who they think is going to have the advantage. So I think that's what ends up happening when they decide that their sister is causing a problem.
Advice to Lift Women up in Medicine
Dr. Ryan Gray: How can a premed- that's the audience right now listening. How can a premed who's a female- and I have a lot of women that listen to this that already have kids and are on their way to medical school, or maybe in medical school. How can they start utilizing this information that you've gathered all along and are so passionately involved with? How can they start using this information for the betterment of themselves on their journey, the betterment of the women around them, and also the betterment of physicians as a whole in helping their male colleagues understand what maybe they're not seeing?
Dr. Jean Robey: Well I'm going to tell you male or female, when you go into this profession, you need to have support and resources. So it isn't- like we've seen a lot of women ask, ‘Should I? Could I do this?' And they'll say things like, ‘I'm single, I've got three kids.' Or, ‘I'm married and I want kids.' Or, ‘Heck I'm single and I want to be married.' I mean they'll say things like this as if these things are important to consider. And they are, but the answer is not specific to, ‘Oh you've got three kids, well you're going to have your hands full.' The question in a Socratic method has to be answered with another question. What are your resources? What's your support like? If you've got eighteen kids but you've got tons of resources, does it really matter? You're free, you're free to do the things that you're asked to do. So when I look at medical training and medical education, I'm not saying that we can make it easy, we can't. It is hard and it's necessary to be hard because that's how you're going to grow into authority. Remember we can't be punk kids telling the social order how to behave, and how to do well, and how to pick better, and invest better. We have to be people who are wise, and in gaining wisdom we have to spend time, and we have to focus. So you're going to have to marry medicine, and the way you can have two marriages and ten responsibilities is you need support and resources. If you don't have support and resources then you're going to be very challenged. Now we'll see postings from female physicians who say things like, ‘I was single, I had one kid, my husband was far, far away.' So you know they're telling me of a system where they didn't have great support, but they continued to pull through, and they made their choices, and their sacrifices, and they'll make it through because they're just very driven, very accomplished women, and their children are fine, right? Because they're also kind of programmed and genetic that way. But what they will say hands down is, ‘It was really hard. It was horrible and I cried a lot, and I thought I was going to fail, and there were many times I wish I would quit, and I had a lot of doubt, and I didn't know what to think about myself, and I felt like a failure a lot.' And so universally if you go into it with very little on the side of support and resources, it's not that you can't do it, it's going to be really, really hard, okay? So when the people that are having a hard time look around and say, ‘Okay well does the medical society have preprogrammed support for me? And can they help me?' To an extent we should help everyone, but again it wasn't really a journey for the unprepared, right? So when you ask me- if someone's going into this and they have that other role and responsibility, what should they do? Well they can certainly ask the programs that they're going into, ‘Do you have on-site daycare? What do you think about my situation here?' And like I told you, University of Arizona, they open their doors to this. They knew what they were taking, they welcomed it because as an establishment they recognized that these people have something to offer. So when we talk about changing the perspective and the impression, we can go by science like the study I quoted, we can go by the very fact that different people doing different things in different ways creates support for- in a reflective way, the society they serve. I mean this is the argument for diversification. We have to be diversified to care for the diverse population that we are going to encounter, right? So we need people of different races, we need people of different color, we need people of different life experiences. We need those things because those people are going to bring value to the very people they take care of. We can't be singular. I mean what's an infinite group of single twenty year olds going to offer medicine? It was much better to have some of these, and some of these, and some of these in order to serve the very diverse population that we are about to get into. I mean who's going to take authority from one kind of generic physician? So I say to my male colleagues, I say to my sisters, in different life experiences we all have something to offer because hands down you're going to care for someone that looks like you, is living like you, had a history like you, and you can relate. Because that's really what medicine is about, it's about compassion, and empathy, and relating. And if you can't relate because you've never been hurt, and you've never had trials and tribulations, and you've never had challenges, and you've never had families, and children, and death and dying, then you don't have a whole lot to offer in terms of authority in medical caretaking. I think there's room for all of it, but medicine itself is such an arduous journey that you have to be prepared, and then the institutions themselves have to be prepared. I mean the idea of medical leave for maternity leave and stuff interestingly is almost like a new idea. It's like, ‘Oh I guess you have to go and have a baby now.' Okay well yeah, I mean my biological years are running down here and not only do I need to do this, I want to do this, and this is the time in my life that I would do it, and there's no way for me to choose an alternative time for me to do it. So yeah, it's got to be now and this is the way it's got to be done, and I want to do it well because remember I'm a preacher of health and wellness so I've got to do it a healthy way in order to go and preach to others health and wellness. So as an institution, as an establishment, we need to support these kinds of life roles and life needs, otherwise we're just hypocrites, right? Like we're sitting her talking about how to be well when we ourselves are the most unwell people; high suicide rates, poor coping with being new moms and new dads, and distant relationships with our children. You know it's not- that doesn't sound like it makes any sense at all. So why wouldn't we have doctors that were good moms, and good dads, and had good relationships with their kids, and took time for themselves, and certainly didn't feel burnout and suicidal. Because then we can go preach good living, right?
Men Supporting Women Physicians
Dr. Ryan Gray: Yeah. How can men that are listening to this support women better as they're going through their medical training, and then as they're physicians later on?
Dr. Jean Robey: You know I've thought about this a lot. Interestingly when I was in my fellowship training, I was pregnant and two of my male fellows had wives that were pregnant. We all went out on leave together. I went out to have the baby, they went out because their wives had babies. They came back after a certain period of time, I stayed out. I got the phone call about when I was going to come back. So within the first week I get a phone call about when I'm going to come back, and I didn't know what to think. I'm kind of a little post-traumatic, I just had a baby, so I'm not thinking real straight, and I got this baby that I'm trying to feed, and sleep that I'm not getting, and so I'm not really understanding what the question is once again. And she's asking me this and I'm telling her, ‘Well I've done my due diligence, I've stock piled my call, I've bid my months accordingly and everything, so I think I'm safe. This was always the plan, this was the plan we talked about.' And then I realized something. They called me but they never called these other guys. I said, ‘Why are you asking me as if I'm the weak link? All of us are on leave here, so did you call those guys?' And then it came out that no, they had a prejudice. They were looking to find out about me because I'm the woman here, and these guys, they were always going to come back. They were going to be reliable, I was the unreliable one. So I asked my colleagues, I said, ‘Did they call you?' and they said, ‘No.' And I said, ‘Because they called me and they said, ‘No.” And I said, ‘Yeah man, they called me, isn't that weird?' And the thing is, is my male colleagues supported me because they were flabbergasted. They were just like, ‘Why would they call you?' I said, ‘I don't know. I think they're trying to imply that I was weak but they never even thought to ask you guys, and you had new kids too.' And I say this because when I look at men supporting women, I think they've got to think of the women as their sisters and their mothers because they are not the same as their brothers, but they are worthy of their respect and support. And only by looking at them as sisters and mothers and wives, can they say, ‘You know I want for you what's good for you. Even though it's different than what I need right now.' And there's a bunch of argument about whether or not it is different meaning if I took four weeks of maternity leave or six weeks of maternity leave, did they need four weeks or six weeks of paternity leave? We can argue that. We can argue whether or not that would make them better fathers, but biologically I know this, I breast fed and my husband didn't have to wake to feed a baby. And he asked me, ‘Should I wake and sit with you?' I'm like, ‘To do what? That's the like the most impractical thing ever. I'll feed the baby, you do something else. Something else that's helpful but you're never going to be the one feeding the baby, which unfortunately when the baby is first out they're eating every two, three hours. So that's the most like disruptive- I mean it was like being on perpetual call, right? So I think there are some- like again biological differences, but yet if they want to have bonding moments, if they want to be there for their children because that's fulfilling for them and good for society, we can argue that all day long. But I know what women need, and women need that time and space, and that permission, and that understanding. And men can give that to us if they frame their relationships with their female colleagues as if they're dealing with their mother, or their own sister, or their own wives. If you can't give me that kind of respect, and that kind of compassion, then we are never going to be able to work together because I have things I have to do, and you have to give me credit for it, and I will not cheat you- you know I'm not trying to get out of work, and I'll pay you back, but I need this room, this time and space. And nowadays like I'm not in that, ‘I'm getting pregnant, I'm pregnant, I just had a baby' phase. I'm in this my kids are eleven and seven phase, but there are still things I need to do, and it looks different than what my husband does. And the timing is different. It's to my satisfaction and to my role in the relationship with my children, and it's going to be different at times than my male colleagues. And I'll tell them, ‘I have things I have to do because of the position I'm in with my children, and the relationships I have with my children which may be different than yours in general and specifically. So I need time for that, and allow them certainly the time they need for the kinds of things- the duties they have as fathers and stuff.
National Woman Physician’s Day
Dr. Ryan Gray: Yeah. Talk about National Women Physician's Day. Why was that born and what is the cause? What is the movement around it?
Dr. Jean Robey: Well you know there's certainly better people that can speak about the whole of it, but I will tell you what my impression is. So two things. One, when we began to realize that we were underrepresented, and not really understood even amongst each other, that's what birthed a movement. I mean in any room you might have a handful of women, and they weren't really talking to one another because they weren't supposed to show weakness. And so the National Women's Physician Day was born of this idea that we need to unite, we need to have more similarities than differences, we need to be proud of who we are and what we're trying to, and our worth, and our sacrifices, and our common- our more common struggles. And this isn't supposed to downplay male physicians, it's not supposed to downplay other females in medicine like nurses, or social workers, or CRNAs, or nurse practitioners, or PAs. It's not, it's really meant to just celebrate this one profession, female physicians, and to help open the discussion about what females might need that are particular to being females in this profession. So it's not supposed to negate other professions, or other working women, and I say that because sometimes the discussion gets derailed. It's really just to say, ‘You know we really didn't acknowledge one another, and we didn't ask for acknowledgement. We were told to blend in. And we have very unique distinguishing features, and we have very interesting attributes, and we've come to serve. And we need to understand what we can do in that mode of service because we have these unique attributes.' And it's starting to come out. So as soon as this national movement came about, people were asking, ‘So what does that mean? How does that benefit society?' And now the discussion is getting really interesting because we want to know can we all be more something, and can society gain something from that? I think it's going to keep gaining momentum in a way that can extract from being female, and being a physician, goodness for society. I think it's going to be a really great thing in the next five to ten years such that society starts being better for it, you know?
Words of Wisdom to the Struggling Premed
Dr. Ryan Gray: Any last words of wisdom for the premed listening on their journey- a female premed on their journey, struggling with those decisions, and those thoughts, and reading stuff online about how you can't be a good mom and a physician trainee at the same time?
Dr. Jean Robey: You know I look at my daughter and I think, ‘What good did I do you? All the while I was doing good for others, or maybe if some would say good for myself, what good did I do you?' And my daughter is the greatest answer to the question you're asking. She knows that she can contribute. She knows that there are no barriers in her contribution, and if she chooses medicine then she knows how to get there, and what it looks once she gets there, and who she has to marry, or be around, or have support her. To that end my son, thankfully I have one of each, he knows what he needs to do to support someone like me or her, and he knows what benefit it is to society to have someone- a female in this position. And so when you ask this question about what women right now looking at this profession should wonder and worry about, I almost want to say, ‘Look you want to do this? You really, really want to do this whether you're male or female? Then do it, and do it right, and don't worry so much. It'll all be fine. And the sacrifices that you make will pay you in ways that you will never understand because the people that watch you and benefit from you choosing to do this are going to be numerous, and they're going to be molded, and changed in ways because they saw you there. Because you came next, or you came before. I mean the very reason that I can keep going is because I was trained in a time when there were plenty around me, enough around me that kept me going. If I was one of the first it would be very difficult, but I mean that glass ceiling has been broke. And so now in this second year of our National Women's Physician celebration, I'm going to say, ‘Look ladies, this ceiling is broke. We are here, come ask me. Come ask me how I do it. Come tell me how hard it is for you and I will tell you it was for me too, and yet here I am still.' So for those women that want to challenge this and do it, it's okay. You want to do it, you see what it takes, you're up for it, you've got resources and support, go for it. I'll be there to hold your hand, I'll be there to praise you along, I'll be there to guide you. And we will never judge you. We will never think you were lesser, okay? So you don't have to be afraid of that. You will have women who support you, and I think if we tell them that you have women and men who support you, then why wouldn't they? Because then they wouldn't be asking themselves, ‘Why am I disabled?' You're not, you're able, go ahead.
Dr. Ryan Gray: Alright that was Dr. Robey- Dr. Jean Robey. She was actually on my Specialty Stories Podcast in episode 6 talking about being a private practice nephrologist. So if you want to hear more from her, go check her out over at the Specialty Stories Podcast.
I encourage you to follow along on February 3rd on social media, use the #NWPD for National Women Physician Day, and search for that hashtag to find out what's going on. Also check out #iamblackwell to celebrate Elizabeth Blackwell. Again February 3rd is National Women Physician Day.
I want to take a second and thank several people who left us ratings and reviews. I have a lot of old ratings and reviews to go through, these ones are from November, 2016. So I'm sorry if you've been waiting for me to read yours.
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And one more here from Amanda who says, ‘A major help in preparing my med school journey.' Yeah. It says, ‘During my senior year and now through my gap year, this podcast has helped me immensely through my journey and goal of attending medical school.' Thank you for leaving that, Amanda.
If you'd like to leave us a rating and review you can do that at www.MedicalSchoolHQ.net/iTunes but here's what I would rather you do. I want you to pay me. I want you to pay me with a friend. Bring a friend to this podcast. Take their phone, give it back to them at the end, but take it and show them how to subscribe to this podcast on whatever device they're using. That's my request for you.
Alright I hope you got a lot of great information out of this podcast today. Male or female, this information is very important and I hope if you are on this journey as a female physician or female premed and you've been doubting yourself, doubting your abilities, take a listen to this podcast one more time because Dr. Robey was very, very motivating. I hope you have a great week as always, and come back and see us next week here at Med Ed Media and The Premed Years Podcast.
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