How a Journal Club Article About Mustaches Sparked a Discussion About Diversity in Emergency Medicine

Posted on Wed, Apr 05, 2017
How a Journal Club Article About Mustaches Sparked a Discussion About Diversity in Emergency Medicine

By N. Adam Brown, MD, MBA, FACEP
A few months ago one of my docs had an idea: Let’s resurrect journal club. To some, the idea of hosting a “journal club” made little sense for a community, non-academic practice. In fact, some of our team, especially our physician assistants and nurse practitioners, had no idea what a journal club was. Others who remembered journal clubs of yore thought it could be a great opportunity to discuss up-to-date topics and have the opportunity to socialize with our colleagues in an off-campus, relaxed atmosphere.
Initially, I was skeptical. I remembered journal clubs from residency and never really liked them. For one, journal “clubs” were a misnomer, as they were never really club-like (By the end of residency, I could have had a PhD in clubbing and I knew journal clubs were very, very different). And two, the articles seemed so academic, esoteric and boring to a sleep-deprived, barely-holding-on-to-sanity resident. But now after being out of residency for 10 years and amassing a significant dose of maturity, I began to see the value in hosting such an event. So I decided: Let’s do it.
To my surprise, our first journal “club” attracted quite a number of participants. After socializing, we took our seats to go over the assigned articles. I picked five articles; three were medical articles and two were non-medicine articles on mustaches and implicit bias (And before you wonder if I made a typo, yes, I picked an article about mustaches. I have a mustache so I was drawn to the title). I wanted our journal clubs to be a little different, where we discussed not only up-to-date medical practice, but discussed “hot topics,” issues surrounding physician wellness, and diversity and inclusion.
After discussing the three medicine articles, we started in on men’s facial hair. The article, released in 2015 by researchers at the University of Pennsylvania, hypothesized that men with mustaches were in more leadership positions in academic medicine than women. As I began to present the mustache article, many of my team appeared annoyed and others shook their heads in frustration as I explained the study’s conclusions that men hold 87 percent of academic leadership positions. Further, despite the relatively rare facial hair fashion statement, more mustached men hold leadership positions (19 percent) than women (13 percent). Overall, academic medicine institutions had a “mustache index” of 0.72 (13/19).
After presenting the article and discussing some of the initial points, I asked an open-ended question: Why do you believe fewer women are in leadership positions than men? All the women in the room began looking around at each other as if they were all in on some sort of inside joke that I had missed out on. So I asked again. Then there was a collective sigh. Some of the responses of my mostly female group were as I expected. A few discussed the challenges women have with juggling leadership and home duties. Administrative positions simply did not take priority when compared to caring for their children. Others were more pointed, conveying great frustration with misogyny in medicine going back all the way to medical school and residency.
“Men have more drive and ego,” one of my colleagues said. To which I countered, “Is that true? Do men really have more of an ego than women or did we as a society condition women and men to believe that it’s more acceptable for men to have a more assertive tone and more drive than women?” Some agreed. Society was partially to blame. Another said, “Dr. XYZ (one of our notorious inpatient attendings) always refers to me as ‘girl’ and is condescending to me on the phone.” Another, speaking about a previous practice experience, expressed the real anxiety she felt being the only female in an all-male practice. She went to work every day believing that she had to exceed the expectations and outperform male colleagues to be considered credible and equal. Now, being in a much more inclusive practice, she feels more at home.
What surprised me the most, however, was one of the final comments: “I’m just glad you were willing to talk about this. It says a lot.” (Everyone nodded in agreement.) Think about that for a minute. One of my staff members was just happy that I, a white male with a beard and mustache, acknowledged the gender issues (sexism and misogyny) and gender disparities in medicine. That acknowledgement, she believed, made her feel comfortable to speak to me about advancement opportunities or any other issue. For me, this comment was a “light bulb” moment and a huge win. Could simply talking about these issues open the door to other women or under-represented groups seeking leadership opportunities? Could broaching the subject matter of gender inequality promote greater inclusion in our practice? Quite possibly.
As a regional medical director for EmCare and Chief of EM at my two-ED campus, I am positioned to make real impacts on diversity and inclusion both in the people I hire and in the atmosphere of inclusion I promote. I’m proud to say that after two years as the leader of our practice, we are more diverse than ever (60 percent of our providers are female and 67 percent are non-white). Two of my medical directors are female and both advanced practice leaders are female. Furthermore, our practice truly reflects the community we serve—a community where more than 87 languages are spoken in the public school.
When I first took the leadership position at our hospital, I had one goal: Become the premier emergency medicine practice in the region, delivering the highest quality healthcare. While the idea is simple enough, executing on such a lofty goal is quite difficult. One area where I knew we needed to continue to improve was on practice diversity. Study after study indicates practice diversity not only benefits our patients, but also our employees and our business. With that in mind, I realized expanding diversity is not just a “nice-to-have;” it’s a necessity.
To ensure a healthy, happy workforce and practice, leaders must begin acknowledging the underrepresentation of women and minorities in our field. We must ensure we support an atmosphere of inclusivity and openness. So where do we being? Maybe hosting a journal club where we talk about and acknowledge the “mustache index” is a simple way to get the conversation started.

Dr. N. Adam Brown
N. Adam Brown, MD, MBA, FACEP, is a board-certified practicing emergency physician and the system chief of emergency medicine at Sentara Northern Virginia and Sentara Lake Ridge emergency departments in Northern Virginia. He also serves as regional medical director for EmCare’s North Division, where he leads a team of EM providers, six medical directors, and an administrative support staff for hospitals in New Jersey, Virginia and North Carolina.

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