Massachusetts Medical Society: Member Making a Difference - Dr. Julie Silver

Member Making a Difference - Dr. Julie Silver

Three Rs for Advancing Women in Health Care: Recruitment, Retention, Re-entry

Dr. Julie Silver
Dr. Julie Silver

Julie Silver, MD, associate chair of the Department of Physical Medicine and Rehabilitation at Harvard Medical School (HMS), provides patient care in musculoskeletal medicine at Brigham and Women’s/Mass General Health Care Center at Foxborough. She also is a leading national voice and scholar on equity for all health care professionals and patients, especially for women in medicine.

In 2016, she launched — and continues to direct — what is now an annual three-day HMS course, Career Advancement and Leadership Skills for Women in Healthcare. Attendance has grown to more than 1,000 attendees, from aspiring leaders to established ones, including physicians, health care administrators, and nurse leaders from across the country. Strategic finance, goal setting, and other specific skills are part of the curriculum, as well as how to create organizational impact in quality, technology, and patient-centered care.

Dr. Silver also was an early architect of the MMS Women’s Section, which was created in 2019 to influence and contribute to MMS policy and program development within the MMS on issues of importance to women physicians. Vital Signs caught up with Dr. Silver recently.

VS: Each year, your Harvard course on health care leadership includes a strategic initiative that gathers support for women in medicine, via social media, during September’s Women in Medicine Month. What is this year’s theme?

Dr. Silver: Past campaigns have include #NeedHerScience, #HerTimeIsNow, and #GiveHerAReasonToStay in Healthcare (all available on This year’s campaign, #InvestInHer, is a call to action for health care institutions, government agencies, foundations, professional societies, and health-related companies for strategic financial investment supporting women in medicine in these three Rs: recruiting women at all levels and especially promoting them to the highest leadership positions; retaining women in health care; and re-entry support for women who have left medicine, many due to the pandemic. As usual this is a collaboration with the American Medical Women’s Association (AMWA) and Executive Leadership in Academic Women (ELAM).

VS: Is re-entry a new focus that is particularly important now? And are these three Rs intertwined?

Dr. Silver: Recruitment is of course always important for bringing women into the pipeline for top leadership positions. Retention, which we define as providing women with resources they need to be successful at work and in their personal lives, is especially important now because it relates to what’s being called the “Great Resignation” — a fourth R — across the United States and in health care due to the pandemic and other factors. Re-entry is now essential in that we need to build an infrastructure to support those who have left medicine, perhaps due to caring for children or aging parents, burnout, or other reasons. And we need to do this through the lens of not only gender equity, but also of other groups that have been historically or socially marginalized.

The campaign describes the urgency of the current situation — not only for physicians, but for all the women who make up 77% of health care and long-term care workers and who have direct patient contact. This infographic offers more specific information, including the cost of replacing doctors who leave an institution.

VS: In a recent commentary in the journal Cell, you led 17 co-authors, including leaders from top institutions nationwide, in a call for scientific and medical organizations to hold each other accountable for discriminatory practices. Can you share the thinking behind this article?

Dr. Silver: This is a novel concept that my colleagues and I call “interorganizational structural discrimination.” It has the following three features:

1) two or more organizations intentionally work together, 2) one or more of them has an obvious issue consistent with structural discrimination, and 3) that issue is known to be remediable. Essentially, we are encouraging organizations not only to fix their own issues but also to avoid collaborating with organizations that do not share a similar commitment.

VS: As we move out of crisis mode from the pandemic, what should hospital and practice leaders focus on now to ensure financial stability and high-quality care for patients?

Dr. Silver: Retention of physicians, nurses, and other workers is critical now and is the best investment hospitals and practices can make. For example, childcare has been a major stressor in recent years for parents as centers have closed and reopened and faced staff shortages. Health care institutions can help solve these issues for their workers through financial investment in secure childcare, including on-site day care centers and subsidized options for health care workers’ children. Paying people well to take care of our children so that we can take good care of our patients is a high priority. The payoff for the institution is much higher than the investment.

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