Reflections on medicine with Julie Silver, MD (M’91)
Associate Professor and Associate Chair, Department of Physical Medicine and Rehabilitation, Harvard Medical School
I grew up in Northern California and was initially an engineering major in college. I liked math and science but didn’t want to sit at a desk all day. I liked to interact with different people. Medicine was the right mix.
For medical school, Georgetown was my first choice. I fell in love with the campus.
Georgetown offered a mix of training hospitals. In patients we saw tremendous socioeconomic diversity, ethnic and racial diversity, acute and chronic condition diversity, national and international patients. We treated prisoners too.
During the time I trained in D.C., around 1990, we saw a lot of trauma. As a rehabilitation physician, it helped me understand the effects of gun violence.
At the VA hospital, filled with patients with AIDS, an attending neurologist asked us what we thought filled the hospital when he was in training. Tuberculosis—surprising since by then there were so few cases.
I learned about my specialty while on rotation at the VA, because we’d walk to the National Rehabilitation Hospital for lunch. I went to a table of doctors and asked them what they do.
The specialty grew out of many who suffered from paralysis from polio, and from helping returning World War II veterans. Today the field includes sports medicine, cancer and stroke rehabilitation, traumatic brain injury, and more.
Physiatrists are increasingly interventional—trained in electrodiagnostic studies such as EMGs and nerve connection studies. We do joint and trigger point injections. My primary clinical and research focus has been musculoskeletal and cancer rehabilitation.
I’ve seen a culture shift in professionalism during medical student training. There used to be no expectation to limit student work hours, and no repercussions for being disrespectful to students.
We have a new normal—academic medicine has collectively decided to treat patients, medical students, trainees, and all people with dignity and respect, regardless of where someone is in the organizational hierarchy.
I got interested in workforce gender equity research when I became associate chair of my department. More than 60% of our faculty come from underrepresented groups. We worked to support them all equitably, but external barriers limited access to leadership roles, speaking opportunities, grant funding, and journal publishing.
My research focuses on using data to document disparities for women in medicine, and address them scientifically.
Medical society recognition awards demonstrate the extent to which women are often not valued for their accomplishments. In one study, in a specialty with more than 40% women, for the most recent four years the society gave no awards to women—the inexorable zero.
I direct a women’s leadership CME course at Harvard. We focus on teaching leadership core competencies, including equity, diversity, and inclusion. All leaders should be familiar with the evidence base on these, and using data to understand what’s happening at their institutions, addressing gaps scientifically, and transparently showing results.
To address gender discrimination in medicine, we should be thinking like scientists.
In one study, we compared how often men versus women were mentioned and their work described in one medical society’s newsletter. In more than a third of their newsletters from the last five years, zero women were mentioned, for a specialty that is 42% women. In 100% of the newsletters, men were mentioned. People develop reputations by someone acknowledging their work.
At Georgetown, I used to study in empty classrooms by Dahlgren Chapel. I loved seeing people celebrating weddings and baptisms, the cycle of life, the commitment to serving humanity that Georgetown represents. It reminded me why I was studying, to make a difference in peoples’ lives, to make the world a better place.
