Women, Work, and the Wish to be a Princess.

Monday, March 17, 2014

Like most little girls born in the 1980's...or ever...I wanted to be a Disney princess. I wish I was one of those cool girls that could claim she was a tomboy and grew up playing sports, but I wasn't. As much as I deny it now my favorite colors were purple and pink and glitter for many years.

I wanted to be a princess but my choices were limited.  Jasmine dressed too skanky. Pocahontas rolled around in the grass with John Smith and sang about the spirits in the wind (so I still haven't seen that movie). Ariel had a bad attitude and disobeyed her dad so my parents didn't like her, although I somehow still pulled off naming my first kitten after her.  Snow White seemed safe but REALLY boring. Does she even talk?

Belle was the best...let's be real.  She has the best songs, she was brunette, she actually got to ride the horse without the prince and the golden ball gown was awesome.  The tea parties weren't bad either.  So yeah, I'd pick Belle although my lifelong dream to own a large feline always drew me towards Jasmine. But since I wasn't allowed to dress like her for Halloween she was out.

I have resolved to finish a book every month this year.  I know that's no big deal for most but I'm someone who has started nearly all the books on my shelf and probably finished 25% of them.  Unlike Belle I'm not really a reader. If I could be a tomboy and reader then maybe my life would be complete or at least I'd feel a lot better about myself.

I did finish Lean In by Sheryl Sandberg in January.  It challenged my life.  While I will resist going on another feminist rant with this post I want to share some of the most memorable moments of the book.  If you haven't read it you should. Male or female, it is important.

1) Ban Bossy.
Personally I think this movement is a little extreme and I was the little girl who was told daily that she was too bossy.  It did hurt. It did make me feel like I shouldn't speak up and it did make me feel disliked by many of my peers. However, asking people to refrain from using the word "bossy" seems a little silly to me.  Instead I think we need to take ownership of our bossiness.  Sheryl was called bossy and now she's the boss of facebook (next to Mark of course). Even early in college Sheryl remembers that as one of five recipients for a scholarship at Harvard (and the only woman) being the top of the class made life easier for males and made it harder for females. Being smart is good in a lot of ways, but it doesn't make you particularly popular or attractive to men...our entrenched cultural ideas associate men with leadership qualities and put women with nurturing qualities...we believe not only that women are nurturing but that they should be nurturing above all else.  When a woman does anything that signals she might not be nice first and foremost, it creates a negative impression and makes us uncomfortable.

Solution? Suck it up and own your success. Sheryl argues that more women should be in leadership.  It's really easy to hate [bossy] senior women when there are only a few...but if 50% of the top jobs were held by women it would just be really difficult to dislike that many people. Powerful women must be less of an exception.

2) Forget Fear.
Women statistically do not speak up in meetings because they fear seeming like they are nagging or negative (story of my life). We fear that constructive criticism will come across as just plain old criticism. We fear that by speaking we will call attention to ourselves which will open us up to attack. We must speak with delicate honestly rather than brutal honesty. I am terrible at this but working on it.

3) Get Married.
The closer I get to thirty the clearer it becomes that single women my age tend to fall in to two categories 1: the OH MY GOD I'M GOING TO BE 35 AND SINGLE AND MY EGGS ARE DYING I MUST FIND A MAN TODAY TO BE TRULY HAPPY category or 2: the I'm INDEPENDENT and FREE and don't NEED a man and I'm not that interested in marriage because I'm career driven and kids are cool but I'm too selfish to have them right now category.  I have wavered through both categories but tend to fall into category 2 on most PMS-free days.

Sheryl would probably tell category 2 to humble yourself and get married. I truly believe that the single most important career decision that a woman makes is whether she will have a life partner and who that partner is. I don't know of one woman in a leadership position whose life partner is not fully supportive of her career. No exceptions. And contrary to the popular notion that only unmarried women can make it to the top, the majority of the most successful female business leaders have partners. 26/28 women who have served as CEOs of fortune 500 companies were married.

4) Discuss Role Definition and Ditch Divorce. 
Statistics show that the risk of divorce reduces by about 50% when a wife earns half the income and a husband does half the housework. Enough said. Or at least enough said by me.

5) Free yourself from Having It All.
It's a lie. It makes women (and men) feel like they are falling short. No one has it all. In a Tina Fey interview she stated that the single most offensive question she is asked as a woman is "how do you juggle it all?" People constantly ask me with that accusatory look in their eyes... 'You're really fucking it all up, aren't you?'

Remember that done is better than perfect. [Balancing a career with a family] will be a little messy, but embrace the mess. It will be complicated, but rejoice in the complications. It will not be anything like what you think it will be like, but surprises are good for you. And don't be frightened: YOU CAN ALWAYS CHANGE YOUR MIND."

6) You have a choice.
Career+family. Family. Career.  It's no ones choice but yours and there is not a wrong answer. Women have been subtly striving all our lives to prove that we have picked up the torch that feminism provided. That we haven't failed the mothers and grandmothers who made our ambitions possible. And yet, in a deep and profound way we are failing. Because feminism wasn't supposed to make us feel guilty, or prod us into constant competitions over who is raising children better, organizing more cooperative marriages, or getting less sleep.  It was supposed to make us free - to give us not only choices but the ability to make these choices without constantely feeling that we somehow got it wrong. ~Debora Spar

I chose not to be a princess. As I got older the castle seemed kind of restricting and I wanted  to try playing sports and riding horses without waiting for the prince to wake me up. For now I am career focused because I have to save enough pennies to purchase my own tiger and while my career is my pride, joy and main focus right now... I reserve the right that it may not be f o r e v e r.

For research studies and statistics please see Lean In by Sheryl Sandberg

Deal, listen to Georgia.

Saturday, January 11, 2014

I do not claim to be an expert on the subject.  I haven’t even tried, but let’s face it…very few of us are.  I have decided I want to write my simplest thoughts about why I believe Georgia needs Medicaid expansion.  Some think that my Emory education has corrupted my once super conservative brain but I just believe that becoming a Nurse Practitioner has enlightened me.

When looking for jobs in the primary care setting, or even specialty offices like Infectious Disease or Cardiology it has become blatantly obvious that most doctors offices do not accept Medicaid.   I used to have it on my "non negotiable job list" that I would not work somewhere that does not accept Medicaid.  This has proven to be nearly impossible.

Why?  The easiest explanation is that Medicaid doesn’t pay.  A Physicians Assistant recently told me that he makes about $10 on a visit seeing one of his chronically ill HIV patients.  Medicaid reimburses physicians at about 59%of what Medicare pays them (some complicated policy has changed this temporarily in most states, thank God).  This is why it is fairly easy to find a physician seeing lots of old folks and zero poor folks. 

I had a renowned Infectious Disease doc sit with me in discussion recently and say, “Well, if Georgia was expanding Medicaid I’d have a job for you, but since Deal isn’t, I just don’t have the money or clientele” (because they don’t qualify for Medicaid they can’t come to his office). This doctor serves a huge number of low income HIV+ patients in Atlanta and if Medicaid was expanding many more of these AIDS patients would be funded through the (state+federal) government program and be able to see a primary care physician rather than an ER doc. I have yet to meet a physician in Atlanta that does not believe Medicaid should expand. 

So why should you care?  The arguments I hear are often are “why expand a broken system?” and “I don’t want my taxes to pay for them.”

Well, first of all the entire health care system is broken.  We can all agree to that, though none of us can agree on how to fix it. I believe expansion is a good step.

Secondly, let’s think of Calvin.  A 54 year old man who has lived on the street for most of his life, noticed that he has a large lump growing on his jaw.  He doesn’t think much about it because he doesn’t have insurance (or Medicaid…he doesn’t have an address).  He continues his life as the tumor grows.  He thinks about going to the doctor a few times but there are very few doctors in his area who would agree to see him even if he had Medicaid because the reimbursement rate is so low.  So the lump grows.

Eventually Calvin is in so much pain and discomfort from the now open, oozing tumor on his face he goes to the public hospital in the area that cannot turn patients away for lack of insurance.  By this time, two years later, he’s diagnosed with stage four cancer with metastasis to his brain.  The physician can’t live with himself doing nothing for Calvin so he is put through hundreds of thousands of dollars worth of chemo, radiation, ICU stays, intubation, life support and multiple physician consults to try to save what can no longer be saved. 

Who do we think is paying for this patient who now has a medical bill of at least six figures with no insurance to speak of? 

It is beyond the scope of this post for me to discuss how non-profit hospitals like this one survive and how your taxes pay for them to keep their doors open, but what I hope to help us remember is that all of this might have been prevented with primary care.

If Calvin had Medicaid, if primary care physicians in Atlanta took Medicaid as payment, and if he had been seen his first week rather than his second year he might still be alive. 

This is why movements such as Moral Monday make claims like, “If Georgia doesn't expand Medicaid 600 more Georgians will die this year.”

Our ER’s are overrun with patients like Calvin. Patients that come in during the last days of their lives because no one would accept them earlier.  Atlanta Magazine put an article out about a year ago about the story of a single mother who knew that she had breast cancer for nine years and came to Grady only when her breast had fallen off.  She couldn’t afford physician copays, couldn’t take time off work and feared the payment system as a whole. 

Hospital funding and politics is tricky.  I know very little.  But what I do know is that if primary care physicians don’t raise the bar and catch cancer and HIV and lung and heart disease early it becomes an astronomical hospital admission bill that the tax payers are left to settle.  It also becomes a lot of dead people that did not have to die.

Physicians must start accepting Medicaid and the only way that is going to happen is if it is expanded.  I used to be upset with physicians for not taking Medicaid, after all it is their choice, but now I realize that no one would choose to do something that will put her out of business. We have a frightening shortage of primary care physicians currently and this shortage is only expected to increase as other aspects of Obamacare go into affect this year. 

Why is there this shortage do you ask? Well clearly it’s because primary care physicians don’t want to pay taxes into a broken system either.