Thank you for being here. We are very happy to have you here with us this morning, early morning. We are going to start our symposium today, and I really appreciate your presence here, and also I appreciate my colleagues and friends, Esperanza, Maria de la Isla, Tatiana, for the opportunity to be with them and to talk in the symposium. We are going to, and I would like to say thank you to American Psychiatric Association for the opportunity to present the symposium today here in the APA. This is the topic we are going to discuss, why despite the current change, the gender gap in psychiatry persists, what are we missing? And this is exactly what we are going to talk, and the next slide is going to have that I disclosure. I am the only person at disclosure that I had financial relation with J&J, but now I don't have any financial relation, so I don't have other thing to disclosure. And the same thing, Maria de la Isla, Tatiana, Esperanza, they don't have any non-relevant financial relationship to disclosure. The educational objectives that we have is to recognize the lack of equality for male and female psychiatrists in terms of leadership roles and salaries, and to provide some illustrative examples exploring the persistence of gender gap in psychiatry. And also to understand, sorry, to understand the current efforts to support the career of women in psychiatry in both junior and senior levels. And this is the agenda, so the introduction, I already had the introduction, and we have three presentations and the discussion at the end. Dr. Esperanza Diaz is going to discuss at the end. So each presenter will address the following questions. Who you are, what he is or has been your journey, what has been challenging as a woman in psychiatry, what are some lessons that you learned, and what are we missing after all of this journey? So I am the first presenter, and this is my journey. So my name is Rubi Castilla. I am a psychiatrist by training in Colombia. I started my career as a director of a mental health unit in Colombia in Bogota, but I transitioned to research at the University of Pittsburgh. And later I entered to the pharmaceutical industry when I worked in safety as a medical safety officer, as a clinical development director of clinical development. And currently I am working for the University of Cincinnati for the Community Leadership Institute. And I am the president and the founder of an NGO called WARMI that is on women in Quechua, Aymara promoting mental health in women. I have the pleasure to be co-author of the Mental Health for Hispanic Communities with Dr. Tatiana Falcone and the Quixotes de la Psiquiatria with Dr. Fernando Espi. I have my family that they are all physicians. My two sisters, an OB-GYN, an anesthesiologist, and a pathologist, my brother. My husband is a neurologist, so in a house of many physicians, it is good to be a psychiatrist there, definitely. And I have been dedicating my career to study more and more about the diversity and what we have to do in order to be more fair in terms of racial and ethnic differences. And they are the cities I have grown up in, Bucaramanga, I went to Bogota for my residency training, in Pittsburgh for the PhD in psychiatric epidemiology, and I work in Philadelphia and now in Cincinnati. And they are the affiliations of the institutions where I have been adjunct professor. And this is the list of industries of medical associations that I have been affiliated with. I have been very proud to be the president of the American Society of Hispanic Psychiatry from the 20 to 22, and very happy to be part of that group of people. So now I am going to discuss what has been challenging as a woman in psychiatry. So I have, I divide this in some of, each slide has what is the challenge. So one of the challenges is that most of the people in the room are men. And this is the pressure of being the only one, and it's really overwhelming, it's not really easy to be the only one. And there are studies that show that individuals who are the only, for example, the only women, the only LGBT person, the only person of color, are subject to a higher percentage of bias and discrimination from members of the majority of the group. Whether intentional or not, this is something that they are probably not intentional, but they are biased against the person. So this is important to recognize that this is a challenge. And I am going to illustrate this with some data. And just for, to present with some facts, the academic extent of reprogression by gender and race that you can see in the left, yes, in the men and women, how they are increasing for males when you are going to be decreasing women, but let me show you here. The women, they are increasing here in the levels that they have not really power, but decrease when they are coming to the levels of powers, being a president. And in the men, you can see how they are increasing. So you can see the pattern. And if you divide this by race, it's worse, in fact. More opportunities for the white and less for Asian or black, Latinx, or indigenous. So this is based in more than a million of the STEM degrees earners, and more than 350 leadership positions at the U.S. laboratories and research facilities. And over more than 6,000 leadership positions at U.S. based in biotechnology, in industry, and making the initial public offerings since 2013. So this is a trend. It's not new, and we have to recognize that. And to illustrate this also with the National Lab Leadership by Gender and Race, and this data is from 2019, what you can see, you can see these lines. They are really representing white men, where you can see quickly and easily how they are the highest numbers in the lab directors versus, for example, women of color that you can see here, just 4%, 4% here in the STEM leadership role. So it's for women of color, but in general, white women also. You can see that it's not only for women of color, but also for white women, they have the same tendency. So the men, they have more possibility to be in these leadership positions compared with females. What is a second challenge is how to build a support network in a boys club world. And this is the reason why we create WARMI. WARMI is a community of women that we are working together because we recognize that this is a gap, and we need more networking groups, professional association, organization, the opportunities to build connection with potential mentors who can offer support and advice later in your career. Not only mentorship, but also sponsorship in your career. The third challenge is the difficulty to balance work with personal life. And later, my colleagues, they are going to dive in this, but this is something that I experienced as a female psychiatry executive. I have been asked the question time and time again, can women really have it all? And they are really something that we don't hear for males. So this is important to recognize this. The lack of access to funding. Female entrepreneurs receive less than 3% of venture capital funds. And this is published in Forbes. And the stereotype that women are more emotional, less decisive than men. This is a harmful gender stereotypes because the women really, we have the same capacity, or the same, we are able to make decision, very big decisions in life, and also in the work setting as well. So this is something that is really a myth. It's not a real problem. Another challenge is expectations are often set lower for women. I face that, and I think that many of my colleagues as well, women continue to face unfair gender bias in the workplace, managers perceiving women employees as ambitious or unassertive, and really something, this discourage women to continue their careers because they have no really good expectations and they have no position where they can be challenging. How many times more often do men interrupt women than other men in a setting? And you can see that in meetings, almost three times more often men interrupt women during a meeting. Common type of bias against women at work, and I am not going, I am going just to mention, a series of bias, performance bias, maternal bias, affinity bias, attributional bias that we face at work, and we have to not only recognize them, but also work together against them, this bias. And this is what I am always advising my students and mentees, that they should stay determined, they need to be courageous, think bigger, take calculated risks, but take risks. We have to take risks. Remain very disciplined, manage their career. And the main thing that I always advise them is that they have to be very well-educated. Study all what they need to study and more. Each time that they can, they have the opportunity to do any course, any degree, take the opportunity and learn more. This is important. Something that I also advise, do not ask if, ask how. Start your own personal board, friends, family, colleagues, people who give honest advice, gender-inclusive boards, and having a personal board of advisors, friends, colleagues, people that you consider that can provide you good advice, always be with them. And this is something that I would like, at the end of my presentation, how this is not only in the US or in Latin America, this is around the globe, this is the women's representation in global health. How we can change this if we have many lower representation of women in all the global health settings? How we can change that if we are very low represented in all... And you can see in the graphic how when you decrease the grade or you decrease the position in power, you have more women, but when you have more position of power, the males are there. So women are almost 70% of the global health and social workforce, but it is estimated that they hold the only 25% of senior roles. And this is data from the UN and the WHO. And this is also for the women in global health, also the percentage of national delegations of the World Health Assembly. This is something that you can see. The lower representation that has been a trend, not changed through the years, between 20 and 30% of women, we have representations in those big meetings. And also it's not because we have... Another idea is that we don't have enough women to be part of those groups, and this is not true. And this is the information that we have here. There is no shortage of women drivers of the leadership that are in the health and care sector. We have a lot of women in different physicians, scientists, pharmacists. So there is really no excuse to say that it's because the women, we have not all the credentials or all the educations in order not to be part of those. And the conclusion, global health and social care are delivered by women and lead by men. We cannot address this inequality by changing women. There is no shortage of women in the health and care talent pipeline in most countries, but gender inequality is systematic and will not change without an action. We need to act, really. Organizations led by diverse groups, including women, have better results and there have been many studies showing this. And taking an intersectional approach is really essential to understand the differences between women and factors such as race, disability, class, and the multiple disadvantages. Leaders said the tone and transparency is critical. We were talking this morning about the possibility to be transparent with the positions that are available in the public sectors and in the private sectors. The same salary for males and females should be publicly available and should be posted, not for improving the transparency. Women are revolutionizing the workplace. This is good as more of us gain leadership positions by becoming managers, executives. We inherit all tables and this is important. But when we are sitting at the table where the discussions and decisions are made, it's not the end, because the tables are rigid, exclusive for men, and we have, as women, the responsibility to flip the table and make our own table of decisions. There is an opportunity to rewrite our definition of table, build our new codes of conduct, and invite other women, people of color, marginalized boys, to be the new table. The table of tomorrow can serve as the fire in our bellies and keep us feeling heard and moving forward. And I am going to finish with one of my favorite quotes. It's from Shirley Clinson, the first African-American woman in the Congress. If they don't give you a seat at the table, bring in a folding chair. This is what I would like to invite you. If they don't give you a seat at the table, bring in two folding, one for yourself and one for another woman. Thank you. And I would like now to invite the second speaker. That is Dr. Maria Delida Rueda. I'm going to invite her to present her slides. Good morning, everyone. Thank you for waking up early and making the effort to be here, especially if you live in the East Coast. So my name is Maria Rueda Lara. I'm a psychiatrist, and I'm going to share with me who I am and what has been my journey. So I'm also from Colombia. I was born in Medellin, Colombia. I went to University of Ponte Vecchio Olivariana for medicine, general medicine, and then after graduating from medicine, I did a year where it's mandatory to work for the government in an underserved area. I did that in an area that was called Magdalena Medio. That was in the mid-'90s. So the country was going through a really, really rough time, and probably like two of my colleagues left the country at that time too. But it was one of the best years of my life. I had an opportunity. I'm a psychiatrist, and I kept this picture because this was the last time that I was going to be in an OR, and I said this is my last time, and I meant it. Then I moved to New York, and when I moved to New York, I had an opportunity to I got a job working for Novartis, and I was really grateful for that opportunity because it gave me an opportunity to learn work life in the pharmaceutical industry. Then I did my residency at Rutgers Robert Wood Johnson, and then I did my fellowship at Sloan Kettering in consultation liaison psychiatry and psychoncology, and then after my fellowship, I went back to where I did my residency, and I'm going to talk about that because it's one of my points in my presentation is how to negotiate, which I'm still learning. Then I moved to Miami 11 years ago, and I work at the cancer center, Sylvester Comprehensive Cancer Center at the University of Miami. So in Novartis, I had the opportunity to be the global coordinator for the medical coding group for data management for clinical trials. As I said, it was a great opportunity, and I was given the opportunity to be a leader, but when I was in the industry, I always wanted to be in academia because I thought academia is better, and then, yes, I was trained like that, and then my dream was to go back there, which I did. I became a research assistant for a research study, and then I did observations in order to get letters of recommendation, and then I became a psychiatry resident there, and I had the opportunity also to be a chief resident, which was an important leadership role. Then I went to Memorial Sloan-Kettering to do my fellowship because I had two mentors, and one gave me one advice that I will share later that was very, very important. After my fellowship, I went back to New Jersey, and I was working at the Rutgers Cancer Center. I wanted to do 100% cancer work, but I couldn't negotiate that. I was quite shy, I was just like grateful that I was gonna get a job, I was like, this is the best. But I wanted to do 100% because that was my heart was and that was a big, big mistake. Because it's really hard to work in two different, having, wearing two hats and especially with clinical care, it was very, very hard. I mean, I enjoy doing general psychiatry but that's not what my heart wants. Then my husband switched jobs and then I moved to Miami and I've been there since then. And when I moved to Miami, I negotiated my contract and I said, I only want to do 100% cancer work. And because I learned from my previous mistake. And now I'm the Medical Director of the Psych Oncology Team and the Director of the Consultation Asian Psychiatry at the University of Miami Hospital. So what has been challenging as a woman in psychiatry for me is finding the right mentor. And functions of mentors, they're there to help for career enhancing function that includes sponsorship. And a sponsor should, for example, should be nominating you for a promotion, should coach, facilitate exposure and visibility, help with research collaboration for professional development and networking and an increased competence and self-esteem. When I made a decision to do my fellowship, I didn't know what to do. Should I stay where I did my residency training? I mean, I was quite happy there. And a mentor said, no, you don't need a fellowship, you don't need to get trained. Stay here, work with us, you know enough, you can do consultation liaison psychiatry. But another mentor said to me, this is a country of credentials, you need training. If you train in a good place, you can go anywhere, you have to leave this institution. And I really thank him for telling me that because that opened the world for many, many, many opportunities. Also, besides the career enhancing function of a mentor, there comes a psychosocial function, which includes being a role model, being a counselor, a friend that helps, especially the young adult develop a sense of personal identity and competence. So right now I work with junior faculty and I am trying and doing my best to at least to teach them not to make the same mistakes I made when I was a version of me, younger version of me. So I'm trying and I'm learning, but. So mentors, so the relationship between mentors and career research success has been investigated and it's very interesting, men established more faculty associations than females and associations linked to greater career success. So there's even how we choose mentors is a gap. There are gaps. There are hazards when choosing the wrong mentor. Could be a relationship of abuse. It can lead to professional stagnation. There are cases of sexual harassment and dependency problems because as a mentee, people can be at a very vulnerable position and admire and thinking that your mentor is the best and sometimes they're like people that are not equipped to be good mentors. Another challenge that I still keep learning is not knowing how to negotiate. So women in academia often have a hard time, not in academia, in general, have a hard time negotiating because women have lower expectations and lack of knowledge of their worth. So when I took my first job in New Jersey, so I was just so grateful. I'm a foreign medical graduate. My God, I'm gonna go back to where I did my residency. I'm so grateful for this opportunity. So whatever you give me is okay. So that was in my mind. So then six months later, another male psychiatrist was hired with similar training. He got $30,000 more. And I was like, I wasn't angry at him. I'm like, what's wrong with me? Why I didn't negotiate? Like I did not even negotiate to work 100% in cancer. That's what I wanted to do. So I stay quiet, but that's many mistakes I made. So many women are so grateful to be offered a job that they accept what they are offered and don't negotiate a salary. So that's a difficult example. So women often don't know the market value of their work. Women report salary expectations between three and 32% lower than those of men for the same jobs. Men expect to earn 13% more than women during their first year of full-time work and 32% more of their career picks. So by not negotiating a first salary, an individual stands to lose more than 500,000 by age 60. And men are more than four times as likely as women to negotiate a first salary. So when I was like doing my research for this presentation, I'm in my 50s, I'm like, man, how much money I lost for not negotiating that first salary. Another challenge for me has been achieving work-life balance. And before I start talking about this, so my daughter is 15, is playing volleyball, and right now she's at a volleyball tournament. And the moms on the team, they were like, they're sending me updates right now with videos, and they won the first set, they lost, and videos of my daughter. So those moms understand that I'm here, but they also want me to be there. So it's very, very important, and I'm grateful of other women that are trying to help me to keep my work-life balance. So women also leave academic medicine at a higher rate than men do, and bear a greater responsibility for childcare and family responsibilities. So one of my colleagues, she's a brilliant psychologist, and excellent clinician, and a researcher. So she left academia. She has three boys, and she told me this, and I will never forget, I have to leave my job because I constantly feel that I'm failing someone, at work and at my house. I'm not being successful in my careers as a researcher, but also I feel like I'm failing my young children, so I'm choosing my family. So it is unfortunate, but she left. So, there's like genders stereotyping. So characteristics associated with leadership are viewed as incongruent with women's gender roles. This means that women may face prejudice in leadership evaluations. Women, for example, who display assertiveness may be perceived as competent, but unpleasant. And they could be maybe labeled as emotional when a man is being rude to a woman. When a man is more assertive, or more aggressive, or gets angry, it's more accepted than if a woman asks a woman, emotional. Of course, drama. So, there are lack of supportive policies. Many universities and academic institutions do not have supportive policies in place for employees who are trying to balance work and family life. These include a lack of maternity leave, childcare options, or flexible working arrangements. There are unsustainable workloads. Women in academia often face unsustainable workloads due to the expectation to publish regularly and teach a large number of classes. This can be difficult to balance with family, life, and other commitments. There's also an unfavorable climate. Women in academia can also face an unfavorable climate within their departments, which can make it difficult for them to achieve work-life balance. This can include unequal treatment for male and female faculty, discriminatory attitudes and lack of respect. So, I run something that is called Schwarz Center's Rounds, and now it's a university policy that happens in many institutions that they want meetings after clinical work. It's either 7 a.m. or 5 p.m. because that affects productivity. I mean, they need to make money, and the money is made between eight and five. Majority of the meetings, two more boards or meetings are after five. So, we wanted to present a case, and I asked one of the male oncologists. I said, because it was his patient, and I said, you know, we have, every three months I run Schwarz Rounds. It is an opportunity for us to talk about difficult cases and go discuss how emotionally we felt treating the patient. He said, 5 p.m., no. I have three kids, and I'm sorry, I cannot attend after five, and he did it, and I was like, this is me, because again, I'm thinking about my promotion, and if I have a leadership role, that is gonna help me to be promoted, but at the same time, this male doctor, nope, thank you, but I'm not doing it, and I was like, wow, okay, good for him, and maybe he will have an opportunity to get promoted doing something else, but then I'm like, you know, I'm gonna sacrifice in family life, but so that was interesting. Something that is very interesting. Mothers are viewed as less competent than women who are not mothers. In a recent experimental study in which participants evaluated application materials for women job, candidates who defer only by parental status, mothers were perceived as less competent and received a lower starting salary than non-mothers. Men were not penalized for, and sometimes benefited from being a parent, and sometimes I see the opposite. I mean, there are women who do not have kids, and because they don't have children, they're expected to work more or stay longer, but that doesn't mean that if they don't have children, but they also have a life, they have a pet, they have a family member, they're caregivers, they have the right to have a break. So there are gender bias and institutional barriers. So despite high levels of achievement, women can suffer from an imposter syndrome in academic science settings, lacking confidence in their intellectual accomplishments and ability in a sense of belonging. Despite being so successful, they feel that, you know, maybe I'm not competent enough, I'm not doing, and compare themselves. Their lack of access to resources, women often have limited access to resources they need to achieve success as education, financial capital, and networks. And I've been observing things at a different lens, and I noticed that successful researchers, or they have an army of people that help them, and then I'm trying to do my best, but I have limited resources, so I'm learning. I'm like, that's resources. Why this male faculty has a lot and then I'm not? So there's maybe not negotiating hard enough, and so again, every day I learn more and more. So both women and men are significantly more likely to vote to hire a man, applicant versus a woman, applicant with the same academic record. So in a way, like we are also gender biased, we may discriminate our own. So gender roles that limit women's mobility interfere with career in science and engineering. Although young single women and men have similar degrees of geographic mobility, women who have children may be less mobile than men who have children. So this places women at a disadvantage in the science and technology labor workforce, given that as many science and technology jobs require relocation and frequent travel. So some lessons learned. It's important to choose the right mentor. Women who had more than one mentor reported greater job success, compared to women that only have one mentor. Support networks for women minority students are sources of assistance in hostile environments. Yes, you can negotiate. Start with your career goals. Understand what you are negotiating for. Negotiating the value of your service and expertise. Use data and metrics. Because when you use data and metrics, these are not emotions, these are facts and they can help you for negotiation. How and with whom to negotiate. It's important to know who is the person who is gonna listen to you and it's going to help you move forward. Also enhance your negotiation through relationships. So what can be done at an institutional level is name the problem, mention their discrepancy, there are gaps, raise the consciousness level, provide means, discuss the various experiences of women in the department. And then I'm doing that, I'm being more assertive with my female chair, to share what my colleagues are suffering, what we need, I'm being more vocal. So I'm hoping to provide a voice for my colleagues. Being activities, initiate programs to support women in faculty. And make a committed to creating a diverse environment. So what are we missing? The institutional support and I know Dr. Falcon is gonna go into that. But we need more women leaders and representation. Now I'm having a different experience, like the finance person of my department is a female. Very strong, very assertive, like I heard people saying that oh, she's not pleasant, she's transparent, she's assertive, but she's business, money, and I appreciate that. And my chair is a woman, so yes, we need more women in leadership positions. Academic institutions should provide protected time for junior faculty. Practice metrics that reflect academic work are not patient care or research productivity. And also we need more training on promotion. We lately have been learning how to get promoted and it's very hard. So say no, research has suggested that women are more likely to volunteer for non-promotable tasks than men. Oh, if there's like a meeting or a lunch, oh, I'm gonna volunteer. Men, no, they volunteer on things that are gonna help them with their success in their career. Set boundaries. Say no. Time management skills. And it is okay to be ambitious. Thank you. So I'm gonna hand over my presentation to Dr. Farber. Well, again, thank you for being here early in the morning. I'm going to give you my perspective on the gender gap from my research experience. So no disclosures, like my current funding is federal. So who am I and what has been my journey? So I'm also from Colombia, and I trained in psychiatry at the same university of Maria Eliza, Universidad Pontificia Bolivariana in Medellin. Then I also came here, did some research. Right at the beginning, actually when I finished medical school, I considered coming here. At that time, I did an internship in University of Texas, San Antonio for six months. But in Colombia, as you said, we have like that one year of social service, and I thought that was such an enriching experience that I actually went to a part of Colombia that is called Los Llanos Orientales, so I wanted to really do that. And I did psychiatry after in Colombia, but then I love research, and I felt like some of the opportunities that you can have here will be more enriching. So I came. I did one year of research at Thomas Jefferson, and I was deciding, I was already a psychiatrist, right? Do I just go into research without doing my residency or do my residency again? And I had a mentor. I was already a psychiatrist. And I was getting opportunities in research, right? But I had a mentor who said, this is a country where the titles are very important. So if you don't do your residency, your opportunities are not going to be the same, and you can value, you can go into industry or you have to do your residency again. So I did. So I'm also married. I have two children, right? And when I was doing, I took my residency also as an opportunity to engage with like the different organizations. So as part of my residency, I also work a little bit at the APA. I did two fellowships. First I did the public psychiatry fellowship, and that fellowship gave me a lot of vision of things that you can do. I was able to participate in the APA Board of Trustees for one year. And then when I finished that, I went into my child psychiatry, 100% knowing that I wanted to do research. I applied to one of the research fellowships from the NIMH, CHIPS. I was assigned a mentor from Pittsburgh, Neil Ryan, who has been instrumental in my career for the last 20 years. And then some of the mentors, I connected the APA, then brought me back. There was another fellowship that I did, the APA Transformational Leadership Fellowship, and worked with Dr. Stewart and Al Prim, and they were great academic mentors too. Then I finished my training and decided to stay where I was working because I felt I was really supportive, right? There was a lot of support there, but I agree, it's so important to negotiate your future, right? The most important time is in any of the transition points. And salary depends on your negotiation skills. As Ruby was saying, we know there's still a gender gap in salary, so negotiating your salary from the beginning is very important. Then one of the reasons why I decided I'm actually a psychiatrist, but my primary appointment is in the neurology department, because when I said I wanted to do research, the neurology department said, we'll support your career for three years until you get your grant. And psychiatry said, no, you have to start 100% clinical. When you get your grants, then you can move to research. So the opportunity was better in neurology in that moment, and I took it. And it's been really successful for me. So a little bit on my research, I do research on inflammation in the brain, then I start looking at inflammatory markers in kids who have attempted suicide. I wanted to put this slide to actually really give you a picture of what it takes to become a researcher, right? So I started in 2009, submitted my first grant, right? It took eight applications of that first grant to go to an R21, right? And this is very, like, when you look at, is this real? Yes, this is how, like, it takes seven to eight applications to really get funded fairly. And what happened is, we know that women by their application change jobs, decide it's not worth it, but man, keep going. So that's one important difference that can make you successful. Then after that, the next grant was just only one application, right? In the meantime, doesn't mean that you are not doing something else, right? So I did get that NIMH funded, we start doing the research, and COVID happened. So then we really struggled to recruit patients, because the hospitals were close to new patients, close to recruit, but we advocated, right? They let us continue to research one extra year, so they give us more fund for the grant. And in the meantime, right, like, when I was working on getting this funding federally, you can't stay just waiting, right? So we look, I had a mentor, as I said, that he was from an outside institution, and he was great. He was like, okay, I'm so glad that you want to do this project on inflammatory markers, and the universe is telling you that is not the time, right? So what else can you do right now that will support your career and take you to the next level? Let's look at your institution, it looks like you're in the neurology department, there's a great epilepsy center, there's so many patients. So I know, like, your goal is to get NIH funding, but we have to start looking for other resources, right? How about SAMHSA? How about HRSA? How about the CDC? And thanks to his vision, right, I was waiting to get that NIH funding, and I kept going, as I showed you, but in the meantime, I was able to secure funding from SAMHSA, and we did some randomized controlled trials with SAMHSA, and since 2010, actually until now, I still have been getting grants from HRSA to work on psychiatric comorbidities on epilepsy patients. I also had the opportunity to work with, like, minority kids who have chronic illness, and if I didn't have this mentor, I actually have two mentors, and my other mentor was like, no, you have to keep going with your initial idea, and don't drop it, because otherwise nothing is gonna happen, but his thought process that you can just keep hitting your head against the wall, let's look at the big picture, really helped me build my career. So right now, I'm doing 50% clinical, 50% research. I work a lot with the pediatricians, and I work a lot with, like, mentoring other researchers, fellows, residents, and medical students. What has been challenging as a women's psychiatry and research, so there are some important things to know, like the funding rates are different between men and women. Men tend to perseverate longer, as I said. Women are stopped by the third grant, men send up to eight, and then that's why they sometimes get funded more, but even when you look at some of the studies comparing how much funding, like, you have the same level of academic achievement between men and women, and how much funding men are getting in their first grant, men are getting 30% more funding than women, and also you have the intersectionality, right? Like, we have so many roles at the same time, and we volunteer for so many things because we think it's important, but is that also impacting our ability to grow in what you really want to grow? So saying no is important to be able to achieve some of these things. So why is the pipeline so leaky for women? So one of the reasons sometimes is children, right? Because, like, the responsibilities for women and children are different, right? So after someone have a baby, like, 35% of the women decide, oh, I'm not gonna go for the tenure track, or they stop, like, publishing at the same level. Actually, I'm gonna give you a personal example. When I was doing the CHIPS Fellowship, I was assigned, my initial mentor wasn't Dr. Neal Ryan, was actually a woman who is a very successful researcher, right? And I was, like, six months pregnant when I was doing my presentation of what I wanted to do with my career, right? And it didn't matter to me because this is what I wanted. I went, and then she looked at me, and she said, well, and I was 28, maybe 30, and she's like, women flourish in their 50s. And then I'm like, I'm 28, right? So what, am I supposed to just go home, have the baby, and come back when I'm 50? No, it was very sad for me that that was my, in my fellowship. So then I asked to change mentors, right? Because I felt like she didn't believe that I could do it if I was pregnant, right? So this is, like, a very unique example. And I picked someone that I felt like it was a man, but he had a great vision of what I wanted to do, and he, to this day, he's still my mentor, right? So why is the pipeline so leaky for women? So it looks like women start at the same level, and then when they have children, they start, like, sometimes not publishing at the same level. They start, like, going to part-time, and then non-negotiating, like, support from the department on not only financial support, but also administrative support. So the less support, the more that you have to do, and the less likely that you'll be able to do activities that really impact your advancement. And then we have what has been called the minority tax. So if you are Hispanic and African-American person in your department, in the last, you know, five years, there's been a lot of turmoil in the country for things that have happened. And so the department look at your minority staff, faculty, to try to help. And, like, of course, we always want to try to help, and we always, but those roles sometimes were not accompanied by the financial support for that. So, yes, we want to do a program, but there's no money for that program. Or we want to do, let's do programs in the community to help Hispanic kids. That's a great idea, but let's do it on Saturday, right? So it's, like, more of your time, right? So a lot of women and minority leaders start thinking, is this really, and some of these roles, we're not getting them to advance their career, right? So you've been asked to do more, right? But, like, the efforts to promote diversity were not valued at the same efforts to how many grants are you getting, right? How many papers are you publishing? So people burned out and stopped doing some of these things because they felt it was, like, impacting their life-work balance, right? And so we can't say that, oh, it's because we don't have enough women. So when you look at the numbers now, we know that the same number of women and men go to medical school, and actually we have a lot of more even women psychiatrists going in the field. But even when you look at the beginning, when people are hired, so women receive less faculty startup support than males, right? So they hired two psychiatrists and one, they're, like, great, so we want you to be a researcher, we support you, but women, no, just work clinically, and when you have grants, then we take you, right? So that difference in my experience really impacted, because if you have, like, a full week of patients, when are you gonna be able to be writing these grants? You need some support at the beginning. Then you have the COVID effect, right? COVID happened, we all went home for, like, a year and a half to work virtually, but also our kids also went home, and most of the domestic responsibilities went to women, like taking care of the children, doing everything at home, so that took even less and less, like, more and more effort and less and less possibilities for women to continue to do what they had to do to grow academically. So we saw that in those COVID years, the publications of women decreased, so there was less publications, less grant, and then, of course, the hospitals struggled financially and started making changes on, like, the availability to go to meetings, right? And so all the meetings moved to virtual, that really limits the networking, right? And the networking is so important to advance your career, right? And the more that we saw these mental health crisis growing, then the increase of our responsibilities, so, again, you have to see more patients, and even if you had grants, if you didn't negotiate your protective time, that started, like, okay, do it on the weekends, do it after hours, and they even say, like, on an open forum, like, yeah, like, you know, all the grants are written on vacations and weekends, and that is not realistic, right? So some people have called the COVID the cheese session, because women, so there was at least 11 articles on this topic on how the burden of the care of the family and other people who are sick in your family had really impacted the ability to women to continue to grow, and that continued to increase the women professional qualifications, right? When they even look at, when departments came and asked for extra help, who are the people who volunteer? Mostly women, right? So the more that we volunteer to do these things, the less that we could do writing the papers, and when it comes to promotions, that's, it comes down to grants and papers, so if you are not able, you could be seeing more patients, you could be doing more of these programs in the community. When we had, like, the racial, major racial problems, and we tried to do programs in the community, that doesn't really, wasn't counting as an activity that will promote your, grow in the department, so a lot of people have left, right? So when you, this, I told you already, like, when, in this study, they look at the 50 top NIH-funded institutions, and they look at people with the same qualifications, so they said, let's look at these researchers, let's look at their papers they're writing, they look at the grants they're getting, and they give a score, taking the gender out, and they look, like, even when you put together the same amount of qualification and academic effectiveness, right, women were getting, like, $30,000 less on their first grant compared to men, right? So there were significant differences on the size of the grants, the first grant that women were getting. I can tell you, for hope, that that happens with the R21s, and the, but when it went to R01s, the amount of money, like, women learn, and then learn to negotiate, and the amount of money was the same, but the first couple of grants, it was always less for women compared to men. What other factors impact this? The lack of confidence, right, like, as Ruby and Maria, like, they were saying, right, we sometimes are not used to promote our work, to promote the activities that we do, like, 50% of women are less likely to do this compared to men, and assuming that, like, when you look at the tenure gap, right, like, so why men continue to gain in tenure, but women get stuck, so is it only the children? What are other reasons why women are not progressing, right? So the confidence is one, because sometimes they're not even likely to ask, they get stuck, and they feel, I'm okay, this is a good job, but they don't think, what do I want next, and how can I get there? And then you have, you know, the burnout. So in 2017, a third of the active psychiatrists were females, and so this is, like, the breakdown of how many of them were in patient care versus teaching, like, most of them in patient care, and the IMGs was, like, 26%, and in this study, they were looking at burnout, and they saw that Hispanic psychiatrists were really burned out, like, 52% were reporting burnout. So, you know, I wanted to see this also in the context of the minority tax, like, some of the things that were asked to be done for minorities were more in the last couple of years. So what are some of the lessons that I learned? That mentors are very important, right? That if you want to advance, you have to get support from people, right? You have to, so you have, you need an academic mentor, you need a research mentor, you also need people who read your grants, you need a mentor from a different institution that can give you a picture that some of the mentors in your institutions are not giving you. You also need a sponsor, someone who said, yes, like, I like what you're doing, and I'm going to continue to support your career no matter what, and then you also need to be part of your organization and network with other women, right? And you also need a research mentor who tells you, like, no, your grant looks terrible, right? And you need to rewrite it, because we learn by redoing, right? So mentors and sponsors are very important. And always start with the end in mind, like, I wanted to show you, like, when I started, I wanted to be a schizophrenia researcher, right? And now I do research on suicide, and, like, that changed through the years, right? At some point, like, there were no other child psychiatry mentors in, like, in research in my institution, so finding that was hard, but I think they play such an important role in your career. And when you volunteer, volunteer selectively. We sometimes are very generous with our time, and that impacts our ability to spend more time with our family, that impacts our ability to write more grants, so we get so many invitations to review journals. Yes, review journals, but review journals in your topic, right? Also grants, being on a study section is very important, because the more that you participate in this that are highly time-consuming, but if you don't do this, you don't know how to write a grant, right? So volunteer for those committees that are relevant in your research area. So even as a new researcher, the NIH also wants new researchers to be on the panels, because when they're looking at the grants, they're looking at everybody, so you have to go and put your CV out there, and when the program officers look, they also pick young researchers, so it's very important to be on those committees, network on your professional organization, and sometimes say no, because managing your time effectively is important, so network, find a topic that you like, and collaborate with a team that is doing something similar, right? It's so important to be able to show your academic progress. If you don't have enough papers, you're not gonna get the grants, and when you're gonna send a grant, get three people to read your grant before you send them, and think about every decision that you make, like where are you working, what are you doing next, because every grant that you send, every paper that you send, is kind of building your career, right? So take pride in doing things really well, but think about that you're always competing with great people, so you have to be amazing, like think about the elevator pitch, you have to do something that is so convincing, that if you're in an elevator for five minutes, you can really talk people into doing this grant. So I don't know if you guys read this book, but I love this book from Simon Sinek, Start With Why, and that's the most important thing, like when you're picking your research questions, you have to do something that really motivates you, that you think is part of your purpose, and is getting you to the next level. When you do something that you love, the time doesn't matter, right? Because you are doing something that you really like, and always take a step back, do some beach thinking, like what is the purpose of your research, what question do you want to answer, why is it important to you, how you think that question is going to move the field forward, why you think you are in a better position than other people to answer that question, if you feel stuck, ask different questions from other people on how they manage the same program, and get all the help that you can, like even NIH determined that it takes like 5,000 to 10,000 hours to become an expert, so that goes, like the eight applications that you have to set before it becomes really good. Always work together, right? Like we know that doing it alone is impossible, so have a team of people that you can trust, find people that you can work with, and help them get through the next level too, so as Drew was saying, not only bring a chair, bring two chairs so your people can sing, can help you too. Make sure that you have a good support network, and I'm not just talking about the support network at work, so also at home, if you have kids, are you having some extra help to take care of them when you're not there? Exercise, take some time out, or when you feel like you are not productive, think about what are we missing, how can I do it different, and look for all the support that you need, like I mean financial, emotional, friends, right? Because this is not an easy journey, you have to be resilient, right? Like some of the comments that you get from the grants are harsh, right? And think about that they're not specifically to you, they are just trying to make you better, so you just have to watch them over and send the next grant, that's the only way to do it. Mentor other people because they're the future. If we don't mentor them, then it's gonna be hard to you know, grow our network, so I think it's very important to continue to mentor medical students, residents, fellows. The elevator pitch, think about your idea, be ready to pitch it on an elevator, so you can go and write it in a grant, so if you can describe your idea in five minutes, it's gonna be successful, be persistent, persevere, it's a long-term game. So I show you, I started in 2009 with that initial neuroinflammation idea, and it wasn't really funded until 2016, but it took eight different submissions. At the same time, I was doing other grants, but I never lost the initial one that I wanted to do, so if I will give advice to me, it will be, you know, look around you, like what my mentor said, what can you access, right? At that moment, it was kids with epilepsy, right? Contribute to a team of researchers, you do more when you are in a group, right? So people can be working in several papers at the same time, publish what you can, right? Find things that you, that motivate you, and get funding. If you are sending grants to NIH and you're not getting funded, think about all the other agencies, like CDC, SAMHSA, HRSA, foundations, like it starts small, right? There are many resources, like APA has a couple of research fellowships for people who want mentorship, right? And work, start with like smaller grants and then work your way up. Yes, reviewing staff is helpful, but think about, like, they probably have to be on your topic, right? Expect that, yes, you're gonna have to work some extra hours, you know, find a mentor that listens to you, right? And give you advice, and then become a mentor yourself, because you have to help the next generations, and, you know, learn how to play well with others, right? Like, look for feedback, accept it, and then change. And it has to be fun, so really enjoy the ride. What are we missing? Like, institutional support, right? Because we're doing all these things, but unless they're backed by resources, like financial, protective time, administrative, then we're not gonna be able to do it. you know, and emotional wellness, you know, is very important, promote your success, prioritize the things that you have to do, take a break, and then go back, and then I think Esperanza is next. Oh? Sure, yes. Okay, well, sorry for so many technical situations here, so good morning. I'm Esperanza Diaz, and I am professor of psychiatry at Yale University, and it's an honor for me to discuss my three colleagues, and I'm going to say it on purpose, Dr. Tatiana Falcón, Dr. Castilla-Fuentes, and Dr. Rueda Lara, and I say that because usually when men are introduced, they are introduced with all sorts of degrees, and when women are introduced, then it's Tatiana or whatever, so making a point, but it's an honor, and thank you for sharing your lives. You are immigrants, and it's a long journey. So you confirm persistence, gender disparities in the medical and psychiatric world, invisible barriers for women, full of stereotypes and prejudices and inaction on top of the people in power, and the consequences of this disparities affect physical and mental health, and that is concerning. So Dr. Ruby Castilla-Fuentes, the leader of this symposium, asked the most relevant question, what are we missing? And she is a model of women careers in industry, and I didn't know much about that, and actually I had a lot of questions about that. So her model of bring another chair, and it has to be a folding chair because we have to carry it around so we can make it into different groups. I think it's wonderful, and she is a mentor herself, trying to really help younger people and people from South America, and all over. Actually, tomorrow she also chairs one of the symposiums about building networks, and it's a wonderful effort that she has meant. So she's a mentor herself, nationally and internationally. So Dr. Falcón, she really make us think about what an effort to be a woman in research and in academia. So she reminded us of the intersectionality, being a woman, being a mother, being a son or daughter of people, of parents who are aging sometimes, taking care of the minority tax of every institution. And the challenges of women researchers and grants, it's a long walk, it's a lot of effort, and it's immense energy that she's described. And then she also reminded us of building networks and balancing work-life and the effects of physical health. And just briefly, I don't want to repeat what they say, but one of, I just brought this book because you imperative resilience, that's what it is. And this book is written by a PhD, one of the medical students that just graduated at Yale, and she did that research in our neighborhoods in New Haven. And it's about immigrant women, not doctors, not academics, but she called it imperative resilience. And this is what you are describing today. If you don't really, I mean, if you don't continue, you don't make it. Like the immigrant mothers, if you don't continue, you are not resilient, you are not going to make it. And these immigrant mothers are a model for me and for many women. It's a nice book. And Maria de la Reda, examples of multiple roles she has performed. I didn't know that you have a working industry. And in the, well, certainly all the trips, travels that you have made along, finding the right mentor is a major issue. And women, she insists on having women. The imposter syndrome that we all have, even at this age, I still have it, I think. The negotiations. And I found this paper, women in surgery, because surgeons are very aggressive. And so with women, they are tremendous. And so it's reminding us that the use of vacation for maternity is discriminatory. And that's been known for many, many years, but it's a major issue for women. So they agree that some change has started, but it's not sufficient. And that we need peer support, both mentorship and sponsorship. So it's different, mentor and sponsor. And need for Hispanic women mentors and need for institutional changes. And I think that's probably the main thing that we need to learn here. And I think, yes, it's very nice that you're all here. But the ones that need to be here are the leaders, the people in power. And I hope that you can carry all that message to your bosses, any deans, anything, any person in power. So there's suggested systematic approach to promote equitable opportunities in psychiatry, support each other, and create women mentors. The support each other, the networks is a great one. So and they did not actually emphasize too much about the immigrants part and the women part. But we women are effective at communication. We bring to services culturally sensitive care. We enhance the diagnosis. We enhance that people adhere to treatment. We expand research opportunities because we understand what is in families, what women need, what children need. And the collaboration and consultation facilitate in the interdisciplinary teamwork. So what is this about cultural stereotypes? So they said that we are kind, dependent, and nurturing. And yes, we're right. And what they say about men is that they're logical, independent, strong, and stereotypically masculine. Don't you think that I, do I look like logical? I think I am. But. And independent? Yeah, maybe not so much in certain things. But. And strong. But that's the stereotype, that they are that way and that we are just nice and lovely and sweet. But no, we can be powerful too. So that we need to, we need to learn from that. And I didn't like this research, but I thought I'd put it here. So when women perform, big women perform worse on math tests when they are reminded of their gender. The mere presence of other people affects performance. Women taking math examinations do worse in the presence of men. And these are articles from psychologists. Well done. A stereotype related difference in performance can be eliminated by manipulating the perception of that stereotype. And that's the case for, for Hispanic women mentors. Therefore, mentors who instill confidence in their women mentees can address such issues as the gender confidence gap and the stereotype threat. And this is achieved, obviously, through education and introspection. I remember my mentor, a man, very nice, who we were rehearsing a presentation. And he was doing his part, and I started. And then he said, but, he noticed that I got nervous. I really, I don't like public speaking. You cannot believe it now. And he said, but Esperanza is me. And, but that's, that's it. I mean, that was the, I don't know. That was a male mentor. And he was very supportive, yeah. So what is next? Less to do, but it could be fun. It could be fun. So I review the national recommendations of the American Medical Association that have been there for many years. I didn't include all those, but I just brought the main ones. And I don't want to go through this list. I'm going to just continue with. So they create, you know, equity training curriculum. And I think a lot of institutions have that. So it's educating individuals about equity, diversion, inclusion. And I think that's important, and that needs to continue. But not only diversity, it's equity too. Covering topics such as bias, power, dynamics, privilege, and discrimination. And the curriculum is tailored to the group. So whether it's the students, whether it's the leaders, whether it's the community organizers. Actually, one of the best trainings I take about cultural insensitivity was from community organizers. They call it experience undoing racism. It's a very nice training. It's a group that goes around the country, and I recommend it. Evaluate the curriculum. So you don't evaluate. You don't know what's going on. So define the goals. Understand what are you doing for equity and inclusion. Identify what you want your participants to learn and what they need to learn. So identifying the needs that that group has is important. Developing skills to address bias and discrimination, and increasing their ability to create more inclusive environments. And that all said is very easy. But it's a lot of work and requires a lot of network, teamwork, support. Then they also said that produce equity action plans. And I like that one because it's about the organization. It's the assessment of what is the organization doing for us women and in general for equity. Develop training programs to address issues of diversity and inclusion. Recruiting and retaining a diverse workforce. That's very hard. And for us, it's been a year of that at my institution. Because a lot of people are leaving, and then it's a very major issue. And we have recruited great people, diverse people, and they leave because they are being taken to other institutions. And so it's a problem. Engaging with diverse stakeholders, tracking and reporting progress. And so it's kind of an ongoing product. But it needs to, it's both. It's not just the base, but it's the top that needs to work on that. And spread best practices, like what we're doing here, perhaps. Encourage research on gender disparities and collaborate with professional organizations like, well, the EPA, the educational organizations, the AMC, all those that could provide some support and sometimes some funding. So increase the visibility of studies. I love that one. Because we have to support each other. We have to say, hey, you produced this, just publish. Peer-to-peer networking, provide training and resource for visibility and support for recognizing for press. So what are you going to do? Maybe I shouldn't say, what are we going to do? And it's not up to us only. It's up to really the top. And I brought two major studies. Really, there are not that many studies that are important in this area of the gender gap. This is the first one, the intervention addressing four areas of need that was done in Stanford and that was in 2014. Very elegant study, very well done. And they did this intervention in which they really recruit more diverse faculty. The resources were provided to really conduct and publish research. Their career development programs enhanced their professional. And the programs to decrease isolation were there. And so these are the results. And indeed, the Stanford women really did much better. They compared to other women, peers, and national. And that intervention work, that was done in 2014. But as you saw, it took a lot. It's a lot. It's a whole institution. It's a lot of training, education. And actually, the intervention was not just for women. It was for men and women and for everybody because they said, we cannot just teach the women. We have to involve everybody. So it's changed. And that was important. So that's one. The next one is this one, which is more recent, in 2017. So it's a systematic review of interventions to review careers of women. And it's a nice meta-analysis that started with 2,790 articles. And they have to, as you know, the meta-analysis. So they have to meet the criteria and the legality. And finally, they end up with 18 articles, 18. And unfortunately, I don't think this is good news. The success of the intervention is undermined when it relies on the additional labor for those that it's intended to support. So it's the minority tax. So most of these in this study, the women were doing the work on top of whatever else. And so it's more work for them. And in all the programs that provide incentives for those with the most power to remove barriers to women in academia, we'd likely require to create sustainable change. So again, it's about the power. It's about the people at the top, the leaders. So either we make all leaders, we make it, ladies, doctors. You need to make leaders. You need to change. And you all in the audience, please do that. And so now I'm going to just give examples of one of the recommendations from the AMA. I'm going to increase the visibility of these articles. This is Dr. Castillo-Buente's article. It's a beautiful study. It's a huge study. The results of the COVID-19 Mental Health International for the General Population. A lot of authors. It's data from 40 countries with 50,000 and more responses informing the field of COVID-19, providing data and the relationship of having history of depression and worsening, prognosis, suicidality, incidents, conspiracy theories, et cetera. Effects of isolation. Then, I don't know if I choose the right one, but I thought this one was great. Dr. Tatiana Falcone, the digital conversations about suicide among teenagers and adults with epilepsy, a big data machine learning analysis. Objective digital conversations can provide important insight into the concerns and struggles of people with epilepsy. And so that reports, she's worked with neurology, worked with kids, and now is working with AI. And so it's wonderful. And then for Dr. Rueda Lara, Developing Patient-Centered Hybrid Model of Care Delivery in the COVID-19 Epicenter in Miami, Florida, and Supportive Cancer Care in a Culturally Diverse Population. So, what are we missing? But before I get to those, those are my final. I think we're over, my goodness. Yeah, wellness. The piece about working after five or working before, say, seven. I think that's something everybody's talking about, wellness, and we didn't touch on that piece, and that's really very unfair. But, so what are we missing? Increasing diversity goes with equity. We are not disrupting the narrative. So, we keep, we need to keep shaking the tree. Faculty and leaders in power need to act, and we need to make them accountable for the research that's needed, as you see. Thank you very much, and I'm sorry. Maybe you want two questions? Yes. Yeah. I have a list of questions. Okay. Great. Well, okay. Okay. So, I'll try to be brief. I followed these comments about the mentors, how important they are. And of course, 20 years ago, probably there were very few female mentors. But I wanted a comment, like on your picture, you put five out of nine of your mentors were women. So, the question is, is there any difference having a female mentor to a male? Or does it even matter? The other thing is more like a request that Warmi is getting bigger and bigger, that what are you waiting to do the survey with your own people, so you create data on the gap that your people, your members have gone through? Those are... And congratulations, of course. I enjoyed it a lot. What is the first question? Sorry. This is for you. I think the important piece is finding the right mentor. I don't think if it's a woman or a man, right, I think the important part is like someone who can really help you see what are the issues that you are trying to work on. And the second important is having multiple mentors, right, like an academic mentor, a research mentor, an institutional mentor, right, because each one can give you different ideas. Supporting what Tatiana said, also, you can listen what the mentors say, because the mentor can say many things to you, and you are the person making the decision. You can listen, and you are making your own decision, because sometimes the mentors, they have their own experience, they have their own background, and they provide you the best opinion. And this is what happened with the mentor, the female mentor that Tatiana mentioned, that she said that women flourish in the 50s. It's her own opinion, and you can put together, and at the end of the day, you decide. This is the best, you know? Listen, listen many opinions, and at the end of the day, it's your decision, it's your life's unique decision. I had the opportunity to have very good mentors in Pittsburgh, all males, unfortunately, but well, fortunately, doesn't matter, yeah, but there are different opinions about things, for example, submissions of the APA, one was very conservative and said, no, no, no, no, it's not perfect, not, and another say, go ahead. So they were both, you know, and the balance, it was perfect for me, so you made the decision at the end. And about WARMI, yes, we are in the process to put together this big group, people doing this, because it's important to have that experience for many people. So I agree with Ruby that says that you, at the end, you're the one who makes the decision. I have a mentor I still keep in touch with, it's a female mentor, and it's important to take into consideration that they're also human, they're also going through things in their career, personal life, and sometimes when they give an advice, it's not because they want to harm you, it just depends where they are. And one of my female mentors who told me, you don't need a fellowship to stay here, you know, we can work together, and I know she was extremely supportive, but I decided to do my fellowship, when I went back, I went back to work with her, but she quit a week before I started my first job. But I understand why she had to leave, I mean, it was her personal decision, she had to move on, but, and her advice was not malicious, it's just, she was not at the right place, so it's important, you make your own decision and consider the data, ask multiple people, and it's not gender specific. Thank you, and I think, thank you, thank you people, they are coming for the next session, so thank you very much for being here.

gender gap

psychiatry

leadership roles

professional networks

societal biases

salary negotiation

work-life balance

domestic responsibilities

research funding

minority tax

institutional support

gender inequality