The Feminization of Endocrinology with Dr. Francine Kaufman
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🎙 Episode 8 & 8.2 | Endocrine Matters Podcast
In this compelling episode, Dr. Arti Thangudu sits down with pediatric endocrinology legend Dr. Francine Kaufman to explore the evolving landscape of endocrinology through the lens of gender, leadership, and legacy. With over four decades of experience in medicine, research, and industry, Dr. Kaufman shares stories from the early days of her career, when women in medicine were rare and the seismic changes she’s witnessed since.
Together, they unpack the "feminization" of endocrinology: what it means, why it matters, and how gender parity in the field intersects with pay, leadership, and quality of patient care. From global diabetes work to technological breakthroughs in insulin delivery, this conversation is packed with wisdom, candor, and a call to action.
💡 This episode is essential listening for anyone navigating a career in medicine, especially early-career endocrinologists, women physicians, or anyone passionate about equity in healthcare.
Listen to the Full Episodes
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Key Topics & Timestamps
Skip to specific parts of the episode:
PART ONE:
04:05 – Experiences in a Male-Dominated Field
09:04 – Career Trajectory and Technological Advancements
13:01 – The Importance of Clinical Practice
16:01 – Building Relationships with Patients
19:16 – Changes in Endocrinology Over the Decades
22:44 – The Shift in Patient Ownership
PART TWO:
29:35 – The Feminization of Endocrinology
32:45 – Gender Parity in Academia
39:01 – The Impact of Feminization on Pay
44:34 – Supporting Women in Endocrinology
51:22 – Finding Meaning in Endocrinology
Episode Highlights
Key Takeaways:
A Pioneer’s Journey – Dr. Kaufman reflects on being one of few women in medicine in the 1970s—and what’s changed since.
The Feminization of Endocrinology – Why more women are entering the field, and what that means for its future.
Persistent Pay Gaps – How occupational segregation and the “motherhood penalty” continue to impact women physicians.
Cognitive Labor & Compensation – Endocrinologists carry complex mental loads but often lack proper reimbursement.
How Care Has Changed – From patient ownership to hospitalists, the doctor-patient dynamic is shifting.
Mentorship & Advocacy – Why mentorship, advocacy, and negotiation skills are critical for women in medicine.
Career as a Journey – How saying “yes” to diverse opportunities—from industry to international care—can fight burnout and create impact.
Creating Supportive Structures – Flexible models like job sharing and intentional community-building may be key to retaining more women in medicine.
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Francine: [00:00:00] I remember when I got my first NIH grant, um, I called the, um, grant manager at the NIH to be sure there wasn't a mistake. Did I really get this grant? And she said to me, I, you know, I don't know who she was. She said, Dr. Kauffman, does it have your name on the application? I said, yes. Does it say you've been funded?
I said, yes. She said, why would you think that's a mistake? Why do women think that? And no man has ever called me.
Arti: I had the incredible privilege of speaking with Dr. Fran Kauffman, a legendary pediatric endocrinologist with 45 years of experience. Dr. Kauffman's career is truly extraordinary. She has led groundbreaking research, [00:01:00] trained countless residents and fellows, and worked in industry as the chief medical officer for Medtronic and now Senseonics, all while continuing to care for her patients in her clinical practice.
She's also been a leader in diabetes camps and traveled the world delivering endocrinology care, often bringing her family along with her as a mother in medicine. Dr. Kauffman's insights into endocrinology and medicine as a whole are unparalleled. In this episode, we focus on how the field has evolved over her career and explore the feminization of endocrinology and its implications for our specialty.
Today, more than 70 percent of endocrinology fellows are women. While this might suggest the field has become more accommodating for women, The reality tells a different story. Applications for endocrinology fellowships are declining for both men and women, though the drop is more pronounced among male physicians.
Endocrinology now ranks as the lowest paying specialty in medicine, according to Medscape's 2024 Physician Salary Report. [00:02:00] Despite similar training durations to high earning specialties like cardiology or orthopedics and longer training than many better compensated fields, endocrinologists face significant financial disadvantages.
This compensation struggle has created a critical shortage of endocrinologists, with only about 7, 000 practicing endocrinologists in the U. S. compared to the 38 million people living with diabetes, not to mention those with other endocrine disorders. Even if every endocrinologist saw 20 diabetes patients daily, 52 weeks a year without a single day off, we still wouldn't meet the demand.
Dr. Elaine Peli, an endocrinologist, published a thought provoking article in the Journal of Clinical Endocrinology and Metabolism on the feminization of endocrinology and its repercussions. She highlights the challenges women in the field face, the gender pay gap, which persists even in medicine.
Occupational segregation, where female dominated specialties tend to have lower wages across all fields. The motherhood [00:03:00] penalty, where mothers are perceived as less committed and competent compared to non mothers and are less likely to be promoted. This contrasts sharply with the fatherhood bonus, where fathers are rewarded with higher pay, promotions, and greater flexibility.
Endocrinologists are already an endangered species, and the feminization of the field raises additional concerns. Without endocrinologists, patient care suffers, especially in the midst of a global pandemic of diabetes. In this episode, Dr. Kaufman reflects on her remarkable journey And the seismic shifts she's witnessed in endocrinology and healthcare.
Together, we discuss the challenges and opportunities that come with the feminization of our specialty and brainstorm potential solutions to make endocrinology more appealing to trainees. Thank you for tuning in. I hope you enjoy the conversation. If you're looking for links to any of the topics we cover, you'll find them in the show notes.[00:04:00]
Dr. Kaufman, I am so excited to have you on our show to talk about the feminization of endocrinology and just give us a historical breakdown of what you've experienced in, in this field. So thank you. Thank you. Thank you so much for, for being here with me today. Wow. Thanks for this
Francine: opportunity. Um, so I've been doing endocrinology about 45 years.
Which is a long time, um, seen a lot of advancements. It's been really exciting to be in the field, um, for this duration. When I first started medical school, it was about 10 percent women. Um, and then the, I wanted to want to be a surgeon, but. I didn't really like it once I got in the OR and then, um, you know, got enamored with a long term relationship with patients, could see them over time and also decided to do it from a pediatric perspective [00:05:00] rather than from internal medicine.
So of course there were more women in pediatrics and more women in pediatric endocrinology as a result, but, um, got very involved in, you know, what was going on in the general landscape. And, um, there were the minority of, you know, individuals who were women, you know, fewer on the, um, internal medicine side again than the pediatric side, but it was still a predominantly male field, um, as was all of medicine, um, better than surgery, obviously, but still male dominated.
And particularly. White male dominated and most of the mentors and luminaries in the field had been practicing for decades, um, had made major contributions. I'm not by any means diminishing what these, you know, incredible individuals did during their career. Um, and at the same time, there were very little [00:06:00] provisions around pregnancy, um, you know, around anything that kind of related to being a woman.
Um, when I got pregnant as a resident, um, it was one of the first, you know, pregnancies that had occurred and they weren't clear what to do. I mean, they asked me, so who's going to take your call if you don't feel well? Um, and I said, well, you know, what happens if I didn't feel well? And I. Not pregnant.
Who's going to take my call? So there was a lot of, uh, pushback, um, around many aspects of what are you need, you know, to being women. And then, of course, once you had a child. What about part time possibilities or, uh, job sharing or any of those aspects? And we've come a long way. Um, we're not all the way there yet, but you know, we've certainly made strides and, and maybe because we're the majority of people or close to the majority of people entering [00:07:00] medical school and in specialties.
Like endocrinology. Um, however, um, I still think there's a bit of a glass ceiling. It's still a little bit harder when you, you know, try to figure out how do I fit in children? And the fact that even in a relatively equal or marriage of equality, women still end up doing more, um, you know, childcare more, um, concern around housekeeping and groceries and laundry and things like that.
So. It's been a struggle. We've made a lot of strides, but we're not completely where we should be either.
Arti: Yeah, absolutely. And I love having your perspective because when I came into endocrinology, it looked like it does today. You know, it's 70 percent of endocrinology fellows are women today. And so hearing that shift in in the way the career has looked is [00:08:00] really interesting and fascinating.
I'm curious, how did it feel to be a woman in such a male dominated environment?
Francine: Well, I, you know, I think it felt differently. Depending on who you were. I was involved very early on in a little research project at the University of Southern California where I was on faculty. And they asked a bunch of questions about, you know, have you been discriminated against?
Have you been, um, you know, massaged? I mean, all those kind of things. And I didn't really see it until I started examining, um, you know, some of the, pushed downs that women could receive and, um, you know, aspects in our career, again, because it was still male dominated. And I just didn't want to bother me.
So I, you know, I had grown up only with brothers and male cousins. So I was used to just ignoring what was ridiculous. Um, [00:09:00] and not every woman, you know, had that same kind of outlook or experience, but there was, you know, a lot of, I just remember when I was an intern, I was part of the first all women's team we had at Children's Hospital Los Angeles and the guys would open the door and kind of, you know, um, say things, you know, to kind of diminish the fact that.
We could do a job as four women, you know, as equal to four men, um, those days are over. Um, fortunately, and obviously we have certainly proven ourselves whether we needed to or not, you know, is to our contributions and our capabilities, but it was, um, a bit of a struggle. I mean, you had to, I think I worked harder in some ways and some of the men I was.
You know, not competing with, but, you know, at the same level and competing in grants and competing, you know, even in patient care in a city as big as Los Angeles, that, um, [00:10:00] there was, you know, some innate,
Arti: you know, need to prove yourself. It's so interesting. Like, I think women have this experience of, I need to not only do as much work, but more work than, perhaps my male counterparts and show up more to receive equal or perhaps even lesser recognition for that work.
And when, when you were starting out, the, it was so, I guess, unusual to see a woman in, in medicine that I imagine you probably felt that pressure more, even more so than we do now. Would you say that's true?
Francine: Absolutely. So never, but probably two decades ago, I had the opportunity to look at my own file inside my own institution.
And my intern interview started [00:11:00] out for a woman comma, you know, so it already diminished compared to what you'd expect from a man. Um, so, you know, I do think. There was, you know, some issues, maybe not every day. I mean, you worked equally, people certainly appreciated, um, you know, all that everybody did. Um, and it was a tremendous, um, camaraderie, right, uh, to be able to, you know, to be together as interns and residents and faculty and older faculty.
And I, you know, truly value the relationships I had. With everybody, but it, but it was a, you know, a little bit of a struggle. I certainly, I worked part time for a while, um, mainly because there were tremendous budget constraints in my, um, hospital that they could only afford somebody part time and, um, you know, had to negotiate that, uh, 50 percent [00:12:00] working effort shouldn't be, you an equivalent year for my tenure.
Um, you know, they said, well, you're here a year. You should, you know, that should count as a year. I said, well, I'm only here 50 percent of the time. How can that count as a full year? So there were all kinds of little pitfalls that you didn't know until you were deep inside one of them. But, you know, with rationale and, um, you know, I think just achievement, I was able to.
Get that kind of balance that I think, you know, I needed personally, um, but it was only because there were tremendous budget cuts.
Arti: So when you first finished your training, did you work clinically? I know that you have, um, done both as far as, um, industry and clinically. What was your career trajectory in endocrinology?
Francine: So, um, from 1978 to 2009, I [00:13:00] was a faculty member at Children's Hospital Los Angeles and USC was my faculty appointment. Um, I had research grants, I had, I was NIH funded, um, my entire career. Um, and in those days, you know what, maybe I was doing all three components, I was teaching. I was doing research. I had a basic lab for a while and a lot of clinical research, as well as seeing patients.
And then I became head of our division of pediatric endocrinology at Children's Hospital and was doing administrative work as well. But at that point, obviously, it was full time. It was only part time for two years. And then after 2009, what did you? Then I went to become the chief medical officer at Medtronic Diabetes for 10 years, um, mainly to be involved with the finalization and the launch of the first, um, automated insulin delivery device, uh, the 670, and, um, was there till 2019, [00:14:00] and now I'm the chief medical officer at Senseatix.
But I have still seen patients all along. So I, matter of fact, I'm
Arti: in my clinic today. So I think that, first of all, I think, can we just sit in appreciation of the grandeur of that technological advancement of the hybrid closed loop system? Like I, I trained on the cusp of when I was in my training, we, we didn't use it, but it's came out kind of in my first year of, of practice and the profound impact that it has had on our patients lives is just, it's astounding and it amazes me that I'm sure I know the research has gone on for.
A very long time, but in such a short window of time, technology has advanced diabetes care just so, so much. And it's how do you feel being on the kind [00:15:00] of forefront of that?
Francine: I was in the right place at the right time. Um, uh, it was, you know, I've always done clinical research in diabetes technology as well.
Diabetes advancements. I remember when Humalog came out, um, you know, we were, or actually Humalin even, human insulin. I mean, you know, we, we were involved in some of that, uh, early research, early pump research, sensor research. And, um, it was always exciting to be part of large consortiums of other investigators with the ability to have a big enough patient population to contribute, uh, to a number of these efforts.
But, but personally, um, you know, I was, uh, kind of recruited to Medtronic by the then president of the diabetes division, a man named Chris O'Connell who wanted. me to be the chief medical officer to really kind of help tie together all the aspects [00:16:00] of first we have threshold suspend and then predictive threshold suspend and then we got to you know the hybrid closed loop so was it just a phenomenal experience for me it was a little hard leaving academics at the beginning i always viewed myself as an academic um and uh but but i but i got over it and i've really enjoyed This ability to be kind of on both sides of the world and although I'm, you know, kind of in my mid 70s at this point, I'm, I'm not going to quit working and who knows, maybe I'll even have another career opportunity.
Arti: Yeah. I, you know, I love that you mentioned that you still practice clinically because I think as we decide on alternative opportunities that may be non clinical, I think it's very difficult. And I, I actually am a huge believer in staying at least clinical part time because I, I think that it [00:17:00] makes us relevant and it enables us to really be in touch with our patients and what's going on on the ground.
I think it's very difficult to not lose touch and probably not lose touch quickly with, with what's going on with our patients if we don't have some clinical time. Um, so I. I, I love that, that you're doing that. Is that why you choose to stay clinical or what's your reasoning? I
Francine: mean, certainly, um, that's part of it.
I, I think it's an opportunity to, you know, come to work for a day and actually interact, solve problems, um, work collaboratively, whereas, you know, if you just do research and I did a tremendous amount of research in my career, um, you know, it's, it's really delayed. gratification. I mean, some of those projects are last forever, right?
Um, and, uh, if you just do administration, you know, it's, it's, it's at a much different [00:18:00] level, the interactions. So I, I kind of feel like when I come to clinic, it's almost like a, A fix, you know, I walk out even however challenging it might be, you know, kind of feeling that I contributed today in this very specific way.
Um, and, uh, you know, it feels good. Yeah. And of course, you know, I mean, I just saw a patient. He's 12. I've seen him since he was two, you know, I know everything about him. His family knows everything about me. I mean, you know, it's it's a real You know amazing partnership.
Arti: I I love that. We've talked a lot today about relationships and how the relationship between a doctor and Patient has to be a give and take and so I love that you said they know everything about me, too Because I don't know if it was like this in your medical training, but in mine and I finished medical school in 2012 there was this [00:19:00] idea that you should intentionally separate yourself from the patient.
And it wasn't, um, it was kind of a professional distance. And of course, yes, there, there are lines that we shouldn't cross. But as I've gone into practice, I've recognized that I have to give a little to, to get a lot from them and that relationship should, that relationship actually is very healing for, for patients, of course, but also for us to have a human experience as a physician.
How do you feel about that?
Francine: Oh, and I started, I mean, you were Dr. Kaufman in a long white coat and you never said anything about yourself at all. Um, and I write out. of my training, refused to wear a white coat. It was the beginning of that movement. And I asked my patients to call me Fran. Um, and I remember my mentor, who, you know, I [00:20:00] still adore.
And, um, you know, just from a different world. Um, you know, the world right before I was there, I mean, she said, no, none of your patients are going to respect you. You can't do this. It's ridiculous. I mean, they can't call you by your first name. Um, and you know, I just didn't agree with that. So, you know, I've been fran to all of them.
The kids call me Fran. Um, and you know, if they want to call me Dr. Fran, you know, I think that's more contrived than just calling me Fran. My home phone number, or I don't have a home phone anymore, I guess, you know, my, um, my cell and, um, you know, my, and, you know, obviously this is very individual and it is also how my practice was set up.
I wasn't, you know, seeing a patient every 15 minutes, you know, I had much more luxury than that. But, um, you know, my concept is if you, if you need me, just find me. It's easier to be found [00:21:00] than to unwind. You talking to somebody else who doesn't know what's going on and, you know, or calling going to an ER and, you know, them getting your hypoglycemic and they're still going to get a CT, but you don't need one.
Um, so that's, you know, just how I chose to practice. Um, and, you know, I think, um. I've hardly ever lost a patient, you know, to saying, Oh, I don't like her style. Um, it's more, they really like my style. I mean, I, you know, to my patients now are a little bit older than perhaps they should be, um, for a pediatric endocrinologist.
I will, the patient before this last one flew in from New York to see me because, you know, she's, um, just not able to find somebody who she thinks can relate to her.
Arti: Yeah, I think that relatability is so, so important, and I think our patients are craving that, [00:22:00] especially now that, like you mentioned, a lot of visits are 15 minutes, and there are these big barriers, and trying to get in touch with your doctor if you have a question, if they are part of a big hospital system, well, good luck, because I can't even find them, and I'm a doctor.
There's like, there's no longer that number to push. If you're a physician, push two. I've tried calling several clinics at some of our large hospital systems here in Houston. It's no longer an option. And so I, I think that patients need that, especially people living with diabetes. They are living with it every second of every minute of every day and they need it.
So I'm so grateful that, that people like you exist to take care of our, our kiddos. Um, I would love to hear sort of, and this is kind of a big question, so we can break it, break it apart, but I would love to hear, How you've seen endocrinology as a [00:23:00] field change over the last few decades. I know it's a big question, so I can ask a more specific one, um, if that's too much, but I'll let you start.
Francine: Well, I mean, I could take hunks of it. I think, um, maybe the biggest change has been hospitalists. Um, you know, I followed my patient through their hospital stay. Even when maybe you're not on call, you'd never think of leaving the hospital for that day without even going by and saying hi. You know, you never think about not reaching out to your coworker to find out what's going on with your own patient.
And you know, that's. I started medicine. There was no word called hospitalist. It was called interns in residence, actually, is what I think, or maybe chief residence. And then one day, I don't know, how many are there? 100, 000 of them in the country. Um, maybe it's better. I don't know. And, and certainly the [00:24:00] whole shift.
So I do view myself as a dying species of how I practice and, you know, my entire career, the hospital isn't like that anymore. Practices aren't like that anymore. Um, the, you know, the expectations, the EMR, I mean, you name it. It's all changed. Um, probably for the better in a lot of ways, um, in that there's more efficiency in looking in the EMR.
It's easier to get. The right prescription perhaps, although I searched all morning for afrezza for somebody and realized it's not even in our EMR. Um, so I, I mean, you know, the, the trends are bigger than all of us. I, I don't think there's an endocrinologist left in Los Angeles who isn't part of a big system.
You know, either Cedars or UCLA or USC or Providence or, you know, a couple systems, but they're the private [00:25:00] practice of medicine is gone. Um, you know, the, the, what's. reimbursable, um, how your day is divided up, what the expectations are, how you interact with patients. I mean, it's, it's all changed. And I just have to believe in the long run it's for the better.
Um, although I do, you know, I do miss the days of when I first started my career. I mean, we had enough time. To meet after every clinic we had and we talk about every patient somebody saw. Um, and you know, on Diabetes Day, we talk about every patient before somebody saw them. We had 300 patients with diabetes.
Now we have 3, 000. Um, we were, when I came back. Um, part time after my fellowship and after my second child, we were two and a half doctors. Now we're 22. So, I mean, you know, the [00:26:00] population change, um, the incidence of diabetes change, I mean, all of this has just fundamentally, you know, altered, um, the, you know, the core tenets of the practice of medicine.
Arti: So you mentioned something that I share a sentiment with, and it's extreme ownership. Extreme ownership, that is my patient. And my worry is that in this system where we're so separated from our patients, I have a direct care practice, so my practice is probably more similar to your old practice than the traditional settings.
Um, that you're describing today, but that my fear is that with all the separation between the doctor and their patient, we have lost that extreme ownership that that is my patient. And I'll tell you a story, um, that was one of the events that led me [00:27:00] to seek a different practice model. And I was in private practice and employed and, um, an MA said, can I, Add this patient on to your schedule today.
And she said, it'll be really quick. It's just, uh, it's just a prediabetes. And I was in a rush and I didn't really think I just said, fine, whatever. Add the patient to my schedule. So I go in, and it was an 18 year old woman with prediabetes and PCOS, struggling with obesity. And an hour later, I walk out of the office visit, and I said, Thank you for adding that patient to my schedule.
She really needed my help. But don't you ever tell me that It's just anything because this is my patient and I have the incredible privilege to change the trajectory of her life and her metabolic health [00:28:00] and it's never just anything and she was very taken aback, but I think it taught her a lot about me, but more importantly, it taught me a lot about me and how I was going to struggle in a system where I only had Five to 10 minutes with my patients and in order for me to I liked that about myself, you know, I liked that.
I loved my patient so much. And I liked that. I believe that had this crazy confidence that my actions could actually change something. Um, and, um, I worry that in a setting where many doctors Uh, kind of have that, that passion beaten out of them in, in a productivity based setting that we're losing that, that extreme ownership that I think is, is [00:29:00] valuable to both physicians and patients.
Francine: Oh, I think it's gone. Um, I absolutely agree with you. I think it's not my patient anymore. It's our system's patient. And however, the system sees, you know, she needs, or he needs. An educator, they go to the educator, if the system doesn't. Seem they need one, maybe they don't get one. And, and that system is maybe the healthcare provider system along with the insurance system.
I mean, that has so much play, you know, in, in, in what we do and how we spend our time. And I don't feel like, you know, early in my own life, I felt I had a doctor. Who if something happened to me would show up at my bedside and direct my care. I certainly don't feel that anymore. I'm part of a system and somebody will show up, maybe, if I can get to the right bed.
And, um, and direct [00:30:00] my care and, and maybe better in some ways, not so much on what I might need, but what somebody my age, my demographics should have. Um, you know, I just went to a doctor, you know, in a big system and, um, it was my first Medicare checkup and it didn't involve really anything about me. It was about, I needed to hear about falling and I needed to hear about Um, you know, uh, clutter and am I depre it, it, it, there never got to be a time where I said, here's my concern, um, or here's what I need.
It was, you know, you're this age. You need, this is what you need.
Arti: Yeah, I, I looked at this graph recently and now there's all these EMR checkboxes, right? And there's like these well visits and all of these things and the doctor's kind of [00:31:00] more focused on the computer than the patient because of all of this EMR clutter.
Um, and so. I saw this graph and it tracked the cost of health care and the, there was another graph that tracked the percentage of employed physicians versus non employed physicians over time. It was like 20 percent in the 80s and 90s. Now it's closer to 80 percent of employed physicians, um, and medical costs.
And they all were the same line. They all went up exponentially over time. Um, but there were two. Two time points that you see a kind of a exponential shift and one was when EMR became required and The other was when HIPAA was implemented In 96. So I thought it was just fascinating that these things that [00:32:00] we are told improve efficiency seem to be the turning points of when things just seem to get worse from a cost perspective, at least, yeah,
Francine: yeah, well, I mean, cost, you know, it's mind boggling, right?
Um, and when the, um, you know, just kind of experiencing, saying it. It personally, um, you know, they're, I just look at how appalled I am with all my coverage and, and still some of my co pays and some of the denials where I still need it no matter what. And certainly, you know, um, for my husband as well, and we're able to afford it, but I mean, at some point, you know, it, it, it's not affordable for people.
And in the old days. You might have been able to get more, um, from the system than you can now. Um, I mean, now, you know, there's just too many boxes you got to fit in to be able [00:33:00] to get approval.
Arti: Yeah. And the, the ability to collect data is just insane as well. Yeah. Um, so I'm curious, you know, you gave this talk about.
the feminization of endocrinology. And I would love to kind of dig into that because you mentioned that medicine was mostly men. Maybe this field was a little bit, um, More women than other fields, but how have you seen that change and what effects have have you seen? And what do you predict for the future?
Francine: Well, you know, I think things are better. Um, certainly when I personally, and this got me interested, negotiated My first contract, I guess I didn't realize that it was a negotiation, um, and that what I was willing to take might not be the same as what the next guy in my division with the same titles might be willing to take.
And, um, after my second pregnancy, you know, I, for the first [00:34:00] time, was home for three months. Because I had finished my fellowship and I didn't have a job yet when they offered me this part time job, it was just ideal. But I would have, you know, my husband said, don't go there and tell them, you'll give them money for you to work, be sure you get a salary.
But I, you know, I took a really ridiculous salary. Um, and then that sets. It's the goal, you know, as you go on, that first negotiation you do is so critical. And nobody told me, you know, and I just didn't know. Um, and then when I went to full time, they wanted to kind of take that as the baseline and just convert it.
And um, and that's when I realized, no, no way, you know, I need parity and it, it, and it was a big struggle. And for a couple of years, I didn't have parity to my male counterparts. at the exact same level I was at. And women do this all the time, right? We're not great [00:35:00] negotiators. You know, we're not the, that, that mindset of walking in and saying, I'm worth, you know, I'm worth whatever.
And you pay me this, or I walk it's, oh, really? You know, could I give that much? Yeah. So, so we have to. You know, and then I spent time helping other women with that first negotiation and, you know, getting parity, you know, up until that time I gave that talk, which is probably about five, six years ago, um, we were significantly underpaid as women in endocrinology, it was about 80 something cents on the dollar.
And, um, and although it was shifting to all those older men leaving the field and. The fellowship bringing in women, you know, it, it took some time and I'm not sure it's completely. at parity, but it certainly has gotten a lot better. And then it's not just [00:36:00] parity on, on pay, but parity on how much, you know, who's got that half day off to go through all your charts or develop your slide deck that you need to teach the residents.
So it's, you know, it really has to be equal. Um, and then of course in an academic center, it's a little bit more difficult because if you've got grants. You're at a different level. And if you're, you know, tenured on the tenure track, it's different. And then you of course saw more women going not on the tenure track, but on the, you know, the clinical track where the workload, you know, was more, you know, more, more given to women than to men.
So, you know, kind of, um, lots, lots of groups were looking at this and coming up with data. Um, so, you know, it's been, I think, a concerted effort on all of our part to be sure our dollar is a dollar, [00:37:00] whether you're a man or a woman, and that, you know, the expectations, uh, match to what. Um, and I think it's better.
Um, but, you know, it may never be completely
Arti: on parity. And I think, uh, in addition to pay the promotion to like, right. The number of women that are deans or chairs of departments or, um, high levels in academics are just. So much fewer than men, and I think in endocrinology, I think we have seen more as the women become, as the field becomes feminized, um, hopefully we see more women in those positions, those higher positions.
But when you look at the percentage of women in the field compared to the percentage of women in those leadership [00:38:00] positions. There is, you can see that there's a big, big gap there.
Francine: Absolutely. You know, I think you can look on podiums, uh, publications, deans, um, division heads, department chairs. There's still fewer women than you would expect.
And, you know, in part on, you know, We have children, you know, we want to spend some time with our children, you know, it's it's it's hard It's a reality and and how we get that mommy track Or you know, and it's it's not permanent. It's not a permanent track. I mean I had a Mommy mindset for probably the first five years of my career and you know, I was just, I had a grant.
I was doing some, you know, novel basic research and, um, you know, a far off field of ovarian failure in women with galactosemia, um, which I think now has become a great question on [00:39:00] most of the boards of what causes primary ovarian failure in women. But, um, Yeah, I, but it was a real struggle and, you know, I had to, I was nursing through part of it, you know, I can remember, you know, filling out some of my grant application, you know, with while I was nursing one of my sons at the same time.
So it's. It's hard and men will point out, you know, you weren't there, you were on maternity leave or whatever, but we've got to figure out some way and I think having paternity leave is a great idea to let those guys experience the same thing and, you know, realize that it's, it's a reality that is here for a short period of time and you don't want to miss it, but, um, you know, there's been a lot and I always go back to that.
Yeah. Internship, you know, evaluation that I had for a woman. Um, I remember when I got my first NIH grant, [00:40:00] um, I called the, um, grant manager at the NIH to be sure there wasn't a mistake. Did I really get this grant? And she said to me, I, you know, I don't know who she was, she said, Dr. Kaufman, does it have your name on the application?
I said, yes. Does it say you've been funded? I said, yes. She said, why would you think that's a mistake? Why do women think that?
Arti: And no man has ever called me. It's that imposter syndrome that. Right, right. That culturally. Yeah.
Francine: And I do want to say, you know, even in outside society. So I was the second woman president of the ADA.
In 2003, the ADA was founded in 1940 something, and you know, there's still, for the number of women in endocrinology, have not at all been the number of women presidents [00:41:00] that there should be.
Arti: Yeah. Yeah. I, I think the imposter syndrome for women is, we have too much of it. And then there's the contrary, sometimes men.
Have way too much confidence when in saying things that are actually inaccurate And that's not true for all men. I know some very humble men who have experienced imposter syndrome as well, but I do think It is something that kind of pervades women, especially women with careers now, you know, 70 percent or perhaps even more than that of endocrinology fellows are women and, um, As you know, endocrinology is a very, very poorly reimbursed specialty at Medscape.
It made me, I don't know why it made me laugh a little bit. It's either laughing or crying, I guess. But endocrinology was the lowest paying [00:42:00] medical specialty in the entire list. Like, lower than internal medicine, pediatrics, you know, with our five to six years of training. That is on par with our cardiology colleagues and orthopedics colleagues.
Right, right. We We're the lowest. Do you think and I know there are a lot of different forces going into that reimbursement structure, but there is this cultural or sociologic concept that as a profession becomes feminized or more women go into a profession it is Devalued or not as not seen as Um, complex or, um, not worth as much pay.
Do you think that is hurting us? I do.
Francine: Um, and you know, this was a main thrust of, of the talk I gave was that it's kind of a cycle, right? It's, um, [00:43:00] uh, there are lots of opportunities, um, you know, it's an exciting field. gravitate and maybe in part they gravitate because there's not a procedure that takes, you know, the skill that we think a surgeon and of course, surgery is still much more male dominated than any of the other fields.
Um, so, uh, you know, women gravitate, women are willing to take less because of this mommy track or whatever it may be. Um, therefore we pay less. Then it's easier for a woman to get in there, you know, and it just keeps cycling on itself. Um, so there is a big concern and, you know, I think we can see, you know, one could argue, we don't value children the way we should in this country.
Therefore, pediatricians get paid. Less than internists for the [00:44:00] same, you know, maybe even more complicated, um, you know, prevention and all the other issues that pediatrics can face. Um, obstetrics and gynecology, you know, at least they've got some really significant procedures. But, you know, it's, it's always in the hierarchy where they're placed kind of next to peas because they're taking care of women.
Um, and then, you know, once this is what happened with teaching, right, the big example in the Western world was, was teaching where it was completely male dominated. And once women got into it and became a woman dominated, you know, it's not only. It's not only payment, but it's stature in our, um, world changed, you know, to the negative as well.
And, you know, I think we still look at, you know, a man who wants to become a third grade teacher, what's wrong with him? You know? Um, so it's, it's kind of sad because it does affect men in a lot of [00:45:00] ways in addition. And maybe a man who would love to be an endocrinologist can't justify in his own mind doing that because the pay is so low.
Um, so we, we've got to. Figure out a way, um, to have parity and I, I, I wish I had some answers, um, but I, I don't think I do, whether we need a procedure. We can't just manufacture a procedure, you know, our cognitive involvement is huge. You know, can anybody else recall, you know, the hypothalamic, uh, pituitary adrenal axis like we, I mean, it's just very.
You know, complicated stuff that we deal with, and yet we're not reimbursed for that cognitive load that we bear.
Arti: I think the insulin pumps are the, the craziest example with, with no, CPT code, unless you know of one that, that exists, whereas like, you can, you can bill for a CGM, but you can't [00:46:00] bill to interpret an insulin pump download.
That one I find baffling. It's because that
Francine: alone is just about insulin delivery and without. Um, looking at the matching glucose, you know, what can you actually really do? So, um, but, but I agree with you. Um, it, it, a lot of it doesn't make sense.
Arti: Yeah. Like an EKG, even, even if you don't get reimbursed a lot for it, at least, at least it's recognized as, as work being done.
Right. You know, I have this thought about, you know, a lot of women are going into endocrinology. A lot more applicants are women. And mostly, from what I was reading, Elaine Pelley has a great article that I'll send you after this on the feminization of endocrinology, but she talks about how we're not gaining more endocrinology fellows because more women are applying for endocrinology.
It's because fewer men are. So, [00:47:00] all numbers are down. Fewer women are applying for fellowship and men. It's just The men are far less, but I wonder if when we think about endocrinology in the future, if perhaps pay parity is one thing to think about, but perhaps it's not everything because there are other reasons that we choose our specialty that aren't aren't pay.
And, um, as a mom, not being stuck in the O. R. In the middle of the night is. is good, right? And so that's, my husband's an intensivist and I loved ICU too, but I thought that would be quite challenging on our children if we're both ICU docs gone at all kinds of hours of the day. And I would like to raise my own children.
And so I think that perhaps thinking about the intangibles, like what can we do in endocrinology to support the women coming in to the field? Cause we know they are, [00:48:00] um, in ways that, because we are not going to overnight change CMS numbers and, um, insurance reimbursement. Although, you know, we would love to with time, but, um, perhaps it's more that we support each other, you know, create environments where we.
Give women grace postpartum and support them when they're breastfeeding, because I remember that being extremely challenging as a fellow. Um, or we cover for each other. It, when. You know, we have an engagement at our children's school or we have to take our child to the pediatrician or the things that we know we're going to be struggling with, struggling with from a time perspective, a clinical perspective, but also a mom guilt perspective to those, those responsibilities that we [00:49:00] don't want to necessarily give to others.
What do you think about that?
Francine: Well, you know, there was, um, a movement, I don't know, maybe it was 15, 20 years ago about job sharing, where, um, you know, you would have pool of people, you know, maybe two, three, maybe more people who were not full time and that could have more flexibility in negotiating, you know, what clinics they would do and when, and, and of course, maybe not so much.
My own patient, but our little consortium's patients, um, and, you know, that they could, you know, really work together. I don't I don't think it took off because again, it meant much less. Reimbursement, you know, everybody's, you know, going to be the equivalent of a full FTE or one and a half FTEs, but you could maybe do it, you [00:50:00] know, in a group of women in a practice, um, and, and just, you know, have really good scheduling where, you know, if I need to have a clinic from four to six one day, because I need to take off two to four, that there's that kind of flexibility, um, you know, I, I, I think, yeah.
You're right. The hardest thing is walking out of that hospital in the middle of the day because your kids. Um, going to be singing on some stage somewhere, um, and then not wanting to go back because everybody else is going to go to the ice cream place and be the only mom, you know? So I, I do think, um, some kind of greater support.
And if you're not a mom, you know, just maybe there's other things you want to do, travel, more travel and things like that. Um, you know, one of the things that pediatric endocrinologists do a lot of is diabetes camps. And there's a Turner's camp, you know, where, um, [00:51:00] that's an opportunity for some of them.
You can bring your own family, um, and you know, uh, really give back. You get a sense of, you know, I'm here, they really need somebody. Um, it's not that easy to find people, um, or international work. If people really like that, um, you know. In the pediatric world, we have, um, a school that goes around the world teaching, often not endocrinologists, but pediatricians who want to concentrate on caring for the diabetes pediatric population, maybe in Zimbabwe, where there aren't enough endocrine, I mean, there are not enough pediatric endocrinologists in the U.
S., let alone, you know, outside. So some of those maybe. Perks built into some of the systems where, you know, particularly some of the hospitals, you know, have community give back that they have to do so they could pick up a camp and, um, you know, help the faculty man the [00:52:00] camp in a more equitable way.
Arti: I think so.
I think some of these very humanizing experiences are what a lot of us are craving and My practice, we've created a space that, um, I have, we're three women endocrinologists and we all have very similar philosophies on how we want to take care of patients and how we want to live our lives and so it makes it very Nice and easy to collaborate together to ensure that our patients are taken care of and our families are taken care of.
Um, but I do think that there might be ways in endocrinology creating solutions like what we have or creating interesting opportunities because I think what happens is people don't want to go into a specialty where there On a hamster wheel, they're a cog in a wheel. They're not getting paid very [00:53:00] much to do it.
You know, I think it's 25 percent of women leave medicine within six years of training or at least go part time. Um, and in a field where you're making very little it becomes this balance of well, is it, is it even worth it? Am I, I kind of went through this too because when I was In practice, I wasn't earning enough, and I was in private practice working full time.
It still didn't feel like I was earning enough to justify, one, the exorbitant cost of child care. We had to have two nannies, and um, Just the, the cost, the actual financial cost of supporting my career, as well as the opportunity cost to, to myself and my family and our, our overall health. Um, but if we can give back in some of those ways, [00:54:00] where maybe women aren't feeling like they're sacrificing as much.
Even if the pay stays the same, perhaps that's a way to, to get more people into this field because I just am trying to find solutions to make this field attractive to people because we need, we, you know, this, we have such a shortage of endocrinologists that we've got to find a way to Enhance access to our expertise,
Francine: right?
Right. Well, you know, I think it might be kind of individually based, but I like the whole concept of, um, you know, how how can we expand. Further, um, the benefits of being an endocrinologist and to me, I spent 30 years in our diabetes camp in Southern California. Um, you know, do I look like I like camping to anybody?
Uh, just not my idea of [00:55:00] fun. You know, I don't like dirt and I certainly don't like the wilderness. Um, but I had the opportunity. I mean. The first year I went, I was still nursing one of my kids and you get to, first of all, experience diabetes in a way that's just incomparable. Um, and, and as well, um, you know, I was always able to bring my whole family.
My husband's a general pediatrician, so he would, he would come as well. And my kids grew up there. They became counselors when they were old enough. And, um, you know, it was a. a great family experience. Um, my hospital does a fair amount of international medicine. And that was another thing where, um, you know, it wasn't just because you weren't an endocrinologist, but early on in my career, my hospital adopted the children's hospital of a lawn back tour.
And so a bunch of us went. Um, you know, the analyst and medicine doctor, the ENT guys, uh, uh, [00:56:00] hematologist. And we were there teaching for a while and seeing patients, you know, those kind of experiences are, are phenomenal. And I would suggest maybe even, I mean, meaningful to anybody for sure, but, um, to see what it's like, um, someplace else.
There's just so many opportunities, um, and particularly for endocrine now, it's maybe a little different if you're a plastic surgeon and going, you could fix, you know, a cleft palate and walk out. This is a little bit more of a commitment because we can't fix the diabetes, right? We can only help somebody there stabilize and manage them through the years.
So I still am in contact with a number of these. I mean, I've been to. Um, Bangladesh, Ethiopia, um, uh, Ecuador, I mean, you know, lots of places where you make an, an impact and relationships that kind of last a long time.
Arti: [00:57:00] I think you've said so many things in this, this interview that Just demonstrate, I know burnout is a big issue and moral injury, but just the dynamic nature of a career in medicine and all of the different opportunities to advocate for people that we have the privilege to have and in your career, you've done so many different types of things and juggled so many things that.
I, I find that so inspiring because I think we forget now in, in this kind of rat race type medicine that we're living in that we, we actually can do something, you know, we actually can advocate for our patients in front of us in other places. All over the world with our voice, we can, we can really do something.
So I am in awe of you [00:58:00] and so grateful for your time. Um, as we sort of wrap up, I was just wondering, is there anything that you would want to leave our audience with or anything that you would, um, want to say to women endocrinologists or people considering this field?
Francine: Yeah, I mean, it would. I think in my own career, um, I early on viewed it kind of like as a journey that I wasn't gonna necessarily, I mean, even in academics, you know, you start in, you know, however much time you're in the lab versus in the clinic versus teaching.
I mean, all that can fluctuate and change. Find a passion somewhere, um, or a, you know, uh, an opportunity to take it. Um, and don't say, well, no, I have to see my patients, you know, 30 hours a week or whatever. Negotiate that, you know, I, I want to be. In an international framework, and I want some kind of [00:59:00] whatever it is, and I just feel like I've had a zillion different opportunities in my career and mainly because I was willing to step out of a comfort zone, knowing that, you know, sure, I can go to Ethiopia.
Diabetes isn't going to be that much different in Ethiopia. How I treat it. You know, they're still on RNN, but, um, you know, it's, it's, it's a challenge. And then while you're there, you're, you know, you're making a difference, but that what you walk away with is even. infinitely more than what you left. And so, you know, view it as a journey.
Um, you know, I took a big leap to go into industry and then change, you know, it, it, from a big company to a startup, you know, making the first fully implanted sensor. Um, and, and just, you know, be on a journey. Don't, don't say I'm, I've made my destination. I mean, look what you're [01:00:00] doing. I mean, this is phenomenal as well, right?
Um, you know, you took an opportunity, you took a risk, a challenge and, uh, and, and it's exciting. It keeps them burnout
Arti: gone. Yeah. Yeah. I, I certainly don't experience burnout and I'm so grateful for that. Um, it's, it brings me to something that I think about a lot and just because it's customary, doesn't make it right.
And certainly doesn't make it right for you. And I think just, that's great advice to. Seek different opportunities, even if they seem crazy or different or you know, if it seems interesting to you or it could help grow your mind or grow your passion or grow your expertise, just do it. You know, you only have one life to live and as an endocrinologist, you always have a job.
You know, you're always hireable. So, I think that a lot of physicians [01:01:00] are have been on a path, right? You go to high school, college, med school, residency, and it's scary to jump off that path and do something different, but it can be the most exciting, rewarding, biggest mistake, but you always learn from something sometimes.
But usually, you know, you're, you're smart enough to get this far. You're probably not going to make that big of a mistake, um, at this phase. And
Francine: if you don't keep on the journey and, you know, keep, keep moving forward. Right. And, and find the next thing that, that you're interested in and, and realize, um, I mean, you said it many times and, uh, you know, it kind of gives me the shivers.
What better job than being a doctor, you know, the way we can impact in people's lives and how they impact on our life. Um, you know, it's just. It's unequaled, I think.
Arti: Yeah, it is the best career in the world. Certainly has its challenges, but I wouldn't trade it for the world, and [01:02:00] it certainly sounds like we're in the same boat on that.
Well, Fran, thank you so, so very much for your time.
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