Authors: Meghan Etsey, Vashti Price, Dr. Karen Leitner
“Our Voices, Our Future” is a podcast by the Gender Equity Task Force of the American Medical Women’s Association that explores the challenges, stories, and successes of those working to advance gender equity in medicine. Through candid conversations with changemakers, advocates, and leaders, each episode dives into issues like pay gaps, leadership disparities, and inclusive workplace culture. Tune in to be inspired, informed, and empowered to take action. Full episode listening links are available below the transcription.
Meghan: Welcome to Our Voices, Our Future, a podcast where we amplify the voices driving change in equity within medicine and beyond. Brought to you by the Gender Equity Task Force, a committee of the American Medical Women’s Association. We’re here to challenge norms, break barriers, and ignite conversations that matter.
I’m Meghan Etsey, and in each episode, we bring you candid conversations with leaders, change makers, and advocates, working to create a more inclusive and just world. No more silence, no more waiting. It’s time to get Our Voices, Our Future.
Let’s get into it. Today, we’re welcoming Dr. Karen Leitner, an Ivy League-trained Med-Peds physician coach who has helped over 500 women doctors move beyond burnout, guilt, and overwork into careers and lives that actually feel good to live. Through her coaching and CME-accredited programs, she teaches physicians to renegotiate their time, energy, and worth internally and institutionally. She’s also an ambassador for the Dr. Lorna Bre Heroes Foundation and a passionate advocate for physician mental health and gender equity in medicine. Thank you for being with us today, Dr. Leitner.
Dr. Leitner: Thanks for having me.
Meghan: So to start us off, could you share a bit about your medical journey? What inspired you to become a physician, and how did that path lead you to founding How To Feel Better For Women Physicians?
Dr. Leitner: How long do you have, Megan? I’ll just keep it brief. My dad was a doctor, and I wasn’t one of those people who thought I wanted to do it from a super early age. Still, I loved being kind, empathetic, compassionate, and caring for others. That’s really what drove me into medicine. Plus, I enjoyed science and learning about the body.
I found training to be pretty challenging, and I think it’s really important to talk about mental health issues related to people in training because I don’t think it’s spoken about enough. So I definitely had, let’s say, untreated or undertreated anxiety, and I had ADHD, which I didn’t know. Those things made me struggle internally with my experience of going through training. I think I did fine, but it did not feel good to me, and it really led me to question if I wanted to go into medicine.
I finally got out and got a wonderful job working at a community health center doing primary care Med-Peds, which is what I wanted to do. I also met my husband, and we had two children. So the first seven years in primary care were really challenging for me, progressively more challenging as I added children and cut back my time. I was doing a halftime job with a full-time, full-size panel and trying to take care of my family. I really felt like I was drowning, and I was going through burnout, and I didn’t even know what that was. I don’t think I heard that word.
So I left my job and did a whole bunch for the next seven years. I thought it was the job and felt ashamed about my experience. I thought I just couldn’t handle it, and I just maybe wasn’t good enough. Then, I was exposed to coaching and many other interesting nonclinical roles that I had, which we could talk about another time. It just helped me see that so many reasons I burned out had to do with an imperfect system and some characteristics I possessed, which I now recognize in so many of my coaching clients, once we talk about them. Do you know, wanna know what they are?
Meghan: Yeah, of course.
Dr. Leitner: Perfectionism, people pleasing, learned helplessness, which is not recognizing where we do, maybe have more agency than we realize. Being excessively self-critical and imposter thinking were all the perfect storms for me. I wanted to be a do-gooder and excel at everything. It was impossible, you can’t, so I felt like I was failing at everything, so I left. I don’t want people to go through that. Coaching helped me reframe some of that narrative, and now that’s what I do with many of my clients.
Meghan: Sounds amazing. It sounds like a painful but amazing journey you had to go through to come to this, but I’m glad you can take what you went through and turn it into light for other people. I know that you talk about the invisible curriculum of medicine.
What are some unspoken lessons that disproportionately affect women physicians, and how do they show up in daily clinical life?
Dr. Leitner: I think that there is a culture of perfectionism and infallibility, and we’re sort of taught not to fail. Instead of here’s what you do when you do fail. We’re taught not to be vulnerable when really we need to be vulnerable. Otherwise, if you take all those emotions that you go through doing the challenging work we do, stuff them down, and never show any of it, and just act like you got it all, it takes a toll on you. You know, physicians and other people in healthcare have really high rates of untreated mental health, comorbid conditions, anxiety, depression, suicidal ideation, and substance use disorders. I think the hidden curriculum is part of what drives that. We are messaged, we’re supposed to be the help, not necessarily that we should need help. There’s so much stigma about getting that or admitting to anything less than this all-knowing physician. That’s the biggest ones, I think. What do you think?
Meghan: I think that’s good. My question is, when we’re aware of this hidden curriculum and all these things that may affect us disproportionately, how do we come to not only a realization, but also learn to help ourselves? Advocate for ourselves in these positions that are really difficult too.
Dr. Leitner: We start by looking at how we treat ourselves and talk to ourselves. For example, if the external messaging is to keep going, work a hundred hours, not sleep all night, not go to the bathroom, not eat, and be universally accessible. The system is so under-resourced and overburdened that you could work 24 hours a day, seven days a week, and never stop. The system is basically just like working yourself to death in medicine. That’s a real overgeneralization, but if you use that inside your own brain. You don’t stop to eat for two minutes, and you don’t go to the bathroom. You don’t say “you know what, I can’t add on that one other patient because then I don’t get home and I don’t see my family and I don’t get to take care of myself like”. These are all small things that we do have control over. Still, oftentimes we are the ones keeping ourselves in this cycle of overworking and under-caretaking. It’s not in any way to blame. It’s like it’s expected of us, and we don’t want to disappoint anyone else.
What I talk about so much is that it’s not that you care less or work less hard, but you have to consider yourself in the equation somewhere. What I see my clients all doing is that I can’t not see that patient. What if my boss thinks this? What if my colleagues think that? It leads to people going to work when they are physically ill, too ill to work. Like, our judgment is really impaired. I’ve had clients who had DVTs, not wanting to get help. I’ve had someone who is a surgeon having Pneumonia, but showing up to the OR. You know, being in preterm labor and worrying about what our colleagues will think if we call out.
It’s like an over fear, or maybe fear isn’t the right word. Still, it’s over-prioritizing the needs of everyone else but ourselves. We can take better care of ourselves than we do. We can. We have to accept all the guilt and all the societal messaging like “no, you don’t matter, just care about everyone else.” You have to reject that. It’s not easy. Partially reject it. We’re so worried about being perceived as selfish that we don’t care for ourselves. It’s very black and white, so we just have to find the areas of gray.
Meghan: To kind of stem off that, Many women in medicine struggle with this internalized perfectionism and that pressure to be good enough. Can you speak on how that mindset develops and how we can begin to shift away from it?
Dr. Leitner: We tend to be like very high-achieving smart women. I’m speaking about the women I know. Part of that perfectionism leads us to strive and excel. So we don’t want to say, be mediocre, but we take it to an extreme.
The way that shows up, the more perfectionist we are, oftentimes, the worse we do. I’ll just give you a little coaching example. It’s like seeing a patient and thinking, “Oh, this is so complicated, I need to get this note right. So I will wait until I have two hours to think about this patient. So I’m not gonna do it now”. We want the note to be so good that we don’t do it now, and then we like to avoid it because we’re like, when am I gonna find the perfect two hours to do it? So we end up writing it significantly later or in the middle of the night when we’re exhausted and the note is not better because we’ve wanted it to be too perfect. The note’s actually worse because it’s two weeks later.
It’s starting to notice like, you know, perfect is the enemy of done. Good enough is actually and sometimes better than when we perfect because the note I write right when I saw the patient is almost always better than the note I write three weeks later when I’m trying to remember what we even spoke about. Because my brain tells me it has to be perfect. It’s starting to realize there’s no such thing as perfect.
Sometimes, the other way I can really get people thinking about this is it’s like, Do you want your notes to be perfect and your life to be horrible, or could the care you give be exceptional but the notes you write are decent, and your life will be more of what you want. It’s sort of like you get to choose, and what choices do you wanna make, and do you like your reasons?
Meghan: Yeah, that’s great. That’s a great way to put it. Do notes need to be exceptional?
Dr. Leitner: The other thing is when we’ve made them so detailed and perfect and punctuated everything. I kind of joke with my clients about it, and no disrespect intended to the New England Journal of Medicine, but the people reading your notes are also overwhelmed and really busy and struggling to get through their day. So they don’t wanna read an encyclopedia in a note. They want the most important information to be abstract, like the needed knowledge, and move on and care for the patient.
It’s just this culture that other people will read my notes and think about me. We also have a lot of fear about what other people think about us, which is normal. Still, sometimes we don’t even realize we are just inventing much of it with our internal negative monologue. So just maybe I’m not gonna listen so much to that. Maybe that’s not what I want driving my behaviors.
Meghan: Speaking about this late-night writing notes and all of these needs for perfection, they lead to burnout. This burnout and moral injury are often discussed as a systemic issue, but it’s also deeply personal. How do you help your clients start to untangle those forces in their lives to reclaim their sense of value?
Dr. Leitner: This is another one that’s like a longer conversation, but I believe the system is the upstream driver of burnout. Physicians often blame themselves. When I was going through burnout, I thought it was me. I just thought I couldn’t handle it. I had a lot of shame around that. This is not intended to shame anybody because most of us work as hard as possible. It’s not about how good we are, but there are more demands for our time than we can provide.
Also, there’s moral injury, which means, let’s say, being forced to act in ways that don’t align with our morals and values. So, like having a limited amount of time with patients and not being able to prescribe the medications we want because we have to, prior authorizations, and all these little, like, deaths by a thousand cuts.
Within the system, we can’t change the whole system today, and we definitely can’t do it if we’re burned out. So I approach this with my clients through coaching: Where do you have agency? Yes, the system. Let’s blame it all on the system. Let’s say the system is horrible. Let’s say, even though there are many wonderful things about our healthcare system in this country. But if it’s not the system that’s gonna change for you to feel better, what can you do? What agency do you have?
Then it comes around to, well, what are the things I’m doing? For sure, it’s paperwork and how much we’re working, but part of what leads to burnout is the belief that I’m gonna take care of everyone but me. I’m gonna have unlimited access. I’m going to be so afraid of missing something. I will work all the time and never be present in my own life. That’s not sustainable for anyone.
Boundaries mean what is and isn’t okay with you. For example, “I am going to have to say after the third double-book on my schedule, you can’t put anyone else on here”. That doesn’t feel good to us. We may think, “What are they gonna think? What are they gonna say? What if my boss does this?” So we don’t protect ourselves.
There are boundaries for other people, time, and boundaries on our schedule, but also for ourselves. We finally get home or go on vacation, and we just don’t even use the coverage we have. We’re like, I’m so worried my colleagues are gonna, you know, I’m the best person to handle that, so I’m gonna take phone calls on my vacation. I will check my inbox for the very little vacation I get.
Again, we are violating our boundaries, leading us closer and closer to burnout. So I tell people, like, if you wanna be there for your patients because you care about them so much, you must dial back. You have to take care of yourself because you burn out and leave if you overwork, overcare, and overgive. Then that’s the worst-case scenario, which is pretty much what I did. I don’t want other people to do that. It’s a reverse. It’s sort of like, yes, you have to worry about yourself, protect yourself, take care of yourself, but in doing that, you are taking care of them ’cause you’re gonna still be around to help them.
I had a client recently, she’s a subspecialist in a very male-dominated field, and she had so much reluctance to let go of things and just not respond to things. So she was always working. Then, she finally didn’t for one week, and we worked so hard. I’m just not gonna jump in to, you know, save everybody or help everybody. She felt so much better the next week when she returned to work. She’s like, I like my job so much better. I felt so much better able to do it because I rested.
It’s like one of those errors. “I think if I work all the time, I will do a better job. If I don’t work so hard, I’ll be more present, more rested, and more able to do what’s needed of me”.
We must also advocate against excessive work hours, inadequate support, etc. We have to ask for what we need, which is not easy.
Meghan: I feel like you have to fill your cup before you pour into others. Right? We say that and preach that to others, but I think no one does.
Dr. Leitner: No one does, well, because it doesn’t feel safe, right? We’re like, “But what will everyone think of me if I do that”? Yeah. Like, okay, but what if we all did it? Then, you know, that’s how we make change. We have to humanize, as I spend so much time talking about. We are human beings who need food, medical care, and maternity leave. Why do we see ourselves as so different?
Meghan: I was focusing on that. Personally this morning I was like, you know, when I was like pre-med, I looked up to doctors as if they were these people who were like super human and just beyond, you know, and the more that the closer I get to being a doctor, I realized like, these are actually humans, you know, we are just as human as the next person. We need to take care of ourselves as well, right?
Dr. Leitner: We make mistakes just like anyone does. We drop the ball, we screw things up, and it’s like, and then we apologize, and we can move on. It’s hard for us to admit to that, and we’re not taught how to manage it. At least I wasn’t in my training. I don’t know if you’ve learned anything about what to do when making a mistake. What do you do if there is a complaint or a lawsuit? How do you handle that? We usually think. Well, it’s not gonna happen to me ’cause I’m, that only happens to like bad doctors. It’s like no. So they teach us to do no harm. I wish they taught us to do no intentional harm because we will do harm. After all, that’s just the nature of being human. So then what? Like, teach us how to move past it. Learn from it instead of beating ourselves up and hiding under our beds.
Meghan: I think that maybe another player to burnout is what is often written and spoken about, the gender pay gap in medicine. Not just as numbers that are an issue, but a reflection of deeper systemic inequities. What do you think needs to change both culturally and institutionally? How do we address this thing that has existed for so long and is still prevalent today?
Dr. Leitner: I have some ideas, but don’t have a solution. I wish I did. I think the movement towards pay transparency is really huge. If no one looks at how much people are being paid, it inevitably shows up repeatedly. So, various states have taken action to promote full transparency and have even passed laws.
In Massachusetts, you’re not allowed to ask someone what their current salary is because we’re just propagating, you know, underpayment from job to job to job. There are systemic things. Someone looking at how much people are paid, people in leadership, like all those department chairs, are being held accountable. So look at your staff. How much are you paying them? Are you taking action to move towards parity and equity? Maybe you don’t get your funding if you’re not doing that, and that’s definitely not happening in many places. I think that would really help on a systemic or structural level.
The thing that I think is really interesting is that, you know, the same way we were talking about if burnout is a systemic problem, but there’s a little bit of control that the individual has, pay equity is a systemic problem, but there really is power that the individual has, and that’s what I love helping my clients do. First, if you don’t believe that pay inequity affects you, you won’t do anything about it. A lot of women don’t believe it. We think: “Oh, but not where I work, they told me this contract wasn’t negotiable”.
One of the things I do in my program is I give everyone MDMA data so we can at least look at the facts, like where they are paid compared to geographic and what kind of practice setting they are in. Even with that, even when I’m showing someone, “You’re an amazing physician. You are paid in the 10th percentile for your work.” Let’s say you’re an oncologist, 10th percentile. So 90% of oncologists working in the same places as you, with the same credentials as you, are getting paid more than you.
Then suddenly we’re faced with, well, women aren’t supposed to ask for money. We might feel greedy if we’re not supposed to ask for anything. We might look greedy. They might have thoughts about me. They might think, “What are they gonna think about me? Maybe I don’t care about money so much. I’m not supposed to care about money because, you know, society tells women they’re not capable of managing money.” There’s been a lot of historical basis for that. We weren’t even allowed credit cards without our husbands’ co-signature until 1974. So it’s only like the last 50 years that women have even felt capable of having their own money without a man supervising them. So all that filters into our psyche.
What I see in my clients is that they don’t actually know how much they’re supposed to be paid. They don’t realize that it’s a fair market value for a role. They don’t realize that when you negotiate, you can do it collaboratively, so you’re not gonna get fired for asking for more, and are expected to ask for more. Most places are not giving you their best offer right off the table. So you need a whole different mindset when you go to negotiate.
You have to believe in yourself and the impostor thinking. So many of us think I’m not that great, so I should be happy to have a job. We always talk about. You know, like you’re JLo, like you are the asset, and you know, you go from residency where you’re underpaid. You have no control. You can’t say anything about your schedule or your vacation or what rotations you do, or how much you’re paid. You have no agency. Suddenly, you’re looking at your first job and still thinking, “I should just take what they give me”. I should just take what’s on the menu.
That’s a huge mistake because even if you don’t negotiate $5,000 at your first job, you know this already. Still, anyone listening who’s like, wait, what? What is she talking about? I’m supposed to ask for more? I didn’t know this. No one taught me that. $5,000 for your first salary negotiation translates into $500,000 throughout your career. We have to take action.
Then there’s all this fear, like “but sometimes women are penalized, or what if I don’t get the job?” There’s a lot of fear. Fear about being perceived in a certain way and magical thinking: “I know what the person’s thoughts are. I’m trying to control that person’s thoughts. I don’t want them to think this about me, so I won’t ask.” It gets very confusing in our minds.
Recently, I was even coaching someone. We found out that the job she was trying to take. We could see how much the person who had had it previously was paid, and they were offering her less than that. So I was saying, “Well, the value for this role is what they’re paying for the role. Not you, but is this role worth this amount?”
She said, ” Well, I’m worried that if I ask for more, I will have to do a better job. I don’t wanna put that kind of pressure on myself”. I’m like, “There’s no correlation between how good a job you do and how much you get paid”. When you’re taking a job offered to you, how would they even measure? So it was just a very strange way of thinking.
Someone else told me recently her contract was coming up again, and she’s like, “I don’t think I’m that great sometimes, so I just don’t know if I should ask for more”. Those thoughts really hurt us. Who’s talking about that? If we don’t change our mindset about our value, and then society is messaging to us that we are less valuable, ’cause we’re seeing white men and all the pictures in all the hallways of our institutions. We’ve been paid less, and we’re being first named, and we’re being told that we’re the nurse. All these things contribute to why we don’t fully embrace our power in our agency and get paid fairly.
So I don’t even know what your question was anymore, but I’m just so passionate. There is stuff you, the individual, can do, and if each of us does the things that we can do, I also wanna mention that. It’s not even all the same for all women, because if you’re a woman of color, the pay gap is even higher. So there are a lot of societal and systemic factors influencing what we can and can’t ask for, and if we’re safe.
I don’t want it to sound like it’s our fault that we’re not paid more because it’s definitely not our fault. I also think we have more agency than we realize if we believe in ourselves more or have someone else believe in us. That’s what I love to do with my clients, because I have infinite belief in them when they don’t have it in themselves.
Meghan: To stem from that, there’s often this fear that advocating for ourselves is seen as selfish or demanding. How do you reframe this idea, and what tools do you recommend for women to advocate for themselves without this guilt attached to it?
Dr. Leitner: Well, some studies show that women are much better at advocating for other women or negotiating for other people than for themselves. So often it’s just looking at, okay, what are you actually thinking about this negotiation?
Oh, interesting. So you think you know that they will think you’re greedy. Well, here’s all the evidence that that’s not true. Most people do negotiate a first offer. Also, breaking down, how would you even know if they thought that? We don’t read other people’s thoughts. Are you greedy? You know? Where does that idea come from and why? Let’s get so curious about why you would even think that?
For example, if your friend went to a job and I showed you this is the median salary for this position, and they’re offering significantly less, your friend would ask for more. Would you tell her, “Wow, that’s so greedy of you”? So much of the time when we think of it that way, we’re like, No, I would say, “You are amazing. You should make what all the men, other people, and other candidates are making.”
It’s just noticing and being aware of how you think about things and seeing if that helps you. You also really need to have a compelling why when you’re gonna do something scary, like negotiate. So it’s like, why do you even want this money? What are you gonna do with it? Is this going to help you retire? Is this gonna fund your kids’ education? Is this gonna help you take care of an aging parent? Are we donating to charity? What are we doing with this?
A lot of it is just education. People haven’t been taught, and they don’t realize. We think somehow that if I negotiate a higher starting salary, it’s coming out of patients’ mouths somehow. So we don’t even understand the finances of how budgets are created.
I think you asked me how I help people not feel like advocating for themselves is selfish? It may be selfish, and that’s okay sometimes. Like, who is going to be looking out for you if it’s not you? So I don’t like that word ’cause it has a negative connotation. Still, it’s like we’re so worried about seeming full of ourselves and being arrogant that we don’t even allow ourselves to take pride in our accomplishments. Let’s just find a happy medium. You know, maybe it’s selfish when you negotiate, but maybe you deserve to be fairly paid for your work.
Meghan: I love that. To bring it all together. For women physicians, especially those who may be early in their careers and are feeling overwhelmed, undervalued, or unsure where to begin with themselves, what advice would you offer as they start to reclaim their time, voice, and worth overall?
Dr. Leitner: This may not be what you think I would say, but self-compassion is the most important lesson for us to start learning from a really early age. What does that mean? It’s just how to be kind to yourself and be there for yourself, because it is not an easy road to go into medicine.
We are, you know, exposed to a lot of trauma, actually, in training and working with people who are so sick and needy. If we’re not careful. Our default is to just be super mean to ourselves. Think we’re the only ones going through what we’re going through. The truth is, it’s not at all.
So, self-compassion is kindly talking to yourself, like you would a friend. It doesn’t mean just being a slacker and being like, it’s fine, you failed your boards, it’s fine, don’t worry about it. It’s not fine, but we tend to say, “You idiot, what’s wrong with you? Why did you do that? Everyone’s gonna think you’re so, you shouldn’t have even been a doctor. No one’s gonna hire you and you’re gonna live under a bridge.” So mean? Instead of, you know what, you tried your best. We’ll hit the drawing board again. This is really important to you. You know, there are many people to whom this happens. It’s not just you. This is part of being human.
This goes back to the messy human part of this talk. It’s like humans are messy, and they make mistakes and fail sometimes. What if that’s okay? So just starting to have that kind of relationship with yourself, it’s not. Easy, even just to notice, I’m not being very nice to myself when I say that.
I used to go through my day being like, I’m really bad at the exam. My notes aren’t as good as everyone else’s. I would constantly say so many mean things, and now I am much more aware of that. You can even say that’s not very nice when you say that to me. Ouch. That hurts when you tell me I should never have become a surgeon. It’s not nice.
So how else do I wanna relate to myself? So I help get myself through the hardest parts? How do I find my community? How do I find other people? Who are open to being vulnerable and discussing what it’s like to do what we do.
In my community, so much of the time, people say, I thought it was just me. I had no idea other people felt insecure. Sometimes, even people like heads of departments who have been doing it for 30 years think, “I don’t deserve to be here, or I feel like I’m faking it”. It’s good to know it’s not just us; it’s human brains.
Meghan: Yeah, but it all starts with somebody saying something, right?. Somebody has to say something first to get that conversation started. Thank you so much, Dr. Leitner, for being here tonight. This has been an incredible conversation. I’ve had a great time.
Dr. Leitner: Me too. Thanks for having me..
Meghan: So that’s a wrap on this episode of Our Voices Our Future. We hope today’s conversation inspired, challenged, and reminded you of the power of raising your voice. The fight for equity doesn’t stop here. Join us in the movement. Subscribe wherever you get your podcast. If you love this episode, share it with someone who needs to hear it. Until next time, stay bold, vocal, and keep the conversation going. This is Our Voices, Our Future.
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About the Authors
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Vashti Price, MS3
Vashti Price is a third-year medical student at St. George’s University. She holds a Bachelor of Science in Biology from the University of Louisiana at Lafayette, a Master’s in Biological Sciences from Alcorn State University, and a Master’s in Health Sciences from Meharry Medical College. With a strong passion for public health and health equity, Vashti has dedicated much of her time over the years to volunteering with underserved populations, including individuals experiencing homelessness and children in need. Her commitment to service continues through her involvement with the American Medical Women’s Association, where she serves on the Gender Equity Task Force and the Sex & Gender Health Collaborative Committees. Vashti is particularly interested in the intersection of medicine, public health, and community outreach. Outside of her academic and clinical pursuits, she enjoys spending time with friends and family, attending festivals, exploring new cities, and winding down with a good Netflix series.