Authors: Meghan Etsey, Vashti Price, Dr. Mai Pham
“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.
Meghan: 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. Today, we’re welcoming Dr. Mai Pham, founder and leader of the Institute for Exceptional Care (IEC), and a national leader in payment policy and healthcare transformation. Thank you for being here with us today.
Dr. Pham: Thanks so much, Meghan. It’s a real honor.
Meghan: Can you share what inspired you to pursue a career in health policy and how your personal or professional experiences helped shape your understanding of gender equity along the way?
Dr. Pham: That’s a big question. I’m proud to report that I was one of the world’s most reluctant premeds. I am a first-generation immigrant, and in many immigrant families, at least back when I was young. Your choices were teacher, doctor, lawyer, and I knew I wanted to help people. I also knew I didn’t have the patience to be a teacher like my dad. So I went into medicine, but what I did was I took a gap year. Back when it wasn’t popular yet between college and medical school. I worked for a public health attorney who was an advocate on Capitol Hill for vaccine development and immunization policy. She and I also worked on issues related to women and HIV, which in 1990 was a new thing. I was exposed to wonderful grassroots efforts, including the International AIDS Conference. That was when I got smitten. I finally could put a name to the thing I felt drawn to, which was policy. I’ve had an interesting career, partly because of it. I didn’t really have a set path in mind. I was trying to follow my belly and make changes in those areas that enrage me the most. That often meant putting myself in rooms where I was nearly always the youngest person, certainly the only woman of color, and oftentimes the only woman physician. I’ve had to grow up in that world, so now it’s an honor because, for the first time in my life, there are so many women in this space doing this work now. I’m glad to have all these new playmates.
Meghan: Yeah, I think it’s cool that you said this before, you were kind of the only woman, especially a woman of color in the room, but now you get to have a lot of people around you. You’ve seen the change of things happening first and foremost, which is super cool. Over the course of your career, what have been some key lessons you’ve learned about promoting gender equity within policy spaces, especially in those environments that may not have been receptive or inclusive at the start?
Dr. Pham: There have certainly been moments in my career when I have done what I thought I needed to do to quote unquote get along. If I’m honest with myself, the moments of breakthrough when I felt like I made the most advances in putting my ideas and making the change I wanted to make out there were moments when I was most myself and least inhibited. That wasn’t always easy for other people to receive, but I say that because we’re all unique. When we try to suppress what is unique about ourselves, we come off as vanilla and not memorable. When you are authentic, you are, for example, authentically conveying the panic you feel for poor people and what happens to them in a system where financial incentives are really dangled in all the wrong places, which conveys that it’s authentic. It gives you a voice, something that is worth listening to.
Similarly, when I moved from doing research into government, I ran programs, created policy programs, and payment structures. Most leaders I worked for didn’t understand research, and I had to authentically convey to them what that meant. You come to learn that the unique combination of what your background comprises and a lot of who I am is my gender. That unique combination makes you valuable to others, especially those counting on you. When you staff a political leader or a policy leader, you’re trying to keep them safe. They feel safer when they feel like they are hearing that unspoken, lesser-known perspective because it’s less likely that they will miss some important issue. Does that make sense?
Meghan: Yeah, absolutely. Gender equity in health policy is often influenced by who’s at the table making those decisions. What challenges or barriers have you observed either personally or systemically that prevent women or gender diverse professionals from accessing leadership in health policy?
Dr. Pham: It is a matter of finding, building, and maintaining the right relationships. I haven’t always been the most efficient or effective at that. I fully grant that I have seen lots of boys’ clubs. They’re good people and well-intended, but you gravitate toward people who are familiar to you and make you feel comfortable. There are such things as healthcare pros, and you have to decide how much you want to interact in that world. I think for me, the lesson learned was that at some point, you have to be honest with yourself about what you’re willing to do and what you’re not. I’ve had a few opportunities to consider whether I wanted to be in the C-suite at some rather large healthcare organizations, in both the public and private sectors. A small part of me still says, I wouldn’t turn it down if the opera were made, but a much bigger part of me decided quite definitively, you know what? I don’t like what people have to do to get there, and I don’t like the people who are there when they behave that way. That was one reason I found it much more compelling to start my own nonprofit. I wanted to create a leadership space that I wanted to be in. That’s a hard lesson learned because you know, you’re young and ambitious. You’re chasing this wanted kind of role, industry leadership, and you want to be the kind of person who has done these things, has collected these titles, and made these decisions.
But there is a price to pay if you’re not in the right space.
Meghan: Very fair. Let’s shift towards a little bit more of one of your areas of advocacy, sexual and reproductive health for people with intellectual and developmental disabilities. This is a population that’s often overlooked in policy design. How did you first become engaged in this work, and what gaps did you notice when you started?
Dr. Pham: So this is interesting because when I was a resident, I knew very little about intellectual developmental disabilities. I was taking a required medical ethics course. For that course, I did some research and wrote a policy piece about the sterilization of women with intellectual disability. I got it published, and it was actually what launched me into my fellowship. Then, I didn’t think about it again for many years. Then I became a mom, and my second child, Alex, who’s now 22, is autistic. They have recently, I would say within the last four years, they’ve been on their own trans journey, and that has actually gone beautifully, but it wasn’t guaranteed that way. So learning alongside Alex and learning from Alex, what all that meant.
At the same time, at the Institute for Exceptional Care, we were doing projects where we were trying to learn from the disability community what health outcomes are most important to them. I was not shocked when sexual reproductive gender health and parenting were named as their own key domain of health outcomes that were important to the community. What surprised me were all the nuances of the mistrust, the harm, the access challenges, and the struggles people go through daily to feel. Dignified and respected, and served in the ways that they need. Did you know that many adults with IDD or adolescents with IDD are never asked by their clinicians about their sexual health? We shouldn’t assume that people don’t want to have a sexual life, and we shouldn’t assume that people don’t want to be parents. There are plenty of people who are neurodiverse or have intellectual disability who are also parents. That is part of, for many people, having a fulfilling life, and that’s supposed to be the goal of health and healthcare, which is to help people thrive. So there’s that issue. We aren’t nearly as far away from forced sterilization as we would like to think. We’re not far away at all. Just two or three years ago, we saw a report from Canada that documented 60% higher maternal mortality for women with intellectual disability and for other women, and that is not biology. That’s about their interactions with the healthcare system. Whether that’s prenatal care or communication challenges when they’re under stress or their sensory needs that aren’t taken care of, lack of explanation, whatever it is, we can do a lot better. Then, I also don’t know if it’s commonly known in the medical community that people with IDD have a much higher prevalence of queer identity. Then people who are not, and in particular, a much higher prevalence of trans identity. This may have a biological basis. There’s some reason to think that.
Nevertheless, it’s stigma upon stigma upon stigma and challenge upon challenge to find a trusting care relationship, allowing people to open up and enabling them to advocate for themselves and get the services they need. We ended up, Alex and I, choosing for their gender care a free clinic in the city that has served the queer community for decades. They were one of the barrier breakers in the early HIV epidemic. So it was not surprising that Alex would feel comfortable there with a wonderful primary care clinician. It could have all gone so, so wrong. So finding those best practices and helping clinicians build those very basic skills and knowledge so that they feel more confident and not so anxious and put off when a quote unquote different patient shows up are some of the most important things about IECs’ work.
Meghan: So, like you mentioned, there are often harmful misconceptions that people with IDD are asexual or that they don’t need reproductive healthcare. What would you say is the most urgent policy in clinical changes that need to be made to ensure a more inclusive, respectful, and comprehensive care for these individuals?
Dr. Pham: I think that if you are seeing anyone, any adolescent or young adult, you should be asking them about their sexual life. You should be doing those screenings. You should open that door to a deeper conversation about what’s important to them and their goals and fears. Giving them basic sexual education so that they can take care of themselves.
Assessing sexual safety is a huge thing for this population. Especially, for people with disabilities who are gendered in a way that exposes them to even more potential harm from sexual partners or from family members, or other people in their lives. Those are some really, really basic skills. People don’t have to become experts in transgender care. You have to be an expert in humanness and be consistent in what you offer all your patients. I know this sounds contradictory to being consistent and tailored in your approach. You can consistently ensure you’re asking and offering, then tailor it to how you do it. Tailored in a way that uses plain language, and maybe do some physical demonstrations of using contraceptive devices or methods, or in a way that you refer people to peer support groups. Coaching them about how to recognize the signs of potential abuse and giving them resources to reach out for help. These are, I think, things that are easy for clinicians to absorb. It’s a matter of convincing yourself that you know people; some people need this more than others. So you’ve had a career that bridges policy, equity, and care for historically excluded populations.
Meghan: What advice would you give students or early career professionals, especially women who want to lead with equity in health policy or advocacy, who may not know where to start?
Dr. Pham: I have several bits of advice. One is not to chase a topical area because it seems important. Chase it because it’s what enrages you and where you want to make change. The second thing is, don’t underestimate the power of your technical training. Yes, the credential helps for sure, for good and bad, the MD for some reason. Takes you into more rooms than other degrees might. It’s how the technical training shapes the wiring in your brain and your ability to systematically analyze situations and factors that drive a particular outcome, whether clinical, in the marketplace, or at a policy systems level. That’s really worth leaning into. I feel like we should sprinkle epidemiology into the water system because I think we’d all be better citizens if we all understood that kind of thinking and approach to problem-solving. I would say reach out for mentors and try different things. There is no one great path. If you are not sure what platform or venue you want to be in when you do this practice. It’s good to find a postgraduate training program that gives you a community while you gain some additional skills. That community will launch you in terms of mentorship and connections that help you find interesting positions later in ways you can’t predict. Then beyond that, you know, it’s all about specifics and how to do this while raising a family, if that’s what you wanna do, or living in a certain place.
Meghan: I think that comes back to more mentorship, right? It’s great to have people who have done that before. You kind of give your advice on how to navigate life with everything. So thank you so much today for this conversation and all your insight. It’s been a great talk.
Dr. Pham: Thank you, Meghan. It’s such a great idea to have this podcast as a steady source of inspiration.
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.