I’m Rachel Gerson. This is the Tunnel of Truth podcast. We jokingly refer to the CT scanners as the tunnel of truth in radiology because they tell you all the answers. Today’s guest is Dr. Yoshimi Anzai. She is Professor of Radiology and Associate Chief Quality Officer at the University of Utah.

I lost my father earlier for surgical complication. He had a gastric ulcer. Back then, long time ago in Japan, they thought the gastric ulcer will become cancer. He ended up having subtotal gastrectomy because of the gastric ulcer. I know now it’s treated with antibiotics, but back then, they thought it’s going to becoming a cancer, therefore need to be removed. I think he had a surgical complication and then passed away. So, that triggered to thinking about medicine is the area that I might wanted to focus, but it’s something that I could help other people. That’s the things about medicine is you feel rewarded by helping other people.

You trained in Japan, is that correct?

Yes, I was. I was born and grown up in Japan. It was unusual. We had 120 medical students, and it’s only 16 were girl. Now, it’s close to 50/50, but back then… I think 16 was a big number because a class above us only had eight. It’s unusual for woman, particularly Japanese woman to pursue medicine.

What was that like for you to be one of 16 in a class of 120?

It was great. I enjoyed it. I mean, it’s like we take a granted woman’s a minority in the medical field, and we had a very strong woman, very tough and then very determined.

Did you know what field of medicine you wanted to study?

I liked kind of head and neck, like an ENT field. Although I liked, also interested in plastic surgery. Although plastic surgery was a more new field and more function rather than treating a cancer, that kind of things. But I went to Tokyo University for plastic surgery program. But they say, “Oh, no, we can’t take women because we only have one call room.” I didn’t understand what that means, but apparently there’s some nudity posters and all these things in the call room, so we cannot have a woman. And then, I went there with my male colleagues and then he was accepted right away like, “Yeah, you are sure. He can come. But you, no, a woman, no, we can’t have a woman.”

Because they were posters on the wall in the call room?

It’s like, “Wow.” Radiology was relatively very new field back then, and they didn’t have a woman. Women never chose to go to radiology. They all went to ophthalmology, dermatology, internal medicine, OB-GYN. So, radiologist like, “Well, we want to have a woman. We welcome. We wanted to have you.” And it’s like, “Okay. Well, I will be there.” So, the professor, the chairman of radiology back in Chiba University was super excited. Now, we have a woman resident in our department. He was very supportive of me, and then did anything to help my career well.

He was like, “What are you interested in?” I was like, “Well, I think this magnetic resonance sounds cool.” It wasn’t new. I want to do that instead of angiogram, because angiogram sounds like really radiations and wearing a lead apron for all day long. So I got, “Okay. From now on, Dr. Anzai will do MRI or something.” That was possible back then. And then, I was running part of this institutional PI on a clinical trial for MRI contrast agent and things like that. It was just impossible for training to do, but he really wanted to support me and make sure that I will be successful. So again-

Wow, that’s great.

… huge mentorship, sponsorship.

Yeah, that’s amazing to have those opportunities at the resident level.

Yes, yes. And then, I could go on for ENT for a long time, but I thought like, “Well, there are a lot of ENT surgeon here, but I want to go back to become head and neck radiologist.” This is how I went back to head and neck radiology field.

Wow, that’s great. Did you do that training… When you sort of focused on head and neck, did you do that in Japan?

I was, but then, there was not enough head and neck radiologist back then. There’s only a few. I wanted to go to UCLA where there’s a bible called magnetic resonance and then MRI and CT of head and neck there by Tony Mancuso and Bill Hanafee. That was my bible. I highlighted every word and all these comments and things. One of the author, Bill Hanafee, was at the UCLA. So I said, “I want to learn from the best of the best,” and this is how I went to UCLA back in 1990.

Yeah. Tell me more about that transition from Japan to the US. It can’t have been easy to switch from your training there to the US medical system.

Yes. Because I worked hard and everybody said, “Well, you probably want to stay here a little longer.” I just enjoyed being there. So, start taking board exam and maybe wanted to practice here for a while, the real medicine, not as a researcher. And then, I wrote the letter to American Board of Radiology, and I was told I have to do four year radiology residency, so I start looking for a residency program again. And then, I was able to do that at the University of Michigan, which was really phenomenal. So, I moved to University Michigan in 1994.

Wow. Were there challenges in doing that and having to go back to the beginning and having to train in English, those kinds of things?

Yes, absolutely. I didn’t speak English at all. Also, not only that, I didn’t understand that regular conversation.

Was it an obstacle for you or do you feel like people were supportive of your learning English?

I think it was obstacle, but I think people are very supportive at UCLA and also University of Michigan.

How was the experience of having to repeat residency?

Yes. People say, “Oh my God, that poor things. You have to do residency.” But to me, that was a great decision. In fact, the Japanese radiology training is different. They were more super sub specialized earlier in the phase. What do you like? I like head and neck, then you go to head and neck. But it’s not a standard full big foundation of radiology training, which I was able to do that at the University of Michigan. The hardest things was that I was doing a clinical trial at the UCLA as a kind of assistant professor, and I had a office and secretaries to first year radiology resident. The pharmaceutical company was calling me, it’s like, “How can I find you? Who is your secretary?” No, I don’t have any.

When you were at UCLA or in Michigan both, was there the same gender disparity that you had encountered in Japan?

Yes. Definitely, the woman minority in radiology, everywhere, even back then. Only things though, there’s normally that our residency class, eight of 10 were women.

In Michigan?

Yeah. History of University of Michigan residency program, but we have about eight out of 10. In the class of… Was it 1998? Yes, were women. So, it was blast and it was fun.

Where did you go from there?

From there, I went to University of Washington in Seattle. I think there was opportunity for both my husband and I to get a job at University of Washington. And then also, we had a baby and close to Japan than West Coast and Detroit. So, that was kind of a easy move for us to say maybe we were closer to Japan. So the West Coast and then the Seattle job opening up, so we decided to move.

Did you have your baby during residency?

I had when I was fellows to first year attendings. It was a hard, and I think that was the hardest thing. I got only six weeks of maternity leave, not 12 weeks. And then, six weeks, a full weeks plus two weeks of vacation or something. The six weeks of baby is so little. Going back to work full time to finish fellowship and being attendings was very difficult, I would say. I think I was pregnant through the fellowship, and I had a baby when I was the first year of attendings.

Wow. Did that leave you with no vacation?

Yeah. Because I didn’t have a existing how many years of service or something that accumulated because it was a first year, so I couldn’t get the three months off that many women that stayed there for a long time and then having a baby. I was a first year, so I didn’t get that benefit, and it was very difficult. I felt like that was the one of the hardest things that I did was going back to work in six weeks and full-time as a new first year attendings.

And a new mom.

New mom. Yes, yes.

Tell me about the University of Washington when you came there.

University of Washington was great. Again, we had a very supportive family and supportive faculties and department. Still very male dominated when I moved. There’s still many senior professor that are male and only a few women or professor back then. But I think overall, culture’s a little bit more inclusive, try to help each other. We had a great neuro section, and I really had a great time working there for almost 15 years.

I know in academics there’s a progression up to professor and those kinds of things. Were there challenges in moving through that process?

Yes. I think many women struggle because those junior faculty time is about the time that you have children. You can imagine when you go home you have small children that you have feed them or bathe them or play with them or doing a homework, to really doing academic work for writing a book chapter or a presentation. It’s very difficult to do all of that. So, I do notice that the challenges exist for academia, particularly for junior faculty ascending to associate professor.

I know you’ve been involved in the American Association of Women Radiologists for a long time. What was the importance of that organization in your career?

I think AAWR was just phenomenal, just wonderful organization. I met so many amazing women through AAWR that I never ever dreamed of meeting with them. Because for you, I mean, I am neuroradiologist, so my networking is just around neuroradiology. But AAWR is not specific to any specific radiology. You have amazing people from breast imaging, pediatrics, to body radiologists, to interventional radiologists, so your network is much broader. And then, we have a common sense of purpose that we have to elevate all the women and then have them fulfill their potential. That camaraderie and also supporting environment was really, really benefit for me for very long time.

So, I’m really committed for AAWR because I think a woman need those community that you feel like you belong to or you are able to speak your heart, rather than confined to what I’m supposed to say. But being able to talk about things, like childcare issue or on-call challenges and all of that, because we need somebody to hear and agree with us.

Did you feel in your workplace that people didn’t want to hear those things or talk about them?

Sometimes, the senior male people don’t want to hear all the women, like, “I want this. I want this. I want this.” But we had a few women that are senior women that are willing to stood up. But I think we do need to have a woman leader at the top, very top. We had a radiology director, her name is Wendy Cohen at the Harborview Medical Center. She was very tough and very outspoken. So seeing Wendy, I was very inspired. She can call neurosurgery chair and say, “Why did you order this?” It’s like, “Oh, I can do that. She can do that.” I may be able to call neurosurgeon, “Why do you order this?” And maybe questioning or maybe having a conversation, maybe the other studies are better. But she’ll pick up the phone call and then talk to them.

I was very inspired like, “Okay. Wendy can do it. I can do it.” I think seeing someone who is willing to not to just do whatever they order, but rather they’re questioning them because we are the medical expert. We should know what the indication was, the study to be done given the circumstances. And then, I think it’s good to see that role model that somebody feels strong and kind of inspirational.

Right. Did you ever get pushback from people when you did make those phone calls?

I think they might be, but it’s the right things to do. Pushback is inevitable if you try to make something improved or try to make changes in any organizations or program. Pushback is inevitable. If you’re getting a pushback, that’s good. You are kind of a right zone. If you are all getting a pushback and no support, then maybe you’re pushing too hard. But some pushback, some support, I don’t know, that’s a good mixture.

Yeah, that’s a good perspective. I like that. Tell me about your transition to the University of Utah.

University of Utah, part of it was a family reason and my husband became Chair of Radiology at University of Utah, but we had a strong leader, Dr. Vivian Lee, was at University of Utah. She really want both of us to join University of U Utah. So, I had a new job, that associate chief quality officer, which is more operational job than academic job that I had in my whole career. That was a completely new experience.

Was the culture different at the department there than at the University of Washington

Department of radiology at the University of Utah was very, very, I think, collegial and inclusive. Part of that is that we have a very strong women leaders in a department for many, many years. Dr. Anne Osborn, a neuroradiologist, and Dr. Paula Woodward, a body radiologist. There’s just phenomenal legacy people. So really, the women’s empowered, and I think we still carry that tradition of very strong women leadership in a department.

But I think the University of Utah or the State of Utah itself has a different culture. The women tend to stay home, raise children, and taking care of housework. And then, that’s what the mother did, a grandmother did, and aunts and sisters, and then all of that. So, it’s very difficult to understand the woman could be professional and as good as, even sometimes better than men. That’s a very difficult concept. So, there was challenges for that, but I’m just seeing newer generation is getting more acceptance of women professionals.

Do you see that with regards to patients who look at you differently or how does that play out in your professional life?

That’s interesting because if I’m a diagnostic radiologist, so I don’t have a lot of direct patient interactions. But I think the procedure person, like interventional radiologists, women’s perhaps a lot of degree treated differently or trusted less than a male colleagues. And then, I hear that, oftentimes, that not only patient but some staff member, for example, like nursing and other technologists, treating a woman physician differently than a male colleagues. I think that that is always pervasive, and it’s sort of a cot microaggression that we have to encounter all the time. Yes.

Is there much of a Japanese community at the University of Utah?

I think that the racial diversity is lacking in the State of Utah. I think it’s something like 87% of state populations are white. I think maybe not that bad, but the 13% Hispanic and 2% Asian and 1% African American, something like that. Our department, 14% of faculty are Asian. Academia is a little better in terms of racial diversity. But I think what we need to push is more inclusive culture, because diversity is kind of a headcount or ratio, percentage, but how we treat each other well with respect and understanding our difference in culture, we should push that inclusivity regardless of the diversity status. I think that that’s where our department is trying to do is more doing some cultural event, not only race and gender, but sexual orientations, to ages. Ageism. That we tend to have some ageism, and we need to make sure that the senior people still feels empowered in a department. I think that those are very important.

That kind of segues nicely into just talking about inclusivity and access for patients. What is the experience like of patients coming through the department, and how can we make that experience equitable for everyone?

Yes. I think that there are a couple pieces. One, the patient coming to radiology department, we want to make sure that every staff are well trained to treat the patient equally or with respect. Particularly some culture pieces that I hear is ultrasound of the pelvis, all of the things, and some cultures are not comfortable having those procedure, and how do we communicate that with those procedure and in detail with the patient and also family member. So, I think it’s important for us to be part of this technologist. They are frontline of performing those procedure as much as trainee.

The other pieces is that a patient with maybe lack of resources don’t get imaging study. That’s a bigger issue because we don’t see them. They are just not receiving care or receiving an imaging study because of the concern for out-of-pocket expenses, no insurance coverages. And then, that’s a bigger challenges that we have. I was a part of the team that developed the price transparency tool. It’s not a charge master that how much the hospital charge, but rather how much they cost to the patient. And then, we need to be more upfront and disclose that to patient before deciding, “Should I get a CT scan?” Or, “Should I get a x-ray?” We need to go to the places where minority patients are there. We are not in a community where the care is needed.

So, University of Utah is trying to go to the west side of the city that has more diverse population, but it takes a little bit of effort and then support because the transportation issue, because they have language barrier too. They probably don’t feel like if you don’t have a similar racial background in the check-in desk or information desk or in a parking situation, all of that affect the patients access to care. In addition to insurance coverages and then financial challenges, but we really need to be in the places where care is needed to address the health disparity.

What are ways we can promote people of diverse backgrounds in the profession of radiology?

I think it’s very important for a trainee to have that inclusive culture and also reach out to more diverse background medical students. The radiology, the bottleneck is medical student to residency. This is why 50% women go down to 23% or something, like less than half. Also that we don’t recruit culturally racial diverse students to radiology. You cannot be what you can’t see. You have to be able to see and then visualize. I can be this person if I work hard and study hard for 10 years. That kind of role model is little lacking.

So, I think it’s important for us to have the leadership, either chair, vice chair or whatever, program director that has a very diverse background. I think that has to be very conscious effort, not just by chance, because we’ve been asked sort of hoping that’s going to happen one day, but it doesn’t seem to happen easily unless you have a more proactive conscious effort to promote the diverse background faculty to lead an organization. And when medical students see that and then they say, “Oh, maybe I can be that person.” I think that is needed. I think medical students is where we just lose a lot of culturally diverse students into radiology field.

When you look at the trainees that are coming through your program now, do you see similarities to the experience you had? Do you see that they encounter similar challenges or have things evolved?

I think they’re getting better because the younger generation of people have a different mindset in terms of race and ethnicity or gender or sexual orientation. They’re so much more accepting the differences than our generation. So, I think that’s the hope, is that our generations are more inclusive or more accepting of differences. And there are a lot of people who had a multiracial background, because if you have an interracial marriage and having a children, and then they’re not going to be 100% something, but rather 25% of this and 50% of this and whatever.

I think by going through the multiracial family and the younger generation of people, and then they realize that that is cool things, not bad things. I don’t know. I just don’t speak all of them. But when I’m seeing my daughters, their reaction to race and gender is a little different than what I experienced. I think that people are becoming more accepting of differences than the segregating or the discriminating because of the differences.

Yeah. Well, that’s hopeful. Tunnel of Truth is partially funded by the Washington State Radiological Society’s Committee on Women and Diversity. We are also a proud recipient of a 2022 American College of Radiology chapter grant. If you’d like to share your story on this podcast, visit our website, tunneloftruth.com. These stories can be difficult to tell. We create a comfortable recording environment and can keep your identity private should you wish to maintain anonymity.