Dr. Karen Ordovas:
I usually joke that if you are a woman, blonde, and have an accent, those three things together already make people think that some weird things are going to come out of your mouth. You’re going to sound stupid.

Rachel Gerson:
Dr. Karen Ordovas is a professor of radiology from Brazil. She’s a leader in promoting cardiac health for women. 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.

Dr. Karen Ordovas:
One interesting thing is a radiologist usually when clinicians come to the reading room, they see four or five people sitting around in the dark in stations and they pick who they want to go to discuss the cases. Being a junior faculty, it was really noticeable that every time a team would come into the door, they would straight go to the resident or straight go to my male fellow. And when the fellow had challenges with the case, he would call the attending and then they would notice that the attending was actually the female sitting next to them. It would be very noticeable as a junior attending. As you start getting known to the people in the hospital, it happens less and less obviously.

Dr. Karen Ordovas:
But I recently moved to a different institution, so I’m now the section chief of chest radiology here and all my other colleagues are male in the section. I noticed several instances that I’m the least likely person to be the chief of the section when someone approaches the group. Other examples, for example, when the phone rings. This happens every day and now I make a specific effort to point that out so the next generation of women radiologists will not have to go through that. I answer the phone, “Chest radiology,” and then the person says, “I want to speak to a radiologist,” or, “Can you transfer me to the radiologist?” Or immediately assumes I’m the secretary answering the phone. Then some of my male colleagues said, “Oh, you should answer, ‘Chest radiology, Dr. Ordovas speaking,’ so that problem is gone.” I said, “Well, do you have to do that, or you just say, ‘Chest radiology,’ and they don’t ask you to transfer to the doc?”

Dr. Karen Ordovas:
It’s something subtle, but I made a special effort to point that out every time that happens. I say, “I’m the radiologist. Why did you assume I was not the radiologist if you called the reading room?” just to put that person on the spot, I think it makes them reflect.

Rachel Gerson:
Did you train in this country?

Dr. Karen Ordovas:
I did medical school and residency in Brazil and I came here for post doc research fellowship in 2003. Then I did a four year training here as a post doc and then as a fellow. So I did train, but most of my medical training was abroad.

Rachel Gerson:
Have you noticed differences in your experience here versus back in Brazil?

Dr. Karen Ordovas:
Yeah, I would say there are similarities and there are differences. In Brazil when I was training, there was not the notion of politically correct that sometimes we see here that people do things because it’s politically correct and not because they believe in it. Whereas in Brazil, there was no such thing. If someone thought, “Oh, I don’t want to a female resident to do that, they would just say, “Oh, I don’t think you should be doing this kind of studies because you’re a woman.” You would know this right in your face. Whereas here, it’s harder to notice because it’s hidden, it’s in between the lines because of the rule of being politically correct. So different challenges, but basically the same assumptions and the same things.

Rachel Gerson:
Interesting. In your movement in the academic world, how have you felt that being a woman or being from Brazil has impacted your ability to move through the academic ranks?

Dr. Karen Ordovas:
That’s a great question. I think the most obvious example I have is really referring to jumping up the academic rank. There’s usually a mentorship program and as I started as a junior faculty and as an assistant professor, you’re expected to be five years on that rank until you go to associate professor. So many times during those first five years, I’ve had people counsel me that I could hold the clock, that’s what they call it. I had two babies in that interim, so I had to take time for maternity leave and I could hold the clock. I could certainly put a petition or a request to extend that to up to seven years as a assistant and I wouldn’t be hurt by that. But I was never ever given the advice that I could accelerate my course, accelerate to be promoted. I didn’t even know there was such a thing.

Dr. Karen Ordovas:
When I noticed my male colleagues suddenly being promoted to associate, I was like, “What’s happening? It’s been three years only. Why are they being promoted?” Oh, they were accelerated. And it turns out that I had the same or even more achievements that I should have been accelerated for, but no one ever thought about telling me about acceleration. They just told me about how to hold the clock. Isn’t that impressive? So I made a point to every junior faculty I mentor, I talk about acceleration, men and women. I say, “This is what you’re expected to, but if you perform better than that, you’re going to be accelerated.”

Rachel Gerson:
That’s so fascinating because I think even for example, in the talk I heard the other day about promoting equity for women in academics, that aspect has never been mentioned. I only ever hear about the option to extend when I have a child or something like that. Fascinating.

Dr. Karen Ordovas:
Exactly, yeah. I made a point out of it and I applied for two accelerations before I left that institution. The last one I already knew I was about to leave. I was like, “I want to still apply for this acceleration and be promoted because I need to make a point.” I have a very clear example because I have a husband that has the exact same profession, exact same career. If you think about it, he’s a year ahead of me in training. Things that were brought up to him and that were never brought up to me, make it obvious to notice the difference because things that I noticed that are specifically related to gender.

Dr. Karen Ordovas:
I have a few examples actually of when my husband and I were in radiology events and some assumptions happen leading to uncomfortable situations, if you will. There was a time that it was one of the major radiologists societies in the United States and there was a special dinner with the president and with some committee leaders. That specific meeting was to connect with the leadership in radiology from Brazil because they were planning the following meeting was going to be a combined meeting between US and Brazil. It turns out that I was in the international committee of that society and I was the liaison for connecting with Brazil and organizing that meeting.

Dr. Karen Ordovas:
My husband and I walked into the dinner with our IDs, we are greeted and we are seated, and we are introduced to people. Then the meeting starts and when the meeting starts, the president immediately introduces my husband as the liaison for the Brazilian international meeting. It was so shocking and I think it was the vice president or someone right next to him just said, “It’s actually Dr. Ordovas that is the liaison.” He’s like, “Oh, yeah. No, I understand. It’s the couple.” It’s not the couple, it was my role, not my husband’s role. Suddenly it became the couple’s role. But it’s just interesting how it was immediately assumed that I was the wife and he was the person performing the task.

Rachel Gerson:
So blatant.

Dr. Karen Ordovas:
Yeah, and that actually happens quite often.

Rachel Gerson:
You’ve mentioned a few times the advice you’ve given to younger faculty coming up. Do you feel like there are formalized ways to address some of these issues in your institution or does it rely on people like you who have had these experiences to really make the change?

Dr. Karen Ordovas:
Well, I think more and more, there are formalized ways and are forums for us to discuss those things. The personal mentoring and sharing your own experiences and how you handle those things on a one-to-one level is sometimes much more efficient than sitting around and discussing how the entire group should care about gender equity. I’m actually now developing a mentoring program. I structure mentoring program in our department of radiology, because when I came here, there was not such a thing. There’s some informal mentoring here and there, but I really believe in mentoring. So I made a proposal to develop this program and the chairman was very supportive.

Dr. Karen Ordovas:
One of the main motivations is being from a minority medicine, I know that mentoring specifically helps achieve equality, so I’m dedicating a lot of my time to that. Also in professional societies that I’m part of, but this time I decided there’s no mentoring, so I’m going to put myself out there and create a mentoring program. I took some courses on it and I’ve been mentoring for the past 15 years. I thought it was time to go to the next level and promote mentoring. I’ve heard people saying that they totally don’t believe in mentoring, that it’s something that doesn’t help at all, just wastes time. One person’s experience is not the same as others. Usually when someone tells me that it’s a white male, that tells me they don’t believe in mentoring.

Dr. Karen Ordovas:
Actually, when I was proposing a similar program and in my previous institution, I proposed to the chairman and he told me with those words, “Oh, I don’t believe in mentoring. I don’t think we should be focusing on that. I think you should focus on something more important.” Sure enough, he’s a white male and it was everything went naturally to him, happened naturally. He didn’t need that mentoring to achieve what he wanted to. For women and for minorities in radiology, I think mentoring is really crucial.

Rachel Gerson:
Yeah, I think that’s super important and interesting. I’m curious a little bit about how we address changing the culture so that men too change the way they do things, so that we don’t just have to mentor women to navigate the system as it is. Do you have thoughts?

Dr. Karen Ordovas:
Well, yeah. Absolutely, I think the mentoring shouldn’t necessarily be focused on females, but I think mentoring the young radiologists to work in a diverse environment is key. And for them to realize that and appreciate that, they need to see that in their faculty and in their more senior members. To create a structure of leadership that is diverse, brings up for the next generation the idea that’s how things are and that’s how things work when you have diversity in all sorts of leadership position.

Rachel Gerson:
I don’t know if you have any experiences like this, but I’m curious, as Dr. [inaudible 00:12:17] in her talk the other day made a mention of the impact of the Me Too movement on the world at large, but also the healthcare professions and if you have any instances or awareness of issues related to harassment within the workplace for women or for yourself?

Dr. Karen Ordovas:
I can’t think of any specific situation. It must be because my exposure to harassment started so early in life that I’m used to navigating it. In the Latino countries it’s expected of the men sometimes to show interest in the woman, even in the workplace. To treat women differently. It’s the norm to have, I wouldn’t say harassment in terms of having a more senior or a supervisor treat me in a different way because I was a woman, unless I would have some relationship with them, not in that way. But always insinuating that how you’re looking great and how your clothes look awesome and how it’ll be great dating you when this other person come to this reading room all the time, because they want to see you, they want to be around you and things like that.

Dr. Karen Ordovas:
But I’ve never had an experience that was really impactful in that sense. It was easy for me because I got engaged with my husband during residency and then throughout everybody knew that I had a husband and it was easier in that sense. But I’m sure that probably a lot of people started talking about things that they were not talking about for many, many years.

Rachel Gerson:
I’m curious, I know when we spoke on the phone before, that you do work related to promoting equity in our patients in terms of screening and cardiovascular care for women. I’m curious to hear a little bit more about that work that you do and your experience.

Dr. Karen Ordovas:
A lot of people don’t know that the way we see cardiovascular disease in the population is totally influenced by what cardiovascular disease does to males. Because in the past 40, 50 years, all clinical research and all interventional trials in cardiovascular disease, specifically coronary artery disease, have been focused on the male patient. We basically treat women based on our knowledge running studies in men. That has been a knowledge, it’s been at least seven years that even the NIH has been focusing a lot on keeping equality of gender in every major clinical trial going forward.

Dr. Karen Ordovas:
However, applying our clinical knowledge today based on what we learned from older trials is still a challenge. It’s very important to bring awareness to how women heart disease is very different then men. Women think about going to seek care when they’re having symptoms. Clinicians think about a diagnosis obvious, getting heart disease when women present to the hospital and treat them appropriately. It turns out that when women have ischemic heart disease, which is coronary disease, they’re less likely to be diagnosed promptly. When diagnosed, they are less likely to be put in optimal medical therapy and after they have a myocardial infarction, they die more than men because of all these reasons.

Dr. Karen Ordovas:
If you look at the trends of how cardiovascular disease [inaudible 00:15:56] adapts are evolving in the United States, you can see a clear trend that male cardiovascular disease is going down, female cardiovascular disease remains at the same level. All the impacts of modern cardiology are not reaching males and females equally.

Rachel Gerson:
Has it been a challenge to get support for those kinds of academic endeavors that are focused in this way or to interest men who are doing research in these areas or to get funding? Have you encountered any obstacles in that regard?

Dr. Karen Ordovas:
Yeah. Using this specific situation on our society of cardiovascular, we started as a small group of four or five radiologists and cardiologists that were interested in the topic. We set a goal, was a very interesting goal. The entire leadership of the society was male and all past presidents of the society for the past 20 years were all male. So we had two goals: to promote female cardiovascular disease awareness, and to increase female leadership in the society because we thought that was very important to bring diversity to all the goals and aims of the society. The four of us came up with a plan of outreach, of annual dinners, or happy hours, or webinars and talking about it in the meeting. Promoting things that would make it easier for women to attend a meeting, like childcare or like one day registration instead of going for five days.

Dr. Karen Ordovas:
It’s been seven years now, that committee now has 300, I think members and we really had a big impact, but I can’t say it was easy. There were obstacles all the time. Now we are already in the second female president of the society. We made a special effort to really nominate one of our female members to the board, so I was voted into the board. Now I’m about to be president in two years. And the other two, three members had a similar trajectory. But it was really a thought through approach to get to that level because we wanted to bring female to the leadership.

Dr. Karen Ordovas:
One funny story that when I was elected to the board the first time, one male colleague from a different institution came to me and said, “Oh congratulations, that you were elected. But you know that you’re only here because you’re a woman, right? Because women voted for you.” Then it was supposed to be offensive, but I was like, “Yes, that was the strategy. That was the strategy and now I’m going to be here and show that I can perform as well or even better than my male partners.” Then after three, four years I was recommended for the executive committee. That was not just an election by the females, but the whole point was that. We needed to have representatives in the board, so we made an effort to pick one of us at a time. So all the women would vote for them.

Rachel Gerson:
Well, the men do that too, right? They vote for the men.

Dr. Karen Ordovas:
Exactly. I thought it was so stupid. I was like, “So are you saying that all the Democrats voted for the Democratic candidate just because they were Democrats? Yeah, of course, because that was this strategy. They voted for me because I’m a woman.” But anyway.

Rachel Gerson:
I think it’s so important, the idea of having a strategy. You have referenced this a little earlier, but I’m curious to circle back a little bit to strategies for people coming up. Both for advancement in their career, in societies and how women can help each other.

Dr. Karen Ordovas:
Yeah, it really only works if both women and men work together and support each other. You encounter several male leaders that are very supportive, but rarely they would make that extra effort to make that thing happen. They would support your efforts, but rarely would come from them to do that. I really think it’s a responsibility of women in radiology that have achieved a certain leadership position to promote and make sure that achieving that equality continues in the same direction and we don’t go back. Promoting through mentoring, but also promoting through giving the example.

Dr. Karen Ordovas:
Sometimes it was hard and I felt guilty with responsibilities being a mom, being a wife, and being a doctor, and having to focus on my career sometimes. When I was offered leadership positions and I had to say yes and I had to take it knowing that would mean I would give a little less attention to my kids in certain stages of them growing up and that I would need to have more support with my family. Because it was so easy to just say, “No. No, no, that’s not for me.” So encourage people to take that extra step and know that it’s fine, that you can share with their partner the responsibilities for your family and you can seek and look for help.

Rachel Gerson:
Do you think your husband felt the same pressures?

Dr. Karen Ordovas:
Not at all, no. Of course not. I mean, he is a great partner. He’s a wonderful dad and he shares the responsibilities with me, but I’m the one that says what the responsibility is. I’m the one that say, “Okay, they’re calling from school and there’s this thing that we need to do, so you need to do that on a Wednesday from 9:00 to 10:00.” I’m in charge and I delegate things to him and that has always been like that. It could be because of my personality, but I tend to notice that most of women doctors have a similar scenario. Like at school, who is the primary contact? It’s always the mom. I’ve made that experiment, sometimes I put the dad’s phone number first and then they still just call the mom when something happened at school.

Rachel Gerson:
I’ve made that same experiment. I’m curious, you mentioned how important it is that some of these ideas come from male leadership as well. And that often they say, “Sure, you can go ahead and do this,” but they don’t generate the movement in the direction towards equity on their own. Do you have any examples of men that you have worked with, who have done a good job?

Dr. Karen Ordovas:
Yeah, I was mentored by two male doctors since the first day I arrived in this country. They have really helped me grow professionally and put me in positions that I could advance in my career. So I know it’s possible because I lived that. There was a big age gap between my first mentor and me. He came from a totally different generation, but he saw in me that I could do things and he wanted to make it happen for me. A lot of my early years in radiology came from this male mentor. I mean, I should say a lot of the growth I have in the first years of my career in terms of leadership, and getting known in the field, and getting exposed to research projects, or other research groups, and scientific environment, it was his effort. I was there and wanted to do it, but he made a point to put me there.

Dr. Karen Ordovas:
I absolutely think that’s important until we can find a transition in which gender is not going to be an issue at all. I’m not sure if we’re going to get there at some point or not. But that an environment where it’s male dominated, that without the leadership of males that believe in equality, it’s really hard to go forward just based on your female colleagues. It needs to be a change of culture. I was fortunate enough to have two mentors that really helped guide my academic career and they were both male.

Rachel Gerson:
Yeah, I think that speaks to the idea of sponsorship, as well as mentorship. Certainly in a lot of careers, not just radiology, men benefit from someone providing them an opportunity. Why don’t you take on this project? It’s important to have that. I wanted to ask you just in closing, a little bit more about we’ve focused on the gender piece, I wonder if you have any thoughts about being an immigrant or the Latina piece?

Dr. Karen Ordovas:
I have not encountered one other Brazilian radiologist in cardiac imaging in the entire community of cardiac imaging in the United States. There’s many more people from Asia, I think it’s more natural and accepted. Latina really has that flag of being less educated. Although, I was the first in my class in high school, the first in medical school. I did really well on US MLEs. I was all told, “She was trained abroad.” That just comes with you until you can actually prove that in practice you’re doing the same or better than peers that were trained here.

Rachel Gerson:
Do you think that having an accent as a woman is different than having an accent as a man?

Dr. Karen Ordovas:
No, absolutely. I usually joke that if you are a woman, blonde, and have an accent, those three things together already make people think that some weird things are going to come out of your mouth. You’re going to sound stupid. I know because again, my husband has an accent and so we can do that experiment, comparing both of us in how people treat you differently because of the accent.

Rachel Gerson:
Any thoughts on how radiology can reach out or ways we can impact health equity in the Latino community?

Dr. Karen Ordovas:
The effort really should start at medical school to make sure that there’s more equality in the pool of medical students in this country, is really what’s going to make our radiology community more equitable. I’ve seen a lot of progress in that sense, so I truly believe that the gap is going to be better and better in the future.

Rachel Gerson:
Tunnel of Truth is partially funded by the Washington State Radiological Society’s Committee on Women and Diversity. We are grateful for their support. 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.