Women and Work @ MD Anderson

Title

Women and Work @ MD Anderson

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Identifier

KomakiR_04_20190123_Clip05

Publication Date

1-23-2019

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Transcript

T.A. Rosolowski, PhD

To build, yeah, okay. Well, we’ve got about a half hour left and I was thinking about what to talk about next, and I know that you were on a committee to look at diversity and had a lot of observations about women in the institution. So I wonder if you would talk a little bit about that.

R. Komaki, MD

Okay. I was involved with women faculty organization group, the leader was Dr. Liz Travis [oral history interview], who used to be a radiation biologist, and she became the associate vice president of Women Faculty Programs. So we wrote the book about you know, how we became professor in the UT System, and how we can inspire the younger generation --the women-- and equality of salary and the position. We looked into all the details, and we published the book.

T.A. Rosolowski, PhD

Legends and Legacies.

R. Komaki, MD

Yeah, okay. And I really wanted to make sure we are getting adequate numbers of women who’d be promoted to be the leader of each department. You know there is always discrimination for promotion and salaries just because we are women … When I started as a faculty member here, some of the female residents, they didn’t want to get close to the cobalt machine. We did have cobalt equipment and that’s very old equipment. She didn’t want to get close to that when she was pregnant. She was so afraid. So I had to make sure to convince them, the QA --you are not exposed to any radiation when you are pregnant. Also I’m the first radiation oncologist to become president of AAWR, American Association of Women Radiologists. [phone rings]

T.A. Rosolowski, PhD

Let me ask you, I mean I want to talk about that in a sec, but I wanted to ask. Oh, do you need to take that?

R. Komaki, MD

I don’t know what this is. Hello?

T.A. Rosolowski, PhD

It sounds like a call. I wanted to ask you when this female colleague kind of made that decision, what’s your concern about women making those kinds of decisions in the workplace, that they don’t want to get near the equipment or...?

R. Komaki, MD

Those residents, they were around 27, up to 35, and they were so anxious to have their children, babies, and they were so afraid they might get exposure to radiation. I still remember one of our residents told an attending “If anything goes wrong with my baby, that will be all your fault.” Seriously, she said that to the attending, because she didn’t want to get close to the cobalt equipment.

T.A. Rosolowski, PhD

So your thought is that there was actually no risk.

R. Komaki, MD

No, no. Unless the beam is on and you are in the room accidentally --that’s not good. But as long as you are out of the room when they push the button, if you are not inside that room, you’re not at risk.

T.A. Rosolowski, PhD

So what’s the effect of a female faculty member or a resident, saying something like that to a male attending? What does that do to the environment for women?

R. Komaki, MD

The first thing was she did not know exact, the risk of exposure. Also, the male attending had the tendency to discriminate against female residents: “Oh, she’s not doing anything just because she’s pregnant, she’s avoiding to work, she does not get close to the equipment, trying to avoid everything, sabotage, so we should not take any female residents.” They started to tell us this, and I thought oh, this is [discrimination against gender]...

T.A. Rosolowski, PhD

Really, they started to say that actually?

R. Komaki, MD

Yeah. When we get the rotation every three months at the Radiation Oncology Department of MDACC, we get the rotated residents, and attending needs to evaluate their performance, their attitude to attendings, every tiny thing. They write all those … Such as the people who are so afraid to get the treatment equipment. So they have a tendency not to take female residents. See, I really wanted to make sure all those female residents have the facts. And also those men, chauvinistic, or somebody who just wanted a male to be a resident --that’s not correct. They have a right to become our residents, doesn’t matter, male or female, if they are willing to work and if they have passion to become good radiation oncologists. It was very difficult to convince people regarding radiation exposure. When I became the president of the AAWR --and also, I received the highest honor of the AAWR --this was 2005, the Madame Curie Award from AAWR-- because of my background coming from Hiroshima, I became a radiation oncologist. So I tried to convince our women faculty members and also the residents, to join AAWR so they can get more confidence to become a leader and they guide junior attendings and female residents in the future. Somehow, our residents, they were not really convinced, because this AAWR, the majority of them, they are diagnostic radiologists. I am very rare. These days, more and more radiation oncology residents and also attendings, they are joining AAWR. I started to organize AAWR/ASTRO women luncheon every year. We have a Monday luncheon, and a lot of residents and the junior attendings, they come. It doesn’t matter, junior or senior, because senior women radiation oncologists, we sit with junior attendings, and also global international members and the residents. We sit at a separate table and we talk, questions and answers and anything they are concerned about for their future, and equality. We discuss all the details. But I try to teach women, to convince your chairman, or to be the leader, you really have to write. You have to put the facts, rather than just complaining. So just ignore all those --you are discriminated against just because you are pregnant or you are female. As long as you’re writing and show evidence of your capability to be a good radiation oncologist, they will be convinced by your scientific curiosity and you’re going to be the leaders. But you always have to show the facts and evidence. When you [present] cases at the tumor board, you have to discuss with surgeons and medical oncologists you have to know the facts, so you have to know the side effects and efficacy of surgery and chemotherapy, everything. Otherwise, you cannot discuss. You cannot just emphasize radiation treatment: we’re going to give the best treatment for your patients. You have to let them know that you know the side effects of surgery. Some patients who had radical mastectomies and they complain, “the edema of the arm is related to radiation treatment.” Is that related to surgery? Who did the radical lymph node dissection that causes edema of the arm? So you have to know every side effect of the surgery, or numbness of the arms, legs and tingling. Is that related to radiation or is that related to cisplatin? You have to know every side effect from every modality. That’s the way you can argue, you can discuss with surgeon, medical oncologist, pathologist or diagnostic radiologist. You have to be a part of the multidisciplinary clinicians, you have to be an oncologist. You cannot be just technologist. You can develop all different particles and beam arrangements, that’s very important for our [profession], but also you have to be an oncologist.

T.A. Rosolowski, PhD

Interesting. Now, when you were talking about the AAWR and said you were trying to convince women to join, I kind of got the sense that they didn’t really do that?

R. Komaki, MD

They did, they did, oh yeah they did.

T.A. Rosolowski, PhD

Okay, they did, so that was a positive thing. And these luncheons sound like they’re a really great opportunity for women.

R. Komaki, MD

Yeah.

T.A. Rosolowski, PhD

What kinds of things, what kind of issues do you hear younger women bringing in to those meetings?

R. Komaki, MD

All those residents, they come and there are a lot of junior attendings. They worry about their position and they would like to be promoted, and how they can do that, and especially those women coming from China or Japan, Asia. They are totally suppressed by male chauvinistic society, so they cannot be the chair of radiation oncology because in Japan or even China, they have only one professor and there are several attendings. Women, they cannot be promoted to be chair person because there is only one professor, and then two associate professors, two or three assistant professors with one physicist. The main problem, in Japan, if they put one physicist, their faculty members need to be reduced by one. So they have approximately 47 universities, and the majority of university hospitals have established Department of Diagnostic Radiology but very few Radiation Oncology Departments. They are so limited, the numbers, they have only like five up to seven. They don’t have a medical physicist, like in the United States, and the time it takes to make a plan is so consuming for the radiation oncologists, they have to do it by themselves. They don’t have medical physicists, because if they put one medical physicist, that’s one faculty member’s position, and so they cannot get a radiation oncologist. The other problem they have, they have therapists there, technologists: they have so much power and they don’t want any medical physicists to take over their position. So they take care of the patients, you know like our therapist in the United States. We have therapists, at MD Anderson; we have almost a hundred therapists. We have dosimetrists, almost one hundred dosimetrists. They’re the ones, who really do the plan. Then we have physicists who supervise the plan, and then we have radiation oncologists. So the patients have to pay all of that, but in Japan, it’s a social medicine, so they skip all those, the middle part. This means that the radiation oncologists, they have to do everything with technologists without dosimetrists nor medical physicists at some of the radiation Oncology Department or Section of Radiation Oncology. My husband, James Cox, and myself always emphasized in Japanese Radiation Oncology Society that you have to create more medical physicists. But all the physicists in Japan, they are like more basic physicists or theoretical physicists unless they have [a governmental grant and are working in proton or carbon ion facilities].

T.A. Rosolowski, PhD

Not medically focused.

R. Komaki, MD

Not medically focused.

T.A. Rosolowski, PhD

Right, right.

R. Komaki, MD

It’s skipping that part. Unless they can get grants, carbon ion or proton center, they cannot get a physicist. That’s why they have so many proton centers in Japan. Japan is not so large compared to the United States, but they have so many carbon ion [centers], they have so many proton, because that’s the only one way they can get the medical physicist to work, under the grant.

T.A. Rosolowski, PhD

Now let me ask you another question, because I know in a previous session, you had talked about some of your own frustrations with recognition and promotion. I wanted to ask you, you know what do you think would have made a difference for you in the environment and what can make a difference—and not just what women can do but what men can do or what the institution can do, to ensure that women are better recognized and have more promotion and leadership opportunities.

R. Komaki, MD

You know new people, when they come and they don’t really appreciate how much we have done in our institution. It doesn’t matter, men or women, but especially the new chairmen or new leaders, who are intimidated by senior faculty physicians. They would like to get rid of those people. That’s not right. They have to have women, senior faculty members, who contributed to advanced technology and science in our institution. They have to appreciate their opinions and how much we have done. They have to listen and they have to respect us, rather than to get rid of senior faculty members. That’s the biggest mistake some people have made. Maybe it doesn’t make any difference, men and women. But they have to have some kind of respect to people who have been at MDACC more than two decades… Who really contributed to advancement of MD Anderson Proton Center, and patient care, NCCN Guidelines? You know, I have done everything I could have done. Maybe, with my husband’s illness I burned out. When this leader came on, he said, “I won’t renew your tenure position for the next five years.” I said, “That’s fine, you know I can work as a regular professor, I don’t need to honor the next five years tenure position.” By the time I finish the next five years, I’ll be almost 80 years old, so I don’t need that,” But every tiny thing he has done to try to get rid of me, because he did not have his own confidence. He was intimidated because of all my patients and everybody said, “I would like to be seen by Dr. Komaki.” That really made him angry, because he was treated, by the patients or other attending, medical oncologists and surgeons, they treated him like he was junior attending rather than a senior Radiation Oncologist. You know, the radiation oncology department is separated into eight sections; head and neck, CNS, Thoracic, GI, GYN, GU, Pediatric, Skin and Melanoma. There has been a section of Thoracic Radiation Oncology since I arrived here in 1988. He was a division head and the chairman, and he wanted to be the section chief of Thoracic Radiation Oncology. I asked him, “Why do you want to be the section chief of Thoracic Radiation Oncology in addition to being division head and chairman?” He just didn’t like my opinion. So I said that’s fine, if that’s what you want, and then he gave that position to a junior attending.

T.A. Rosolowski, PhD

Do you find that that kind of move by a new leader—have you seen that happen in other divisions as well?

R. Komaki, MD

Yes, yes, I have, I have. There are people who do not have some confidence. They do have a tendency to get rid of senior women.

T.A. Rosolowski, PhD

More so than senior men?

R. Komaki, MD

I think so. Around the same time, they got rid of the senior men as well. At certain age, you know, they really have to kind of [discrimination against age]. Well, he wanted to get rid of those people who are hired by Jim Cox and also, getting a lot of money because of the senior position.

T.A. Rosolowski, PhD

Right.

R. Komaki, MD

He wanted to get that money to make much cheaper, junior attending to be hired, and they will do anything, whatever he wants.

Women and Work @ MD Anderson

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