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Andrea Miyahira: Hi everyone, I'm Andrea Miyahira and I'm the Senior Director of Global Research and Scientific Communications at the Prostate Cancer Foundation. Today I have the great honor of being joined by Dr. Elisabeth Heath. Dr. Heath is a medical oncologist at the Karmanos Cancer Institute, where she is also Associate Center Director of Translational Sciences, professor of Oncology and Medicine, Chair of Genitourinary Oncology Multidisciplinary Team, and Director of the Prostate Cancer Research Program. Thank you for joining us, Dr. Heath.

Elisabeth Heath: Thank you for having me. Such a pleasure to be here.

Andrea Miyahira: Such a pleasure to have you. March is Women's History Month, so we are celebrating women in prostate cancer research and oncology. Dr. Heath, you are a leader in these fields and are certainly someone I have looked up to for a very long time, not just for the impact of your research and patient care, but also as a mentor, as someone who has nurtured the careers of so many at your institution and beyond, even having a program for under-served high school students that are interested in STEM. And you've also helped us organize many of the PCF Women in Science events, including some our new PCF Women in Science Network Initiative, which is having our first forum on work-life balance on March 31st. I do invite anyone who is interested in attending our forums or being on the mailing list to email . So Dr. Heath, would you, I guess, please first tell us about your career journey and what were some of the key moments that propelled you to where you are today?

Elisabeth Heath: Oh, absolutely. First of all, thank you so much. And it's really a pleasure to be part of a terrific community like this because I think it does make a difference when women have other women to lean on and to share our stories with and to learn from one another. I would say that when I started medical school at Jefferson Medical College in Philadelphia, I honestly didn't have any idea what to expect. There weren't really that many women. I think my class had maybe 25% that graduated 30 years ago, but it was a wonderful time in my life. I met my husband there, we made new friends and those were the days where you were kind of thrown in all together with no social media and nothing but the library books and you just had to focus and get it done. But I learned at that point, you really had to have a team with you.

I was very fortunate to have several friends and just sort of a community of folks that we can rely on because there was so much material to learn. And then, gosh, that first introduction to patient care, really scary in some respects. I'm sometimes flabbergasted how these patients are so generous to allow medical students to come in and just pop in during a really tough time in their lives. But I think that, in a way, has changed for a lot of students, but not that much. Everyone sort of goes through that same path, whether it's medical school or graduate school or business school or even undergraduate. For me, when I did my residency at Georgetown and my fellowship at Johns Hopkins, it just was an experience that just kept building, it was learning about different topics, but it was just meeting more and more new people.

And it became quickly evident that women, especially those in leadership, were not that easy to find. They were there on occasion, you obviously could talk to them, but there was really no real set program. So I think what events like what PCF has in terms of the retreat and programs that really support, again, work-life balance, that was almost unheard of 20, 30 years ago. And then when I came to Detroit, now it's 20 years, there was again the same issue of, gosh, where are all the women in leadership? It certainly was a situation where many of us were present, but not sort of in a way that was visible, especially to trainees. So I think that that type of journey is something where we can share to others that are following behind us to show that, well, let's improve that, because it shouldn't be a mystery who we are. So what you're doing here is to really get the folks that have sort of been through the journey out there so people can reach us and ask questions and just kind of share the stories.

Andrea Miyahira: Yeah, thank you. I guess, are there any stories about women mentors or colleagues who helped you along the way in your career?

Elisabeth Heath: Oh, there were numerous. And I think in that sense, I was fortunate. One of the best pieces of advice I've received was, "Create your own board of directors." And sometimes those are people that are in medicine. Sometimes those are people that are just folks you really trust their opinion. Some could be friends, some could be even neighbors or folks that go to your church or whatever community you're in. But building that own board of directors was really valuable, because especially when I moved to Detroit, I didn't really know anyone. I was always doing things on the East Coast and I relied heavily on that group. And some were mentors and some were just peers. But without that, I think it would've been harder. So I really encourage those who are starting this journey to come up with their own board of directors to see what that would feel like, and who's going to populate that. And it may change over time, but I think you'll come to rely on that board to help you make big decisions.

Andrea Miyahira: Yeah, I think that's really great advice. Along the way, were there barriers that you faced and your female colleagues faced that your male colleagues tended not to?

Elisabeth Heath: Well, I'll tell you this, you can't make it this far, especially as a woman in medicine as a professor, without having some barriers and some challenges. I think the one that pops up, and I'm sure this will come up in our work-life balance discussion and seminars, is we're always unsure of as to what to do with the personal aspect of one's career. And I think there's a little bit of a pause, if you will, in your career to say, "Well, what do I do now? Who's going to do what and where?" And that's a big barrier, because there's no set algorithm. Every person's different. And it's not just having a family. It might be taking care of a parent or a grandparent or an auntie. It just is so varied for all of us. But sometimes these caregiving duties do fall to the women, and that is still sort of a number one question that comes up in a lot of the meetings I have with my own mentees in terms of just where is this?

So, one of the big barriers was just, there was no set way to do it. And in a career in science, usually there's steps like, well, you finish this, you move on to this, you have a PhD, you get a postdoc, and then you do the next thing. So with this, it's just not so evident. So I'd say that that's probably a more relevant, in a way, barrier current in your face. It's not to say men don't experience it, but I think our maybe thoughts and concerns may be just a little bit different.

Andrea Miyahira: Yeah, I like to think that we're making progress. I guess what barriers do you think we really come far along in, versus ones that we haven't made any progress in overcoming?

Elisabeth Heath: Yeah. Well, I think the big one is just there's more women in science. I look at our own medical school at Wayne State University in School of Medicine. It's 50%, as it is, I think in most medical schools. And we have one of the largest classes annually here in the US. So, to see that number of women is just exciting for me. When I was the faculty advisor for the Gold Humanism Society every July at the white coat ceremony, that was my favorite moment. That was my real antidote to burnout. Just look out and see 300 pairs of really eager eyes and proud family members cheering them on.

And to see half of that audience be women, I think, is wonderful. I think where we still lack some progress is in the leadership roles. And here we may have 50% women in the medical schools, but as you move up and you're now taking deanship roles and director roles and president roles, those numbers fall very, very quickly. And a lot of that is still a work in progress. So until those kinds of statistics change, I think it remains to me too low, and it remains to me still an untackled and unsolved challenge. So we all have to, as a community, work towards improving those numbers.

Andrea Miyahira: Yeah, I agree completely. I guess for the younger generation of women oncologists, are there any advice that you have? Things they can start doing now to really improve their chances of getting into leadership positions in the future?

Elisabeth Heath: That's a great question. I think one of the things we don't do very well, I think, as women is setting the expectations. So we're great worker bees and team players and collaborators, and I think those words tend to be part of most people's letters. "Oh, she's great, enthusiastic team player." But then it comes time for sort of academic credit. "Oh, where do I fit into this paper? Or am I presenting? Or is that person presenting?" So, I think we can advocate for ourselves a little bit more, and it could just be done in a more sort of informational ask. Like, "Okay, well if I did this, what are your thoughts on where then this could go? Are you envisioning that in a year there's an opportunity here for me to be on this abstract? And if so, would you like me to take the lead?"

"Or why don't you share with me what your thoughts are?" And in that sense, I think, again, being very intentional about it helps, because I think what we do a lot is sort of do a lot of the work and then we're, "Well, everyone's going to notice we did the work," and then think the reward will come, and then it doesn't. And you sort of get really upset at that. And then it just spirals. And sometimes in a way, I think being as direct as you can just for expectations, and at that point the person you're doing the project with or whoever could say, "well, actually you're the fifth person that's joining. So at most, you'd be somewhere in the middle if you're okay with that." Then you could say, "Well, gosh, for what I'm envisioning, is there another project that I could help take the lead on?"

But doing that also takes some homework. So what we don't want is for me to say that and everybody go in and go, "Well, gee, I demanded be first author on this paper I didn't do much." I think there also has to be an understanding that it takes a little bit of time to build that up. So being aware of it, you may not get it right off the bat, but the next opportunity, then at least you've advocated for yourself, and there's that opportunity where that person may say, "Okay, you're up now because you've done the work." A lot of it, I think, is still just setting the expectation and communicating that with everyone around you. I think women also tend to take a lot on. They don't want to say they can't do something. Oh, well there's these five things to do. But then in your mind you're like, "Uh oh, I'm supposed to be somewhere else for two out of these five."

And then you try to make it work and then you're running around and you realize this is a bad idea, and at the end of the day, you are suffering as the person because you just put yourself in a position to fail. So, don't. If you know two out of the five things you can't achieve, just say it. Just say, "Unfortunately I'll have a conflict with this and this. How would you advise me of these five things? Would you prefer that I tackle these three, or would you like me to do something to rearrange it so I can take on these two, but then someone else could take on the other three?" So being really clear in knowing what you can and can't deliver, I think, helps, because we are everywhere and we are usually expected to do everything for everyone. And at the end of the day, we are burning ourselves out and it's just not worth it.