Dr. Jennifer R. Grandis is a distinguished professor of Otolaryngology-Head and Neck Surgery at the University of California San Francisco (UCSF). She earned medical degree and completed her otolaryngology training at the University of Pittsburgh. She is an expert in head and neck squamous cell carcinoma (HNSCC) development and progression and is focused on developing therapeutic strategies targeting key pathways. She has led the Head and Neck Cancer Program and was the Vice Chair for Research in the Department of Otolaryngology at the University of Pittsburgh and the Associate Vice Chancellor of Clinical and Translational Research and the director of the Clinical and Translational Science Institute at UCSF. Her research involves investigating mechanisms in preclinical models, developing novel therapeutic approaches in the laboratory, and conducting clinical trials.
Today, we are thrilled to present a transcribed interview with Dr. Grandis. In this interview, we discussed her career, the challenges to thrive in a male-dominant specialty and her article “Gender Equity in Science and Medicine: Breaking the Impasse”, which is inspirational and eye-opening. Without further ado, here is the transcript of our conversation with Dr. Grandis.
1. To start with, can you tell us about your routine as a surgeon, researcher and woman. How do you balance the multiple aspects of your life?
Thank you for that question. The answer has really changed over time.
In the very beginning, I went into surgery (in my case otolaryngology-head and neck surgery). I was the only woman in the training program and it was really an unusual experience, it was a different time. The awareness of behaviors that were not acceptable in the workplace was very, very different. From day one when I was in my internship, it was me and 18 men and it was the first time that I'd been in such a position, because I went to a co-ed college and women comprised about a third of my medical school class. This situation made me more empathic when someone is different from everybody else in the room, you’re looked upon differently and and you are aware of how you are not like everyone else.
When there was teasing - or worse, I just found ways to overcome it. Early on it was a matter of learning and just surviving. It was also during residency that I discovered research. The judgment of who is an excellent clinician can be subjective. Although we can, we don’t use objective metrics, and I found that, at least in my mind, that the metrics for who is an excellent researcher seemed more definitive and less subject to any kind of assumptions or biases because of my gender.
Early on I found that research involved a lot of postponement of gratification. Frequently the experiments didn't work, my papers weren't accepted the first time abd the grants weren't necessarily funded when first submitted. On the other hand, my clinical experiences were gratifying every single day. I was always helping people and doing procedures.
The combination of what I called “being a superhero” in the clinic and being sometimes disappointed and frustrated in the laboratory for me was a comfortable balance.
When I had children, it was another reminder of how different I was. It was important to me “not to ruin it all for all the women who were going to come after me”. Again, I tried to be resilient, responsible and show up. I was fortunate because not only is my husband a physician, so he was very understanding of the circumstances, but I lived in the same city as my parents. They provided support and help. One of the reasons why I stayed at the University of Pittsburgh for a very long time was because my parents really helped me raise my children.
Even though we were fortunate enough to have the resources to hire people to help with childcare, there was something special about having family nearby that was really quite powerful. I came to the awareness that I wasn't a perfect mother, wife, surgeon or researcher, but I could do it all by being forgiving, flexible, and by having an enormous support system to help.
I want to be clear that it was my decision to have a family and be a very present mother. My children never got in the way of my career and I tried hard not to let my career impair my ability to be the kind of mother I wanted to be. Often women in science are pigeonholed as stuck at a certain level because they choose to have children and that wasn't my experience. I was able to do it all because I had smart, resilient children who were very supportive of what I was doing. I had an enormous amount of help - childcare, housekeeping, family, and I really loved and thrived pursuing the combination of research and clinical medicine.
2. Did it happen that at any time you felt you wouldn’t be able to conquer this dream?
We talk a lot about the imposter phenomenon/imposter syndrome. I don't think I ever doubted that I was capable. What I realized was that my being there made other people uncomfortable.
I knew I had every right to be there. I knew I was capable of everything that my male colleagues were. It was a matter of trying to help people be more comfortable with me. I tried to soften my edges, find a way to present myself professionally to make them more comfortable, which was a heavy lift.
Now I look back and I think: why did I do that? Why did I have to do that? I mean, it wasn't my job. My daughter now is a physician and I want to make sure that the world is a level playing field for all genders, of all backgrounds, and just because we represent a diverse cohort, doesn't mean it's our job to make the status quo comfortable with who we are. But I think we're in an era now where we can talk about that much more freely.
I can tell you that now I can speak out. So when I hear gendered language, for example, we're evaluating a woman for a leadership position and someone says “well, she's just not warm and fuzzy enough.”, I now can say “well, what do you mean by that?”
3. You have a remarkable career as Head and Neck Surgeon focusing on cancer research. In your opinion, which factors have contributed the most to building up your career so far?
Well, I think what's most important is to figure out what kind of work makes you really happy and prioritize that work because everything's hard. It's really hard to have a full personal life with a family if you choose, and a full professional life, no matter what that looks like. We're all going to stumble; we're all going to have obstacles. So, I think one of the reasons why I've been successful is that I love what I do and I never did it because someone else wanted me to do it.
I did it because I wanted to do it. It was really fulfilling a deep need in me. There were hardships all along the way with respect to clinical medicine, research, and how other people experienced me and how that was hard to navigate.
My successes have been possible because I have a wonderful support system, and an innate and acquired ability to survive adversity. At the end of the day, I was guided by my passions.
4. I saw that you work with translational research, perhaps many of our members don´t know what this means. Could you share more about how it works?
Sure. I think it's a relatively newish world, probably the last 10 to 20 years. We all know what an experiment looks like in a laboratory, and how a clinical trial works in our clinics, recruiting patients. This is the space that clinicians and surgeons scientists are really naturally predisposed to occupy. Translational research is that between space, I think of it as bidirectional.
Let’s say I’m looking for a therapeutic target in my patient's tumors. Then I go back into the laboratory and I work in preclinical models to try to understand and characterize that therapeutic target. Then, if I want to test a therapy, I can test it in those preclinical models and then go back to the clinic and do a trial. So it's really this superhighway that is going in both directions.
5. At this point in your career, do you still face challenges regarding being a woman in medicine?
Yes, of course! I did a study, in 2019 to explore, as a qualitative researcher how gender contributes to careers in science and medicine. My motivation to do that study is I was harassed by my boss and I didn't know how to fix it. All the capabilities that I developed, my skills, resilience… I was not able to overcome that particular obstacle.
It was really painful and scary and I thought ”if it happened to me, it must happen to a lot of people and I'm just not seeing it. So let me understand it.” Then I traveled around the United States and I interviewed 52 men and 52 women at 16 different universities. I recorded the interviews, developed codes and used software to help me identify the connections between features of the academic medical ecosystem and gender inequities. Listening to the interviewees and analyzing the data really helped me understand how pervasive inequities are and why we're stuck.
It's pervasive because we all bring ourselves to work with all of our biases fully intact. We're getting better, but it's hard. We don't have a language at work to talk about these kinds of experiences. It is uncomfortable. So my message is we have to get comfortable feeling uncomfortable.
Also, the men in my study weren’t “bad guys.” Most of them were aware of gender inequities, especially when their wives or daughters were in science and medicine. Even when they saw women being treated differently, they often felt powerless to do anything about it. Like many fields, academic medicine is governed by a hierarchy with those at the top, mostly men, having most of the power. If they are unable to see gender inequities or feel empowered to fix problems, it is understandable that progress is limited.
When someone shuts you down, interrupts you, discounts your idea or excludes you from something you want to be part of, we have to be able to talk about that without worrying that it's going to lead to some big explosion or retaliation. We just have to have language so we can say particularly when it happens. “Did I just hear you say this? Can you just repeat what you just said so we can talk about it?”.
I'll give you a recent example. I was at a meeting and somebody asked a woman a question and before she had the chance to answer it, an older man answered it for her. It wasn't a setting where I could easily interrupt right then, but afterwards I reached out to her and said “Hey, I saw that and I'm really sorry that happened to you.” It was clear from her response that the experience was very painful, and I can tell you that when this happens the person becomes dumbstruck, they're not prepared for it to happen. They don't really have a ready response. She expressed gratitude that I reached out. It shouldn’t be hard to reach out to someone who has been wronged and let them know that you are on their side.
Thus, it’s where us- the bystanders-, have a very special responsibility to say something. We need to do something, in an atmosphere where it's not about right or wrong or good or bad, but it's just about people being people.
6. I read the statements in your article "Gender Equity in Science: at Cancer Discovery". Implicit bias and microaggressions in the workplace can be very hard to identify. How do you believe that we, women, can become more aware of these? And do you have a few tips for our members to quickly identify them and protect themselves?
We just have to talk about it. So first of all, when something happens to you, you have to know immediately that you're not alone. Take it seriously, but not personally and if you have someone you trust, talk about it, go to them tell what happened and ask for help to understand it.
I feel like we are so inclined to want to downplay everything, but then it all accumulates and at the end of the day, we just feel depleted and frustrated. I feel like if there were ways for us to work through the “microaggressions” as we now have a language for it. We are the experts when it comes to our experiences.
It's hard because we aren't all on the same level in the hierarchy. When the person harming you is more powerful than you are in the organization, it's much more difficult to navigate that. But depending on where you are, there should be people that you can talk to and get advice. And sometimes a mediated conversation can really go a long way.
We're all guilty. It's not a matter of being a woman or a man. For example, once I had a graduate student who expressed some concerns about some data that we had published, and I didn't want to hear it. I explained it away and that felt to her like I was shutting her down. So, she went and spoke to her chairman, and then he spoke to me. We reconciled and today, everything's fine. It was a long time ago, but at that moment it was uncomfortable for me. I thought “why didn't she come to me?”, then I realized, that she did come to me and I didn't handle that well. We are people and there are going be things that we do that we regret. Luckily, we have many chances to have a do over.
It's a hard, complicated problem. But the worst thing we can do is to pretend it's not. I believe being open to the fact that we all have blindspots, we all make mistakes, and sometimes we harm others along the way.
7. What advice do you have for this new generation of women who want to pursue a medical or academic career?
I would say that surgery has changed a lot. The fact that half of our trainees are women and half of the faculty are women, is extraordinary. But it doesn't mean that the issues are gone, it just means that it's a different cast of characters.
At the end of the day, if it's what you want to do, pursue it. The only reason I would say that surgery might still be somewhat more susceptible to gender bias is that our hours and lifestyles are different from non-surgical specialists. As my chairman used to say, we commit assault and battery for a living, the stakes are very high, and sometimes the emotions can really get ratcheted up.
That being said, we're responsible for treating each other with respect and dignity, and just find places to work that you can be your full self. Remember, if someone is uncomfortable with you, it's their problem, not yours.
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For those interested in her article and learning more, here's the link: Gender Equity in Science and Medicine: Breaking the Impasse | Cancer Discovery | American Association for Cancer Research (aacrjournals.org)
Words cannot explain how much we are grateful for having this opportunity with such a top-notch human being. Talking to Dr. Grandis was both a huge pleasure and inspiration. The message I take home from our conversation is “It is important to stay true to yourself and your goals, and to find a supportive community that will help you succeed in the field of surgery”
We wish Dr. Grandis all the best. ✨💜