With her friendly demeanor and insight, Robin Lindsay, MD, is willing to tackle the challenging issues surfacing in our specialty: the shortcomings in billing and coding as Medicare reduces reimbursement payments; pay equity and paid parental leave, which many institutions still don’t offer; and good “bystander behavior”—that is, what we should expect from our leadership when colleagues or peers are subjected to bullying or inequities.
With a circulation of over 14,000 otolaryngologists, ENTtoday serves as a central community publication in our field, and taking on these topics as its editor isn’t for the faint of heart.
“What sold me on this position was realizing that the Triological Society wants to bring these topics to the forefront, even if we haven’t yet crafted solutions for them,” said Dr. Lindsay. “Hopefully, through our writing and the conversation it encourages among our readers, we can start answering questions like, ‘How do we hold leadership responsible for our concerns? And how do we create systems within our institutions and [societies] to help individuals manage these challenges?’”
Robin W. Lindsay, MD
It takes time to grow a practice, and really requires the support and sponsorship of those around you whose practices are already successful. That can sometimes be very hard to come by, especially for women entering our profession. —Robin Lindsay, MD
The daughter of a U.S. Naval aviator, Dr. Lindsay spent part of her childhood in Japan, and later—as a Naval officer herself—worked in Japan as a general medical officer. She trained as a resident in otolaryngology at the National Naval Medical Center in Bethesda, Md., and did subspecialty fellowship training in facial plastic surgery at Massachusetts Eye and Ear in Boston, where she now works as an attending physician on the facility’s full-time staff, with a faculty appointment at Harvard Medical School.
At the time of Dr. Lindsay’s residency in 2002, just over 10% of actively practicing otolaryngologists were women. She was an exemplar: She carried pregnancies twice during residency, once as a PGY3 with her eldest son (who’s now in college), and again at the end of her PGY5 chief year with her daughter, who was born a few weeks after her residency graduation.
Asking tough questions to begin brainstorming solutions to systemic issues takes courage. As you’ll learn from our interview, Dr. Lindsay is up to the challenge. She is no stranger to using real-time data to solve problems, or to confronting gender bias in the workplace.
It helps you become a better surgeon to know what your results are, and it also gives you a solid foundation for clinical research. —Robin Lindsay, MD
This interview was condensed and edited for clarity.
SR: Did you expect research to play a central role in your academic practice as a facial plastic surgeon?
RL: Not exactly. I found that niche over time. When I was in the Navy, I had a large population of young, healthy patients who were struggling with nasal obstruction. During fellowship we performed numerous rhinoplasties as well as facial nerve surgeries. At that time the NOSE [Nasal Obstruction Symptom Evaluation survey] score had just come out, so I was an early promoter in the utilization of patient-reported outcome measures, and I developed a solid foundation in their use. I completed my Triological Society thesis while I was still in the Navy; that research looked at patient-reported outcome measures for nasal obstruction. When I moved to Boston, I expanded that framework into an electronic-based patient-reporting system.
SR: It’s rare to be able to dive into your niche interest early in your career. If you do, it can also create wonderful opportunities from the very beginning. Did you have someone who modeled that for you in your training?
RL: Yes, definitely. Tessa Hadlock, MD, the director of our division of facial plastic and reconstructive surgery, whom I trained with during my fellowship, was a very early adopter of patient-reported outcome measures. From her I learned to value tracking patient outcomes. And, from that work, I realized how important it is to monitor your own performance from day one. You never know how your practice will evolve. It helps you become a better surgeon to know what your results are, and it also gives you a solid foundation for clinical research. I advise all my residents to start tracking their outcomes as soon as they begin their independent practices.
SR: Do you find that the earlier one learns to become comfortable with such critical self-analysis, the better one advances in independent practice?
RL: Yes, I do. Many consider broad-based patient-reported outcome measures to be a barrier for concern rather than a tool for improvement. Junior faculty, particularly, are worried that their outcomes are going to be used against them and will stunt their practice growth. But, in my experience, it was exactly the opposite: Applying self-analysis early in my career actually helped to advance my career. We had huge volumes of patients that we were able to report on. I carefully followed my results, and it put me on the international stage. Also, patients really liked the idea that we took the time to look at their results before and after surgery, and that we could answer their questions about their personal operative care based on real data.
SR: You have experience working at multiple high-caliber institutions in varied settings, including Harvard and the Navy. What have you found the support to be like for female faculty in these arenas?
RL: The Navy was a fantastic place to train and to continue as a junior faculty member. And that speaks to the impact that leadership can have in shaping the culture of an institution or a team.
After my fellowship, I still had several years of service to complete, so I returned to the Navy, where I was an otolaryngologist attending and served as both the associate resident program director and the assistant department head before returning to Mass Eye and Ear. I was very used to being one of the only female faculty members in a department. I cannot say that during my time in the military I was treated differently because of my gender. My military colleagues were tremendously supportive of my pregnancy; it was a non-issue. In fact, I don’t think at the time I appreciated just how supportive they were; I took their support for granted. In contrast, I see what others have experienced elsewhere, and I think that academic medicine is a different beast.
SR: Given that you’re now an academic clinician, how do these experiences shape how you mentor your residents and junior faculty?
RL: It takes time to grow a practice, and really requires the support and sponsorship of those around you whose practices are already successful. That can sometimes be very hard to come by, especially for women entering our profession.
Because of these issues, I’ve become very involved with an organization called the Joint Committee on the Status of Women [JCSW] at Harvard Medical School. The JCSW is a group of individuals from all the Harvard-affiliated hospitals whose purpose is to improve equity and promote equal resource allocation, leadership, and pay for women across Harvard Medical School-affiliated hospitals and beyond. I’ve co-chaired their professional equity committee and I’ve also been the chair of the entire committee.
It’s been a gratifying experience to have these leadership opportunities, and my involvement with JCSW has driven me to write on the topic of gender pay and gender pay equity. I’ve seen the harm that can be done when women aren’t valued or given adequate resources compared to other colleagues. And these disparities aren’t solely women’s issues—they’re a reflection of system issues. It’s not that women can’t negotiate well or that they need more leadership classes, but they become “women’s issues” instead of system-wide issues.
SR: Are there men involved in the committee as well, or is it composed solely of women?
RL: We’re rewriting the strategic plan for the JCSW right now with this very question in mind. While it’s important for women to have a safe space to discuss their concerns, we also need strong male allies and sponsors who are willing to be good bystanders and who help implement policy changes. It’s challenging work and there is much more work to be done.
SR: That sounds similar to how you described the role you believe you’re taking on as ENTtoday’s physician editor. How optimistic are you that we, as a field, can effect positive change for such broad issues as billing and coding, or gender pay equity?
RL: I’m feeling encouraged that well-established leaders in our field, both female and male, who are financially set and who won’t directly benefit from resolving these issues, are advocating that these issues be discussed and gradually solved, simply because it’s the right thing to do. I think they realize that they have a lot of influence in our field and can help make change from both a policy standpoint and by modeling good behavior. It’s inspiring to watch them encourage change of the status quo. They’re willing to help take on the challenge of implementing change so that those who come after them have access to it. I believe that that’s a very generous way of contributing to our field.
Dr. Rapoport is an attending physician in otolaryngology–head and neck surgery at the Veterans Affairs Medical Center in Washington, D.C., and an assistant professor at Georgetown University’s Department of Otolaryngology–Head and Neck Surgery.