In recognition of International Women’s Day on March 8, Medical and Academic Affairs is profiling some of the women in medicine and medical leadership positions that help deliver excellent health care and lead our organization. Dr. Rachel Carson is a nephrologist and internal medicine specialist in Nanaimo with an interest in end of life renal care. Dr. Carson shared her thoughts about what she loves about her work, inequalities women face in medicine and what she enjoys doing in her free time.
What do you love about practicing medicine?
“I originally trained to be a chemical engineer for my first degree but found that it lacked human interaction, so I switched paths and enrolled in medical school instead. An engineer may clean up a river and help thousands of people, but you don’t get to talk to those people. Medicine has allowed me to engage in complex scientific work while interacting with people.”
Why did you choose your field of speciality?
“I wanted to become a family doctor. I saw it as holistic, whole person care, with lots of personal interaction but I found family medicine was much more difficult than I expected. Being a good family physician is one of the hardest jobs in medicine.”
“Nephrology provides me with the perfect mix of science, mathematics, human interaction and end-of-life care. That is what drew me to the speciality.”
What experiences have you had as a woman in medicine?
“Pay equity is a major issue in medicine. This is not a personal complaint - numerous research papers have shown the gap is significant and real. University of Toronto researchers earlier this year found that female surgeons in Ontario earned 24 percent less per hour than male surgeons. Another study shows that women in academic medicine are paid less than their male peers. The gap between female and male specialists’ pay in New Zealand is 12.5 percent. Researchers looked at medical school faculty and found significant sex differences in salary exist even after accounting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue.”
“Many factors contribute to the pay gap, including referral bias (socially challenging cases streamed to female physicians because of ‘great bedside manner’, a disproportionate drop in referrals to female specialists after a bad outcome), and patient behaviours (disproportionate requests to discuss additional problems – often primary care questions – during visits with female specialists).”
“There’s an ongoing discussion on social media about female doctors being misidentified as nurses or other staff. While that used to bother me, I think pay equity, harassment and respect are more important issues than whether or not someone calls me doctor.”
“Harassment exists on a spectrum from obviously inappropriate to micro-aggressions. These can be brief uncomfortable comments, that a male physician would never receive, which are a daily reminder that I am a woman and am treated differently because of that.”
What are your professional interests and notable achievements?
“I grew up in Ottawa, came to UBC for a visit during high school and always wanted to move out to the coast. After medical school, I saw the gap in nephrology services in Nanaimo and took the risk to come here to establish my practice and build the services. I am proud to have led the early development of the NRGH renal services. From 2008 to 2015, we have grown to provide a kidney care clinic, hospital hemodialysis service, home dialysis and kidney transplant services. I was the Nephrology site chief for NRGH until 2012. I am a member of the Clinical Faculty at UBC and I have additional Quality Improvement training through the Clinician Quality Academy.”
“My interest in end of life care led to my involvement in advance care planning. I want to ensure patient’s wishes are ‘Expressed, Heard, and Respected’ which is really about figuring out what matters to them at the end of their life. I serve on a renal palliative provincial committee and teach about palliative renal care regularly, having authored one of the earliest research papers on conservative (non-dialysis) support of end stage renal disease during my time in the UK. I have a leadership role in Island Health and provincially with the BC Centre for Palliative Care in teaching clinicians how to have these conversations with patients and families and in developing systems to then document those patient wishes.”
Where did you complete medical school and residency?
“I completed medical school at Queen’s University in 1999 then began a family medicine internship in Victoria – I was one of the last interns to live at the intern house on the Royal Jubilee campus. Then I went to the University of British Columbia to specialize in internal medicine. I then specialized in nephrology at the University of Western Ontario before taking on a renal end of life care research fellowship in the UK.”
What hobbies or activities do you enjoy doing in your spare time?
“Spending as much time as I can with my two teen kids. I also love to swim, cross country ski and cycle. I used to sing opera and have been known to sing at a few weddings. I also enjoy painting and drawing.”