Victoria Fraser, MD, is the Adolphus Busch Professor of Medicine and Chair of the Department of Medicine at Washington University School of Medicine. She is the first female chair of a clinical department at Washington University and is a fierce advocate for diversity, equity and inclusion.
Preet Shaikh: Thank you for doing this with us! Tell us how you chose your specialty.
Victoria Fraser: I liked everything when I was a medical student and a resident. I had trouble choosing because I was interested in many different types of patients and diseases. I ended up doing infectious disease (ID) because I did an elective rotation at the Albert Schweitzer Hospital in Haiti when I was a third-year resident and that was life-altering. The medical director of the hospital went to the United States for surgery so I became the senior internist in his absence. We saw typhoid, malaria and it was the beginning of the HIV epidemic so there was a lot of AIDS. It was very, very busy and the patients often desperately ill. There were many people with preventable diseases and tremendous diseases of poverty and malnutrition. I was inspired to do ID because of the global health aspect and the focus of ID on underserved populations.
Shaikh: ID is definitely a specialty where health disparities are amplified. I think we see that in HIV, sexually transmitted infections, TB, and now, the COVID-19 pandemic.
Fraser: Yes, some of it is related to structural racism … there are incredible barriers to healthcare delivery and limited access to education and prevention services for many people. Addressing health disparities has always been a really important part of ID. In ID, more providers have liberal politics, are more likely to be interested in social justice, and community engagement. These are things that mean a lot to me. COVID has increased interest in ID careers and amplified the importance of the specialty.
Shaikh: While waiting in your lobby, I only see one female face on the “Chairs of Medicine” board. Of course, that is something that brings a lot of us pride. What were some of the challenges you faced?
Fraser: I am the first woman chair of a clinical department at Washington University. There were two other female basic science department chairs before me: Helen Piwnica-Worms, who was the head of cell biology, and Lilianna Solnica-Krezel, who is the head of developmental biology. They’re both fabulous PhD scientists that I have great respect for. For me, being the first woman chair of a clinical department did set a certain level of expectation. People assumed that I would be a champion for diversity, inclusion and equity … particularly gender equity, but also an advocate for equity broadly.
I have been here for 30 years and I trained in an era when there were fewer women at every level, and I’ve had incredible opportunities. I’ve been very fortunate to have outstanding mentors, all of whom were white men, because (those were) the people that were most available as mentors. I have found Washington University to be an outstanding place for career development. The School of Medicine has lots and lots of sponsors, mentors, infrastructure, and resources for people to develop career paths that are personalized and unique. When I came here, I really didn’t have an exact career plan, I was just trying to get the best training possible at the time. My husband and I thought we would come here for a few years and leave. But Gerald (Jerry) Medoff, MD, was the head of ID and he was super supportive of me. He encouraged me to take additional training in healthcare epidemiology. He really pushed me into a niche that was underdeveloped here and really important at the time. William (Bill) Powderly, MD, has also been an incredible mentor for me. I think things are much better now in the sense that there are greater numbers of women in medicine, although there’s still a lot more that we can do to make things more equitable for women and people of color. Many institutions have structural barriers that facilitate gender disparities in pay, honors, awards, and advancement. The more we all learn about structural bias, how to be an ally, and how to foster equity, the better it will be for everybody.
Shaikh: It is often said that for a woman to sit at a table and be a voice for change, she has to navigate it a little differently than men do. How do you think you have had to channel that voice to navigate change?
Fraser: It’s pretty easy to identify problems (but) not so easy to identify solutions. I think being process-oriented, thinking about solutions and the reasons behind inequity is better if you want to foster change. If you only identify the problem, it really doesn’t take into account the work that’s necessary to make things better. We need cultural change and structural change. One positive example is the Doris Duke Fund to Retain Clinical Scientists. This grant recognizes that women are disproportionately impacted in their careers because of extra-professional demands. Many more physicians and scientists are dual-career couples now compared to generations past. So, if we are going to have more dual-career couples and we want them both to succeed, we have to figure out how can we make childcare more accessible and affordable. We need to make the work environment more flexible so that men and women can be more successful. We need to allow people to go part-time, when they need to and flex up and flex down when they need to. We need to foster systems that really are open to everyone. We can ensure that search committees are diverse so that we are more likely to have diverse candidates who will be thinking about issues women are going to face. Ensuring that honors and awards committees are diverse, and making it clear to people that we want diverse nominations helps. By tracking diversity at the podium, it shines a light on the fact that we may not be inviting people to speak in an equitable manner. So in the department, for example, we set targets for having diversity at the podium in terms of the proportion of women and people of color who should be invited as outside or internal speakers.
For many people, seeing people who look like them makes a huge difference in terms of their confidence, their potential, and their hope that they can have a successful career. It’s hard for people to define a path when they’ve never seen anybody that looks like them in that path. Looking forward I am optimistic. We have had about 50/50 men and women medical students for a long time now. What we really need to address is the leaky pipeline where we lose women before they get to mid-career, senior, and leadership positions. The interventions that are needed to advance women in senior leadership roles are different than the interventions that are needed to get more women into STEM careers, medical school, or internal medicine residencies in the first place. In some fields, medicine is still set up like it was 20 or 30 years ago when somebody stayed home full-time to take care of the kids. So I think more flexibility and hardwiring of equity principles in everything we do will make a big difference.
Shaikh: What have been some the pivotal moments in your career?
Fraser: One thing that made a big difference for me was people encouraging me to learn to write grants and to do research. Research was not something that that I thought was going to be a big part of my career initially. Lucky for me, research training is a real strength of Washington University. People helped me learn to write grants. I would encourage people to get additional training in research methods or a master’s degree in clinical investigation, public health or in epidemiology because that facilitates your career development in terms of having a niche.
Shaikh: Busy as you are, is there a time that you can point to and think that you feel spent or burned out?
Fraser: Coming out of COVID, I think, has been the hardest year and a half for all physicians, both on the clinical side, the research side and for our educators. Many people at the medical center were working 24/7 just to try to get everybody through this and protect as many patients and healthcare workers as possible. I would say, for sure, I got really tired in the past year.
One time that I probably felt burned out was 10 or so years ago when my parents died. I was trying to juggle and take care of my kids, my husband, and my parents who were elderly and quite sick and still do my job. When they died, I felt horrible, like I was a bad daughter and a bad doctor, like I didn’t do enough for them in the end. It took a while to sort of get back on track and realize that you can’t keep everybody alive forever or fix everything. I think that’s normal but we don’t talk about it enough. In reality, the loss of a parent or family member is harder than anything in medicine. We need to really support people through those personal challenges. They’re inevitable and they’re going to happen so we need to be there emotionally for our faculty, staff and trainees going through these difficult life events.
Shaikh: Very true. Do you ever get the opportunity to turn off and take a break?
Fraser: I do! I’m very fortunate: I have a wonderful husband who is still with me after 33-plus years so we like to do a lot of things together. We have three kids, 31-year-old twins, and a 27-year-old. We also recently were blessed with our first grandchild. We are very fortunate because our kids still love us and like to do things with us! We ski, fish and hike and generally we like to be together.
Shaikh: What part of your work brings you the most joy? You do so many things!
Fraser: I think one of the greatest things about being the chair is the ability to recruit junior faculty and trainees and to help them with their career development. I think this is an extraordinary place and the department has grown dramatically. Interacting with people and fostering their career development is the best part of being the chair.
Shaikh: Time is scarce in academic medicine. Is there a part of your job that you wish you could do more or less of?
Fraser: I wish I could do more clinical time, attending on firm, working with housestaff and medical students. That is a really fun part of my job. If I did something less, it would be less of the administrative and regulatory work.
Shaikh: What have been some of the more challenging times in your career?
Fraser: Some of the most challenging parts of this career relate to delivering health care to colleagues. This is a big department with a lot of moving pieces. People get sick and their family members get sick and have tragedies. To me, the personal aspect of it, losing a faculty or staff member is the most tragic.
The other dramatic thing that I will remember about this job is when George Floyd was killed. We have had such incredible racial violence over the past decade here in St. Louis, in Ferguson, the fires and the riots, the police brutality. We learned a lot and it catalyzed many of our initiatives to become anti-racist and to really promote diversity, inclusion and equity in the department.
I feel some good things have come out of George Floyd’s death, even though it was terrible. We have such a long way to go still. We are much more transparent about racial inequity, much more committed to reduce disparities and we are much more engaged in the hard work that’s needed to make this really an anti-racist institution.
Shaikh: Having tough conversations and looking past the blind spots.
Fraser: It’s on all of us to try to really have a better sense of where people are coming from, what their lived experiences are. By spending more time with people and getting to know them and their background, being able to communicate openly and honestly, it will make us a better institution, a better department, a better training program with better doctors.
Shaikh: Shifting gears a bit! Do you get weekends off? Many, I hope! Where would we find you on a Saturday morning?
Fraser: Usually on Saturday mornings, I go work out with my trainer. I started working with him a few years ago because I was so unfit. I was certainly my own worst enemy by working too much and not exercising. A colleague of mine suggested that I go to his trainer and, of course, I was not going to do that. My friend gave my name to the trainer who then called me and I was too embarrassed to say no. And I go to Orangetheory on Sunday mornings.
Shaikh: What are some of your hobbies?
Fraser: I do like skiing … my family will laugh and say I’ve become the worst skier because I don’t like to fall. All my kids ski much faster than I do. We’ve taken up trout fishing recently. That is really very fun. I like to go hiking. I got an electric bicycle recently, which has been a game changer because now I can beat my husband going uphill. Our kids come back pretty frequently, they all like to ski so, you know, if the parents offer the opportunity for a ski trip, it’s pretty easy to get them all to agree.
Shaikh: What makes you most proud of your career?
Fraser: I feel really good about my ability to make a difference in patients’ lives … through my research, developing interventions to reduce healthcare-associated infections. Also, mentoring people. There’s nothing better than watching your trainees do even better than you did in your career. So that’s a particularly joyous thing for me.
Shaikh: What is one piece of advice you would give to a female physician?
Fraser: I think women should continue to be brave and pursue their passions. There isn’t anything that women can’t do in their careers right now. We often say you can’t have it all. In reality, I think people can have a really great career and a family and friends. But they have to be organized and they have to know that it’s going to be hard to juggle. In order to manage, they have to be able to make compromises, and give more or less time and effort to their work and career at different phases of their lives.
Preet Shaikh is a third-year medicine resident with an interest in cardiology and women’s heart disease.