Celebrating Women in Medicine Month: An Interview with Dr. Karen Nichols

Karen Nichols, DO, MA, the first woman elected president of the Arizona Osteopathic Medical Association, the American College of Osteopathic Internists and the American Osteopathic Association, and the first woman dean of the Chicago College of Osteopathic Medicine of Midwestern University (CCOM/MWU), is truly a trailblazer in osteopathic medicine and medical education.

As the American Association of Colleges of Osteopathic Medicine (AACOM) celebrates Women in Medicine Month this September, we recognize that Dr. Nichols’ example has inspired countless women in medicine. However, her influence extends far beyond that, as her leadership has made a positive and lasting impact across the osteopathic and broader medical community.

AACOM spoke with Dr. Nichols about her significant accomplishments as a leader in osteopathic medical education, her advice and words of wisdom to others, especially women, who are interested in leadership and her thoughts about the importance of supporting, recruiting and retaining women in medicine.

The answers below have been edited for brevity and clarity.

Q: Dr. Nichols, you have a master’s degree in management and healthcare, which taught you important leadership skills, but you didn’t enroll in this program until after you were appointed interim chief of the lab at Phoenix General Hospital when you were just 21 years old. Has leadership always come naturally to you?

Dr. Nichols: I appreciate the opportunity to talk about women in medicine at this very important time, and yes, my sisters would confirm the fact that I’ve always been bossy, so being a leader was something that I’ve always done, even if I didn’t seek it out. I would also say that being a doctor implies leadership. “Doctor” comes from the Latin word meaning “to teach,” and teaching is certainly a leadership role. Moreover, physicians are likely to be the most formally educated individuals in most settings, and in a healthcare environment, we’re going to be looked to as leaders. Even if physicians think they are not leaders, they are.

Q: You’ve faced many challenges as a leader, such as accepting a job offer as a dean without having worked in a dean’s suite role before. As a leader, what has helped you navigate these challenges to achieve success?

Dr. Nichols: Reflecting back on accepting the position to be dean when I knew so little about what a dean did is probably not a piece of career advice that I would give to anybody else. The reason it worked was that CCOM/MWU was such a well-established school with so many great faculty members and chairs that they could figure out how to keep the school running smoothy as I figured out how to be dean. Sometimes as women we don’t think we are qualified for a particular situation and we will say no, even though we are as qualified as anyone else applying for that position. Studies show that men are more likely than women to accept opportunities even if they don’t feel like they have all the required background or experience. I would encourage women who are interested in pursuing leadership opportunities to consider if they could learn from others and pull together resources to fill any gaps in their qualifications, as I did at CCOM/MWU, because by the classic literature, that’s not something women usually do and there’s no reason that we shouldn’t.

Q: You had an experience losing your way walking through fog, not seeing a road that was there the whole time, which you treat as a metaphor for being okay with not knowing where your next road will take you, but trusting that it’s always there. What has helped you stay faithful in the future throughout the COVID-19 pandemic?

Dr. Nichols: I think our faith is tested in a situation like COVID-19 that is so uncertain. What gives me hope and reinforces my faith is that our students, our residents, our faculty members and our physicians in practice are stepping up to do what needs to be done to improve healthcare and take care of patients. Yes, we may be in a fog of not knowing what’s ahead, but our determination and dedication to the reason we all became doctors is what will see us through.

Q: You value the importance of being prepared and passionate over having a rigid plan for the future. Do you find that approach has any parallels with osteopathic medicine and has it influenced how you connect with and care for patients as an osteopathic physician?

Dr. Nichols: Every single leadership experience and educational preparation that I’ve had has come into play later in my life, even though I had no idea that it was going to apply. I earned a master’s in management with a specialty in healthcare administration, and then I went to medical school and thought, how will I ever use my management skills, what am I ever going to manage? Then I became dean of a medical school! As physicians, we are educated to treat a wide variety of illnesses, injuries and more. Some of what we are trained to treat we may never see, but we are prepared to if the need arises. We can’t plan and will never know what we are going to run into in our practice, and even if we aren’t specifically prepared for something—for example, if we’ve never taken a course in tropical medicine and find ourselves in a Central American practice setting—we’ve still got the tools to understand how to put our preparations into play. So, the education and training that we have as physicians is directly applicable to our leadership. We need to prepare and know how to approach things without always being able to plan. Dr. A.T. Still’s metaphor is helpful here, as well, using the simple example of how, when you pull a cat’s tail and it howls, the problem isn’t in the howl, it’s in pulling the tail. Knowing to treat the tail, the source of illness or injury, and remembering that everything is interconnected, helps us see the big picture even when we may not have a clearly defined plan in place.

Q: What has your experience been like not only as a woman in medicine, but a woman in leadership? What advice would you share with other women in the osteopathic medical field?

Dr. Nichols: That is a really good question, and it has a really simply answer—you can do this! Don’t put limits on yourself. Virginia Satir was a psychotherapist who said we must not let other peoples’ limited perceptions define us. We must not let our own limited perceptions define us. We are fully qualified to be leaders. We need the diversity of women, along with people from all different backgrounds, if we want to improve our leadership in medicine in every single way.

Q: You just published a new book, Physician Leadership: The 11 Skills Every Doctor Needs to Be an Effective Leader. In its first chapter, you write about the importance of knowing who you are and how you act, quoting Warren Bennis, who said, “Becoming a leader is synonymous with becoming yourself. It is that simple. It is that difficult.” How did you come to know yourself, and how often, if ever, have you had to re-assess who you are as your circumstances or experiences have changed?

Dr. Nichols: I did not realize that I had a leadership style all the time I was in practice. It never occurred to me that there was a specific way that I looked at the world based on who I was and my background. And guess what, other people have a different way of looking at the world based on their background! And this is a difference between being a doctor and a leader. As a doctor, I always knew that there were different perspectives on health. This goes way beyond that. When I became dean, I met with the 15 different department chairs at CCOM/MWU, and they could have been textbook examples of all the different ways to communicate. I would ask myself, how come this person talks all the time and never lets me ask questions? How come that person answers the questions I ask but doesn’t volunteer information on ten other related ideas? How come this person never answers my questions, but brings up endless possibilities? It was astounding to me that each person had a very different way of approaching their leadership. I learned that to be successful, I couldn’t approach leadership the same way I had as a doctor. I’ve learned that it’s not wrong to see the world as we see it, it’s wrong to think that how we see the world is exactly the way it is, because other people see things differently. So, I’ve not changed my approach, but I’ve learned that 1) other people have different approaches, and 2) sometimes mine is not the best approach.

Q: The COVID-19 pandemic is causing an unprecedented number of women to leave the healthcare workforce. In your view, why is it important to support, recruit and retain women in medicine?

Dr. Nichols: I would expand that question to ask why it’s important to recruit a diverse medical school class beyond just women, to include all gender expressions, ethnicities, life experiences and more. Studies are clear that women patients do better when they are taken care of by women physicians, and patients from racial and ethnic minorities do better when they are taken care of by physicians from similar racial and ethnic backgrounds. In terms of recruiting a more diverse medical student body, the saying is true, you can’t be what you can’t see. And as physicians, we may not always realize our limitations or gaps in care we can provide, even if we don’t intend for these to exist or are trying to be mindful of them. For example, one of my students who was raised in a foreign country served as an interpreter for an organization that worked with refugees. As an interpreter, he was required to vocalize from the speaker’s point of view. One day, he was interpreting for a woman who said, “I was raped and robbed.” So, he had to turn to the organization and say, “I was raped and robbed,” not, “She was raped and robbed.” He was shaken by this experience. Until he had to say the exact words like it was him, it didn’t affect him the same way, which illustrates the importance of true empathy and connection with others and the power of embodied or lived experience to affect care.

Q: In addition to your many accomplishments and responsibilities, you have also been an extremely strong and passionate advocate for the osteopathic profession, and have consistently helped raise the profile of AACOM’s public policy priorities on Capitol Hill. Do you see any connection between the skills required for strong advocacy and strong leadership?

Dr. Nichols: You’re bringing me back to my favorite comment—you can do this! This is part of the reason physicians need to learn leadership skills, because who is a better advocate for their patients? And I get it, we’re very busy. I was in private practice for 17 years. A 20-hour day was not unusual, with, in my case, working every third weekend. You just did what you had to do. So, it’s hard sometimes for physicians to say, how am I ever going to have time to step away and advocate? You may need to put advocacy off early in your career, but physicians need to step up and speak out for what’s necessary for their patients. We need to be leading in the political arena, in health systems, in state and national government, in medical organizations and in hospitals. We desperately need the physician voice. I’m very passionate about that.

AACOM thanks Dr. Nichols for helping us celebrate Women in Medicine Month and is grateful for all the important contributions made by women in the osteopathic medical education (OME) community.