Women Take the Lead in Pulmonary Critical Care Medicine

Women Take the Lead in Pulmonary Critical Care Medicine

Several years ago, the pulmonary, allergy, and critical care division at Stanford Medicine planned to expand. Division leadership hoped to build more specialized departments that would better serve the community. “I tell this to potential trainee recruits as well as faculty recruits—a lot has changed in a very positive way in our division over the course of the last decade. Our current leadership has a very forward-thinking approach to advancing women and just people in general, even from different lines of academic sort of pursuit,” says Kristina Kudelko, MD, clinical associate professor and a pulmonary vascular disease fellowship director.

“We hope to expand in a way that reflects more accurately what the population at large looks like,” says Mark Nicolls, MD, professor of pulmonary and critical care medicine. Hiring and promoting a diverse team is a goal shared by many other departments at Stanford Medicine.

Pulmonary, allergy, and critical care medicine are well-known to be male-dominated specialties, several researchers explain. Arthur Sung, MD, senior associate chief of the division of pulmonary, allergy, and critical care medicine, says that when the division decided it was time to expand, the leadership wanted to be intentional about not just recruiting women and underrepresented groups, but supporting them as they rose into leadership.

Today, the department is about 50% women, with many of those women leading their own teams. And the more specialized tracks, such as the pulmonary hypertension fellowship, are attracting physicians and educators like Kudelko, who says she came to Stanford for “a very specialized fellowship that didn’t exist on the East Coast.”

Today, the department is about 50% women, with many of those women leading their own teams.

Today, the department is about 50% women, with many of those women leading their own teams.

Sung emphasizes that the division leadership didn’t set out specifically to hire the same number of men and women, but instead they aimed to help equalize the privilege and support for women and other underprivileged groups as they rose to leadership roles on their own merit.

“We decided to try and grow our division organically. We have amazing fellows or physicians in training, who graduate and then may go into the community or get other academic centers to further their careers,” says Sung. “We felt the need to hire our own faculty.”

One of the challenges is that the academic hospital can’t always offer salaries that are higher than a physician might earn in a private practice, explains Nicolls. The team has worked to make up for that by offering leadership opportunities and mentorship that help develop portfolios and by providing flexibility for those who are building their families.

Sung says they told junior faculty members, “We want to cultivate your ideas. You have a great vision of a particular clinical program. So why don’t you take this leadership role, develop that program with the hospital and along with me and Mark, and we’ll promote you?”

Dedicating resources to growing the division’s subspecialties and supporting a gender-diverse faculty has paid off. “We’ve become an internationally recognized division in the past 10 years,” says Nicolls.

Several women have risen through the ranks in the division of pulmonary, critical care, and allergy medicine. The following stories highlight their achievements.

Meghan Ramsey, MD—Critical Care Medicine Fellowship Program Director and ValleyCare Interim ICU Medical Director

Ramsey found her way to Stanford Medicine 20 years ago, when she was just a medical student. She stayed for her internal medicine residency, then a pulmonary critical care medicine fellowship, and now a faculty position. “I don’t think most people stay on for that long at one institution,” she says. “It’s fairly unique.”

The opportunity for growth played a large role in her decision to continue with Stanford for two decades. In addition to taking care of patients, Ramsey feels strongly about teaching. That’s why she’s become the critical care medicine fellowship program director. “I can take care of patients myself and do a great job, but if I can teach 10 people to take care of those patients, then I can extend the amount of health we can promote in our community.”

She says the department’s emphasis on diversity is important for improving the quality of patient care and education. “Anytime you bring diverse groups of people together, you’re able to draw from broad experiences and perspectives,” she says. “ You can take the best of all worlds and elevate everyone’s standard.”

It’s not just the support from leadership, she explains. In her early years at Stanford, she refused to take sick days, but now she has two children. “All of a sudden, I had to call out because my kid was sick.” She realized that she had a number of colleagues who understood her situation and were able to step up and help her. “That family balance, which our division in particular has really supported,” has made a big difference in allowing Ramsey to achieve her full potential.

“I can take care of patients myself and do a great job, but if I can teach 10 people to take care of those patients, then I can extend the amount of health we can promote in our community.”

– Meghan Ramsey, MD, with daughters Reagan (left) and Quinn.

Kristina Kudelko, MD

Kristina Kudelko, MD—Pulmonary Vascular Disease Fellowship Director and Director of Clinician Educator Faculty and Fellowship Career Development

Kudelko came to Stanford in 2008 for a pulmonary hypertension fellowship. “Being able to subspecialize in such a unique field, take care of patients with this fairly rare disease, and serve as a referral center for that disease was a privilege,” she says.

One of the reasons Kudelko stayed with Stanford after her fellowship ended was for the diversity. She doesn’t primarily focus on research, but she relished the opportunity to attend pulmonary critical care grand rounds where she’d hear research talks and continue learning.

A sense of curiosity has always driven her, and over her time in the department, she’s taken advantage of opportunities to expand her skill set. “I really liked that I’ve been able to pivot every five years or so and find a new passion,” she says, explaining that her interest in mentoring and supporting clinician educator–oriented junior faculty and trainees emerged recently.

Since her first few years here, “a lot has changed in a really positive way,” says Kudelko, describing an increase in the department’s diversity over the years that has helped her understand different experiences. And she personally feels “very heard and very engaged in the change.”

Angela Rogers, MD—Director of Critical Care Research

In 2013, Nicolls recruited Angela Rogers with the promise that she would be able to do intensive care research in an extremely collaborative atmosphere. “I love taking care of very sick patients,” she says. “It’s something I’m very passionate about.” To do that, she joined the hospital in a junior faculty position but didn’t have any plans to take on a leadership role, at least at first.

Throughout her tenure, she says, the leadership has consistently made a point of asking her what resources would help her succeed. “It’s just such an important thing for junior faculty to be supported like that,” she says.

When COVID-19 hit, she was ready to take the reins. “Leading the ICU task force for COVID was definitely the thing I’m most proud of in my career,” she says. In doing so, she had the opportunity to collaborate with leaders throughout the hospital, in infectious diseases, hospital medicine, rheumatology, and more. “That part was really great from a science perspective,” she says.

Rogers has also noticed the rise in gender diversity since she joined the staff nearly a decade ago. “When I came to Stanford, there were only two or three women in our division,” she says. “It’s been great to see women rising up the ranks.”

“When I came to Stanford, there were only two or three women in our division,” she says. “It’s been great to see women rising up the ranks.”

– Angela Rogers, MD

Edda Spiekerkoetter, MD

Edda Spiekerkoetter, MD—Principal Investigator and Associate Professor of Medicine

Spiekerkoetter came from Germany to do a postdoctoral research fellowship in pulmonary hypertension at Stanford in 2002. “We didn’t have good treatments for pulmonary hypertension [in 2002], and patients ended up needing lung transplants. It was very frustrating,” she says. “I wanted to do basic research to understand the disease pathobiology and find ways to treat it better.”

Since then, Spiekerkoetter says, she’s noticed many more women working as clinical professors and clinical researchers but would love to see more running basic science labs. “I think we can definitely improve on that,” she says.

Spiekerkoetter came to Stanford strictly as a researcher, but soon she got certified to treat patients in the United States. Over the course of her 20 years at Stanford, she’s particularly proud to say, several clinical trials have been initiated based on her research. She tells the story of one particular patient, a woman with end-stage pulmonary hypertension who wanted to go camping, but her treatment regimen required her to be hooked up to two separate infusion pumps. “It was so cumbersome,” says Spiekerkoetter. “It’s so difficult when you have to go to these extremes just to stay alive.” The care team decided to give the woman one of the medicines that Spiekerkoetter had studied in the lab. She wasn’t cured, Spiekerkoetter says, “but at least she didn’t have to come to the hospital so frequently afterwards. She could really enjoy her time and do things she enjoyed for the remainder of her life.”

Spiekerkoetter’s strongest motivation is this: to translate her research findings into improving clinical care.