Pearls Are a Woman’s Necktie

My Story

I grew up in rural North Carolina in the 1960s, the oldest of four children. I was a classic tomboy, spending most of my free time playing outside with my brothers and cousins when I wasn’t working in the garden, feeding the livestock, going to school and church, or watching favorite TV shows.

My first years in school were stressful for me, because temperamentally I was different from the other girls. As a result, I was picked on by the boys and became disruptive in class. I dreaded report card days, when my all-A record was inevitably spoiled by that D-minus in conduct. Although the bullying I experienced in school was quite severe, as I gradually became more confident of my own talents and self worth, it actually made me fearless. Later, as a medical student and resident, behavior others would interpret as harassing or abusive just rolled right off my back.

The culture in which I grew up drew clear distinctions between the roles of girls and boys, and I often felt uncomfortable with those things traditionally assigned to women.

Reading finally saved me from perpetual misery at school. I devoured books by the dozen and developed a love of reading that has remained an important part of my life. My parents knew they had their hands full with me, so they made sure I had lots of activities to keep me focused. Starting at age six, I participated in scouting, choral music, piano lessons, oil painting, and plays. Although not typical then, this was very much like the activity-filled lives of many children today. I even had my own horse, named Daisy. Since none of my other siblings liked to ride, some of my best memories are of my dad and me riding our horses together.

The culture in which I grew up drew clear distinctions between the roles of girls and boys, and I often felt uncomfortable with those things traditionally assigned to women. I didn’t want to learn to cook, sew, or homemaking, and I didn’t want to become a secretary, teacher, or nurse—the only careers I thought were available to women. Although I had the highest grade point average in my class, I was told to learn to type. That way, “if I had to work,” I could always get a job.

Prior to Title IX, there were few sports opportunities for girls. I was jealous of my brothers’ participation on baseball and football teams. I wanted to be an athlete, but year after year I was cut from the basketball team, the only sport open to girls at the time. Despite many hours of practicing alone, my petite and clumsy self couldn’t seem to master the game. Luckily, I discovered running. In ninth grade I tried out for track and excelled, lettering in it. The following year, there were not enough girls trying out to form a team, so I ran on the boys’ team. I ran the mile and the 880. Every boy I beat would promptly quit the team as a matter of pride rather than wait to be cut. As a result, I was middle of the pack at the first of the season but dead last by the end.

As a young person, I began to become a student of human nature. This was in part a result of experiencing so much death among the people I was close to, including family. First, my grandfather died of a cardiomyopathy at age 59. Not long after, my third-grade teacher died of metastatic breast cancer—in the middle of the school year. My other grandfather died of coronary disease when I was in eighth grade, and one of my grandmothers died of colon cancer when I was 15. My last grandparent died of a stroke when I was 19.

My parents are only 20 and 22 years older than I am. As I think back now, they had lost all four of their parents before they were 40. They were wrestling with all the issues of young adulthood while deeply grieving. In the midst of all that, they were able to create a family life that emphasized the moral imperative to make one’s life meaningful in a loving and supportive environment. The message I heard from my mother, whose own life choices had been theoretically limited by economic circumstances, was “you can do anything you want to do, Grace, so long as you set your mind to it.” This existentialist message I have taken to heart.

Like Barack Obama, I graduated from high school in 1979. This was the class that divided the baby boomers from generation X. I believe our values are boomer: focused on hard work, achievement, finding meaningfulness in our careers and life choices. But our circumstances are X-er: attending high school during recessionary, Watergate-driven cynical ’70s, graduating from college in the midst of the Reagan recession of 1983, entering our 50s after the 2007 crash.

From a leadership perspective, this historical margin creates the possibility of a group of individuals who are simultaneously idealistic and cynical, hard-working and somewhat self-centered. That juxtaposition allows a certain degree of conviction mixed with energy, perseverance, and caution that may be just what is necessary to lead us through our current national challenges.

In 1979, I won a Morehead scholarship to attend the University of North Carolina at Chapel Hill. At that point, the scholarship had been open to females for only three years. The scholarship allowed me to obtain an incredibly rich undergraduate education. During the summer months before college, I participated in an Outward Bound program in Colorado. I got to ride in a plane for the first time and spent four weeks in the Rockies in a challenging physical and mental environment. Other summer experiences included working for a police department in California, working at a law firm in North Carolina, and, in 1982, during the Falklands War, working for the Liberal Whip’s Office of the Parliament of Great Britain.

In college I ran on the women’s track team for a year and participated in crew another year. Track turned me into a lifelong runner. Choosing a major was difficult because I wanted to learn “everything.” I ultimately majored in religion and English, with enough economics courses to nearly declare a third major.

More importantly, college is where I met the love of my life. Tim is the fifth of six children. Both his mother and father are physicians. Like me, he grew up in a large, close-knit family. We had both grown up on farms where we lived with grandparents in the same house. Our families were intensely committed to Democratic politics in an increasingly conservative state and equally involved in church— his were sixth-generation Quakers, mine were Southern Baptists.

College for me included student government, track, and crew. For Tim, it included managing the kitchen at his fraternity, delivering pizzas for Domino’s, working as a camp counselor, and exploring the new field of computer science with punch cards, algorithms, and programming. We both majored in religion because it was the most intellectually comprehensive department in the university.

A week after we graduated in 1983, we married. In the midst of a recession, we had about $500 between us, no jobs, and liberal arts degrees in humanities. A year before, almost on a whim, I began thinking about medical school. The idea of taking a deep dive into the natural sciences, which I had not really studied since high school, with a career focused on helping people, seemed appealing.

Tim’s mother, Dr. Eldora Terrell, was a role model. She showed me such a life was possible. In an era in which women’s choices were supposedly fixed, she had six children, practiced internal medicine, founded a clinic for uninsured patients in the community, took a public stand for integration in the Civil Rights era, was active in her church, and served as a medical director of a nursing home, as a college board trustee, and as chief of staff of the hospital where she attended patients, and still managed to can green beans, make strawberry jelly, harvest asparagus, and ride horses to help with the cattle round-up on the weekends. Through her, I saw how the professional role of physician actually frees women from certain social constraints.

Ten days after graduating and three days after getting married I was in summer school studying physics. That wasn’t the only course I had to take before applying to medical school. There were two physics courses, two organic chemistry courses, and some biology. Then I had to take the MCAT and do well in order to be accepted.

From 1983 to 1985 we lived in Richmond, Indiana, while Tim pursued a master’s degree in Quaker history at Earlham School of Religion. We had a three-room cinderblock apartment in an undergraduate dormitory where I worked as head resident. My salary was $3000 a year. We ate for free in the campus cafeteria. I thought it was the coldest place in the universe.

At age 22, I found myself married to a creative, idealistic, and definitely unfocused man, working in a job where I was responsible for students only a few years younger than myself. They challenged me, insulted me, and generally pursued their own agendas. They didn’t know that I had a recent “grand past” as a Morehead scholar, intern to Parliament, and UNC varsity athlete. To them, I was either the person who let them into their dorm room when they lost their key, the one from whom they hid their marijuana, or the person who was supposed to settle their roommate complaints.

For intellectual enrichment I took a “wives’ course” on John Updike at the School of Religion. It was awful: faculty wives crocheting and talking about their children’s preschool experiences.

Tim was trying to find himself and I was trying not to lose myself.

I focused upon those science courses at the college that I needed for medical school. Fortunately, I could take these for free as part of my employment. In addition, I decided to expand my general knowledge base.

First, I found a Cliff’s Notes pamphlet and looked at all the great books listed on the back page. Then I started from the As and read each work of literature, from Absalom, Absalom on down the alphabet. After that I read all the works of philosophy I could locate, including all of Hegel, all of Kant, all of Kierkegaard, and so on. I told myself I was doing this before I went to medical school because then I wouldn’t have time to read for pleasure. In retrospect, though, I was probably depressed. Training and running a triathlon finally got me out of my funk. I took the MCAT, interviewed, and applied for several medical schools. I was accepted at Duke and entered in 1985.

Tim and I traded places in the fall of 1985. Suddenly I was the medical student, with purpose and focus, and he was looking for a job. He worked as a bartender in the Duke faculty lounge for a bit, and finally landed a job counseling Native American high school students, helping them get into college through the North Carolina Commission of Indian Affairs. For the first two years we scraped by on his $13,500 a year salary. Then we decided we just had to have a baby.

Katy was born at the end of my third year of medical school. I took eight weeks off, then did my fourth year “in reverse,” taking the sub-internships at the end of the fourth year rather than at the beginning.

The year Katy was born, Tim decided to return to school for a master’s degree in the burgeoning new field of computer science. He took all of his classes on Tuesdays and Thursdays so he could be home with the baby on the other days. On Tuesdays and Thursdays, my sister, a freshman at UNC, drove over to Durham to watch the baby, while Tim drove over to North Carolina State University to take his classes.

After I graduated from medical school, I stayed at Duke Medical Center an extra year and did an internship in pathology, reasoning that without night call, I could be with the baby at home, giving Tim time to finish his degree.

My year as a pathology intern still seems surreal. Like many working mothers, I felt the pangs of guilt every morning as I left my daughter at home. It didn’t matter that her father and aunt were available as primary caregivers. Katy walked early, talked early, and was like a little Tasmanian devil full of energy. I hated missing any part of her development, although her irregular sleeping and eating patterns kept us all perpetually exhausted.

I spent my days doing surgical and autopsy pathology. The autopsies on fetuses and children were particularly difficult for me. I still remember how I felt entering the autopsy suite to view one particular case. The little girl was almost the same age as my Katy, her body in a nightgown, still clutching a teddy bear. Like many internships of that era, the pathology department at Duke was not a particularly warm environment. Because the program directors knew I did not intend to remain in pathology as a specialty, they focused their mentoring energies elsewhere.

When some of the physicians learned of my plan to practice general internal medicine, I began to experience discrimination for the first time.

When some of the physicians learned of my plan to practice general internal medicine, I began to experience discrimination for the first time. Duke was not primary care friendly. One professor told me that I should leave and find some primary care program in a community setting, that as a “real” academic institution, there was no place for a generalist at Duke.

That year, while in the surgical suite, I accidentally severed the artery and nerve to my left index finger on a formalin-hardened surgical specimen. The injury required hand surgery. For eight weeks while the reanastomosis healed, I was unable to cut surgical specimens. When I returned to work the day after my surgery, an upper level resident yelled at me for a good 30 minutes, making it clear that my injury was going to make life difficult for the other pathology interns. The department administrator was equally unsympathetic; his only concern that this might bring OSHA down on the department.

Once Tim finished his degree, we knew we needed to make a change. I was accepted into the primary care track in internal medicine at NC Baptist Hospital in Winston-Salem. I completed my pathology internship on June 29, 1990, and began my second internship July 1. That was the start of the second craziest year of my life.

We were living with Tim’s parents in High Point, North Carolina, about 20 miles from Winston-Salem. Tim got a job in public health sciences in research computing at the medical school. Our household was not exactly mainstream America. We had four generations, including Tim’s 94-year-old grandmother, my busy internist mother- in-law and father-in-law, Tim, me, and Katy, the quintessential “terrible two”- year-old. The four dogs in the house added to the chaos. Still, it was wonderful having the security of two salaries for the first time after eight years of marriage.

Like every other medical intern, I rotated through cardiology, heme-onc, general medicine, emergency medicine, and the other specialties with every second or third night call. I do not remember that time as being difficult or abusive. I was excited to finally learn my craft in a residency environment that was both rigorous and supportive.

I developed a very close relationship with Dr. Bryant Kendrick, a chaplain at the medical center who managed the internal medicine primary care track. He became my real mentor, helping me process my continued “strangeness”: we focused upon medical ethical issues, the excitement engendered by the Clinton era’s anticipated healthcare reform, and the spiritual wholeness of the doctor–patient experience.

After 14 months of living with Tim’s parents, we had saved enough for a down payment to purchase our first house. It was on a wooded lot with a stream, a tree house, a swing set, and an elementary school and playground next door. We balanced our roles as young parents and professionals, began paying off our student loans, and spent our free time together hiking, parenting, exercising, and keeping up this new house.

In 1993, seven months pregnant with my second daughter, Robyn, I completed my residency and began private practice with my in-laws. I took my medical boards that September, before promptly going into labor. The next eight weeks were some of the sweetest of my life. I took maternity leave and was able to walk Katy to the neighborhood school for her first days of kindergarten. I also got to spend some very quiet and special time with my new little girl.

Although as grandparents, my in-laws were both interested in the welfare of their new granddaughter, as medical practice partners they were equally eager for my return to work. This was the period when primary care started to lose status and get slogged by the economic forces of managed care. Our once-a-week call meant covering seven internists, three nursing homes, and unassigned hospital cases.

The intensity of the experiences with patients in the office, the hospital, and the nursing home in that era has been unsurpassed.

These were also the days before hospitalists and before nurse triage. The paradigm was still for the internist to be the center of all activity in the middle of the medical universe, despite the degradation of both reimbursement and status. It was far more brutal in many respects than my residency, but also more rewarding.

The intensity of the experiences with patients in the office, the hospital, and the nursing home in that era has been unsurpassed. It was comprehensive, and I had been trained to be effective in a multitude of settings. In areas where I had not, the 40-year experience of my father-in-law and mother-in-law filled in the gaps left in my training. It helped me understand the real role of physicians: to listen, to act, to help, to heal.

About six months after I had joined my in-laws’ private practice, administration at High Point Regional Hospital, where I admitted patients, began discussions about the creation of a physician hospital organization (PHO) as a response to anticipated changes in the healthcare environment from managed care.

The chief-of-staff, Dr. Al Hawks, gave a passionate speech about the need for collaboration and cooperation, and a steering committee of seven was formed. The three specialists and three primary care physicians nominated to form the steering committee were all established male medical staff members.

Almost as an afterthought, my father-in-law nominated me. Over the course of the next 18 months, we met every Thursday night, sometimes until 1 or 2 o’clock in the morning, to create what ultimately became Cornerstone Health Care.

Most of us were junior partners in our practices. Because we were young and less established in the community, we were more willing to be reckless. We figured out our governance and income distribution and began developing a culture based less on autonomy and more on collaboration. We also focused on investing in information, technology, and advanced models of care delivery.

Cornerstone Health Care was established October 1, 1995, from the merger of 16 practices in High Point, North Carolina. In 2000, I became CEO. During that time, I saw my daughters grow to young adults, my in-laws retire from medical practice, and my practice merge with two other Cornerstone internal medical practices to become the first NCQA-recognized level-three Physician Practice Connection Medical Home in our state.

Cornerstone grew from the original 16 practices in High Point, to 93 locations throughout the Piedmont Triad region of North Carolina, with over 300 providers practicing in 10 separate hospitals that were part of six separate health systems. Our company’s focus was to be the model for physician-led healthcare in America. We were committed to transform our model from a volume-based system to one that was value-based, leading our market in innovative approaches to a sustainable 21st-century healthcare delivery system.

From 2013 through 2017, Cornerstone and I gained a lot of national prominence and, some would say, notoriety. In 2013 Cornerstone Health Care developed innovative care models in primary care, cardiology, oncology, pulmonology, and dual-eligible populations, and moved all of our contracts to early value-based models. Within 18 months, we had lowered the cost of care by 20%, and in 2015 won the prestigious AMGA Acclaim Award for its highest-performing medical groups.

We spun off our infrastructure into a company called CHESS, which was invested in by LabCorp, Wake Forest, and now, Atrium. That company, for which I was the first CEO, remains an underrecognized powerhouse in value-based care, managing over 150,000 lives in high-performing risk contracts in Medicare Advantage, NextGen ACO, and commercial contracts. I remain on the board of CHESS and am proud to see the vision we had for it a decade ago is coming to fruition as “the market catches up.”

Payers talked a good game about wanting to move to value, but they were as ill-equipped to do so as the high-cost hospital systems.

Under my leadership, Cornerstone made the move to value-based healthcare earlier than much of the rest of the market. Our rationale was built upon our confidence in our ability to provide higher-quality healthcare at a lower cost in a physician-led independent medical group.

We went all in, but the market did not. Payers talked a good game about wanting to move to value, but they were as ill-equipped to do so as the high-cost hospital systems. As the payers dragged their feet in providing value-based reimbursement, the move to value strained our finances, and local hospitals quickly took advantage by hiring our physicians who were feeling the strain of our financial commitments.

In 2016, Cornerstone lost its independence, becoming part of the Wake Forest Health System, which is itself now part of the multistate Atrium Health System. By 2016, the other physicians at Cornerstone had had enough of me, and I was mentally exhausted and quite heartbroken at the public animosity I experienced in the local medical community to which I had dedicated 23 years as a practicing physician and CEO of Cornerstone. I had a new ambiguous role at Wake Forest within the confines of CHESS, and I was certainly not culturally well-suited for the Wake Forest environment at that time.

Two women academic department heads at Wake took me out to dinner and told me about their own challenges, emphasizing that Wake was not a good environment for women leaders. Although now Dr. Julie Freischlag is the CEO of Wake and much of that culture has changed, at the time, the entire executive team at Wake consisted of white men. Two of them, Dr. Russ Howerton and Terry Williams, are very good friends of mine, but that did not make my ability to navigate the Wake environment any easier—an environment that felt as sexist and unwelcoming as any I had ever experienced. In 2017, I could stand it no longer. I accepted a position as CEO of Envision Genomics at the Hudson Alpha Institute of Biotechnology in Huntsville, Alabama, a startup founded by the legendary team featured in the Pulitzer prize-winning article and subsequent book One in a Billion that made the first diagnosis of a rare disease in a child using genomic sequencing technology that resulted in a life-saving cure.

Our startup company had a revolutionary information technology that could use whole-genomic sequencing to diagnose heretofore rare and undiagnosed illnesses. Although I practiced primary care medicine every day, I, like most physicians, was not very knowledgeable about the capabilities of cutting-edge genomics. To get up to speed, I used my reading superpowers to read every textbook on genomics I could find and quickly got a professional certification in genomics from Stanford University through their online learning platform.

Upon arrival at Envision, I wrote a business plan built upon the unmet needs of patients with rare disease and went to the market to get out a minimally viable product. Compared to the resources of Cornerstone and Wake, Envision’s resources were minimal. I learned the world of venture capital, startups, biotechnology, pitch decks, and fundraising.

Once again, I was in a company trying to do something ahead of the market. Payers would not reimburse our technology, and potential health system partners were not interested in any technology, no matter how much it improved patient care, if they didn’t make money using it. Over the course of the past few years, that has changed, but not soon enough to save Envision.

On September 19, 2018, I learned that Tom Main, a long-time friend, mentor, Envision board member, and investor, had died unexpectedly of a pulmonary embolus, just hours after we had communicated about the next round of funding for Envision. While I grieved Tom’s death, I realized it was the death knell for Envision, too.

Although I spent the next six months desperately seeking alternative sources of funding and used a considerable amount of Tim’s and my personal savings to do so, I was unsuccessful. We closed down Envision in early 2019. I spent the next several months working in a strategy position at Kailos Genetics, an innovative company focused on pharmacogenetics, as well as doing 5,000 pre-pandemic teladoc visits, consulting for Oliver Wyman’s healthcare practice, and, continuing to see some patients at the internal medicine practice I have been part of since 1993, now part of Atrium Health.

Out of the blue, a recruiter contacted me in July 2019 for a CEO position at a North Carolina–based company called Eventus WholeHealth. When I looked at the job description, I couldn’t believe it—it read like my dream job. Eventus is a company that provides an integrated model of care to medically vulnerable adults who reside in skilled nursing facilities, assisted living facilities, or are home bound. I started the position in November 2019. Since then, the integrated primary care, mental health, and podiatry care model has expanded to more than 1200 facilities and private homes in five states.

The 650 providers and support staff have been on the front lines during the COVID pandemic, serving the sickest, most medically vulnerable patient population with patient-centered, evidence-based models of care.

I believe the Eventus model of care is not “ahead of its time” but, in fact, just in time, as our country takes on the challenge of providing whole-person care to the 70 million baby boomers beginning to enter their senior years. Eventus is positioned to be a transformative healthcare delivery platform just when our aging population needs it the most.

In 2021, I left Eventus and am looking for my next adventure. I believe all my previous experiences, from running multimillion-dollar businesses to startups; developing deep expertise in care model design, healthcare policy and economics; and continuing to practice (very) part time in the internal medicine practice I’ve been a part of since 1993, positions me to continue to improve our healthcare delivery system. Stay tuned . . .

It is said that women leaders do not articulate their accomplishments as assertively as men and that is one reason we aren’t as likely to rise to the top leadership positions. Maybe that is true. Here are some things I haven’t talked about here.

While I have been living the life I articulated above, I’ve written three books, served as vice-chair of the federal Physician-Focused Technical Advisory Committee (PTAC) commission, chair of the American Medical Group Association (AMGA), a board member of the American Association for Physician Leadership, an advisor to the innovative IKS company, founding member of the Oliver Wyman Health Innovation Center, given scores of talks, earned a Master’s in Medical Management, and, above all, tried to lead with authenticity. I’ve taught myself Spanish and I still run 25 miles or so a week, although very slowly these days. I’ve built four medical buildings and have kept a fern alive for 40 years. I have certainly failed at a lot of things. Just Google me if you want the dirty details.

Today both my daughters are married to wonderful men. Katy is an attorney and pregnant with my first granddaughter. Robyn is in medical school. I doubt when she graduates there will be many other women physicians who can say that she has both a mother and grandmother who are physicians. Tim is most certainly not “a 22-year-old unfocused young man” anymore. My gorgeous gray-haired husband of 38 years continues his own successful career in health information technology and remains the love of my life.

My Message

The story I have written here is not the one I expected to write. It is deeply personal and one that speaks to many elements of my life that are not directly pertinent to my day-to-day role as a physician executive. I have not discussed in detail my 21 years of experience as chief executive officer or my more than 30 years as a practicing physician in terms of lessons learned that might help other women physicians considering a career in medical management.

Instead, I have decided to share my story within the context of my complex roles as daughter, mother, wife, and daughter-in-law because I believe it is these roles that help define how women are viewed as professionals and the special skills they bring to their leadership responsibilities.

We are at the beginning of what I expect will be the single fastest transformation of any industry in U.S. history. Physician leadership in healthcare during this transformation is crucial and the healthcare delivery system transformation will be an enormous opportunity for women. But the relative lack of women in leadership roles in healthcare currently needs to be understood and addressed.

I would suggest that one approach to addressing this discrepancy is through the language of archetypes as articulated by Carl Jung. Jung theorized that archetypes are symbolic figures hardwired into our unconsciousness. He focused upon the archetypes of hero, father, mother, temptress, witch, villain, wise old woman (or man), and innocent, ingrained in our collective unconsciousness as identified in myths across cultures and times.

Unlike men, most of the female archetypes are characterized by relationships that adhere to traditional social roles (mother, daughter, grandmother, sister). Although men are also represented in archetypes based upon traditional social roles (father, son, grandfather, brother), there are some strong male archetypes based on the relationship between man and society. These are the roles of hero and villain, both of which are external to the family. The hero is focused more upon saving the group, defending the weak and innocent, administering justice. The villain is his foil.

Our country’s future success depends upon our ability to transform our healthcare delivery system to one that is equitable, affordable, and effective. That transformation will require leadership from many individuals who have neither prepared for nor expected to play these critical roles.

For women is it crucial that we understand that effective leaders learn the language of leadership and master it. Using Jung’s paradigm, we need to appreciate how we are perceived in various situations in order to discern how a particular female gender archetype might impact our message. By listening to the language used by others, we can create the situational story in which our role is played. Then we can choose which voice to use in order to be most effective leaders.

The grandmother voice is the storytelling voice. It is particularly useful when giving a presentation, as the human mind is designed to retain information it hears from stories. For physicians, a story about a patient that teaches a lesson and evokes empathy can be a very powerful tool.

In the working world, the mother voice can be dangerous. It can be perceived as both loving and scolding and should be used with caution. On the other hand, the sister voice is powerful because it is collaborative. The connotations of sisterhood eliminate inappropriate sexual overtones and its implied equal status in the sibling relationship can positively impact team building.

Women tend to overuse the daughter voice. Female subordinates often find the daughter role to be a safe relationship with male bosses/mentors because it may diminish sexual tension. However, this is a problem when attempting to transition to a leadership role.

Beware of language in which sexual allusions are used in descriptions of women. The temptress/prostitute archetypes are universal and powerful, but not appropriate within the context of leadership. Likewise, the domineering woman/bitch role is dangerous. Some women avoid leadership roles because they fear being depicted within this context.

The most enigmatic role for women is that of witch. The witch role is powerful, but frightening because it is a role contextualized around female power that is outside of the standard male dominant cultural context. Powerful men may rely upon the language of the warrior/hero archetype as the context for their effective leadership, but being perceived as powerful using the witch archetype is generally a problem for women in leadership roles.

As women leaders, pay attention to the language you are speaking and the language in which others speak to you. Pay attention to the subtle messages of clothing, body language, and underlying archetypes in the language of colleagues. Choose the voice with which you speak and the language with which you organize your leadership roles. Think about those symbols that project power.

Leadership is an existential construct based upon social roles, language, and archetypal understandings that constitute the deep wisdom written into the human experience. We are tomboys, sisters, mothers, daughters, grandmothers, temptresses, bitches, and witches. To be leaders we must also be authentic. I do not believe authentic leadership for women is found within a neutered male heroic archetype. It rises out of our own experiences. Pearls are a woman’s necktie.

I wrote the above message for the original Lessons Learned: Stories from Women in Medical Management, published 10 years ago. When I reflect on those words about my life story since, I do not see anything I would change in the narrative to that point, nor my general beliefs about how women physician leaders can navigate some of the gender challenges that often bedevil us. I believe the Jungian archetypes are still pertinent and listening deeply to how one is spoken to in conversations can help one perceive gender biases.

The archetypes for me are life hacks, allowing me to judge quickly how to steer through some of the unconscious stereotypes inherent in the dialogue and alter my responses accordingly. My “pearls are a woman’s necktie” is meant to distinguish gender-based equivalent signals of power and professionalism that can serve to equalize in appropriate business settings. I will leave the reader to reflect on their own regarding the relevance of my original necktie metaphor within the context of the national dialogue, but I believe updating my own story has relevance, too.