Voices in Pain Medicine: Women in Pain Medicine Reflect on Their Careers: Top 3 Things I Wish I Knew Earlier

• Early Career- Kristen MacKenzie, MD, Clinical Assistant Professor, Stanford University, AAPM WIPM SIG Co-Chair
• Mid Career- Nafisseh S. Warner, MD, Associate Professor, Mayo Clinic Rochester, AAPM WIPM SIG Co-Chair
• Late Career- Pamela Flood, MD, Clinical Professor, Stanford University

Early Career – Kristen MacKenzie, MD

We all need someone to network with. After finishing my fellowship, I had horrible imposter syndrome: As a trainee, I had just been at conferences learning from the greatest people in the field- and now I was expected to be the one giving lectures at conferences? I found that connecting with physicians- especially female leaders who have been where I was now- allowed me to amplify their work and show that I am engaged in the field. Social Media, such as LinkedIn, allowed me to develop my thoughts, voice, and confidence. Soon, the physicians whose work I was “liking” were “liking” mine as well, and it opened up space to suggest meetings and collaboration. Turns out, we all need someone to network with.

Being a female pain physician is a superpower. Chronic pain disproportionately affects females over males, and pain is exacerbated by stressful life events, trauma, and lived experience of prior pain- all of which also tend to have a female predominance. Many female patients feel dismissed by the medical system, and many prefer a female provider. Even though I have many wonderful male colleagues, I have also had patients tell me they want a provider who “can really get it.” This allows us to quickly build rapport and trust with patients, paving the way for excellent clinical care.

[Female] mentors are really important. After having a residency mentor and a fellowship mentor, I started my faculty journey ready to be free of formal mentorship. Funny thing is, early career is actually when mentorship matters the most. How have contracts historically looked- am I getting a worse deal than my male counterparts? What does work-life balance realistically look like in the first few years? With a partner? With kids? With a dog? You need someone who has been there, done that, and can give real advice. This is when a trusted mentor is essential.

Mid Career – Nafisseh S. Warner, MD:

Cultivate Your Core Purpose: The “Why” of Doing What You Do. Understand what initially drew you to medicine and your specialty. This intrinsic “why” should serve as a compass. The medical journey and life in general are challenging, with many transitions (both anticipated and unanticipated), so periodic introspection is vital. Ensure your daily actions and roles align with this fundamental purpose to optimize your personal and professional well-being.

Embrace Perpetual Inquiry: The Spirit of Curiosity. Maintain curiosity. In clinical practice, relentlessly question established practices (“Why do we do it this way?”), Delve into scientific evidence, identify and address knowledge gaps, and refine practices as you learn. Apply this same level of inquiry inward when facing dissatisfaction in your professional or personal life. Understanding root causes empowers you to pivot and adapt, ensuring healthy growth while maintaining a focus on your “why”.

Redefine Success: A Personalized and Holistic Perspective. Resist the urge to compare your achievements with those of colleagues. Instead, cultivate a deeply personal definition of success that aligns with your unique goals. This might include meaningful patient relationships, mentorship, or dedicating time to family. Oftentimes, a fulfilling career integrates personal commitments, creating an authentically rewarding and sustainable path.

Late Career – Pamela Flood, MD:

You need a network of mentors throughout your life. This necessity for a network, I’ve found, does not simply vanish upon retirement; it merely transforms. The intense demands of daily clinical practice and departmental leadership may fade, but they are replaced by a new, equally complex set of challenges: navigating a professional life after the structured career. Perhaps you’ll need a peer, someone a few years ahead in retirement, to guide you in establishing a new identity and purpose. You will likely seek “reverse mentors” in younger colleagues to keep you intellectually engaged with cutting-edge developments you’re no longer seeing in practice or research. This post-career network is your safeguard against isolation and irrelevance. It’s the community that helps you thoughtfully transition your identity from doing to advising, ensuring that your accumulated wisdom isn’t just a memory, but remains a living resource that continues to serve the field and, just as importantly, provides you with a lasting sense of connection and fulfillment.

You can expand the breadth of your curiosity as time permits. In a clinical and academic career, particularly one as demanding as pain medicine, curiosity is often a tool with a specific purpose. Your focus is necessarily channeled—you must understand the intricate pathways of neuropathic pain, the pharmacology of new analgesics, or the nuances of patient psychology. “As time permits” is the crucial phrase; for decades, time simply doesn’t permit. Retirement, however, dismantles that constraint. The urgent need to apply your knowledge is replaced by the simple freedom to acquire it. That long-postponed interest in lampwork glassmaking, the economics of global trade, or even the botany in your own garden can finally be explored. Your mind, once a spotlight focused on a single, complex problem, is now free to become a floodlight, illuminating all the fascinating territories you once had to pass by in the dark.

You can step back without signing out. For most of my career in pain medicine, engagement was a blunt instrument: you were either on the schedule, on call, and managing a full patient load, or you were absent. The prevailing idea was that to be in, you had to be all in. But my current status has taught me the vital difference between stepping back and signing out. “Stepping back” means you are free to relinquish the daily grind, the administrative battles, the pressure of clinical productivity, and the sleepless on-call nights. “Signing out,” however, implies a total disconnection, a removal of your voice and experience from the field. This, I’ve found, is a disservice to both yourself and the profession. You can step back from the labor while remaining fully engaged in the legacy. You can mentor, write, guest lecture, sit on an advisory board, or work at a local free clinic. You cede the frontline responsibility but retain your influence, offering perspective that only decades of practice can provide, ensuring your wisdom remains a resource, not just a memory.

Kristen MacKenzie, MD

AAPM WIPM SIG Co-Chair, Clinical Assistant Professor, Stanford University

Nafisseh S. Warner, MD

AAPM WIPM SIG Co-Chair, Associate Professor, Mayo Clinic Rochester

Pamela Flood, MD

Clinical Professor, Stanford University