Interview with Ilana Rosman, MD

Dr. Ilana Rosman is an associate professor of Dermatology and Pathology, and Dermatology Residency Program Director at Washington University in St. Louis. Dr. Rosman completed medical school at Washington University School of Medicine and then continued as a resident in Dermatology at WUSTL. Following her residency training, she completed a fellowship in dermatopathology at Albert Einstein College of Medicine/Montefiore in New York. Dr. Rosman’s professional interests include mentorship of students, residents, and junior faculty, and equity and sustainability in the resident application and selection process.

Basia Michalski: Can you start by giving us a little background on yourself?

Ilana Rosman: I guess the short version is … I was a Latin-American Studies and Economics major at Brown. I decided in my senior year that I wanted to go into medicine. I did a post-bac at Harvard, and entered WUSM in 2004. I thought I would go into pediatric neurology or pediatric psychiatry. Once I got to the more clinical side of things, I realized that neither neurology nor psychiatry were quite the right fit. I really liked dermatology, so I decided to go into it. I met my husband in my first week of medical school during orientation. He was in the MD/PhD program, a year ahead of me, and we met at a first-year social event during orientation because one of his friends dragged him to this event. We got married at the very beginning of my MS4 while he was doing his PhD. I did not apply to too many places and was lucky enough to match at Washington University. After residency, I did a dermatopathology fellowship at Einstein in New York. We had a one-year-old at the time and came back to WashU so my husband could finish his clinical clerkships. Fast forward to now … I am the director of dermatopathology, the program director (PD) of the dermatology residency, and previously was PD of the dermatopathology fellowship. My husband ended up doing pediatric dermatology, he is now on faculty as a physician-scientist. We have three girls, who are three, six and nine.

Michalski: I have some hard questions! What has been the biggest challenge as female faculty member in dermatology?

Rosman: There are a lot of women in dermatology, so there is a lot of support in the field. It’s definitely a little easier to balance work and life. People maybe have preconceptions of why I have gone into dermatology because I am a woman and have a family. Certainly, that played a role but that is not why I chose dermatology. I think there have been more challenges being a woman in pathology than in dermatology. I have a dual appointment; there are not that many women in pathology, although that is changing, but there have been few women in leadership in pathology, so I do feel that is a little more challenging to navigate (than in dermatology).

Michalski: Have you ever felt burned out and wanted to take a break?

Rosman: Yes, there are definitely days and even weeks where things are overwhelming. Right now is an overwhelming time for me, I took over the residency program officially in July but, in effect, in March, when COVID happened. I was responsible for the residents, making sure they were okay. That was challenging as I was working mostly from home and did not have childcare. In the midst of the pandemic, we had to change all of our recruitment strategies. I’m involved in reforms to the application process on the national level and that can feel overwhelming. I worry about my residents and my kids; I have a huge mental load right now. There are so many things I want to do and need to do; trying to prioritize and balance that in the context of my normal life is really hard.

Michalski: Do you think because of the lifestyle aspect of dermatology there is more pressure to excel both at home and at work?

Rosman: That’s very interesting! Let’s say you were in a specialty where when you are working, you have zero control over your schedule. You are working 80 or 90 hour-weeks. When you are on call, on non-outpatient specialties, it is all-consuming, I would imagine there may be this feeling of “I literally can’t do anything else so I won’t worry about anything else.” Whereas for us we always have the same schedule; it can’t change and that is hard sometimes. However, the on-service, off-service model may make it easier to excuse yourself (from work or family); I don’t know if that’s true. I feel very compelled to go to every single one of my daughters’ events, and I feel guilty when I cannot. I imagine that is true for all moms. For most dermatologists who have clinic 5 days a week, you can’t take time off. I do feel compelled to take care of everything and I sometimes feel guilty and sometimes I feel behind.

Michalski: What aspects of your work bring you joy?

Rosman: Teaching residents and students brings me joy. Sometimes I sit down at the microscope to teach, and I feel like I’m not in the headspace to do it, but once I start teaching, it brings me energy. I love that interaction. I also love being able to talk to people one-on-one, to have mentoring sessions with students, trainees, and junior faculty.

Michalski: What advice would you have given your younger self?

Rosman: I don’t take my own advice sometimes! Don’t be so quick to respond to emails and take care of tasks. I multitask very well and I like getting things off my to-do list. But then there is an expectation that I will do that for everything. Maybe I should have given myself a grace period so people don’t get into the habit of relying on me to respond so quickly. That’s hard to keep up with. And also, learn how to say ‘no’ to things. I am getting better at it but still not great.

Michalski: That’s very good advice. What were some pivotal moments in your career?

Rosman: The realization that I loved teaching residents was definitely an “aha” moment. I never thought I would be PD. In general, medical education is not a career path that is emphasized in medical school. I was teaching dermpath to residents and I realized how much I enjoyed it. That was probably the biggest “aha” moment and that set me on a path to med ed and being a PD.

There was a big debate on Twitter a couple years ago about Step 1 and the (residency) application process in general. I realized there were so many problems, that it was something we needed to be talking about in dermatology. I contacted a PD colleague at another institution and we both agreed this is something we should be talking about at our national academic derm meeting. Next thing we knew, we were both invited to give a talk on the application process and highlight the issues with it. I had never thought this is what it would become. We gave this talk at our national meeting, it went well and generated a lot of discussion and we realized that we don’t have a formalized PD group in dermatology. So we started this group that I co-founded with another PD and that has now catapulted discussions and work on the application process in dermatology and with other specialties. The “aha” moment there was: you don’t have to be an expert; if you care about it and want to learn about it, that’s really enough. Because I cared about it, and wanted to learn about it, and put effort into it, I became an expert.

We are now also expanding dermatology mentorship programs to match applicants with residents and faculty for advice throughout the application process. I think one silver lining of COVID has been the ability to connect with people in a different way over social media and other virtual forms, and to make much-needed changes to the residency application and recruitment process.

Michalski: We hear about building our own village. How can women do that in medicine?

Rosman: Great question! I feel like I have my work village and my home village, and there could be overlap there but I don’t think there has to be. My work village includes my colleagues in dermatology, the other faculty and residents I talk to regularly. Then my home village, there is my actual family: a partner you can trust. My husband is amazing, and he is very involved in taking care of the kids, but still the mental load of household chores lands mostly on me. It starts with your partner, your family, building out more networks of friends in the neighborhood, the schools, other organizations or local communities you belong to. Also if you can afford to, whatever you can outsource, outsource – cleaning, laundry, cooking, etc! Continue to build the social connections that will help you.

Michalski: What makes you most proud of yourself?

Rosman: I’m proud of the connections I have with people. I feel I have strong connections with my colleagues here (within dermatology and the university) and at other institutions as well as my residents, students, and mentees. I’m proud of my kids … they’re kind of crazy but I am proud to be their mom. Sometimes, I feel like I’m a mom to everyone! I’m proud of that.

Michalski: If you could give one piece of advice to a young, female physician, what would it be?

Rosman: That’s so hard! Be really honest with yourself about what you want out of life. A lot of times I’ve seen women at different stages do things that they think are expected of them. Even with choosing specialties or career paths. “If I don’t do this people will think it’s because I have kids, or I don’t want to work hard” or “I need to prove something.” And they will end up choosing things that make them unhappy. It’s okay if you want to prioritize having time with your family. It is also okay to prioritize not having a family. Make sure that you know what it is that will make you happy, and not to do things based on other people’s expectations or expectations that you had of yourself at some point in time that may not be valid anymore.

Dr. Basia Michalski is a 4th-year and co-chief dermatology resident with an interest in advocacy and dermatologic surgery.