National Women Physicians Day: Janis Miyasaki, Neuropalliative Care, and Advancing Women Leadersip

National Women Physicians Day offers an opportunity to recognize the leadership, scholarship, and sustained influence of women physicians whose work has reshaped patient care and academic medicine. In neurology, women have driven advances across clinical care, research, education, and policy, yet structural inequities persist in promotion, sponsorship, and leadership representation. Highlighting women leaders is not only a moment of celebration but also a call to examine how institutions support diverse career paths and ensure that innovation driven by women is recognized and sustained.

Few neurologists embody this intersection of leadership, innovation, and advocacy more fully than Janis Miyasaki, MD, Med, FRCPC, FAAN, a professor of neurology at the University of Alberta and a pioneer in the field of neuropalliative care. With more than 160 peer-reviewed publications and a global collaborative footprint, Miyasaki has helped redefine how neurologists address quality of life, communication, and complex decision-making in progressive neurologic disease. Miyasaki, a teacher in neuropalliative care, has also written several books on the subject, addressing clinical considerations for diseases such as dementia, multiple sclerosis, and severe acute brain injury, among others.

As part of National Women Physicians Day, held annually February 3^rd, NeurologyLive^® reached out to Miyasaki to gain her thoughts and perspectives. In the conversation below, she reflected on the significance of the day, her path into neuropalliative care, and the challenges of building acceptance for a new clinical discipline. Furthermore, Miyasaki offered practical insights for neurologists supporting patients with progressive disease while mentoring the next generation of women leaders.

NeurologyLive: Discuss the significance of National Women Physicians Day and the importance of raising up women leaders in neurology?

Janis Miyasaki, MD, Med, FRCPC, FAAN: Women in neurology have made steady strides in the field including leadership, yet women still fall behind in promotion to Professor and Department Chair positions. In the past, the argument was made that the pipeline would look after this, but it is clear the pipeline is not enough. For women, there is the "leaky" pipeline of those who leave at Assistant Professor or Associate Professor level. Universities need to look at their departments and get the data.

What drew you to neuropalliative care, and what point did you realize this was where you wanted to focus your clinical and academic work?

I am a Movement Disorders neurologist and found that patients and families were struggling with advanced stages of illness or with parkinsonian syndromes. Attending a course on Palliative Care in Neurology by Jerry Kurent at the American Academy of Neurology was like a lightbulb - a more holistic approach to Neurodegenerative conditions was needed. This was met with high resistance and required developing an evidence base to change neurologists' and palliative care physicians' attitudes towards those with neurologic illness. It took about 15 years of researching and lecturing about Palliative Care for Neurodegenerative Illnesses to develop acceptance of this field. It is important for anyone to realize that a totally new area will take about 15 years or longer to gain acceptance. Changing the medical paradigm is not for the faint of heart.

Looking back, were there inflection points where being a woman in academic medicine shaped your career trajectory, opportunities, or leadership path, either positively or negatively?

I have been fortunate to have had sponsors along the way. Additionally, saying Yes to opportunities that seemed not to fit with my original course of being a clinical trialist was crucial to developing another path for my career. Focusing on service to my patients, families, and colleagues shaped my activities in evidence-based medicine, developing evidence for neuropalliative care and mentorship. I tell my learners that when they get to be in a position of power, they should give opportunities to people who don't look like themselves - we all need sponsors and mentors to give us opportunities.

For neurologists who may not formally practice neuropalliative care, what are the most important principles or skills they should incorporate into routine visits with patients who have progressive neurologic disease?

Communication skills are crucial for delivery of neuropalliative care. During these times of crisis and wait times expanding, physicians feel pressed for time. Giving people to express their concerns and their suffering can help you be responsive to their needs and also avoid “communication gaps.” Palliative care physicians are also great at accepting conflicting wishes - just this week, a spouse said, I hope he will stand and walk AND I know that I must take him home to die. Both wishes can be present in her heart and she recognizes what will likely happen. We need to be better as neurologists to hold seemingly conflicting wishes as true for that family - and ask ourselves, "what can we do now that will serve the patient and family?"

What do you think departments can do better to support women neurologists pursuing leadership roles or nontraditional career paths like neuropalliative care?

Having posted many ads for leadership positions, I notice this trend among women: If there are 10 requirements and the woman has 9, they won't apply. Women should realize that any new position should be a stretch and growth opportunity. Women can be more proactively tapped to apply in addition to men who have leadership potential. Applying for positions, even if unsuccessful, can help you formalize your thoughts about leadership and vision. Departments mostly do provide leadership education for their members and once again, specifically suggesting or nominating women (and men) for these opportunities who want to lead can help build skills and knowledge for a leadership position. The other barrier is that sometimes decision-making groups make assumptions about a woman's ability to take on leadership. It is better to ask the person, Is this something you have capacity for? rather than making assumptions.

Transcript edited for clarity.