The Daily Dose • Tuesday, May 1

Women in Medicine and Leadership: Time for Change

By Dr. Nawal Ragheb-Mueller, from the IARS 2018 Annual Meeting*

Dr. Maya Jalbout Hastie, anesthesiologist at Columbia University Medical Center, presented the results of her research on women in leadership positions in medicine and engaged the audience at IARS 2018 today.

“Women in Medicine and Leadership: Glass Ceiling, Sticky Floors, and Everything in Between” was both well received and extremely timely. In large part, her presentation emerged from her interviews of women in leadership roles.

She noted that while 50% of medical students are now female, women beyond the rank of medical student are not as well represented in leadership roles as their male counterparts.

Acknowledging that the presence of women in leadership positions varies by specialty, Dr. Hastie pointed to statistics in anesthesiology. Although there are 104 active committees within ASA, only 22 are chaired by women. The proportion of women who are full professors or chairs of academic anesthesiology departments is low despite some progress. And on editorial boards of major journals, women are also poorly represented.

Twenty years ago, “the glass ceiling” was the more common metaphor; over time, this gave way to a “pipeline issue” and now we have “sticky floors or a leaky pipeline”. However you define it, women are not as visible or prominent as men.

Why does this matter? There are financial implications as diverse teams are smarter teams. Women are role models for the next generation and our participation in policy can help shape health outcomes (of which the establishment of the Women’s Health Initiative within NIH is a good example). Female role models help shape the course of society.

Why is there such a dearth of women in leadership? Leadership and career advancement are largely driven by 1) innate traits and learned behaviors; 2) interest, motivation and ambition; 3) networks, connections, and politics; 4) research and publications; 5) grants and funding; which then yielded, 6) recognition and expertise.

Dr. Hastie noted that having a mentor is a great facilitator. Mentors advise their mentees and introduce them to individuals who may help them along their career paths. Those with mentors are more productive, publish more and get promoted faster. She noted that faculty development resources should include mentoring programs.

Promotions along the research track have traditionally been clearer, but women often pursue a clinician educator track. While essential in academic departments, the metrics for promotion for clinician educators are often less established or less clearly delineated.

Situational factors also come into play. If you can relocate geographically, you are more likely to be able to negotiate a better position and salary than those who stay put. But women are traditionally less likely to move because of a partner’s career and/or the need for childcare and family nearby. Multiple surveys also have shown that women on average spend 3-4 hours per day on unpaid work, domestic responsibilities and parenting, which is an hour a day more than men invest in this arena.

How can the leaky pipeline be fixed? At the organizational level, address issues related to child and elder care for both men and women. Allow some flexibility in schedules that does not negatively impact promotion. Recognize gender biases that may be explicit or implicit and address them. Acknowledge the value of patient care and reward excellent clinicians who devote themselves to that area. Promote transparency within the department and provide opportunities for women, not just tasks.

With momentum moving in women’s favor throughout various industries, now may be the perfect the time to rethink our approach this long-term problem.

*Coverage from the Review Course Lecture, Women in Medicine and Leadership: Glass Ceiling, Sticky Floors, and Everything in Between