The Daily Dose • Monday, March 28, 2022

Debunking the Myths: A Candid Discussion with Two Black Women Department Chairs

Jane S. Moon, MD

Underrepresented minority (URM) chairwomen in academic medicine remain few and far between. During an honest and inspiring campfire session entitled, “The Intersectionality of Underrepresented Minority (URM) Chairwomen in Medicine: Debunking the Myths and Stating the Facts,” on Sunday, March 20, at the IARS 2022 Annual Meeting, many unspoken assumptions about URM women leaders were meaningfully addressed.

Tracey Straker, MD, MS, MPH, CBA, FASA, Professor and Vice Chair of Clinical Operations at Montefiore Medical Center, presented a series of provocative myths and questions to two Black female department chairs: Alice Coombs, MD, Professor and Chair of the Department of Anesthesiology at Virginia Commonwealth University, and Karen Gibbs, MD, Chair of Surgery at Yale New Haven Health – Bridgeport Hospital. Key points of discussion included the meaning of leadership; qualities of a good leader; hiring and promoting the right people; partnering with leaders to achieve goals; unique challenges faced by women and URM leaders; and the universal value of an institutional commitment to diversity, equity, and inclusion (DEI). This article will list many of the myths and questions that were presented and summarize the panelists’ responses.

Dr. Straker began the discussion by stating the following myth: “You have achieved this position [of being a department chair] because of your intersectionality of being black and female.” In response, Dr. Coombs pointed out the extremely rare incidence of Black physician department chairs, whether male or female, in the United States today. In order to achieve the recognition, she continued, one needs to be very qualified and stand out above other applicants. At the same time, she acknowledged that recently increased societal awareness of unconscious bias has finally motivated people to begin considering talented individuals whom they might have passed over previously. Dr. Gibbs acknowledged that the myth stated above “may surface from time to time,” but that ultimately, one’s actions — “the job that you do, the things that you accomplish, who you are, and how you carry yourself” — are essential to dismantling it.

Dr. Straker then presented another myth: “You will be an ineffective leader because you speak to a small intersectionality of people.” Dr. Gibbs responded that it would have been impossible for the panelists to become leaders if they were only able to communicate with a small group. She underscored the importance of leaders to “communicate with a broad and diverse group of physicians” and to “have a vision to move our respective departments and institutions forward.” Dr. Coombs emphasized the need for department chairs to look at broader institutional benchmarks and goals using outcomes data — a process that “isn’t color-coded.” A failure to meet organizational objectives would certainly be noticed.

“You’re too emotional to lead,” Dr. Straker then stated. “How do you deal with that [myth]?” Dr. Gibbs responded that while she herself has not been accused of being too emotional — more likely the opposite — passion and deep commitment can be strengths. She commented on the double standard for women — they are often labeled as emotional when they “bring their authentic selves,” and aggressive when they “lean in” the way male leaders do. Dr. Coombs also shared a story of a time when she witnessed how a man’s emotional expression “moved the table and people in the room to do something.” If a woman had acted the same way, she would be accused of “lack[ing] objectivity.” Dr. Coombs also provided an example of an emotional behavior that might not be recognized as such — the tendency of leaders to “anchor” discussions of contentious topics by stating their opinions before many others have a chance to chime in.

Another myth was raised: “You have no hard-core academic or business rigor.” Dr. Coombs and Dr. Gibbs emphasized that scholarly activity and business skills are both essential to success as an academic chair. Coming from different professional backgrounds, each of them has honed specific core skills while moving up the leadership ladder. At the same time, Dr. Coombs emphasized the importance of “adaptive leadership,” or people-management skills, to complete the profile of an effective leader.

Dr. Straker presented another myth: “Your personal life will get in the way of your career.” Dr. Gibbs expressed gratitude for the growing acceptance of discussions over “work-life balance.” She pointed to the quantity of men taking paternity leave as evidence of this changed culture. Dr. Coombs shared a personal regret — taking an abbreviated maternity leave during a time when there was minimal support for physician mothers. She encouraged the audience to “make the right decision at the right time.”

The following myth was then stated: “All of your appointments will be women or URM.” Dr. Gibbs replied that diversity should be “across the board,” as so many good people are needed to provide excellent clinical care, develop programs, and achieve strategic goals. Recognize qualified underrepresented faculty members and giving them previously unavailable opportunities constitute only a portion of the overall recruitment effort. Dr. Coombs stated that diversity results from finding qualified people to fill positions: “You put the best people in the best spots. You not only do that, you look at people who are in the spots that they’re currently in. Does that person belong there? Be honest and say no when it’s no.” At the same time, she emphasized the importance of continuing to “shepherd” and guide all department members into the roles in which they function best.

An audience member then asked, “How do you deal with the phenomenon of ‘powerless power’ when you’re given a leadership position, but have your power diluted or frequently challenged?” Dr. Coombs first made a distinction between people with “designated authority” and those with “informal authority.” Often, people who have remained at an institution for a long time have informal authority but may not have been granted designated authority for a specific reason. She recommended against trying to “strongarm a pre-existing problem” and instead suggested enlisting the help of department chairs, who are responsible for empowering the faculty members whom they have appointed.

Dr. Gibbs then responded to an observation made by another audience member: “When asking for non-clinical/administrative time, women are often met with recommendations on resignation when men are granted the time.” She suggested engaging with a department chair in the following way: defining one’s value by showing a track record of scholarly activity, delineating a plan for the future, and explaining how nonclinical time would help achieve that plan. She also suggested explaining how the work benefits the department as well.

Another question followed: “Do you have recommendations on dealing with administrative and leadership high above not [being] able to consider non-white or women physicians as future leaders?” Both Dr. Coombs and Dr. Gibbs suggested beginning as a junior faculty member with smaller, realistic goals; seeking mentorship, sponsorship, and leadership training along the way; and establishing others’ trust in one’s abilities to do the work and manage pressure at every step. Dr. Straker also added that sometimes it is necessary to leave an environment altogether if the institutional culture does not support women or minority leaders.

There was another question from the audience: “What strategies are most effective to manage or coach leaders whose teams appear to be unable to support diversity?” The panelists encouraged enlisting the assistance of an institutional Chief Diversity Office or DEI Committee in order to address one’s individual situation and the broader culture most effectively. The approach should be measured and professional, given the possibility of retaliation if the problem is escalated to the wrong people. Dr. Straker also emphasized that “DEI principles start from the top down.” Without institutional support and leadership, departments will not be able to carry out their DEI mission.

“Do you believe in equity or equality when it comes to recruitment and retention? How do you balance development of URM leaders with being labeled as practicing reverse racism?,” another audience member inquired. Dr. Coombs explained that she assesses candidates by three fundamental standards: (1) integrity and character, (2) work ethic, (3) motivation for scholarly or clinical excellence. Once they meet these essential criteria, she begins to assess their unique passion and background, as well as the department’s needs. Dr. Gibbs also emphasized the importance of consistency in recruitment. Structured interviews with some standardized questions can help maintain fairness. In addition, Dr. Coombs suggested considering “cluster recruiting” 3-4 individuals at a time if a department is seeking to diversify in a particular area. The natural social support that can arise from this could promote retention and wellness.

Finally, when asked for concluding thoughts, Dr. Coombs said: “One key thing to understand is that everyone in your department has value.” She urged the audience to put effort into deciphering each person’s value irrespective of outward appearances or actions. She also encouraged each of us to bring our unique value to our respective departments and to communicate it to the leadership.

Dr. Gibbs’ parting words conveyed hope and gratitude: “Years ago we weren’t talking about leadership in this manner. We weren’t part of the conversation. It’s great to see people who are thinking about how they can continue to grow and lead and bring the next generation forward. So thank you!”