Why are there so few women physician leaders?

In July 2011, I made the decision to defer matriculation to medical school for a year. While I was hoping to relax in Philadelphia before entering a lifelong journey in medical training, what I got instead was one of the most emotionally tiring and challenging years of my life.

3 months after I decided to defer medical school, my aunt was diagnosed with acute myeloid leukemia. She was immediately hospitalized and spent most of the remaining year and a half of her life prevailing through aggressive chemotherapy sessions and a slew of medical complications. My uncle, a self-employed contractor with a long daily commute into D.C., spent every moment he wasn’t working by my aunt’s hospital bed, but he was also determined to minimize the disruptions my aunt’s sudden illness caused in their children’s lives. That’s where I enter the story.

Two days after my aunt was diagnosed with leukemia, I packed a suitcase and jumped on a bus headed to her home in Virginia. There, I served as a full-time, substitute mom for my 5 and 7-year-old cousins. I picked them up from school, helped them with their homework, practiced piano with them, took them to Tae Kwon Do classes, tried to convince them to shower for less than an hour, figured out what dinner foods they would actually eat, learned how to graciously lose in every game of chess, made scrapbooks with them, and tucked them in by 9pm.

When I wasn’t running after my cousins or shopping at Gymboree, I worked remotely as a research associate. I was lucky to have a supervisor who supported my decision to leave the office and trusted my abilities to work independently, but even so, I quickly learned the urgency behind making every moment count and the need to make sacrifices. Project deadlines sometimes resulted in sleepless nights filled with literature reviews and manuscript revisions, and touching base with my supervisor occasionally meant weekend trips back to the office in Philadelphia.

That year, I learned an incredible amount about empathy, health, loss, and sacrifice.  I became more motivated than ever to enter medicine, but I also became more terrified as well. Would I ever, in my career, have that much time to dedicate to my family again? Was this really just a rare year of flexibility, freedom, and control?

I admit that even as a medical student, I’ve been relatively oblivious to the dearth of female leadership in healthcare. I had no idea, for example, that less than 20% of hospital CEOs are women until I joined XX in Health. I’ve been lucky to be surrounded by strong female figures throughout my life; for instance, the presidents of both my undergraduate and graduate universities have been well-respected women, and so is the CEO of the healthcare system I’m currently training in. My oblivion to the lack of female leadership is also partially due to the great support women receive in medical school. Our school’s AMWA chapter has a strong presence, and at almost every career panel there is a female physician who serves as evidence that one can have a family and still enter that specific specialty.

But here’s something I never picked up on until I really evaluated the atmosphere for female leadership in medicine. The question I ask myself as I think about my career has never really been, “How can I be the change agent and leader I want to be in this specialty or field?” because I’m too preoccupied asking, “Can I even enter this field?”

This question is not uniquely asked by female students. My peers and I, regardless of gender, all grapple with the lifestyle questions that come with our potential career and specialty choices. Yet, in medicine especially, this still seems to hit women harder than men.

The AAMC reports that less than 35% of physicians and surgeons are women, and as of 2010, <15% of active physicians are women in 9 out of 36 specialties. It isn’t just that fewer women are entering these specialties, either: of all 36 specialties, only orthopedic surgery has <15% of women entering its residency programs.  The problem is even more alarming when looking at leadership positions held by females. In 2011, 12% of medical school deans were women; the figure reported in 2006 was identical.

I echo many people when I say that women have the potential to make critical contributions to the healthcare industry as leaders. Women are collaborative, empathetic, driven to make a difference, and have experiences that provide them with a unique intuition into the system. For example, women are essentially the healthcare decision-makers of the home: 85% of women choose their children’s doctors, and 84% are chiefly responsible for taking their children to appointments.

So when I consider why there so few active women physicians and even fewer leaders, even when almost half of medical school graduates today are women, it is somewhat ironic to recognize that one potential answer is because women do play such a pivotal role in healthcare. The devotion women have to being caretakers and nurturers may actually be pulling them away from becoming leaders in the field that they are so well suited for. This should not happen. Women’s experiences in these roles should be qualifying them, not preventing them, for leadership positions in this field, and choosing a career devoted to taking care of others should not have to conflict with a devotion to nurturing one’s own family.

While internal barriers like a lack of self-confidence are important to recognize, in healthcare there remains a huge need for making the workplace environment more accommodating for women. I’m only a medical student, so my insights on working in the healthcare industry are limited, but what I did learn during my “year off” was the importance of flexibility, control, and (relative) predictability. As I advance in my career and the healthcare industry transforms, I hope that we can build systems and create a culture that promote these and allow for women (and men) to thrive professionally and personally.

Both women and men can uniquely contribute to the advancement of the healthcare industry, so why shouldn’t we share the responsibilities as healthcare decision-makers in both the home and workplace?

Linda Li is a medical student.

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  • Guest

    What percent of male doctors work full time and have never taken long periods of time-outs from their career, versus female doctors?

    Part-time doctors who only work a couple of days a week, and take a year off here and five years off there, are probably not likely to climb the ladder as quickly as their full-time counterparts, regardless of gender.

    • Anthony D

      Agreed!

    • Anthony D

      “Part-time doctors who only work a couple of days a week, and take a year
      off here and five years off there, are probably not likely to climb the
      ladder as quickly as their full-time counterparts, regardless of
      gender.”

      Then you have 18-40 million new patients coming into a system with a shrinking doctor workforce. No time to have a balance lifestyle either folks!

    • Linda Li

      I agree completely that this is true. And somewhat unfortunate especially for women. I guess I just wish it didn’t fall so hard on women and am wondering in what ways that it could change- but perhaps in a way larger than within the medical field.

      • guest

        Unless you or someone else figures out how to rearrange basic human biology and instinct, it will continue to be the case that the brunt of the childcare responsibilities fall on women, and impact their ability (and desire) to take on leadership roles in the profession. Men just are not interested in arranging playdates, scheduling activities, volunteering in the kids’ school, making sure that the immunizations are up to date and getting food on the table on a regular basis.

        And, they don’t appear to have a sense that those things are important enough to take independent responsibility for doing them. They are able to be supervised (some of them) to assist with some of these tasks, but it is almost always going to be the mother who one way or another has primary responsibility for coordination and delegation of those tasks. It’s a huge distraction, as you will learn when you have children of your own, whether you are doing it yourself, or just making sure your husband has gotten it done.

        • buzzkillerjsmith

          Your comments are very insulting to us men but are nevertheless completely true. And this state of affairs will never change. It’s in all cultures and don’t let the Nordics fool you. It’s hormonal.

          Sometimes men, given certain cultural or social or economic situations, will take on more of what has traditionally been called women’s work. But no matter what we say to women about it, most of us hate it and will try to get out of it if possible.

          Of course these are aggregate tendencies and do not always obtain. Your mileage may differ.

          • azmd

            Ha–your honesty is refreshing. And, I intended no insult to men by my comments above, why should you enjoy those things? Most of them are quite boring indeed.

          • buzzkillerjsmith

            I know. Insulting was tongue-in-cheek.

          • Suzi Q 38

            “….Most of them are quite boring indeed.”

            I hope you are speaking for yourself.
            My husband and I found time and activities with our children to be personally satisfying.

          • Suzi Q 38

            Thank goodness this was not the norm in our family. Are you saying that men have little importance or input to the day to day family activities?

        • Suzi Q 38

          “Men just are not interested in arranging playdates, scheduling activities, volunteering in the kids’ school, making sure that the immunizations are up to date and getting food on the table on a regular basis.”

          All men and women are different. My husband was particularly good at scheduling activities, helping with homework, brushing daughters hair and cutting her bangs. When they were babies, he changed their diapers at every opportunity when he was home. He bathed the kids when they were little. He occasionally helped in the classroom and took vacation days to do so.

          He also worked 10 hours a day a work.

          Your assessment is a generalization.
          I do agree that many mothers have the primary responsibility of the care of the children, but there are many fathers that play a significant role as well.

  • Jasmine Yang

    Women have equal opportunity as men to enter medicine, and to enter any field they wish, and to compete for any leadership position. Equality of opportunity does not guarantee equality of outcome, and we should be accepting of that. Inequality of outcome does not necessarily mean there is a problem, either, and government and hospital administrators do not need to social-engineer a false sense of 50/50 gender representation.

  • ninguem

    We need more women physician leaders.

    They can’t screw up medicine any worse than it already is.

  • Guest

    The answer seems simple to me. Women cannot have it all and are aware of it. They will sacrifice career advancement to have a family.

    • Linda Li

      Certainly not with this mentality. Maybe none of us can have it all in medicine, but my question is more why it has to hit women harder? I appreciate your thoughts!

      • Anthony D

        “Certainly not with this mentality.”

        “Guest” is just being truthful. You can’t have everything in life and that goes for both men & women. So you have to sacrifice in order to achieve.

        You as a medical student will know that sometime in your career!

        “Without pain, without sacrifice we would have nothing. Like the first monkey shot into space.”
        -Chuck Palahniuk-

      • Guest

        When you become a mom you’ll know. This is coming from me, the least maternal woman I know. Since kids, I am a mom first and foremost above all. Work has been sacrificed, but that’s the choice I made.

        • Anthony D

          “When you become a mom you’ll know”

          Remember, that’s “if” she wants to be a mom! .

          • Guest

            Yes, that was thoughtless of me to say. Thanks, I should have said “if.”

        • Rob Burnside

          Then there’s that very old saying: “The hand that rocks the cradle rules the world.” Very appropriate to this blog and always food for thought–I think.

          • Suzi Q 38

            Thank you for your quote. Very appropriate for this blog.

          • Rob Burnside

            Did a little research, Suzi. It’s the title of a poem written in the late 19th century by William Ross Wallace (1819-81). Here’s a line from the 3rd stanza: “All true trophies of the ages are from mother-love impearled.” The poem seems not so much condescending but conciliatory, as if the author held a loftier opinion of what used to be called “women’s work” than most men of the period and wanted to demonstrate same. Interesting to note, if I’m correct, that the most powerful world leader of his time was, in fact, England’s Queen Victoria. Perhaps he was consoling women readers who would not, and could not achieve the same status by proclaiming their contributions superior to Victoria’s. Call me old-fashioned–I must agree.

      • Guest

        There is something unique about the mom. Dads can be great with kids, but kids want their mommy. There isno scientific study proving this; your lack of female leaders supports this.

        • Rob Burnside

          There are studies showing a rapidly rising rate of cardiovascular illness in women, presumed to be stress-induced. It makes me wonder about the risk/reward aspect of “wanting it all.” To what end?

          • Suzi Q 38

            So true.
            Some women are sanguine with their choices, but others are tormented. It is that latter group that may be very stressed out.

        • Suzi Q 38

          Thank you. moms are unique….I have to say that dads are as well.

      • guest

        If you want to be a leader in any field, you have to be willing to live, eat and breathe your work. It can’t be something you do 9-5 and then go home to make dinner. It can’t be something you leave in the middle of the day to take a kid to the doctor, or to volunteer at a school event.

        In terms of why women end up doing this work more than men,although it’s politically incorrect to say so, on the whole, women are more committed to those day-in and day-out tasks that are essential for being an adequate caregiver. Studies have shown that fathers are better at engaging their children in play, but mother are better at getting them to the doctor when they are sick. Both are needed, but engaging your children in play is something you can do on the weekends when you’re not busy with work. Getting them to the doctor will frequently intrude on the workday.

      • buzzkillerjsmith

        You might or might not know that the idea of having it all is not a topic of discussion among men. We know it can’t be done so talking about would be as interesting as a debate about the multiplication table. Why do (some) women fall for this foolishness?

      • Eric Thompson

        I think that having time with family is undervalued. Some people realize this and choose to spend more time with their families and sacrifice career advancement. I also believe they are making the superior choice. The bottom line is that it is a personal choice.

        • Suzi Q 38

          I agree.

      • Suzi Q 38

        At times, “somethings gotta give.”

        You were selfless and chose your family, who sorely needed your help.
        I admire you more for doing what you did than for any prestigious position that you could have landed at your job. That is all it is…..a job.

        This was an important lesson in life.
        Who or what is more important?
        For some people, they can do both.
        For others, they have to make difficult choices.

        If a couple is married and both have careers, one or the other may have to make more time for the family.

        My BIL loved staying home with his kids. He wanted to be a “househusband.” He was great at it. The problem was that my sister wanted the same as well. She made more money than he did. For them, it was at times, a “tug of war.”

      • https://www.facebook.com/arobert6 Alice Robertson

        Some women don’t see it that way. Speaking for myself I thought it was a joy and privilege to give up my career for my kids. Neither the kids, nor I, nor my husband have any regrets (just that we didn’t have more kids…only had six:). The women doctors I know enjoy their children so much they just don’t talk about it as a chore (even the single ones). It’s a choice and instead of bemoaning it they feel good that life and society is now at this point. At a Thanksgiving Party we were invited to the county prosecutor didn’t understand the whining from women about her choice. She said she stayed home for two years after her last child and had no problem getting the student loan people to lower her payment and if she had not had a balloon payment on her home she would have gladly stayed home longer. She saw it as a win-win for herself as a woman, her kids, and her husband gladly picked up extra hours. She was able to find good care and became the county prosecutor and as her kids are getting older she is thriving. For many couples this is exactly what they were striving for while in school all those years…They wanted a career and family and got it. But they did not want to sacrifice their children over their career. I admire that. The kids grow up in a blink of an eye and we miss them much more than a career which needs put into perspective and just a season for many women.

        Speaking for myself the career or leadership world isn’t missing me…but my children would have.

        • Suzi Q 38

          Well said.

    • Suzi Q 38

      “The answer seems simple to me. Women cannot have it all and are aware of it.”
      True. It is difficult for anyone, male or female, to “have it all.”

      ” They will sacrifice career advancement to have a family.”

      True for many, but not all.
      Some choose not to have a family.
      Look at Oprah Winfry.

  • http://barefootmeds.wordpress.com/ Barefootmeds

    I’d love to do a study of stats like these in South Africa. Anecdotally, in the hospital where I train, the medical specialties currently have large numbers of female residents, and only the surgical specialties still seem to be largely male.

  • commentator

    The issue of why there are proportionally few women leaders is more complicated than “biology”. Men are more likely to aggressively seek leadership positions and are thought of as leaders more so than women. Also, junior male physicians more easily find mentors in older male physician leaders. It’s an affinity thing or as we all know it, “the boys club”. More junior women physicians do well these days entering the profession, getting into good training programs and finding jobs. But we hit that glass ceiling, even if we didn’t take time off or work part time during our careers. Until perceptions change and leaders recognize these biases, we will continue to have fewer female physician leaders.

    • Rob Burnside

      Yes, but…aren’t you looking at a very narrow slice of the pie–a generation or two, three at the most? Taking the longer view, our roles are far from static, and there’s every reason to believe the dreaded glass ceiling will soon be gone entirely.

      And getting back to biology, I’d love to know how average male/female testosterone levels have changed in those same three generations. After spending two years without any testosterone (prostate cancer treatment), I’ve come to better appreciate the role of this key hormone in everyday life, for both sexes. Estrogen too, of course, but of the two I’m now fairly certain testosterone has had a greater role throughout the course of human history, and certainly not always for the better. This is not to say that males are inherently superior, but to suggest that perhaps men and women who seek and achieve leadership roles are simply more testosterone-driven than others. It is, after all, a proven fact that men who stay home to nurture and raise children experience higher levels of estrogen. Whether function determines body chemistry or the reverse, I’m unsure, but I would guess it works both ways.

  • disqus_mmpOofx73c

    Yes, there are less women leaders than men, and why does it have to change? I know this will lead to bashing by all the feminists, but what’s so bad about men leading healthcare and women doing their part to the best of their ability? The woman is the pillar of a family, and chances are that if you want a happy, well-adjusted home you will have to sacrifice your career. Is that so bad? In return you get the unique fulfillment of raising children that a man will never have.
    At one point I had the choice of continuing to head the department at the firm where I work, or opening my own company. I chose to remain an employee. I am happy with my decision and proud that I am a mother to my children before I am a business woman. I am proud that I am the one to tuck my son into bed at night, and the first one he sees in the morning. The men don’t have a complex with their roles in society, why do we?

  • Peggy Zuckerman

    While the writer and others may decry the lack of females as CEOs of hospitals and such, I am impressed daily at the sheer number of females who reach such jobs. That is no doubt due to the fact that at my age, 64, I can remember the struggle female classmates had to get into the basic science courses they needed to prep for medical school, since classes were impacted by our baby-boomer numbers, and women didn’t
    “need” those classes as much as men! That changed dramatically in a few short years, but the dearth of older and experienced women in those positions continued to impact the expectations of all people in the field.

    Congratulations to us for now being in a world where women have more choices, have higher expectations for themselves and have such skills to offer. Now I can wonder who is raising the children, and how the values that led to those expectations are being nurtured in those families.

  • https://www.facebook.com/arobert6 Alice Robertson

    Where I live we have some excellent women doctors and my friends and I benefit greatly from them because some of the really great doctors tend to avoid administrative jobs and stay right where they are doing exactly what they signed up for. But some go down to part-time so they can be home at certain times or certain seasons with their children (which sorry to say to the men here but women have this attachment thing going on with their kids that is simply one of the most beautiful things to experience on this earth). I once told our cancer specialist that if I had my way he would be running the huge organization. He smiled and said there was no way he would ever want to do that. He was right….I am eternally grateful he stayed right where my daughter and I could find him.

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