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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