A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
The path to becoming a physician is remarkably devoid of leadership training. Being an adept manager is an increasingly important aspect of medicine and is not explicitly taught as part of medical training. When we, as attending physicians, suddenly find ourselves in situations where we are expected to train, manage or lead others, we may be ill-equipped to do so. This is a disadvantage for all, but the impact is most profound for women. We have the additional challenges of navigating well-described biases, overcoming cultural barriers and personal obstacles with often very little support or guidance.
In 2017, the Association of American Medical Colleges (AAMC) reported that 51 percent of incoming medical school applicants were women. Compared to the proportion of women entering medical school, the number of women holding leadership positions in academic medicine remains remarkably low. Only 15 percent of department chairs and 16 percent of all deans at U.S. medical schools are women, indicating a significant gender gap. So why is it that despite equal numbers of men and women entering medical school, only a fraction of women make it to leadership positions and eventually into the C-suite? More importantly, how do we change this?
The first step is acknowledging these realities as widespread and undesirable. This lack of parity in providing women with the same professional development opportunities as men results in a failure to access potential gifted managers and leaders among half of the community. While many are engaged in this discussion and have embraced the call for reform, fewer have piloted encouraging initiatives. Discussions on approaching these issues should include incorporating leadership training in medical school while also providing training and support to already practicing female physicians. Many national medical and subspecialty societies have created committees specifically focused on the challenges encountered by female physicians. For example, after realizing that only a small percentage of women were included in leadership positions in the American Society of Anesthesiologists (ASA), Linda Hertzberg, MD, FASA, a practicing physician anesthesiologist, spearheaded an effort to create a community for women. Thus, the ad hoc Committee on Women in Anesthesia was appointed in 2016 to bring awareness to the specific career obstacles women face. More importantly, the committee provides a mentoring program allowing junior members to connect directly with leaders in the field for continued guidance, advice and support.
On a smaller scale, offering these types of initiatives at a regional or even institutional level will help foster mentorship and may eventually lead to sponsorship. This is particularly important for trainees, junior faculty, and physicians new to practice to learn how to navigate gender-specific challenges.
While these activities may not immediately change the institutional culture, they will provide female physicians with role models and strategies that have been effective in the past. They will also provide a forum where the importance of simple behavioral changes, such as sitting at the table, leaning in and asking for what one wants can be emphasized and reinforced. Learning these skills has been shown to be effective and necessary to ensuring visibility within an institution. For example, studies have repeatedly found that women are less likely to ask or negotiate on their own behalf in their professional lives. Their general assumption is that their work and accomplishments will speak for themselves and lead to advancements and promotion. Unfortunately, such an assumption would hold only in a perfect world with objective assessment and without bias. As Linda Babcock and Sara Laschever point out in their book Women Don’t Ask, women are far less likely to articulate their expectations and therefore are often overlooked in favor of male counterparts who are more active in self-promotion.
There is a broad consensus on the need for important cultural and institutional changes that must occur to ensure women who choose to pursue leadership roles have the same access and support as their male colleagues. Nonetheless, even small changes, such as creating a strong mentorship program can lead to significant improvements by raising awareness, providing role models for trainees and reinforcing strategies that have been proven successful. This will ensure that female physicians interested in leadership positions are well equipped and supported to face challenges, while society catches up to provide equal grounds for men and women in the future.
Roya Saffary is an anesthesiologist.
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