Fixing the Gender Imbalance in Health Care Leadership

Female physicians continue to face myriad challenges in medicine ranging from implicit bias to gaps in payment and promotion to sexual harassment. So it is not surprising (though it’s still appalling) that although equal numbers of men and women now graduate from medical school, only a small fraction of female physicians become medical leaders. Currently in the US, only 3% of healthcare CEOs are women, 6% are department chairs, 9% are division chiefs, and 3% are serving as chief medical officers. This is despite women comprising 80% of the healthcare workforce and evidence that having women in upper management and on corporate boards is associated with improved financial performance and enhanced accountability.

These numbers point to a clear need for better representation of female physicians in leadership. How exactly to achieve this given the many barriers they face is less clear. Yet bright spots have emerged, both in healthcare and in other industries asking themselves a similar question. They highlight four priority areas for organizations seeking to systematically improve the promotion of women.

1. Quantification

Before they can make progress, healthcare organizations need to see how well (or poorly) women are represented among their leadership. They’ll also benefit from understanding female physicians’ experiences in the workplace, and how those compare to those of their male counterparts. Quantification is a key facilitator of change in addressing gender imbalance. A powerful example of this can be seen in the United Kingdom’s Athena Swan Charter and Awards. The Charter recognizes commitment to advancement of women in higher education and research. Depending on how well they meet the Charter’s requirements, institutions are eligible for Bronze, Silver, or Gold Awards. As of 2011, organizations must have received at least Silver Awards to qualify for National Institute for Health Research Funding. Evaluation thus far suggests that the Charter has increased awareness of gender and other diversity issues, created numerical and financial incentives for change, and catalyzed structural and cultural changes, such as increased career support for female researchers.

2. Re-thinking awards and promotions

Women physicians lag their male colleagues in the rates at which they receive major awards or recognitions. This obviously has an impact on promotions. Systematization can ensure that male and female faculty’s achievements are equitably recognized. Recent work from Brigham and Women’s Hospital highlights that gender gaps in recognition emerge early in female physicians’ careers, but that systematic identification and publicity of their accomplishments can narrow gender-based gaps. This lesson can be applied more broadly, including to systematizing search processes, appointment of physicians to committees, and nomination for leadership roles and increased responsibility.

For many decades, medicine has valued and preferentially promoted clinicians who also conducted biomedical research. As the career paths available in medicine have broadened, the career profiles of those who get promoted have not commensurately expanded. Continuing to prioritize clinician-researchers for promotion can disadvantage certain groups (among them female physicians, who are more likely to choose careers as clinician-educators) and doesn’t necessarily align with the skills needed for modern healthcare system leadership. Several institutions have begun promoting for accomplishment in less traditional career paths in which women may be over-represented. For example, Duke has promotion tracks specifically for faculty with clinical service and educational focuses to their careers, providing tenure-track guidelines for advancement from assistant all the way to full professor. Similarly, the Dana Farber Cancer Institute each year names those among its most accomplished clinical faculty as Senior and Institute Physicians, recognizing clinical prowess that is often not acknowledged in a traditional, academics-focused institution.

3. Engaging broadly

Men and women alike should work to enhance gender diversity in leadership. There is substantial data on the pervasiveness of implicit bias and gender-based microaggressions in STEM fields in general, and medicine in particular. Implicit bias training has been shown to decrease negative, implicitly held beliefs and attitudes about women’s capabilities in STEM. Engaging men alongside women in efforts to reduce bias has proven powerful. At Dell, for example, the Men Advocating Real Change program engages men as key allies in driving gender equity. Targeted at the largely-male executive leadership, the program is run by the nonprofit Catalyst and covers topics such as privilege, unconscious bias, dominant culture, and gender role conditioning and its link to leadership. Anecdotal feedback suggests the program is having a positive effect on Dell’s ability to recruit, retain, and promote women and on the gender balance in male dominated divisions such as sales, for example, although the gender imbalance in leadership generally still persists.

4. Creating opportunities for development and sponsorship

A final lesson from the technology industry suggests that support for women’s advancement must go beyond networking and forums towards true sponsorship and career advancement opportunities. Both male and female leaders should take on sponsorship roles to promote high-potential women’s access to diverse opportunities, and to avoid the common problem of female leaders becoming overburdened with mentee requests. IBM’s Technical Women Pipeline Program is a good example. Established in 2010, it engages mid and senior-level women identified as strong leadership candidates in a two-day program aimed at boosting their careers. The women are paired with executive advocates with whom they work on development plans and check in on a quarterly basis after initial face-to-face meetings. Women also join quarterly, international calls with others in the Pipeline Program community. The program has improved retention rates for mid- and senior-level technical women and increased the number of women considered distinguished engineers.

Given the value placed on data and evidence in medicine, the impact of these interventions will be further increased by rigorous study of their effects. In the meantime, they provide valuable starting points for a problem affecting not just female physicians, but the health and performance of the systems they work in.