Zarina Ali, MD, hears it from patients all the time even though she has been conducting brain and spinal surgery at Pennsylvania Hospital for a decade. Patient reactions were even more polarized when she was doing surgical rounds while eight months pregnant with twins, she recalls. “I just take it as an opportunity to educate that person by saying, ‘No, I’m the neurosurgeon who’s going to be operating on your dad’s brain tomorrow, so let me explain the procedure.’”
Female applicants to medical school have increased by more than 50 percent in the past 15 years. In 2017, for the first time, more women entered U.S. medical schools than men, notes the Association of American Medical Colleges (AAMC). While AAMC President and CEO Darrell G. Kirch, MD, calls this a “notable milestone,” today’s numbers make other disparities even more glaring than in the past.
Female physicians still are disproportionately sparse among the upper echelons of academia and as leads on research teams and in medical departments. Even fewer women are represented in medical specialty societies—many specialty societies didn’t honor any female recipients with recognition awards until the 1990s, notes the 2017 study “Where Are The Women?”
The barriers to female leadership and career advancement are deep within the fabric of the U.S. medical profession and within us as people, explains Valencia Walker, MD, MPH, immediate past-president of the Association of Black Women Physicians. The obstacles for female physicians of color are geometrically greater, including in the wallet: National medical compensation reports have consistently shown that black and Latina women are paid the least compared to their professional peers.
Gender assumptions and biases about medical professionals begin in early childhood, run rampant in academia, and persist to the top of the professional chain. We’ve all heard them: Women are viewed as too emotional and not dedicated enough. Men are viewed as gruff and bossy. Ironically, even women often assume the team leader should be a man.
So, how can all physicians best support their female colleagues as medical professionals and kindred spirits in the career advancement journey? Although the physician gender equity issue is complex and formidable, plenty of progress can be made by focusing on five goals in your everyday practice.
Acknowledge the obstacles
The realities of obstacles to female leadership and advancement are beginning to receive greater attention, including at the nation’s top medical associations. In June, the AMA unanimously passed a gender equity resolution to analyze and address gender-based compensation disparities and impediments to career advancement. “This was a big step in the right direction, because the AMA agreed to ‘walk the talk’ and take specific action,” says Julie K. Silver, MD, associate professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School, who helped write the AMA resolution. “A lot of the advocacy came from trainees and early-career physicians, and this clearly showed us what powerful change agents they are and will continue to be.”
Tip: While recruitment and pay equity are obvious places to push for culture change, so is post-employment support. Most physician practices can ease the burden of the choices women must make when seeking education for career advancement and/or raising children through creative scheduling, job transitioning, and even job-sharing strategies.
Engage leadership equality
Becoming a female physician leader takes medical expertise, self-confidence, and the respect of colleagues. But, too often male and female physicians fail to do the little things that foster equality while communicating in the workplace, from the brusque dismissal of ideas to “mansplaining.” Damaging examples happen every day—in front of patients during grand rounds, with administrative staff in the physician practice hallways, and with colleagues during care team meetings.
“You learn what you see, and a lot of it reinforces unhealthy stereotypes,” Walker says. “We’re ingrained with the ideas that we need to let boys be boys, but girls well should be well-behaved and thoughtful. That affects the roles we assign to women and men. We have more women entering medical school than ever, but how many women get out there and become CEOs and department chairs and directors of community health centers?”
Tip: Words, facial expressions, and body language matter. Good leadership begins with healthy communication skills and authentic respect for the thoughts of others. Insist on inclusivity and encourage participation in staff meetings and on care teams. Practice openness in idea exchange while respecting that men and women can have different yet equally valid interpretations.
Mentor as a mission
Both women and men have crucial roles to play as mentors for female physicians but not enough realize the importance of mentoring beyond medical school.
For Ali, female mentors and role models were rare during schooling and in her early days as Penn Hospital’s first female neurosurgeon. But even after 10 years on the hospital staff, she says still sees a dearth of female leadership and female mentors in the surgical field.
Female mentors provide a unique perspective, especially since one of the biggest conundrums for female physicians is weighing the choices of children and career. As a mother of four young children, Ali says the “family or field” decision is a life choice every woman must make for herself. “I’m a better mom because I get to practice medicine, and I’m a better physician because I care for four little kids. A lot of it comes with understanding who you are, understanding your own personality, and deciding what is going to make you happy.”
Tip: Valuable mentoring doesn’t always have to come from a structured program, and it doesn’t need to be a burden to physicians’ busy schedules. Encouraging a 15-minute coffee group, a job-shadowing period or an educational opportunity can help female physicians grow their potential—and the energy from idea exchange and learning can benefit the practice, too.
Support the groundswell
Times are changing, but not fast enough, Walker says. Inequality among physicians may not seem as blatant in large metropolitan health systems and teaching institutions, but the issues holding women back are cultural and national. Physician practices can, and should, encourage participation in advocacy efforts to change the status quo, whether it be embracing an innovative education assistance initiative or adding female mentoring programs, she adds.
Tip: Both male and female physicians can increase their own awareness and discover ways to adopt healthier business practices by tapping into the leadership community. Check out diversity events happening at local hospitals and medical organizations, seek out local speaker presentations, and encourage colleagues to take part in conferences as session speakers.
Be the culture change
While changing the inequity within the physician practice community many not happen overnight, everyone can choose to make progress one person at a time. “One of the most important things that women can do for other women is to recognize our value and to not hold each other to an impossibly high standard of perfection,” Silver says. “We are constantly in a double bind situation where if we are too nice then we may not be viewed as serious contenders for promotion, and if we are appropriately assertive we risk being labeled as too aggressive to be effective leaders. Women can do a lot to help each other by giving each other grace—by being slow to criticize and quick to provide backup support.”
It’s important for practices to encourage female colleagues to grow their leadership potential and learn from other leaders, adds Silver, whose three-day “Career Advancement and Leadership Skills for Women in Healthcare”conference at Harvard Medical School has sold out since it began two years ago.
Tip: Encourage colleagues to take their innovative care programs or research to the conference forum as session speakers and to join relevant medical societies. Support female physicians who wish to attend conferences and find a way to help with funding or time off, if needed. Most importantly, ask them to share their educational findings with others.
One thing seems clear: Offering token mentoring programs and the occasional college course have value but aren’t enough to propel female physicians forward. The “soft” obstacles to career advancement and leadership—getting time off, finding available opportunities that fit with family responsibilities, gaining support, and encouragement from superiors—still shackle many female physicians.
Yet, as the numbers of women entering the medical field surge, the cost of not changing seems detrimental both to female physicians and to the future of medical practice, Ali observes. “The more we can support each other to aspire to and achieve those goals of leadership positions, the greater the dividends will be not just for that individual, but for many, many other women
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