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American Association for Physician Leadership
American Association for Physician Leadership

When Medical Institutions Hire Leaders, External Female Candidates Have an Extra Disadvantage

by Melissa J. Danesh | Nicole Golbari | Martina Porter | Alexa B. Kimball

July 9, 2020


Summary:

While 70 percent of firms still promote from within to fill the CEO’s chair, increasing numbers of companies have been looking outside for their new chief executives in recent decades, reasoning that outsiders can leverage their experience in another domain to promote innovation, learning and high performance. The literature is mixed on how these external hires do, but it does seem that insiders have a slight edge.



While 70 percent of firms still promote from within to fill the CEO’s chair, increasing numbers of companies have been looking outside for their new chief executives in recent decades, reasoning that outsiders can leverage their experience in another domain to promote innovation, learning and high performance. The literature is mixed on how these external hires do, but it does seem that insiders have a slight edge.

We were interested in whether large academic medical centers adhere to the still-dominant preference for internal leadership hires, since the complexity of the healthcare endeavor might favor them, and, if so, whether that pattern worked for or against female candidates, who are currently underrepresented in the top ranks.

We studied the 13 leading academic medical institutions that appeared on both the U.S. News & World Report 2017-2018 Hospital Honor Roll and 2018 Best Medical Schools report, looking at the hiring history for 185 department chairs and 13 deans. We found that people in both roles were slightly more likely to have been hired externally (56% and 54%, respectively). However, while male deans outnumbered female deans by 3-to-1 (a ratio that’s still common across healthcare leadership), we were surprised to find that only three of the 10 male deans had been internally promoted, while all three of the female deans had. These are small numbers to be sure, but they are statistically significant. As such, this gender skew in academic medicine is unlikely to be attributable to chance and raises important questions.

Why the inclination toward hiring female leaders from within? One possibility is that subconscious biases against women are stronger when a female candidate is not personally known in an institution. Studies in other sectors show that men are given preferential attention from external recruitment and hiring practices, while women in the external labor market are more likely to be rejected for higher-level jobs. Many businesses have focused on ensuring a fair process for internal hires, but recent studies show that external hiring practices are rampant with gender discrimination that promotes disparities among top leadership.

Gender bias in external hiring isn’t just unfair; it might also put the organization at a disadvantage. In his book “Chasing Stars,” Boris Groysberg of Harvard Business School showed that among externally hired Wall Street investment bankers, women appeared to bear the pressures of a new work environment better than their male counterparts. External male new hires tend to suffer a decline in their performance after the move, while external female hires do not.

Our findings raise concerns about gender bias in the recruitment and hiring of leaders at leading medical institutions. These organizations should seek to both understand and develop remedies to address it. This challenge has become even more pressing as the number of women entering medical school surpassed the number of men this year. Though the medical field has succeeded in erasing gender discrimination at the school admissions level, it must redouble its efforts to correct imbalances at the top.

Copyright 2019 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.

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Melissa J. Danesh

Nicole Golbari

Martina Porter

Alexa B. Kimball

Alexa B. Kimball, MD, is CEO and president of Harvard Medical Faculty Physicians and professor of dermatology at Beth Israel Deaconess Medical Center in Boston.

For over 45 years.

The American Association for Physician Leadership has helped physicians develop their leadership skills through education, career development, thought leadership and community building.

The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.

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