Exploring Equality in Physician Leadership Roles

Women are underrepresented in physician leadership. Exploring the issue, researchers created a study focused on developing successful skills, behaviors and attitudes for 15 first-year female residents.

In 2009, the Association of American Medical Colleges reported that 48 percent of the individuals accepted into medical school were women.1 Although barriers to medical school entrance by women have all but been abolished, recent studies show that women who choose to pursue leadership careers in academic medicine are sparse when compared with their male counterparts.

At medical schools or teaching hospitals, women comprise 35 percent of all faculty, concentrated in junior teaching positions. They represent less than half the population in the following positions: assistant professors (42 percent), associate professors (31 percent), full professors (19 percent), division or section chiefs (21 percent), department chairs (13 percent) and deans (13 percent).1

Theories that attempt to explain this leadership gap associate gender-specific behaviors and roles and cultural and racial conventions with a reduction in productivity and the perceived ability to succeed in higher management positions.2,3 That is, cultural and racial stereotypes may have pernicious effects on diverse individuals’ opportunities for leadership because they can act as self-fulfilling prophecies undermining the willingness to step forward as potential leaders — or “stereotype threat.”3

Descriptive gender stereotypes about leadership in the general population are considered accurate in that women display more transformational behaviors and fewer laissez-faire behaviors than men.4 Despite overall good managerial functioning, women tend to be judged as less effective than men in male-dominated roles and in more masculine settings.3

In the June 2014 issue of the Journal of Women’s Health, authors Anna Kaatz and Molly Carnes explore the phenomenon of stereotype-based gender bias, which impedes female physician advancement in academic medicine.2 These long-standing discriminatory behaviors about men and women are observed both formally in review processes for hiring and promotion, as well as informally in social encounters. Female physicians are vulnerable to these attitudes, thereby positioning them into one of three conceptual categories that form the so-called “out-group.” This, in turn, thwarts their career-advancing opportunities.

The first is borne out of social emphasis placed on agentic or assertive qualities rather than on communal or collective qualities. The result is that gender is melded with status, and women “can’t grow up” into status positions. Evidence supporting this is well-recognized: Women are sparsely represented in strong agentic, high-status specialties or activities (such as interventional cardiology or large-scale research projects) and overrepresented in low-status communal fields (such as pediatrics, teaching and service activities).

The second is based on perception and the assumption that women lack the characteristic agentic traits associated with stereotypical male-dominated leadership. Women therefore are viewed as ineligible for these roles and as such are “invisible” regardless of their credentials, which can be equivalent or identical to those of their male counterparts.

The third is formed by senior female academicians. Despite their lengthy accomplishments and more advanced tenure, these physicians are nevertheless perceived to lack male-typed agentic traits, an assumption that increases with career stage. These “over the hill” women are treated as symbolic rather than legitimate members of the academic community, which further reinforces their out-group status.

In an article for the Journal of the National Medical Association, “Mentoring Women in Academic Surgery: Overcoming Institutional Barriers to Success,” author Eddie L. Hoover presents the argument that the discrepancy between the increasing number of women entering medical school and the relative paucity of female physicians at the highest faculty ranks in surgery is related to gender-specific barriers.5 Despite their scholastic achievements, female surgeons face challenges in recruitment, retention, promotion and salary compared to male surgeons.

Diversity is recognized as a desirable goal in creating an equitable and productive environment in the field of surgery. However, obstacles related to gender play a role in the under-representation of women at all levels of academic surgery. These include child care responsibilities and quality-of-life issues associated with surgical specialties. Taken in parallel, the career path obligations (such as membership to academic societies and colleges) a female surgeon must accept in comparison to their male counterparts is almost double if she is to be successful. This translates into more time away from work, home and family.

Benefits of Mentoring

Mentoring has been shown to be one of the most effective means for women to scale the leadership ladder in surgery. At the University of Pennsylvania, for example, mentoring has had a direct impact on women being promoted to senior academic rank.5

Mentoring addresses a wide variety of topics that are potential barriers to success — finances, podium presence and public speaking, scientific writing skills, balancing work and family, and other gender-equity issues. Other mentoring programs, under the auspices of national medical organizations, offer assistance to women who demonstrate strong potential for advancement.

A lack of higher female influence can prevent female physicians from seeking out a mentor, even though the experience is strongly tied to job satisfaction and career advancement.6,7 Effective leadership emerges from inspiring, motivating and mentoring followers.3 A mentoring relationship may be essential to development and advancement of women in an organization, although women leaders perceive more barriers to gaining a mentor than men do.8

Beyond similar exposure to mentoring relationships for men and women leaders, predictions of a positive association between mentoring and career attainment are supported; mentors are able to delegate more to their mentees and enhance their own effectiveness to further their careers.7

To break through barriers that prevent women and minorities from climbing the professional ladder, leadership development programs can help women create a supportive network, find mentorships and promote their value to the workplace.9 This will lay the foundation to change perceptions of female leaders, causing a true culture shift to one day break the glass ceiling.

In addition to leadership development programs, mentorship is considered another important component in facilitating success among female physicians; female leadership and female promotion are linked through mentorship.6 For example, the likelihood of female physicians being hired and promoted in academic centers increases when the department chair is a woman.6

Summary of the Study

The main objective of this longitudinal study is to identify and develop positive leadership attributes, behaviors and attitudes in women residents.

Year 1 of the project presents the concept and definition of professionalism from a variety of perspectives as they align with organizational culture in medicine. Each participating first-year resident will be assigned a coach in Year 2, and a mentor in Year 3. The expectation is that female physicians in training will acquire the necessary skills, tools and qualities to achieve success in leadership. A quantitative analysis of the study will determine the impact of both the educational and coaching/mentoring interventions.

This study follows 15 first-year female resident volunteers from Advocate Lutheran General Hospital in Illinois and Advocate Children’s Hospital’s Park Ridge and Oak Lawn campuses. The participants represent concentrated departments, including internal medicine, family medicine, pediatrics, psychiatry and obstetrics/gynecology.

A detailed educational curriculum complements the residency training program and focuses on three key areas of leadership growth and development: professionalism, coaching and mentoring. (It was determined that implementing the study with second- and third-year residents would require a more individualized curriculum to accommodate program differences, which would complicate the methodology and present logistical challenges beyond the scope of this pilot program). Male residents are excluded from this project.

The first year of residency presents a steep learning curve for clinical expertise and skills development. Commensurate with this intensive year filled with new experiences, stresses and unfamiliar challenges, residents are nevertheless encouraged to learn about and practice professionalism. Year 1 of the project exposed young doctors to both universally accepted norms about professionalism at the workplace as well as the values, mores and attitudes that align with the Behaviors of Excellence of Advocate Health Care.10

During the first year of the study, all activities were well received. Lecturers, workshop facilitators and residents reported positively about the reciprocal learning experience, especially during the workshops, with lectures and corresponding small-group interactive workshops running smoothly. Resident lecture attendance ranged between five and 15, and each workshop was composed of three to five residents, with participation described as excellent. Residents were honest and forthcoming with their feelings, apprehensions and anxieties. Challenges with on-call schedules, vacations and personal obligations seemed to be the most common reasons for not attending a lecture in person.

As it continues, this is anticipated to be an exciting, informative and relevant investigation, based on the results that defined Part 1. Part 2 will serve as the halfway point, which will include the evaluation from the participants after years 1 and 2. Part 3 will include the complete quantitative statistical analyses as well as the comprehensive qualitative review from evaluations and other activities.

This research project has been received enthusiastically by executives at the system level and by physician leaders and nonphysician leaders, colleagues and associates.

There are many reported reasons why women continue to face challenges in leadership advancement. The 15 women who stepped forward and volunteered to participate in this investigation have demonstrated leadership attributes already, by virtue of their commitment, interest and willingness to learn and grow. We are embarking on an exciting journey to learn more about why and how physicians in training can develop into future leaders while creating a culture of effective leadership successive planning.

Lisa Laurent, MD, MBA, CPE, is president of Advanced Radiology Consultants and president-elect of the medical staff at Advocate Lutheran General Hospital in Park Ridge, Illinois. She is also on AAPL’s board of directors.

Teresa Sosenko, MD, is an internal medicine resident at Trihealth Good Samaritan Hospital in Cincinnati, Ohio.

Ina Zamfirova, MS, is a health outcomes research coordinator at the Russell Institute for Research and Innovation at Advocate Lutheran General Hospital in Park Ridge, Illinois.

Cindy Hartwig, RN, MS, BSN, is the executive director of women's services and professional development for Advocate Lutheran General Hospital in Park Ridge, Illinois.

With contributions from Benjamin Warren, BS, and Megan Tran, BS, who reviewed this documentation, peer-reviewed literature, and poster and abstract development for the study.

REFERENCES

1. Gabriel BA (2011). “Lonely at the Top: Academic Medicine’s Women Leaders.” AAMC Reporter. Retrieved from aamc.org/newsroom/reporter/ may11/188562/lonely.html

2. Kaatz A and Carnes M (2014). “Stuck in the Out-Group: Jennifer Can’t Grow Up, Jane’s Invisible, and Janet’s Over the Hill.” Journal of Women’s Health, 23, 481-484.

3. Eagly AH and Chin JL (2010). “Diversity and Leadership in a Changing World.” American Psychologist, 65(3), 216-224.

4. Vinkenburg CJ, van Engen ML, Eagly AH and Johannesen-Schmidt MC (2011). “An exploration of stereotypical beliefs about leadership styles: Is transformational leadership a route to women's promotion?” The Leadership Quarterly, 22(1), 10-21.

5. Hoover EL (2006). “Mentoring Women in Academic Surgery: Overcoming Institutional Barriers to Success.” J Natl Med Assoc, 98, 1542-1545.

6. Wietsma AC (2014). “Barriers to Success for Female Physicians in Academic Medicine.” Journal of Community Hospital Internal Medicine Perspectives, 4, 1-3.

7. Dreher GF and Ash RA (1990). “A comparative study of mentoring among men and women in managerial, professional, and technical positions.” Journal of Applied Psychology, 75(5), 539-546.

8. Burke RJ and McKeen CA (1996). “Gender effects in mentoring relationships.” Journal of Social Behavior and Personality, 11(5), 91-104.

9. Johns ML (2013). “Breaking the Glass Ceiling: Structural, Cultural, and Organizational Barriers Preventing Women from Achieving Senior and Executive Positions.” Perspectives in Health Information Management, American Health Information Management Association, 10(Winter), 1e.

10. Advocate Health Care (2011). Retrieved from advocatehealth.com.