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Female Leaders in Medicine: It’s Lonely at the Top

I recently recreated a now-famous business school study on a subset of residents in my internal medicine residency program.

In the original study, researchers asked students to read a case of the real-life venture capitalist Heidi Roizen, who expertly leveraged an extensive professional network to forward her career.  Half of the students read the original case; half were given a case in which Heidi’s name was switched to Howard — a fictional male persona. When asked their impressions, students considered Howard the better colleague. He wasn’t just a strong leader; he was likable. People trusted him.

Heidi was, thankfully, perceived as equally capable as Howard. But when it came to likability, her scores floundered. Students saw her as political, calculated. They didn’t want to work with her. The disheartening implication, of course, was that success and likability remain positively correlated for men, and negatively correlated for women.

Prior to hearing my colleagues’ impressions on Heidi/Howard, I assumed their perspectives would be more gender-neutral than those of the business students. We are, after all, millennials in a profession driven by a deep-rooted altruism that often feels incomparable to that of other fields. It seemed we would be more willing to look at others with a non-judgmental, non-biased perspective.

But I discovered the results of my group were almost identical to the original study.

I don’t share this story with an upturned nose at the gender attitudes of my fellow residents. If I had been on the other side of the experiment, I may have fallen victim to my own subconscious biases and also disliked Heidi. I only hope to direct our attention to the reality of the gender bias among us. The consequences of bias — along with a multitude of other complex phenomena that consistently hold women back — are startling.

The most disheartening of these is the paucity of women at the top of academic medicine. Only 16 percent of medical school deans are female. Women chair only 9 percent of all clinical departments in US academic medical centers. We have a male president of the AMA, a male head of the CDC, and a male surgeon general. (To be fair, his predecessor was female — but her gender made news, not his.)

My institution follows a similar trend, with a male dean and 80 percent male department chairs.  Many have blamed these numbers on a “pipeline” problem, stating there simply haven’t been enough women in medical school to translate to equal numbers at the top. Considering that women have comprised at least 40 percent of medical schools nationwide for the past two decades, I disagree. We’re not dealing with a supply problem.

The reasons are vast, largely entrenched in culture — both within medicine and the greater American context — that has persisted for hundreds of years. Gender bias, as I observed firsthand, is likely a key player. With studies in the last ten years revealing that CVs are judged more favorably when they are linked to male identities, or that women post-doc candidates need to be two and a half times as productive as male counterparts to be considered equally competent, we can’t deny that academic medicine is still tainted by bias at best, and active discrimination at worst.

This certainly isn’t the only force, however, contributing to the “glass ceiling.” Surveys among female physicians illustrate that women experience much greater role conflict — particularly between their professional and family lives — than their male counterparts. Female medical students don’t feel the culture of medicine support their work-life balance. And we can’t ignore the fact that women have traditionally been socialized to actually shy away from success or power.

Considering the strong evidence to suggest that women not only match, but often outperform, men in leadership roles, we need to start focusing on closing our top-level gender gap with a multifaceted approach. I believe that a cultural resocialization of both men and women is crucial in working toward this goal. We need to teach girls how to compete, self-promote, and assert themselves in a way that doesn’t sacrifice likability. We need to teach them traits needed to be successful outside of the home. Perhaps more importantly, we need to empower young boys to value and succeed in roles within the home.

But for the generations of current female physicians that were socialized in a much different context, we can make institutional changes to help women compete with men effectively at the top of our field. To reduce gender bias, we can anonymize everything from residency applications to research proposals to CV reviews. To reduce the role conflict among women, we can push for a more family-oriented culture that incentivizes extended paternity and maternity leave, provides free or low-cost onsite well and sick child care, and allows for modified tenure tracks for physician scientists with children. We can fine-tune and institutionalize hand-off policies to facilitate leaving work on time so that parents can fulfill family responsibilities. We can even change our leadership culture by setting quotas or targets to increase women at the top. But perhaps most importantly, we need to first confront our personal and institutional biases to start working for the change we need.

Editor’s note: A version of this piece first appeared on KevinMD on December 28, 2015.

Nicole Van Groningen, MD Nicole Van Groningen, MD (1 Posts)

Resident Physician Contributing Writer

New York University

Nicole Van Groningen earned her MD from the David Geffen School of Medicine at UCLA and is now a third-year resident in internal medicine at NYU. She has an interest in value-based care and is one of two national recipients of the ACP/ABIM Choosing Wisely High Value Care In Action Fellowship, through which she is working to decrease overuse in the preoperative setting. She is also passionate about medical innovation, and writes about the why and what of innovation at www.theavantmed.com.