Helping the healthcare system respond to women

I did not start out my professional life in medicine; I started out in corporate finance. All along, since I was a teenager, I had been volunteering with underserved women in a variety of capacities. In my twenties, I realised that what I really wanted to do was help the healthcare system respond better to women who were traditionally marginalised. That’s what drove me to go to medical school.

For my first decade in medicine, including my training and then early faculty, my focus was in developing medical education curricula and improving hospital systems to better serve women who are experiencing gender-based violence or intimate partner violence. Along the way, I started to become more and more involved with helping my women colleagues advance in their careers. Medicine seemed to have a gender equity problem in terms of harnessing the talents of its incredible women as a workforce resource.

Medicine’s gender equity problem

According to the data, although women have represented a significant proportion of medical school graduates, graduate medical trainees and faculty for the last four decades, they are still tremendously underrepresented in the leadership pipeline. Only about 18% of medical school deans and 30% of C-suite healthcare leaders are women. So, I’m still working with a marginalised population, but it just happens to be based on career advancement, particularly leadership within medicine and science.

In the US, women represent about half of medical school graduates and graduate medical trainees, and over a third of faculty and physicians. Unfortunately, as one progresses up the leadership ladder, those numbers diminish tremendously. For example, in academic medicine, the highest rank one can achieve is professor of medicine. Only 26% of full professors are women. That is shockingly low, given the evolution over the last four decades in terms of the pipeline of women coming forward. And when we look at intersectionality and women of colour, the data is even more concerning.

A group of doctors consulting X-rays at the hospital by Donenko Oleksii.

Robust and consistent research has shown that there are tremendous organisational barriers to advancement in terms of academic rank and organisational leadership. There are barriers and disparities around research, support and compensation, and all of those forces come together to produce these statistics.

What’s stalling the career advancement of women?

These organisational barriers are secondary to two elements. One is the cultural context in academics and medicine and science and healthcare, which lends itself to these disparities. The second element is policies, practices and patterns of interaction that inadvertently benefit men and disadvantage women.

Let’s unpack the first element. What women experience now, in academic medicine in particular, is second-generation gender bias. I did not coin this term; it’s been written about in the literature for at least a decade. Second-generation gender bias is different from the sexism that existed, for instance, before Title VII and Title IX in the US. It’s not overt; it’s embedded in our unconscious expectations and stereotypes of women, women leaders, and how men and women should behave.

These biases manifest in a variety of ways that we have observed through rigorous peer-reviewed research. For example, in academic medicine and science and healthcare, women tend to be shunted into gendered career paths: more consultative roles, rather than roles that have budgetary or managerial responsibilities. Second-generation gender bias is also the driver behind the fact that women tend to be assigned non-promotable tasks, efforts that benefit the organization but are not relevant for individual performance evaluation or promotion. Women tend to be evaluated more negatively or harshly; they tend to be paid less, and they often experience double binds and backlash when behaving like traditional leaders.

The importance of culture change

There are two domains in which organisations can move the needle. One is culture change. There’s been a lot in the business literature written about this, and a critical aspect of culture change is stating the aspiration. Organisations and organisational leaders in academic medicine, science and healthcare need to overtly state that one of their goals is to cultivate a culture that supports the success and advancement of women in medicine and science.

The second element of culture change is for organisations and leaders to create psychological safety, or safe spaces, within their institutions to have frank discussions about progress. Are we meeting this goal? And if not, why not? And the third element is hiring. The data show that both men and women have implicit biases against women leaders, or women in medicine and science, with regard to particular activities or fields or ambitions. As organisations, we need to hire more inclusively.

What’s in a title?

The second domain, which is equally important as this more high-level culture change, is noticing and changing practices and patterns of interaction in the workplace that inadvertently disadvantage women and benefit men. That means paying attention to those touchpoints around recruiting, hiring, advancement, compensation evaluation and promotion where gender biases can emerge.

by Eastfaceinimage

There is so much data and research looking at the different ways in which men and women who are equally qualified by objective measures are evaluated differently. And evaluations have a significant impact on one’s ability to move forward in any professional trajectory. There are simple things that we need to pay attention to, like the words used when describing women professionals versus men in standard evaluations.

Numerous studies in academic medicine and science have examined how women professionals are introduced at academic conferences and in esteemed lectureships. Men are typically introduced by their title. In the US, an MD or a PhD would typically be introduced as Dr, so I would be Dr Amy Gottlieb. The data show that this happens with men almost all the time, whereas women are only introduced by their professional title less than half the time. That immediately sets up a construct of diminishing a woman’s professional gravitas, training, background and expertise, which just doesn’t necessarily affect a man of equal qualification. Language has impact; paying attention to those small moments of language is important.

Do women and men act differently on the job?

There are evidence-based differences in how women “perform” differently, and potentially more effectively, than men within the clinical realm. Data has consistently emerged showing that women physicians deliver a higher level of quality outcomes and are better at doctor-patient communication.

Doctor-patient conversation by Fizkes

However, it’s a double-edged sword. In the clinical realm, for example, we in the United States are still heavily entrenched in a compensation rubric that prizes volume of patients seen over other elements. Women who have been shown to deliver higher quality in certain aspects, who take more time with their patients, will potentially have lower volumes, and they face certain compensation penalties because of that.

In the leadership realm, there’s been a lot of discussion in the sociology literature about how agentic leadership (decisive, directive, executive) is stereotypically male and women’s leadership is stereotypically communal (caretaking, participative, approachable). Research shows that women experience penalties in the workplace when exhibiting agentic leadership qualities. Like most things in life, the ideal is a balance. As we move forward, after the pandemic in particular, there’s a real need to have leadership inclined towards community and towards people. At the same time, there are elements of agentic leadership in terms of decision-making that are critical. One gender doesn’t necessarily have to embody one or the other; but having a leadership team of men and women is what brings about the highest level of organisational performance.

Discover more about

gender bias in medicine

Bates, C. K., & Gottlieb A. S. (2019). Moving the needle on gender equity: A call for personal and organizational action. Journal of General Internal Medicine, 34, 329–330.

Gottlieb, A. S. (2016). Promoting academic careers of women in medicine. Maturitas, 96, 114–115.

Ibarra, H., Ely, R., & Kolb, D. (2013). Women rising: The unseen barriers. Harvard Business Review.

Tackling embedded gender bias in medicine