OPINION: It’s time to use proven methods to improve gender equity in medicine
Gail Beck, MD
Women experience difficulties in being elected or appointed to leadership positions in medical organizations in Canada. Although methods exist to remedy this underrepresentation, the will to make the necessary changes has been lacking during my 45 years of experience with medical organizations.
The first time I held office of any kind in medicine was in my second year of medical school, when I was class representative to the McGill faculty of medicine for educational matters. I won an election to earn this position but, as I was often told, “It wasn’t a hard election. Nobody wants that job.” I suppose they meant that no one wanted the job other than the guy who ran against me, but I knew better than to make a sarcastic retort in those days.
In March 2018, the Canadian Medical Association Journal published a two-part series on women in medicine.1,2 Although the articles looked at the current situation, the most startling finding was that the difficulties and concerns of women physicians were not new. The numbers of women studying and practising medicine have increased, but women physicians are still facing the same challenges when they seek leadership roles.
Rather than reviewing well-known statistics, I want to recommend a fundamental redesign of our equity programs in medicine. Do gender equity programs that are evidence-based and measure outcomes exist in academic medicine?
Bloomberg has developed an index to measure an organization’s commitment to gender equality. This gender equality index (GEI) is based on a survey that quantitatively measures an organization’s adoption of best practices in four areas: employee policies, workforce statistics, community engagement, and product offerings.3
The survey is comprehensive: 67 questions seek detailed information in each of the four topic areas.4 Twenty-six questions ask for statistics: number of women on the board, percentage of the board composed of women, number of women in senior management. These numbers reveal the organization’s willingness to hire, promote, and include women. Other parts of the survey look at policies, such as maternity and parental leave, that support gender equality in the workplace. The survey also includes items that measure an organization’s support for women in the community and as suppliers and clients. Top
In 2017, 52 firms around the world took the survey. In a report on the results, Bloomberg published these highlights5:
These are the kinds of outcomes and measures that have a real impact of women’s lives, and especially on their career advancement.
Not only could the GEI be adapted for health care institutions, such as hospitals and medical associations or faculties of medicine, but Bloomberg is also willing to assist by modifying the survey for particular circumstances.
A second program originates at the United Nations. UN Women has established seven “women’s empowerment principles” (WEP) that organizations must adopt to promote gender equality6:
Like Bloomberg, UN Women has created a tool — WEP gender gap analysis tool7— that can help organizations improve gender equality.
The work of Bloomberg and the UN Women’s initiative demonstrate that there is no reason why medical organizations cannot become more proactive in supporting women physicians’ advancement. Although the number of women in leadership roles in medicine has grown, it often seems as though the only reason for this is that the number of women in medicine has increased. Some models for improving gender equity are more effective than those we have used so far. It is time to start using them and to prove to women physicians that medical organizations are committed to their advancement.
Activism for gender equity is not new, but, in my view, it has not been welcomed in medicine until very recently. Even as I write this, it strikes me that gender activism is still not really “welcomed,” but rather it is accepted that there is a concern about the underrepresentation of women physicians in positions of influence and leadership. Top
While I have described some of the measures that can be taken to improve the appointment of women to leadership positions, I also want to comment on how difficult it can be for women to become elected to leadership roles. There is very little literature to help me examine this concern, but with respect to running for election, I do have experience to fall back on.
As recently as three years ago, I have been told that my gender and my specialty are drawbacks. I always remember a colleague saying, “You’re a woman and a psychiatrist. That’s two strikes.” This was someone who was supporting me. When I considered running in a very public election, there was no one to counsel me that people would say extraordinary things to me and make quite unkind statements. I was aware that this occurred in traditional political arenas, but I naively believed that medicine was different. In fact, it was only my experience in more traditional political arenas that prepared me for the viciousness of medical politics. It would have helped to have support, such as that provided to women in politics by Equal Voice. Equal Voice describes itself as “a national, bilingual, multi-partisan organization dedicated to electing more women to all levels of political office in Canada.8
Like most people who run for office, I intend to improve some aspect of the world. It makes no sense to have a position for the sake of having it and not for what one can achieve. Determined to be respectful and gracious in discourse, I want to spend my energy working toward goals that I believe in, as I cannot work for causes I don’t believe in. When I have been willing to walk away from a political situation because it no longer fit with my ideals, I have been told that I did not have the “persistence” required for politics. In my view, my work for many years for gender equity disproves this, and perhaps that type of statement indicates that gender equity has never been a particularly admired cause, unless you are a guy.
That we don’t “persist” and that we “don’t run” are reasons organizations give when they do not have enough women in elected positions. But if political parties mandate that they must recruit a certain number of women, why can’t medical organizations?
Accountability is now widely accepted in corporate and academic endeavours, and, as has happened in some institutions, it is time for us to insist that organizations use the tools available to help change the gender balance among the ranks of their leaders. Medicine is falling behind and it will affect our influence in society not to give women their place at the table.
1.Glauser W. Medicine changing as women make up more of physician workforce. CMAJ News 2018;8 March. Available: https://tinyurl.com/y7sc8qo2
2.Glauser W. Rise of women in medicine not matched by leadership roles. CMAJ News 2018;26 March. Available: https://tinyurl.com/ya8a2nbb
3.Bloomberg gender-equality index shows progress below the c-suite. London: Bloomberg Professional Services; 2018. Available: https://tinyurl.com/ycaw8cyx
4.2019 gender-equality index survey. Bloomberg Professional Services; 2018. Available: https://tinyurl.com/yb3t27z5
5.Bloomberg financial services gender-equality index reveals global progress. New York: Bloomberg; 2017 https://tinyurl.com/zm2zhfj
6.The principles. New York: UN Women; 2018. Available: http://www.weprinciples.org/
7.The women’s empowerment principles gender gap analysis tool. New York: United Nations Global Compact; 2018. Available: https://weps-gapanalysis.org/
8.About Equal Voice. Ottawa: Equal Voice; 2018. Available: https://tinyurl.com/y7kqfw7x
Gail Beck, O.Ont., MD, CM, FRCPC, is clinical director for youth psychiatry at the Royal Ottawa Mental Health Centre. Top
This article has been peer reviewed.