Unlocking the leadership potential of women in medicine
Virginia R. Roth, MD, Kathleen Gartke, MD, Jacqueline Parai, MD, Lara Khoury, MD
In medicine, as in many sectors, women are underrepresented as leaders. At The Ottawa Hospital, we found that many women exclude themselves from leadership because they perceive that the costs far outweigh the potential benefits. Under the guidance of a strategic committee composed of a diverse group of our women physicians, we developed and executed a strategy to identify potential leaders; mentor and train potential leaders; and recognize, enable, and support leaders. Key initiatives included formalizing the recognition of leadership activities and accomplishments as a performance metric, ensuring gender representation on leadership selection committees, developing a leave policy, enabling flexibility, and identifying and supporting intermediate female leaders. We solicited the active participation of our senior hospital executives, the Medical Advisory Committee, and department and division heads. Over six years, we have seen sustained progress. More new physician recruits are now women (including in specialties where women are traditionally underrepresented), a higher proportion of division heads are women, and many of our committee members have assumed formal leadership roles.
KEY WORDS: physician leadership, women, gender, career development, focus group, barriers
Now, more than ever, the Canadian health care system needs physicians who are willing to venture beyond their clinical responsibilities into leadership roles. Despite increasing demand for physician leaders and increasing numbers of women in medicine, there remains a significant gender gap in formal leadership roles.1 The advantages of including women on leadership teams are well documented2; however, evidence-based guidelines and practical experience to address this gap are lacking in medicine.
With strong endorsement from the Senior Executive Team at The Ottawa Hospital (TOH), we established a strategic committee of a diverse group of women to learn what prevents women physicians from taking on leadership roles, engage them in identifying opportunities for change, and provide recommendations on how to increase the proportion of women physicians in leadership at our hospital.
Our first step was to conduct focus group sessions with women physicians across a wide range of clinical specialties, age groups, and length of hospital appointments to better understand their experiences and perceptions.3 Participants welcomed the opportunity to discuss the topic, to network, and to learn from others.
We discovered that the women physicians in our hospital are often unwilling to assume leadership roles because they believe the sacrifices are too great and outweigh the benefits. From their perspective, the costs of taking on leadership roles were numerous. They felt that leaders are alienated, lack control over their time, are expected to be available 24/7 without reprieve, and are undervalued. Further, they felt that physicians assume leadership roles at the expense of their clinical practice, clinical income, autonomy as clinicians, and the respect of their colleagues.
Women who held formal leadership roles were more likely to identify the benefits of leadership. Among the strongest motivating factors were a sense of purpose, the ability to make a meaningful contribution, and the opportunity to build relations with leaders from other backgrounds and areas of expertise (Figure 1).
Our focus group participants identified subtle potential barriers to female physicians, including a system that rewards those who are more visible over those best qualified, a hesitancy to put themselves forward unless they are asked, fear of rejection, and a perception that their leadership pursuits may deprive others of the opportunity. In their experience, they did not feel excluded from leadership opportunities simply because they were women, but felt that impediments to leadership (e.g., time demands) are often generational rather than gender-related. At the same time, they readily identified important differences in social norms related to both domestic responsibilities and leadership behaviours.
Although they welcomed proactive measures to support women physicians, they were strongly opposed to affirmative action. They want to be nominated for leadership because they are seen as capable candidates, not because they are women.
Focus group participants indicated that they would be more willing to consider leadership opportunities if there was increased transparency around the roles, qualifications, and expectations of these positions. They would welcome more formal leadership training, opportunities to learn more about various leadership roles, networking events, and both male and female mentors. Finally, a tap on the shoulder is sometimes needed. Our women physicians felt empowered when approached and encouraged to take on leadership roles on the basis of their qualifications and abilities rather than their gender.
Focus group participants identified practical supports that would ease the pressures of leadership and make women more willing to step forward. These included parental leave policies, providing access to child care, more administrative support, and on-site office space. They indicated that departmental support is crucial to providing the clinical coverage that would allow them to attend leadership training and become more involved in leadership activities. Although protected time is often allocated for research activities in academic centres, leadership development is not perceived as a priority in many departments. Participants identified a need to make compensation more equitable for those who give up clinical time to shoulder leadership responsibilities and recommended formal recognition as a demonstration of support. Top
Designing a strategy
Armed with these essential insights gleaned from the focus group sessions, the TOH Female Physician Leadership Committee set out a strategic plan. This document was an ambitious manifesto and a call to action (Table 1). It laid out underlying principles and assumptions, an action plan, a timeline, and the most responsible persons. This list drew not only on the committee members, but also included other members of the senior management team, thus bringing them into the process and widening the base of support. The committee recognized immediately that the first step in increasing the number of women in leadership was to identify potential leaders. This needed to be followed by training and mentorship of these people, as well as recognition of the work they did.
Identify potential leaders
The importance of leadership as a career path had to be more widely recognized. We expanded our annual physician performance review4 to reflect this focus on leadership. Leadership goals and activities became an essential part of individual submissions and were reviewed by department and division heads during their annual interview. More widespread recognition of the importance and prominence of leadership was accomplished when it became a performance metric.
An obvious question arose. What is the likelihood that selection committees will choose female applicants for formal leadership positions, if the committees themselves include few, if any, female members? The Medical Advisory Committee agreed to accept “in principle” that there would be at least two women on every physician leadership selection committee. Their performance was tracked. Initially, they faltered, but a “statement of concern” from the committee seemed to spur renewed commitment.
The gender balance of every department and division’s leadership selection committee continues to be monitored yearly by the committee. At this time, over three years of compliance has been followed by a change in TOH’s medical staff bylaws that entrenches the concept that the gender balance of selection committees will reflect that of the medical staff. Top
The committee surveyed all department and division heads to identify, not only what positions of leadership were held by women, but also the actual identities of these women. This allowed leadership roles typically held by female physicians (e.g., residency program directors, clinical leads, undergraduate and postgraduate teaching leads, quality leads) to be recognized as intermediate leadership positions. It also allowed their department heads to formally recognize them as leaders and permitted specific targeting of these female physicians for advance notice of educational opportunities, annual leadership development courses, and networking events. The committee believes that these recognition and development opportunities will indirectly result in women physicians changing their perception of leadership and the importance of the contributions they are making.
Mentor and train potential leaders
The availability of mentorship for potential female leaders has been expanded. The Equity, Diversity and Gender Committee at the University of Ottawa’s faculty of medicine has a well-established program that matches mentors with mentees following a detailed intake process to potentiate the match. Recently, a separate LGBTQ mentorship program has widened the possibilities. In addition, the Female Physician Leadership Committee established a “cup of coffee mentorship” program whereby female medical staff could be matched with mentees in a slightly more informal manner, centred around specific issues, such as child rearing, career stages, social issues, and others.
The importance of role models to potential leaders is well recognized. The TOH Leadership Development Institute’s, half- or full-day programs of information and inspiration for all hospital leaders were made accessible to more physicians. Every member of the committee was invited to these sessions to allow them to be informed and to raise their level of comfort with hospital leadership activities. TOH also subsidizes tuition fees for certain leadership development courses. For the past several years, these resources have been distributed with a focus on gender balance, ensuring a proportionate number of women participate in leadership training and courses.
Recognize, enable, and support leaders
Our focus group participants identified a number of meaningful ways in which women physicians could be recognized, enabled, and supported to assume leadership roles. Yearly, and sometimes twice a year, networking events are held at the hospital as an opportunity for women to connect, share their stories, and explore prevalent attitudes toward, and challenges of, female leadership. Guest speakers have been invited from outside institutions, TED talks have been reviewed and discussed, and educational leaders have helped to direct an ongoing exploration of attitudes. Residents and medical students are included as important contributors to this culture change. Top
A lack of work flexibility, coupled with unclear expectations around leaves of absence, was identified by women physicians as an important barrier to leadership. Detailed surveys of all TOH department and division heads revealed no consistent policies for maternity, parental, or elder care leaves, few if any opportunities for shared or part-time work, and variable attitudes toward barriers that women might face in achieving leadership positions. This led to the development of the TOH medical leaves policy, aimed at shining a positive light on these necessities and encouraging equitable access to leaves. Hesitation to invoke these rights is fading slowly following a gradual cultural shift.
More recently, the committee assisted in coordinating emergency child care for staff and resident physicians (both male and female) through an outside private contractor. This service provides at-home care on short notice for physicians when their child is ill or when the child’s usual caregiver is unavailable, assisting young physicians in the challenge of balancing family and work.
To further improve workplace flexibility, TOH declared an intent to establish a culture of enablement, investing in technology so that participation in important events was made possible through widespread use of teleconferencing and videoconferencing. Women, whose other life commitments had been limiting their attendance, are now able to participate much more widely.
In 2018, the committee joined the internationally recognized #GoSponsorHer social media campaign5 as another way to highlight female physician leaders in the hospital. Each of the 12 department heads was challenged to sponsor a female physician in their department; larger departments could sponsor more than one. The sponsored physicians were announced over the course of the year in the hospital newsletter and through social media. At the end of the year, they were invited to attend a networking event that was dedicated to their sponsorship. They were also added to the list of recognized intermediate leaders. This encouraged department heads to actively recognize and engage in the careers of women in their department.
We celebrate our leaders (female and male) to underscore the value of physician leadership at our hospital. A peer-nominated award is given annually to recognize an outstanding physician leader. Letters of appreciation encourage leadership activity at multiple levels. Recognition of the committee and advocacy for female physicians is ongoing through periodic updates to the hospital’s Board of Governors and the Medical Advisory Committee.
An early sign of progress was seen in our physician engagement scores, with an 11% increase in engagement for female physicians, compared with a 5% increase for male physicians, within 3 years of the establishment of the Female Physician Leadership Committee. With our focus on women in medicine, we have observed a steady increase year-over-year in the proportion of new physician recruits who are women. Women now comprise 37.8% of all active or associate medical staff at TOH, compared with 29.6% in 2011 before the establishment of the committee. The largest increases were seen in the Departments of Otolaryngology (15% increase), Surgery (10% increase), and Emergency Medicine (12% increase).
Over time, the number of women physicians in formal leadership positions at TOH has continued to increase. For example, 21% of all division heads are now women compared with 17% in 2011, although the number of female department heads remains the same (8% or 1 in 12). Nearly half of all members of the Female Physician Leadership Committee have assumed prominent leadership positions. Examples of roles include medical director of physician health and wellness, director of cancer research, deputy division head, senior medical officer, and chief of staff.
We did not find a single “golden key” to unlock the leadership potential of women in medicine. However, we focused on addressing the real and perceived barriers, while reinforcing the benefits of leadership, so that potential leaders do not opt out. Health care organizations looking to include more women physicians in leadership roles may benefit from our practical experience. Although we have not yet achieved equal representation in our hospital, we have sustained steady progress over six years by learning from, and working with, front-line clinicians to develop and execute a strategy to increase the number of female physician leaders. Top
1.Glauser W. Rise of women in medicine not matched by leadership roles. CMAJ 2018;190(15): E479-80. Available: http://www.cmaj.ca/content/190/15/E479 (accessed 18 June 2018).
2.Hunt V, Yee L, Prince S, Dixon-Fyle S. Delivering through diversity. Toronto: McKinsey & Company; 2018. Available: https://tinyurl.com/yafmt4nx (accessed 18 June 2018).
3.Roth VR, Theriault A, Clement C, Worthington J. Women physicians as healthcare leaders: a qualitative study. J Health Organ Manag 2016;30(4):648-65. doi: 10.1108/JHOM-09-2014-0164.
4.Garvin D, Worthington J, McGuire S, Burgetz S, Forster AJ, Gerin-Lajoie C, et al. Physician performance feedback in a Canadian academic center. Leadersh Health Serv (Bradf Engl) 2017;30(4):457-74. doi: 10.1108/LHS-08-2016-0037.
5.Join the #GoSponsorHer challenge today. Deloitte, Catalyst, McKinsey & Company; 2017. Available: http://gosponsorher.com/
Conflict of interest
The authors all confirm that they have no conflicts of interest or potential conflicts of interest to declare.
All authors contributed substantially to the content and editing of this manuscript and approved the final version. All authors have served terms as chair/co-chair of TOH’s Female Physician Leadership Committee and led the implementation of key initiatives described in the article.
Virginia Roth, MD, FRCPC, MBA, is chief of staff at The Ottawa Hospital, professor of medicine at the University of Ottawa, and clinician investigator at The Ottawa Hospital Research Institute.
Kathleen Gartke, MD, FRCSC, is senior medical officer at The Ottawa Hospital, assistant professor of surgery (orthopedics) at the University of Ottawa, and clinician investigator at The Ottawa Hospital Research Institute. She is also national co-treasurer and a past president of the Federation of Medical Women of Canada.
Jacqueline Parai, MD, MSc, FRCPC, is a forensic pathologist, chair of the Royal College Specialty Committee in Forensic Pathology, and assistant professor at the University of Ottawa’s Department of Pathology and Laboratory Medicine.
Lara Khoury, MD, FRCPC, is medical director of Geriatric Inpatient Services, deputy head of the Division of Geriatric Medicine, assistant professor of medicine at the University of Ottawa, and clinician investigator at The Ottawa Hospital Research Institute. Top
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This article has been peer reviewed.