Volume 5 Number 1 In This Issue
With the start of its fifth year, CJPL is pleased to dedicate this entire issue to women physicians and leadership. Despite contributions from the frontline, academia, and administration, from general practitioners and specialists, from physicians in training and established physicians with different cultural backgrounds, it is difficult to be inclusive and find representatives from all sections and groups of our rich community of women physician leaders. Because diversity in itself is so much broader than issues related specifically to women in our field, the next issue of CJPL will be dedicated to diversity in medical leadership.
Despite the increasing number of women in medicine, they remain underrepresented in leadership roles. Women often decline leadership roles for practical reasons, but also because they lack confidence. Women physicians consistently identify three related themes that undermine their confidence and contribute to their reluctance to seek leadership roles: perfectionism, the inner critic, and the imposter syndrome. We offer tips to help women overcome these obstacles and increase their level of confidence to match their level of competence.
Rural physicians already have a wider scope of practice, higher workloads, greater difficulty accessing continuing medical education, and limited specialist consultation compared with their urban counterparts. As the demand for effective clinical governance, quality improvement, and more formal accountability increases, a commensurate increase in physician resources is needed to lead that work. The proportion of women in rural family medicine is increasing. If we take seriously the need for effective leadership in small systems, then we need to support women to have the capacity to do the work of leadership in small systems effectively.
Society has long placed white men at the top of leadership hierarchies across all fields, and medical science is no exception. Although much progress has been made to advance diversity in these roles, gender parity remains a serious leadership challenge in academic medicine. Achieving equity is a complex cultural and organizational change that will require acknowledgement of the privilege, recognition of the diversity among women, mentorship and sponsorship for women, and strong role models. Greater diversity in leadership will provide benefit from enhanced decision-making, reduced rates of harassment, improved collegiality, more accessible role models for women, and increased productivity. read article
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 CanMEDS Leader role is about collective ownership and stewardship in the health care system. Physicians balance both management skills (preserving organizational homeostasis) and leadership skills (disrupting for change). The tension between leading and managing requires considerable wisdom. I use three scenarios to illustrate the Leader role and show how the curriculum for physicians must include skill-building in systems understanding, in addition to the usual focus on biomedical and epidemiologic sciences, and skills in humanistic interaction.
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.
What do we really know about the representation of female physicians in medical leadership in Canada? Female representation on the current boards of the Canadian Medical Association and provincial/territorial medical associations is 23% and 40%, respectively. Identified barriers to female medical leadership include gendered organizational and workplace culture, gender bias, inflexible work practices, unequal childcare and domestic responsibilities, and biased performance assessment criteria and recruitment practices. Identified enablers include flexible tenure policies, systematic parental leave policies, greater inclusivity in the workplace, and formal mentorship structures. More has been written about the costs of leadership for female physicians rather than the benefits. Reinforcement of the positive aspects of leadership may serve as a motivator, particularly if the message is delivered by other female physician leaders. The negative consequences of the existing gender gap in medical leadership may have implications not only for physicians, but also for patients and the health care system. Further study on diversity and equity in medical leadership in Canada is needed to identify areas for improvement and ongoing work to address and correct gaps. read article
The gap between men and women in academic medical leadership is larger today than it has ever been, and we must all work together to effect the necessary change. In this article, we look at the promotion of diversity in Canadian medical schools, explore implicit biases, and offer practical suggestions to help Canadian health care organizations establish gender equity in leadership positions. Individuals, both men and women, have a role to play in ensuring gender diversity. read article
To identify perceived barriers and strategies related to gender-inclusive medical leadership and to determine whether there are gender differences in these perceptions, we sent a 21-item, web-based survey to all active faculty members and trainees (residents and fellows) in a large academic pediatrics department. The overall response rate was 56.9% (156/274) with a 64.5% response rate for faculty (131/203). Respondents highlighted multiple barriers to women in leadership (family responsibilities, lack of guidance, implicit biases), as well as multiple strategies to address gender disparity (organizational changes, increased guidance, support for family responsibilities). We found significant gender-based differences: 61.7% of men reported that leadership opportunities for women and men were the same, whereas 62.6% of women reported women’s opportunities were inferior; in terms of networking opportunities, 66% of men reported they were the same, whereas 65.9% of women reported they were inferior for women. More women than men cited organization-related challenges and strategies related to women in leadership; men selected more individual-related challenges and strategies. Men and women differ in their perception of the existence and causes of gender-related issues in high-level leadership and of the best approaches to improve gender diversity in leadership. These results may explain why gender disparity is ongoing, even in a pediatrics department where the majority of faculty are women.
Most women physicians can reference female mentors or colleagues who have inspired them or provided them with guidance as they assumed leadership positions. But few reach back more than 300 years for such inspiration, as does Dr. Gillian Kernaghan, President and CEO of St. Joseph’s Health Care in London, Ontario. As she wrote in Leading from the Front,1 a book on physician leaders published by the Canadian Medical Association, in conjunction with the Canadian Society of Physician Leaders, in 2013:
“I appreciate the many opportunities of mentorship that I have received through my work with the AMA. Through AMA support, I have been able to develop my skills as a physician leader and positively affect the health of my community, city, and province.” — Dr. Kimberley Kelly
Margaret Steele, MD read article
How Women Rise: Break the 12 Habits Holding You Back from Your Next Raise, Promotion, or Job
Sally Helgesen and Marshall Goldsmith
Hachette Books, 2018
Reviewed by Shayne P. Taback, MD read review
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