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Ontario Medical Review
March 22, 2021
CH
Clover Hemans

Career advancement and leadership opportunities for women in medicine: 10 actions to stop the stall

By Clover Hemans BScN, MD, MScQIPS, CCFP, FCFP, Co-Chair, OMA Women 

The corridors of power are firmly buttressed by the pillars of patriarchy—this includes medicineIt is 2021. Despite that fact that in 2017, more women enrolled in medical school than men (50.7% vs 49.8%), the numbers certainly do not equal gender equity success. The pandemic certainly has not helped. What can we do about this? What is the hold up?  

This is the message I would like to convey. There is no better time than now to build coalitions, reach out to peers and allies from all realms and blast through the obstacles preventing all women from achieving their full potential. This should be done using an intersectional lens. 

Ubiquitous power imbalance, intrinsic to the patriarchy imbues in all segments of societyacademic, corporate, justice, social welfare, and most definitely medicine. We must resist the inclination to decline taking about uncomfortable issues such as patriarchy, privilege and discrimination based on gender, race, age, sexual orientation, disability status and other intersectional factors. Privilege is the “unearned advantage of an unequal, invisible system.”1  

Patriarchy can be defined as “a social system in which power is held by men, through cultural norms and customs that favour men and withhold opportunities for women.”2

This describes our much of our current societyFurthermore, men benefit/have privilege from being male whether they want to or not, even when they are not being actively sexist. An example of this was seen in research using identical, fake resumes with names modified to influence race and gender stereotypes. Men were deemed more hireable, women more likeable. Black and Hispanic contenders were rated less competent and less hireable than White and Asian sounding candidates.3  

Women in medicine are not exempt from the current pandemic home/career complication. Childcare and the “second shift” of household duties are still largely considered a women’s problem. Many women have had to make significant changes to their work and their work output. Academic papers and research have suffered with the disproportional affect the pandemic has had on women. These “outputs” have stalled significantly, and with that goes opportunities for promotion, increased pay and increased power and prestige—things men take for granted.  

Throughout Canada, for example, there are only four women deans of medicine and from that small sample, only one is a woman of colour. This past year will affect long-term academic promotion. 

In the area of gender, the gender pay gap and opportunities for senior leadership, women lag markedly behind. In Canada, it is more difficult to determine gender and race in leadership because we simply do not measure this metric. Fortunately, 2020 was the year that the gender pay gap was measured in Ontario by the OMA and nationally in a paper by Drs. Michelle Cohen and Tara Kiran 

These papers on the gender pay gap were welcome data since the myth of women not working hard enough or long enough was firmly debunkedSystemic biases were uncovered—again based on deep-seated patriarchal and socialized norms. Measuring and reporting of gender and race in leadership, remuneration and job appointments is a start, but what will it take to stop the stall of equity for women in leadership? 

Recognizing that socialization of our children starts early, starts with all of us, and contributes to perpetuating gender stereotypes and intersectional biases, we know talking about it alone will not change behaviour. Appealing to emotions alone does not change overall behaviours. We need actions that beget movement. The “second shift” at home should not come with a pink ribbon. 

We must put women at every table where decisions are made. To do this, here is my call to action which can be achieved over the next 12 months.  

10 actions to advance the role of women in medicine 

I urge women physicians to choose at least one or two of these actions that resonate with you. Talking alone will not change behaviour. 

  1. Put women (especially BIPOC women) on search committees when hiring physicians, physician leaders, medical educators and surgical specialists, or when appointing people to hospital or other medical boards. Diverse representation on search committees leads to increased diversity in hiring and leadership.4 
  2. Demand transparency in job descriptions and compensation. 
  3. Require all staff receive bias and awareness training to alleviate the excuses/responses to some of the more blatantly misogynistic, racist and sexual affronts and discrimination in medicine. Follow this up with anti-discrimination policies and enforce them. 
  4. Press for fair and equitable compensation, including fair parental leave compensation. The gender pay gap is real. It cannot be explained by hours of work. It has long-term consequences for livelihood, respect and promotion. When specialties become “feminized” they become fiscally devalued.5,6 
  5. Continue the fight against “pink-pointing,” where women are pointed toward specialties more “suitable” for their gender, are penalized when applying to areas such as surgical specialties and are as viewed as “less” if their working life collides with their role as a mother.7,8 
  6. Measure and report data around the lack of female clinical chiefs of departments, corporate division heads and equally paid leaders.9 
  7. WE MUST MAKE OURSELVES VISIBLE AND UNDENIABLE. Learn to leverage informal networks. Make friends with writers and journalists. Become comfortable with writing so you can share your insights and experiences. 
  8. Build and support formal mentorship, allyship and nurturing relationships that support excellence and skill acquisition for women in leadership. Join organizations/committees that appreciate, nurture, elevate and amplify women and their work.10 
  9. Advocate for a deliberate rebalance of roles/positions where women are unfairly absent. Waiting for voluntary steps to rebalance gender inequities and power does not work.11 
  10. Become social media savvy. Leverage this tool for increased awareness of the “cement” ceiling. An enlarged digital footprint and outreach means women can lend support across the globe even when borders are closed.  

Again, I reiterate that there is still no better time than now to build coalitions and reach out to peers and allies from all realms with the aim of blasting through obstacles preventing all women from achieving their full potential. These actions have boundless power when rendered through an intersectional lens. 

 

References

  1. Flood M. So, do men benefit from gender equality? 2020 Jan 31. In: BroadAgenda [Internet]. Canberra, ACT, Australia: 50/50 by 2030 Foundation, University of Canberra. 2020. [about 6 screens]. Available from: https://www.broadagenda.com.au/2020/lets-be-clear-men-also-benefit-from-gender-equality/. Accessed: 2021 Feb 24. 
  2. Definition of patriarchy. Dictionary.com [Internet]. www.dictionary.com. 2021. Available from: https://www.dictionary.com/browse/patriarchy. Accessed: 2021 Feb 24. 
  3. Knoll MA. Female physicians reject “good enough.” Forbes [Internet]. 2019 Aug 23. Available from: https://www.forbes.com/sites/miriamknoll/2019/08/23/female-physicians-reject-good-enough/?sh=d74b33463cab. Accessed: 2021 Feb 24. 
  4. Duke S. The key to closing the gender gap? Putting more women in charge. 2017 Nov 2. In: World Economic Forum [Internet]. Geneva, Switzerland: World Economic Forum; 2021. [about 10 screens]. Available from: https://www.weforum.org/agenda/2017/11/women-leaders-key-to-workplace-equality/. Accessed: 2021 Feb 24. 
  5. Temkin S. When surgery becomes “women’s work”: the devaluation of gynecologic specialties. STAT [Internet]. 2020 Mar 12. Available from: https://www.statnews.com/2020/03/12/gynecology-surgical-specialty-devalued-womens-work/. Accessed: 2021 Feb 24. 
  6. Pelley E, Carnes M. When a specialty becomes "women's work": trends in and implications of specialty gender segregation in medicine. Acad Med. 2020 Oct;95(10):1499-1506. Available from: https://journals.lww.com/academicmedicine/Fulltext/2020/10000/When_a_Specialty_Becomes__Women_s_Work___Trends_in.18.aspx DOI: 10.1097/ACM.0000000000003555. Accessed: 2021 Feb 24. 
  7. Cuddy AC, Fiske ST, Glick P. When professionals become mothers, warmth doesn't cut the ice. J Soc Issues. 60(4):701-18. Available from: https://spssi.onlinelibrary.wiley.com/doi/abs/10.1111/j.0022-4537.2004.00381.x. Accessed: 2021 Feb 24. 
  8. Dossa F, Baxter NN. Reducing gender bias in surgery. Br J Surg. 2018 Dec;105(13):1707-1709. Available from: https://academic.oup.com/bjs/article/105/13/1707/6123193 DOI: 10.1002/bjs.11042. Accessed: 2021 Feb 24. 
  9. Allen, D. U. (2021, January 21). from BNI Committee meeting. (D.C. Hemans, Interviewer). 
  10. Allen T. Executive presence: 8 warning signs that you don’t have it. Forbes [Internet]. 2019 Dec 29. Available from: https://www.forbes.com/sites/terinaallen/2020/12/29/executive-presence-8-warning-signs-that-you-dont-have-it/?sh=758d3153a498. Accessed: 2021 Feb 24. 
  11. Trichur R. Bay Street supports board diversity in theory, but not in practice. Time to end the hypocrisy. The Globe and Mail. [Internet]. 2021 Jan 23. Available from: https://www.theglobeandmail.com/opinion/article-power-gap-bay-street/. Accessed: 2021 Feb 24.