Academic medicine falls short when it comes to female leadership

By Yasmine S. Ali, MD, MSCI, FACC, FACP | Fact-checked by Barbara Bekiesz
Published July 13, 2023

Key Takeaways

  • In academic medicine, female physicians are significantly more likely to be instructors than deans, department chairs, or full-time professors. 

  • A lack of adequate support and mentorship, poor work life balance, and implicit and perceived gender biases are among reasons for this lack of female leadership.

  • Providing adequate support for female physicians from medical school and beyond, while supporting their recruitment into leadership positions, is the first step in addressing gender inequities in academic medicine.

In 2018, for the first time, the majority of students entering medical school were women.[] However, female mentors in leadership positions in academic medicine are still in the minority.

In its most recent report on this disparity, the Association of American Medical Colleges (AAMC) notes that, although the overall percentage of women serving in full-time faculty positions has risen since 2009, women comprise a majority of faculty only at the instructor rank.[]

In fact, when it comes to the highest levels of leadership, women account for only 18% of all medical school deans, 18% of department chairs, and 25% of full professors.

Behind the female leadership disparity

“This isn’t a pipeline issue,” said Sasha Shillcutt, MD, MS, an endowed professor and the vice chair of strategy, department of anesthesiology, at the University of Nebraska Medical Center, in an interview with the AAMC.[] She pointed out that it is, instead, “a lack of intentional effort to recruit and hire women for leadership positions,” noting that providing adequate support for women in leadership after recruitment is just as important to ensure their success.

This sentiment mirrors some of the issues seen in recruitment of women to the highest-paying medical specialties: the lack of adequate support and mentorship. This is especially true for women in positions in which they have traditionally been vastly underrepresented. Issues of work-life balance and work culture are also reasons behind the lack of female leadership.

Related: Why are there so few women in the highest-paying specialties?

In a workshop report by the Association of Pulmonary, Critical Care, and Sleep Division Directors, leaders in the field identified a number of factors that may contribute to gender inequality and inequity in leadership positions.[] These included the gender salary gap, “gender climate” (which includes implicit and perceived biases), lack of women in leadership positions, poor retention of women on rungs of the leadership ladder, and disproportionate family responsibilities.

One physician’s perspective

I have experienced many of these very factors in my own career in academic medicine.

"Although I was director of two different divisions at an academic hospital, I received very little in the way of administrative support, mentorship, or schedule flexibility."

Yasmine S. Ali, MD, MSCI, FACC, FACP

Although I was director of two different divisions at an academic hospital, I received very little in the way of administrative support, mentorship, or schedule flexibility. This lack of support on so many levels was, in fact, the reason for my leaving those leadership positions to open my own private practice. I have also watched numerous female colleagues go through similar experiences.

Pervasive gender biases

Unconscious and implicit biases held by physicians themselves, as well as other healthcare professionals, are at least part of the reason why such gender inequities still exist. Authors writing in The Permanente Journal said, “Gender inequities date back thousands of years, with women expected to be caregivers at home and men expected to be leaders with occupations outside the home.”[]  

"Implicit biases negatively affect women in their medical careers and contribute to slower advancement, less favorable evaluations, underrepresentation in leadership positions, fewer invited lectures, lower salaries, impostor syndrome, and burnout."

Authors, The Permanente Journal

Given the long duration of such societal biases and of the status quo, it will take a continued, conscious effort to effect change on a large scale, but it can be done. Thankfully, publication of the very studies that highlight this problem is an indication of increased awareness of this issue. Academic medicine must now move forward with the changes necessary to recruit women to leadership positions and ensure they have the support and mentorship they need to succeed.

What this means for you

Due to a lack of support starting as early as medical school, academic medicine sees significant gender inequality when it comes to leadership positions. While gender inequality in medicine is nothing new, studies highlighting these issues are one of the first steps to introduce more balanced gender equality in positions of leadership. The catalyst for making real change will have to involve more equal representation of female voices in positions of power. 

Read Next: A female physician’s perspective: Knowing when to quit

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