By: SreyRam Kuy, MD, MHS
Part
I: The Status of Women in Leadership Roles, Changing Culture and Leadership
Training
“If you're offered a seat on a rocket ship, don't ask what seat! Just get on.” -Sheryl Sandberg, Chief Operating Officer of Facebook, from Lean in: Women, Work, and the Will to Lead
“When you ask women, they do want these things [leadership roles] and they want them as much as men do.” - Patricia Numann, MD, Former President of the American College of Surgeons and Association of Women Surgeons Founder
“I used to walk down the street like I was a super star… I want people to walk around delusional about how great they can be – and then to fight so hard for it every day that the lie becomes the truth.” -Stefani Germanotta, entertainer known as “Lady Gaga”
Introduction
A century ago Orison Marden
published, “How They Succeeded: Life Stories of Successful Men Told by
Themselves,” describing the leadership and career success stories of prominent
late nineteenth century US leaders such as Alexander Graham Bell and John D.
Rockefeller. Among these profiled
nineteenth century leaders was Helen Gould, an heiress, philanthropist and a
law school graduate. Ms. Gould remarked
upon the confines of nineteenth century America upon opportunities for upward
mobility available to women, “I do not see, for my part, how any child from the
poorest tenements could ever grow up and develop into strong, successful men or
women… And it is harder on the girls
than the boys! The boys can go forth
into the world and probably secure a position… but the poor girls have so few
opportunities.” And yet, she had the
prescient foresight to say, “But I don’t think it matters much what a girl does
so long as she is active, and doesn’t allow herself to stagnate. There’s nothing, to my mind, as pathetic as a
girl who thinks she can’t do anything.”
A century later, the first woman to be inducted as president of the
American College of Surgeons proved that “girls” can indeed do anything.
Dr. Patricia Numann remarked on
leadership roles that “When you ask women, they do want these things and they
want them as much as men do.” Clearly,
there is a wealth of talent among women surgeons. What is the status of women in leadership
roles in medicine today? And, what are
the resources to assist women medical students, surgical residents and surgeons
in advancing in leadership roles in their hospitals, communities, universities,
and professional organizations?
The Status of Women
in Leadership Roles in Medicine
In 1960, only 5% of medical
students were women.[1] Today, at least half of medical students are
women. Has the advancement of women in
leadership roles in medicine kept up with the growth of women entering
medicine? In a cohort study of all US
medical school graduates from 1979-1993, women were more likely than men to
pursue an academic career (10% more women than would be expected with proportional
representation of men and women, with women significantly over-represented
among medical school graduates entering academic medicine).[2] However, the percentage of women who advanced
to associate or full professor were significantly lower than their male
counterparts. The percentage of women
medical school faculty members holding full professorship has grown slowly over
the years, from 7% in 1978 to 15% in 2005.(Nattinger) This is in contrast to the fact that 30% of
male faculty have held the rank of full professor consistently over this time
period and that in 2005 only 11% of department chairs were women.
Some of the factors that have been
suggested for this gender disparity in leadership roles in medicine include
less preparation for an academic career, fewer resources at the beginning of
the career such as salary disparity either due to sexual discrimination or
ineffective negotiation, lack of mentoring, less supportive institutional environment,
and societal norms dictating home life and child care responsibilities which
impact career trajectory.[3],[4],[5] To close the gender leadership gap, a
multifaceted approach is necessary. A
number of strategies have been suggested.
Changing the culture of medicine, disseminating knowledge about
resources for leadership training, increasing awareness of promotion criteria,
improving mentoring of junior women surgeons and developing negotiation skills
are several other avenues that empower women surgeons in emerging as leaders in
academic and organized medicine.
Changing the Culture
of Medicine
Valantine and Sandborg describe one institutional model
which aims to change the academic culture to allow integration of work-life
balance and flexibility policies into the promotion process, such as parental
leaves and tenure clock extensions, which would enable institutions to better
recruit and retain the best and brightest of both women and men.[6] Fried et al. describe another multifaceted
institutional intervention to address career advancement obstacles faced by
women faculty.[7] By targeting problem identification,
leadership involvement, education of faculty, mentoring, reduction of isolation
and increased integration of women faculty into the scientific community, they
reported a significant increase in the number of women promoted to associate
professor rank over a 5 year intervention period. Other institutional change frameworks
emphasize the need to increase the visibility of women and the work they do by
tracking and publishing institution specific data on women in leadership
positions and valuing women’s relational skills by training deans and other
administrators to look for and recognize the value of women’s behind the scenes
relational expertise in collaboration.[8] The National Institute of Medicine (NIH)
developed a tool to assess if an institution has a Culture Conducive to Women’s
Academic Success (CCWAS).[9] The CCWAS consists of four elements, equal
access, work-life balance, freedom from gender biases and supportive
leadership. This can be a valuable tool
for institutions seeking to reinvigorate their culture to enable women to
flourish in academic medicine.
Leadership Training
Sonnino describes valuable
resources available for professional development and leadership training,
available on the Association of Women Surgeons Website[10]
and the American Journal of Surgery.[11] These opportunities of professional
development described include courses provided by the AAMC (Association of
American Medical Colleges), the ELAM (Executive Leadership in Academic
Medicine) program for women, ACPE (American College of Physician Executives)
Leadership Development Program, Harvard University MBA training programs, and
the Robert Wood Johnson Foundation Fellowships.
ELAM offers senior women faculty at medical and dental schools a
year-long fellowship training experience to enable them to develop the skills
need to competitively seek higher level administrative positions at academic
medical centers.[12] Research has demonstrated that women
physician who participated in ELAM were more successful than non-ELAM women
physicians in attaining department chair or Dean level positions.[13]
Leadership training needs to begin
early, in medical school and residency training. Taking an active leadership role to enable
effective teamwork and patient care during residency medical school is the
training grounds the future surgical leaders.[14] The American College of Surgeons hosts an
annual Residents as Teachers and Leaders Course at their national headquarters
in Chicago, Illinois at no cost to surgical trainees.[15] Residents are taught effective teaching
skills including learning how to give feedback to learners, establish time for
teaching, and seeking teaching opportunities in the operating room and on the
wards. Residents are also taught
techniques for successful leading such as conflict resolution, integrating
diverse working styles, and leading productive teams. The American College of Surgeons also has
course of practicing surgeons, Surgeons as Leaders: From Operating Room to
Boardroom.[16] This three day course teaches surgeons about
consensus building, changing culture, conflict resolution, emotional
intelligence in order to have personal insight, and practical translation of
leadership principles into daily action.
By incorporating a multifaceted
approach of fundamental change in institutional culture, leadership training,
negotiation skills, development of mentoring relationships and awareness of
promotion criteria, hopefully we can one day see more women surgeons following
in the footsteps of Dr. Numann in leading our hospitals, communities, and
professional societies. Check out next
month’s AWS newsletter to learn read the second segment of this two part
article, “Women Surgeon Leaders for
the 21st Century: Part II – Negotiation Skills, Developing
Mentorship Relationships, and Promotion Criteria”.
Parting Thoughts from
Women Leaders
“Always aim high, work hard and care deeply about what you believe in. And when you stumble, keep faith. And, when you’re knocked down, get right back up and never listen to anyone who says you can’t or shouldn’t go on.” - Hillary Rodham Clinton, Former US Senator, First Lady and Secretary of State
“I always did something I was a little not ready to do. I think that’s how you grow. When there’s that moment of ‘Wow, I’m not really sure I can do this,’ and you push through those moments, that’s when you have a breakthrough.”
–Marissa Mayer, Chief Executive Officer of Yahoo
“As a leader, I am tough on myself and I raise the standard for everybody; however, I am very caring because I want I want people to excel at what they are doing so that they can aspire to be me in the future.” –Indra Nooyi, Chief Executive Officer of PepsiCo
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SreyRam Kuy, MD, MHS was born in Cambodia, grew up in Oregon,
graduated from Crescent Valley High School as Valedictorian, and attended
Oregon State University where she earned dual degrees in Philosophy and
Microbiology. Dr. Kuy’s passions are healthcare policy, physician leadership
and health services research. After college she worked as a Kaiser Family
Foundation Barbara Jordan Health Policy Scholar in the Senate, writing speeches
and policy briefs for Senator Tom Harkin on women’s health, coverage for breast
cancer screening and treatment, and health care instrument safety. She
attended medical school at Oregon Health Science University, then finished
general surgery residency in Wisconsin. She earned her master’s degree in
health services research at Yale University School of Medicine as a fellow in
the prestigious Robert Wood Johnson Clinical Scholars Program. She is
also a writer. Her first book, Soul of a Tiger, describes her family’s
survival during the Cambodian Genocide known as the Killing Fields. Her
second book, 50 Studies Every Surgeon Should Know, will be released in 2015 by
Oxford University Press and describes seminal research in the surgical
field. Dr. Kuy is an assistant professor of surgery at Louisiana State
University and the Overton Brooks Veterans Affairs Medical Center.
[1]
Hamel M, Ingelfinger J, Phimister E, Solomon C.
Women in Academic Medicine – Progress and Challenges. NEJM. 2006;355:310-312.
[2]
Nonnemaker L. Women Physicians in
Academic Medicine: New Insights from Cohort Studies. NEJM. 2000;342:399-405.
[3]
Nattinger A. Promoting the Career
Development of Women in Academic Medicine.
Arch Intern Med.
2007;167:323-324.
[4]
Bickel J, Wara D, Atkinson B, Cohen L, Dunn M, Hostler S, Johnson T, Morahan P,
Rubenstein A, Sheldon G, Stokes E. AAMC
Paper: Increasing Women’s Leadership in
Academic Medicine: Report of the AAMC Project Implementation Committee. Acad Med.
2002;77(10):1043-1058.
[5]
Allen I. Women doctors and their
careers: what now? BMJ.
2005;331:569-572.
[6]
Valentine H, Sandborg C. Changing the
Culture of Academic Medicine to Eliminate the Gender Leadership Gap: 50/50 by
2020. Acad Med. 2013;88(10):1411-1413.
[7]
Fried L, Francomano C, MacDonald S, Wagner E, Stokes E, Carbone K, Bias W,
Newman M, Stobo J. Career Development
for Women in Academic Medicine. JAMA. 1996;276:898-905.
[8]
Morahan P, Rosen S, Richman R, Gleason K.
The Leadership Continuum: A Framework for Organizational and Individual
Assessment Relative to the Advancement of Women Physicians and Scientists. Journal of Women’s Halth. 2011;20(3):1-10.
[9]
Westring A, Speck R, Sammel M, Scott P, Tuton L, Grisso J, Abbuhl S. A Culture Conducive to Women’s Academic
Success: Development of a Measure. Acad
Med. 2012;87(11):1622-1631.
[10]
Association of Women Surgeons. https://www.womensurgeons.org/CDR/AJSprofdevleadershiparticle.pdf. Accessed 6/10/2014.
[11]
Sonnino R. Professional development and
leadership training opportunities for healthcare professionals. The American Journal of Surgery. 2013;206:727-731.
[12]
Richman R, Morahan P, Cohen D, McDade S.
Advancing Women and Closing the Leadership Gap: The Executive Leadership in Academic Medicine
(ELAM) Program Experience. Journal of
Women’s Health & Gender Based Medicine.
2001;10(3):271-277.
[13]
Dannels S, Yamagata H, McDade S, Chuang Y, Gleason K, McLaughlin J, Richman R,
Morahan P. Evaluating a Leadership
Program: A Comparative, Longitudinal Study to Assess the Impact of the
Executive Leadership in Academic Medicine (ELAM) Program for Women. Acad Med. 2008;83:488-495.
[14]
Kiesewetter J, Schmidt-Humber M, Netzel J, Krohn A, Angstwurm M, Fischer
M. Training of Leadership Skills in
Medical Education. GMS. 2013;30(4).
[15] American College of Surgeons. Residents as Teachers and Leaders
Course.
http://www.facs.org/education/residentsasteachersandleaders.html. Accessed 6/10/2014.
[16]
American College of Surgeons. Surgeons
as Leaders: From Operating Room to Boardroom.
http://www.facs.org/education/surgeonsasleaders.html. Accessed 6/10/2014.
Cosmetic Surgery with The Spot Healing Brush
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