There are defining moments in all our lives. One of mine was when I was 5 or 6 years old. We lived in Saudi Arabia. My dad was researching his doctorate at the university. A friend of his came to visit, a man whom I remember as little more than a shadowy squat figure with a handlebar moustache. I ran to my father, hugged his leg, felt his hand rest on my head. I was proud of myself: I was clean, I was polite, I was (somewhat) obedient. That’s pretty much all my parents expected.
The man looked at me. “She’s a girl,” he said, shaking his head. “Too bad. She’ll never be a doctor. Girls cannot be doctors.”
At that age, I had no clue what a doctor was. I had no clue what a girl was. But for the first time in my life, I felt shame.
Then my dad asked, “Why not?”
He said quietly, firmly, “My daughter can do anything.”
I live by those words: “why not?”
I am the 6th female president at the OMA. In 2018, we had 10 female Directors out of 26 on the OMA Board, the most we’ve ever had. In 2018, we had 81 female Council Delegates out of 218, again the most we’ve ever had. Across the profession, more and more women are entering medicine. In 1968, women made up 7% of the medical profession; nearly 50 years later, that number is 39%. Looking at the youngest generation of physicians, women now outnumber men.
It’s 2019 and though it’s slowly closing, there is still a gender gap in medicine. Medicine, like other professions, is still male-dominated. Men win more awards, more academic positions, more hospital and government leadership positions.
This varies somewhat around the world. In the US, women make up less than 20% of hospital CEOs, deans or chiefs of departments, and less than 10% of senior authors or Editors-in-Chief of medical journals. In Australia and Norway, it’s a bit better: women make up 30-40% in all the same categories.
Australia, like Norway, is notable for its equal opportunity hiring policies.
We have to ask why a gender gap exists to understand how to fix it.
Looking at studies from Canada, Australia, the EU, the UK, Norway and Austria, a few themes emerge:
The gender gap is often dismissed as a “female” problem.
Medicine is still an old boys’ club, leading to bias, discrimination and outright harassment in some instances. In a recent UK survey of medical students, the majority said gender was irrelevant but 1 in 4 also said men made better leaders; 76% cited social norms as a barrier for female leadership. More male students identified themselves as current leaders — and were also more likely to identify themselves as future medical leaders.
People are more likely to recruit those who are like themselves. So if men dominate leadership positions, like will attract like.
Women still get a larger burden of child care and elder care. In dual-career households, women still spend 8.5h more per week on domestic or parenting tasks.
Women increase productivity later in life but by then, many opportunities are gone.
Women receive less mentoring and sponsorship.
Women also fall prey to imposter syndrome, where self-doubt and lack of self-promotion makes them less aggressive about pursuing leadership.
The gender gap is everyone’s issue.
Characteristics and roles that used to be seen as “female” are now being taken on by men — more men are involved in child-rearing, more men want flexible work schedules and work-life balance, more men want to be involved in collaborative team models. This cultural shift means that the gender gap is no longer just a female problem.
What’s more, if leadership doesn’t mirror the demographic shifts in the profession, it can lead to a divide between leadership and front-line docs. Finally, organizations perform better when they are more balanced between men and women on Boards, senior leadership positions and middle-management.
Our choice is to wait another 50 years for change or try to make change now. There are solutions that have worked in other countries, organizations, and professions:
Acknowledge the problem exists, the bias exists so that we become the merit-based society we want to be.
Create formal networking, mentoring, and sponsorship opportunities. Start young.
Encourage leadership programs.
Institutionalize change. Develop regulations and policies to narrow the gender gap.
Institutionalize training around bias.
Turn that gender lens on granting awards, hiring practices, speaker selection for conferences, salary reviews and so on. Ask the question, are women represented and if not, why not?
Incorporate open or even blinded hiring practices rather than tapping people on the shoulder.
Provide financial support to physician scientists during caregiving years.
Create flexible work-life schedules for women and men.
Provide on-site child care and protected time for breastfeeding.
Facilitate mid-life career transitions into academics.