Currently, women hold few leadership positions in academic medicine and are less likely than men to be promoted through the ranks from assistant to associate professor and then to professor. These steps are necessary to ultimately become a department chair or dean of a medical school, shaping the future of medicine. Even outside of academia, it is hard to find women physicians in leadership positions: as of 2016, only 16 women physicians led hospitals or hospital systems. And at reach step in her career, a woman is likely to be compensated less than a man with equivalent training and experience.

With the increasing number of women entering medicine, we need to continue to address the biases and societal expectations that these women physicians face.

Unconscious biases

The lack of female representation in medical leadership is not a pipeline issue. Women have entered medicine at an increasing rate over the past several decades and currently represent about 40 percent of practicing physicians, far less than their representation in leadership positions. Rather than a pipeline issue, this is more likely due to unconscious biases. These are seen in other industries, but medicine lags behind many in addressing them. Women in all industries are thought to be less interested in leadership than are men. Those in positions of authority, usually men, frequently promote those who look like them or are within their professional or social circles- other men.

Having women exhibit leadership qualities should not be viewed any differently than if those same qualities were demonstrated by a man.

The situation is even worse for women physicians, especially those who are underrepresented minorities. When physicians demonstrate leadership skills, whether during a patient health care crisis or an issue in a hospital, men are thought to be authoritative, while women are criticized and thought to be “not nice.” Communication is critical to all endeavors in health care. But “nice” never saved a patient’s life or facilitated making a tough decision to effect change.

Women physicians, like women in other fields, are subject to “gendered expectations,” meaning that they are also responsible for the majority of work at home and for providing care to children or other family members throughout their careers. These traditional views of the roles of women are used to support the assumption that women are not interested in being leaders. Gendered expectations can also lead to work/home conflicts, in which both men and women are trying to juggle responsibilities in both places. However, women are more likely to report these conflicts than are men and are more likely to suffer from burnout and depression as a result.

Facing burnout

Burnout, especially among women, is manifested primarily by emotional exhaustion. If left unaddressed, it can lead to depression and suicide. The prevalence of burnout has increased for women and men in all fields. There are stressors that are particular to the health care workplace, such as the time needed to fill in data in electronic health records that impact both women and men. This is of concern because if these physicians don’t care for themselves, or are provided the resources to do so, it makes it harder for them to provide optimal care for their patients. However, burnout is more common among women physicians. This may be related to work-home conflict. It may be related to “imposter syndrome” and “stereotype perception threat”, both of which cause women to doubt their abilities and to work harder to make up for perceived deficiencies, further contributing to their emotional and physical exhaustion. It may be related to bias and “glass ceiling” issues in the workplace.

Hopefully, these young women will contribute their voices to the calls to effect change for all physicians, resulting in a healthier and more diverse physician workforce and improved health care for our patients. Acknowledging unconscious bias among those in leadership positions and deliberately working with women physicians so that they can and will be promoted through the ranks in medicine will bring new voices and points of view to the table, important during times of drastic changes in how health care is delivered to an increasingly diverse population. Having women exhibit leadership qualities should not be viewed any differently than if those same qualities were demonstrated by a man. Making family leave and childcare more readily accessible and understanding that making accommodations for women physicians who have responsibilities outside of work will help relieve work home conflict, helping to address issues of burnout and also facilitating the entry of more women into leadership positions. Having these options available will also encourage women- and men- to remain in the health care workforce, important as we contemplate increased physicians shortages, especially in primary care and in underserved areas.