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There is still a marked disparity between the number of women in emergency medicine and the percentage of female leaders. This is damaging both to female physicians and to the specialty as a whole.

Sports Illustrated dedicated its May 2012 issue to the 40th anniversary of Title IX, the law declaring that any institution that received federal funding could not discriminate on the basis of sex. One of the more memorable vignettes in the SI piece was a story about the 1976 female Yale crew team. The women were fed up waiting sweaty and shivering for the post practice bus as the male team took hot showers in their warm locker room. So one day, cleverly accompanied by a NY Times writer and photographer, they stormed into the female athletic director’s office. Once inside, the entire team stripped to reveal “TITLE IX” blocked in blue marker across their chests. Needless to say, the Yale plumbers were soon busy.

Ironically, Title IX may never have been introduced had its sponsor Patsy Mink, a Hawaiian congresswoman, been accepted into medical school. Ms. Mink had dreamed of being a doctor but found law and politics as an after thought when she couldn’t get into medical school based on her gender (Carnes, Jama 2012). Although Title IX is best known for increasing access to women in collegiate sports (today 200,000 women compete collegiately compared to 16,000 in the early 70s), the original bill had nothing to do with athletics. Its original intent concentrated on preventing gender bias in higher education admissions departments (i.e. before Title IX 90% of medical students were men). Since its passage, women have made enormous strides: they have run for president, gone up in space, even led major colleges and corporations. But before we proudly cross off gender balance on our national “to do” list, let’s take a moment for reflection.

OK, any article that focuses on this topic has the potential for sighs, sneers and grunts. Older men often zone out entirely during this conversation, either because they fail to appreciate its personal relevance or because they are leery that any suggestions they contribute might be misinterpreted and used against them. As traditional organizational approaches to gender balance have focused on a human resource based “fix-the-women” strategy in which men were conspicuously absent, perhaps their hesitation is understandable. On the other hand, many senior women are also sick of the subject, as they don’t want it subtly implied that their achievements should have a gender equality asterisk. And younger employees? Well, the generation who grew up post Title IX may sincerely believe this entire discussion is so last century because they’ve yet to experience it directly. But if we take an honest look at the data, we are stuck. US women hold only 16% of board seats and 3% of CEO positions (Catalyst.) Even in professions that have been predominantly female, like nursing and teaching, full time women earn only about 90% of what their male peers make. In our field of emergency medicine women make up 40% of our residents but less than 15% of our professors (American Association of Medical Colleges 2011). The 2010 Daniel Stern salary data showed women ED directors made $288,000 compared to their male peer’s $325,000. The 2012 ACEP Board and Council have only 11% women and the masthead of our major journals weigh in at 83% (Academic EM) and 79% (Annals of EM) male. If we hope to ensure that our best talent, regardless of their gender, reaches their greatest potential, it is time for a frank discussion of the topic.

First off, let’s talk about a few myths and misconceptions. Myth #1: The gap is all about babies and family choices.  Wisconsin Senator Glenn Grothman recently stated this argument as the primary reason to repeal Wisconsin’s equal pay law (he believed this would make Wisconsin more business friendly by prohibiting frivolous gender wage discrepancy lawsuits). “The husband is working 50 or 60 hours a week, going all out, making 200 grand a year. The woman takes time off, raises kids, is not go go go,” said Grothman. “Now they’re 50 years old. The husband is making 200 grand a year, the woman is making 40 grand a year. It wasn’t discrimination. There was a different sense of urgency in each person.” OK, there is no question that women who take off significant chunks of time for family commitments will follow different career trajectories, but it is oversimplified to think this is the whole picture. In 2007 the American Association of University Women did a multi-variant analysis of college graduates including occupation, industry, hours worked, marital and parenting status. After controlling for the above factors they found an unexplained 5% gender difference in earnings at one year after graduation and 12% at 10 years. Similarly, LoSasso (Health Affairs 2011) found a similar discrepancy when they found an unexplained difference of $16,000 in starting salaries for men versus women graduating from New York state medical residencies.

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Myth #2: The just-be-patient-it’s-only-a-matter-of-time argument. Yes, the numbers are moving upward. For example, according to AAMC data there were certainly more women associate professors in medical fields in 2009 than in 1999 (31% up from 23%). But the expected slope is way off. Let’s use pediatrics as an example; this specialty has trained almost 50% women for decades, yet only 14% of academic pediatric chairs are women. Most women find themselves stalled in the middle of their career even if they stay full time and don’t have children. MIT discovered this in the mid 90s when they noted that their enrollment of female students was soaring but that their female science faculty had remained at 8% for 20 years. After significant review they determined their female faculty hit significant roadblocks because they missed out on informal networking, committee participation and collaborative opportunities as compared to their male peers. When presented with the data, the President of MIT Charles M. Vest said “I have always believed that contemporary gender discrimination within universities is part reality and part perception, but I now understand that reality is by far the greater part of the balance.”

Myth #3 is that women lack the leadership abilities to take charge and lead in such a cut-throat world. McKinsey and Company examined this question in their Women 2 Report. They looked at validated organizational key performance drivers and then matched them with 360 degree evaluations of several thousand leaders and managers. They found that of their nine performance driver indices men had a distinct advantage in only two (control/corrective action and individualistic decision making) while women had an advantage in 5 (participation, inspiration, development, role model and rewards) and the last two (effective communication and intellectual stimulation) were equal.

So what are the real reasons that we have not created gender balance in equity and senior leadership? Personally, I believe they are rooted in a complex interaction of subtle gender differences in genetic, hormonal (see insert), societal, and organizational cultures, but that the biggest elephant in the room is unconscious bias. International business consultant Whittenberg-Cox says it best: “The real reasons that women are not moving up do not lie primarily with women. They are embedded in systems that have evolved over decades and reflect the values, motivations and views of a male majority. None of this is done intentionally or even consciously. It is simply the result of history and corporate evolutions. But so long as these issues remain unseen, they form an intractable barrier to a more inclusive work environment.” (Women Mean Business). To objectively test your own unconscious biases got online to Harvard’s Project Implicit. Their study, as well as many others, has shown that lacking explicit instructions otherwise, our brains tend to “default” to our unconscious belief that white men are the most capable leaders.” Unconscious bias is unintentional, ubiquitous and effects both men and women. As the circumstances of any individual situation are so unique, patterns associated with gender-based unconscious bias will only become visible when broader, long term organizational data is tracked. Fortunately, its effects can be significantly mitigated by redesigning processes (interviewing, raises, promotions, committee selections) to be more objectively, rather than subjectively, based and transparent. But the first step to addressing unconscious bias is to recognize that it is very real (see Heidi Roizen case.)

There is an entire industry of business journals and consultants who will happily provide blue prints to help you and your organization “fix” things, but for some immediate suggestions see figure 1. And why commit to all this? Well, simply put, it’s the right thing to do, but if your moral compass is a little rusty, achieving gender balance is also profitable. The NY Times recently stated that in the past 50 years the economic advancement of women and blacks is estimated to have contributed to 20% of America’s growth and productivity (Freeland, May 17). More so, the talent pool of educated professionals has dramatically changed. Last year 60% of graduate students, 48% of med students and 47% of law students were women (Catalyst), meaning that companies who limit their choices to traditional candidates will find a shrinking supply. In addition, gender balance is believed to bring organizational synergy. Men often focus on short-term, risk laden strategic “wins” and women on risk assessment, long term planning and collaborative goals. Companies that can harvest the best of both in their leadership are more competitive. Adler tracked 200 Fortune 500 companies from 2004-2007 and found that companies with more women in their senior management consistently outperformed industry medians (Miller-McCune.com 2009). Conversely, Wilson tracked bankruptcy rates in European companies and found that having a single woman on their board decreased a company’s bankruptcy rate by 20% (The Times 2009).

So on this 40th anniversary of Title IX, it’s time for a renewed effort, this one focused on objective data and outcomes and the participation of both men and women.

Case Study
Testosterone and the Stock Market

JM Coates (PNAS 2008) is a trader turned researcher. For 8 days he took twice daily saliva samples for testosterone and cortisol levels from London short traders. He found that winning streaks increased testosterone levels and that in the short term elevated testosterone levels led to increased profits. With continued increased levels however, traders began to make riskier and riskier transactions. Conversely, during times of elevated cortisol levels traders were more risk averse. Conclusions suggested that international market fluctuations may be heavily influenced by unconscious behavior based on the hormonal fluctuations of young male traders and suggests that market volatility could be stunted by including more women and middle-aged men, who have different hormonal responses to winning, on the trading floors.

Case Study
Howard? He’s cool, but watch your back around that Heidi!

Unconscious bias in gender perception: The Heidi Roizen Case Study 
Cultural prescriptions surrounding gender appropriate behavior start when sex if first identified on prenatal ultrasounds.  Girls “should” be submissive and collaborative and boys aggressive and competitive. Acting in an incongruent fashion can lead to penalties. Flynn at NYU gave a case study to his students about Heidi Roizen, a real life successful venture capitalist. In half the cases he substituted the name “Heidi” with “Howard” and then asked the students to evaluate Heidi/Howard on multiple professional and personal characteristics. Although the students didn’t consciously believe that they had evaluated Heidi or Howard differently, compared to “Howard”, “Heidi” suffered enormous backlash and was viewed as more assertive, manipulative and overall less likeable than Howard. This occurred regardless of the gender of the rater.

 

 

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