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Dear Director,
I rarely see women in leadership roles in emergency medicine. Why do you think this is and what can I do to get an administrative position down the road?
-Jane Whitecoat

Emergency medicine was a predominately male specialty more than 20 years ago. Now, however, 50% of medical school graduates – and a third of emergency medicine residents – are women. These numbers represent dramatic strides towards vocational equality, yet women are still under-represented in EM leadership. At academic centers, a recent study states that only 11% of chair positions are held by women.  At the community hospital level, I estimate that women represent only 10-20% of medical director positions (I base this range on information from sources within a national company, analyzing my own state, and looking in my multi-site, multi-state group).  If women make up 25-30% of our workforce (28% of ACEP members are female), wouldn’t we expect them to approach a similar percentage of the leadership positions?  Granted, the reduced number of women in leadership might be a function of their age and years of experience in the field, but research from the business world would suggest that there are other factors at play. At the end of the day, our specialty is likely missing out on key talent, and the unique perspectives that female leaders bring to the table.

Are women better leaders?
We’re not talking about equality for equality’s sake. When we overlook female leaders, we could literally be weakening our institutions. McKinsey looked at European companies with a higher percentage of female executives and found that they outperformed their comparison group with higher returns on equity, increased operating profits and positive growth in stock price.  Harvard Business Review (HBR) states that women tend to use more of a participative leadership style, encouraging inclusion from the group they lead which builds better teams and tends to generate more diverse opinions, which leads to better ideas.  It goes on to say that women leaders also tend to share power and information better than their male counterparts. In a separate HBR article last year written by two men (Zenger and Folkman), women were rated higher than men in 12 of 16 competencies that go into outstanding leadership. 

Myth: Leadership OR Parenting, but not Both
Many of us went into emergency medicine because of the flexible lifestyle and good work/life balance.  While in the past, child rearing was mostly done by women, today’s families often share those responsibilities.  However, research shows that in duel professional households, and probably in a majority of physician households with children, women still do more of the child rearing. According to another article in the Harvard Business Review, there is the misconception that successful, career minded female professionals are sidetracked by children and the children have caused the mother’s careers to stall out. We suspect some of these attitudes and misconceptions are also present when considering female ER docs for administrative roles. We (the current male dominated leadership) don’t approach women because we assume they want to raise their kids and not advance their careers. This assumption is unfair as plenty of male physicians balance being active, participatory parents and work leadership. Just because women are doing more child rearing than their male counterparts does not mean that they are not interested in pursuing administrative opportunities and advancing their careers. Women may also buy into a little of this myth that they can’t do both home and professional.

Some women are less aggressive in pursuing career advancement because of guilt they feel during the early child raising years. However, women should remember that getting started on the administrative track can involve as little as a few hours a month for meetings at the hospital. The additional work (such as chart reviews and preparing presentations) can be done on the individual’s own time at home. Personally, while my wife worked regular business hours, I did a ton of work at home when my first child was little. This developed into larger and more public administrative projects that helped to grow my reputation with senior hospital leadership, which led to more opportunities and responsibilities on higher profile and more interesting committees. Keep in mind that physician careers are long while the traditional child rearing that impacts work hours tends to only be a small proportion of the career. Seeing the path to leadership as achievable in light of a desire for work/life balance can help increase the number of females who pursue administrative work. In the long run, mentoring and developing the skill set of female leaders increases the applicant pool for key positions at a moment when we need our best and brightest minds applied to medical challenges.

Getting Promoted: Sponsorship vs. Mentorship
Each of us has been blessed with great mentors, but what really advanced our careers was having a sponsor. While a mentor is someone who has experience with the company who can give you day-to-day advice, answer your questions and help you avoid political land mines, sponsors help get their protégés to the next level of leadership by promoting their abilities within the organization. I was recruited by outside groups twice to chair an ED and had it not been for someone on the inside of the other group who was willing to sponsor me, I may have never even heard about the positions.  Research from the business world suggests that women’s inability to advance has more to do with a lack of sponsorship than taking time to raise children (Hewlett, HBR).  While it’s easy for me to grab a beer with a male physician that I’m mentoring, imagine the gossip if I regularly went for lunch or happy hour with a female that I worked with.  This perception can be an impediment to older men mentoring or sponsoring younger women.  Additionally, some men may believe that women who have children won’t be as dedicated or available to work and may not be worth the effort in mentoring or sponsoring. 

So, how do you get a sponsor? It starts by showing up and working hard to establish your credibility. Identify someone in your organization who is respected and influential.  This person is likely your current medical director, but if you’re in a bigger organization, it could be a regional medical director or the company chief medical officer. Find opportunities to get to know this person, informally or formally, so that they can get to know your work ethic. Do a good job and make that person look good and you’ll get noticed. Important caveat: don’t ask for a sponsor. If it’s going to happen, it will happen naturally, but it does help to let those mentors and others in senior leadership know that you’re interested in moving forward and achieving more.  We’ve each mentored many people the last several years and sponsored a few, and it has usually come down to people who are willing to work hard, have the skill set that it takes to successfully lead a department, are interested in advancement and won’t make us look bad for nominating them.

Research also shows that women may not get sponsorship because of how they network in the workplace (HBR). In the healthcare environment, I believe that men do a better job of networking by attending meetings or playing golf (and not feeling guilty about doing so) while women shy away from these events unless there is a clear work related purpose. Women are more likely to attend a CME event if it’s actually interesting to them, rather than to simply seize an opportunity to talk to colleagues. Differences in how men and women network might seem tangential to the practice and leadership of emergency medicine, but they can have far-reaching effects. Even if networking doesn’t land you a sponsor, it could lead to filling a staffing position, or to other valuable work relationships. At the end of the day, networking is an important communication tool and is critical to organizational health.

Conclusions
Having more female medical directors is necessary; without them, our specialty is missing out on a huge potential pool of talent. Our current medical directors need to do a better job of mentoring and sponsoring all talented physicians with an interest in administration. Meanwhile, any physician with an interest in administration needs to actively seek out opportunities to learn the skills to perform administrative tasks, all while networking to find mentors and sponsors. This step may seem a frivolous one, but it’s actually critical to keeping our EDs thriving.
Now, who wants to go play a round of golf?

 

Chatting up the Ladder: Simple Strategies for Improving the Way You Network


Inside your hospital

  • Spend time in the doctor’s lounge or dining room
  • Volunteer for a committee
  • Attend your quarterly medical staff meetings


Inside your group

  • Volunteer to work on a project
  • Volunteer for a committee
  • Attend the formal social functions—summer picnics, holiday parties
  • Make an appointment with your chairman to discuss professional growth


Within your profession

  • Volunteer to join a state level ACEP committee (or your local medical society) and show up for meetings
  • Go to a CME event. Talk to one of the speakers about a topic that interests you.  -Develop a project within your institution based on the topic and present it back to your group or at a local or state meeting
  • -Attend grand rounds on a regular basis at your nearest EM residency program
  • Consider having medical students rotate with you—work with your local medical school and their emergency medicine program coordinator. This contact can lead to great introductions when hiring residents
  • Join the social networking site LinkedIn. If nothing else, it’s an easy way to have contact information at your finger tips of people you all ready know but may not have their email address. Head hunters also use it to look for job candidates.
  • Keep in touch with former residency classmates and colleagues.  
  • Attend a national conference.


Tips on Effective networking

  • Be strategic in picking your groups—your time is valuable
  • Become an active member of the  group you join—networking is more than meeting someone—it’s about establishing relationships
  • Arrive early and stay late
  • Listen. Ask questions and let others talk. Try using the phrase, “Tell me more about….”  
  • Don’t get discouraged—be patient.  It’s a process.
  • Learn about body language clues—appear open, not closed.
  • Have trouble walking up to someone and starting a conversation? Just get in a line for food or drinks where conversations come more easily.


Inclusively Network

  • When attending any of the above, think about people outside your circle, including women, people of color, people different from yourself, to invite with you.
  • Pick up the phone and invite someone to a networking event.




Michael Silverman, MD, is a partner of Emergency Medicine Associates and is chairman of emergency medicine at the Virginia Hospital Center.

Eleanor Silverman, DSc, is a senior executive at NASA where she has direct responsibility for 100 civil servants and hundreds of onsite contractors. The views expressed are her own and not necessarily those of NASA or the U.S. Government


 

Comments   

# One reason whyS P 2012-06-27 15:17
It seems impossible in this day and age but old problems with women getting into leadership positions still exist. The hospital at which I work could use some additional leadership. The man doing the leadership has interest in transitioning and I am the most likely person.

However, personal relationships is how this works. HE invited me to a social event, golfing. Apparently, he felt awkward about going somewhere alone with a woman and tried to get a nurse to accompany us. It was SOOOO 1980's and uncomfortable to the point the social engagement was cancelled. I don't know if his wife had a problem, if he did, or what the issue was, but with older men still in these positions it is nearly impossible to socialize or get to know them out of office without this coming up. Younger men probably would have less of an issue, but THIS is unintentional discrimination.

He is a terrific man and someone who I admire and respect. He just didn't know how to handle a simple social engagement with a fellow physician who happened to be a woman. I would not have thought in this day and age this would still be a problem but it is.

Additionally, women do have a different leadership characteristics which are popular with staff and administration (less "this is a war" and more "how can we get this done together"). Some men find this challenging as they have not learned how to interact in a more personal manner. Different leadership styles that sometimes clash.

Both of these are unintentional but extremely hurtful to women who want to advance. Most women hit ONE wall like this and decide taking care of kids works better.
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# Emergency PhysicianPaula Pearlman 2012-07-03 08:00
10 years ago when I went to my medical school's 20 year reunion I realized that 50% of the women in my class no longer practiced medicine. It spoke to me about the exigency of child rearing and how it trumps everything - even years and years of hard work and ambition. It also confirmed for me how lucky I was to have chosen a career in Emergency Medicine - it has been a perfect choice for this working mother for many reasons.

About 20 years into my very satisfying tenure I became the chief of my dept. of about 25 full-time doctors and many more per diems. It was the next logical step in my career. For 6 years I was charged with overseeing this poorly behaved, whiny, juvenile, unhelpful, entitled staff, administering massive change projects and wishing everyday that my work life was as pleasant and easygoing as my home life with a collaborative husband and two children who say please and thank you. I really liked these doctors, but hated struggling to herd them towards a patient-centric , fiscally responsible practice. Why don't women go into ED administration? Because being chief was for me a thankless, under-remunerat ed and personally miserable job. It only gave additional bragging rights to my mother around her bridge table and gave me dyspepsia.
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