The ‘she’ in medical leadership
In Australia, medicine as a profession has been available to women since the late 1800s. Our first female graduate was registered to practice in 1891, and our profession now boasts a strong female presence.
Female medical graduates have outnumbered males since the 1990s, and female trainees currently make up two-fifths of our vocational cohort. Medicine no longer belongs to a specific gender. However, there is one area of medicine that is still catching up – medical leadership.
Medical leadership is vitally important to our health system.
As a self-regulated profession, doctors hold a unique power in being able to shape the fabric of our health system. As a united front, doctors are simultaneously the voice for our patients, for our health system and for our profession. This requires strong and vocal leadership with a clear vision. It also requires a degree of diversity in order to accurately represent the profession it has been charged to lead.
Female representation in medical leadership is topical. A study of medical leadership last year found that, despite women making up more than a third of specialist medical practitioners, they were under-represented in medical leadership positions. In fact, females made up just 12.5 per cent of leadership roles in larger tertiary hospitals, and only 28 per cent in medical schools and colleges.
While logic would suggest that fair representation of women in senior leadership positions would evolve naturally, this has not been the case. In fact, while the argument for gender equity seems simple and rational, there still remains systemic opposition.
There are three common justifications used: that women have not been in the profession long enough to be leaders; that women do not seek leadership positions due to family commitments; and that women do not possess inherent ‘natural leadership’ characteristics.
Gender parity was achieved among medical graduates in the 1990s, so it is hard to make the argument that women have not been in medicine long enough to be leaders. Female graduates are now in the majority. Currently, 31.5 per cent of the approximately 51,000 medical specialists in Australia are female, as are 45 per cent of vocational trainees.
If women have been in the profession long enough to comprise a third of all specialists, surely we have been there long enough to make up a third of medical leaders. The biggest issue is not time, but instead the inherent barriers that have stopped women progressing to medical leadership positions.
One barrier is the idea that women lack the skills required to be natural leaders. This is based on the assumption that women do not possess the inherent traits that make a good leader. But the very nature of our job means that all doctors are leaders. We are charged with the duty of leading medical teams and supervising our juniors early in our career. As we progress, we become leaders in our field, in research or in our communities.
While not all doctors are destined to (nor wish) to become leaders, all possess the skills that it takes to be a leader. Not inherent traits, but traits learnt and taught. Society needs to lean away from the belief that all leaders should possess the same traits - a belief that is stifling our female colleagues - and embrace the concept that leadership is at its strongest when it is diverse.
The belief that women do not seek leadership opportunities due to parental responsibilities is perhaps embedded in some truth. The barriers affecting doctors who are also parents are not unique to the female members of our profession. But they disproportionately affect women, who spend twice as much time as male colleagues undertaking childcare and household work.
Doctors who are both parents and practitioners are forced to choose between working and caring for their families due to a lack of flexible training and working opportunities. This is exacerbated by the traditional and structured way in which medicine is taught and practiced.
The belief that medicine is a 24/7 job means that many often leave the workforce for extended periods of time rather than juggle the demands of both. This affects not only the path a doctor may take to a medical leadership position, but also the position itself.
If we truly want to encourage doctors in training to become medical leaders then we need to reconsider if the traditional, linear ‘up the ladder’ pathway is the only way we wish to recruit leaders. Additionally, we need to embrace flexible training and working arrangements that facilitate those with families to participate both in the workforce, and in medical leadership.
While the argument can be made purely on equity grounds, there is a greater and more compelling argument for boosting female participation in medical leadership.
A growing body of literature suggests that strong female leadership at senior management and board level is associated with better performance. A diverse, representative board is more engaged with their stakeholders, and benefits from the broad experiences and fresh perspectives that are introduced.
Logic says that a leadership structure made of up people with different strengths, skills, lifestyles, backgrounds and passions leads to a more productive organisation with more engaged leaders. This, in turn, leads to better decision making with more positive outcomes.
Strong female leaders will continue to seek out leadership opportunities. They will plan their career and embrace the challenges that come with medical leadership, as have those who have become before them.
It is not the female leaders that I am proposing need assistance – these are the women we should be celebrating. We instead need meaningful, systemic, and whole-of-profession change that both acknowledges and addresses inherent gender bias in medicine.
Diverse leadership can surely only strengthen the decision-making and organisational strength of our health system, and it should be the job of the profession to cultivate the leaders we believe we need.
So I am calling on all of you, as AMA members and as members of our profession to examine the environment around you. Be a champion for gender equity in medical leadership and in your professions. Celebrate the skills that your trainees bring to your organisations, and recognise and cultivate the leadership potential in all that hold it - regardless of gender.
Published: 17 May 2016