Women and healthcare leadership: mind the gap

December’s blog is by Amanda Bolderston, a Canadian radiation therapist in a leadership role who is also a bit of a feminist. Merry Christmas!

This month’s paper by Wehner et al humorously illustrates the problem of under-representation of women in medical leadership. While more women than ever are entering medicine, the number of women leaders remains disproportionately low, only 13% (137/1018) of department leaders at the top 50 NIH funded medical schools in the US.  This shouldn’t be a surprise, the so called “leaky pipeline” of women dropping out before they reach the top levels of leadership is well known. While women often occupy mid-level managerial health care positions, very few make it up to the top– a 2012 Women in Healthcare report showed that women compose 73% of medical and health services managers, but only 4% of healthcare CEOs were women.  A UK report in the professional services sector showed that in most Western countries women and men were hired at the entry level at the same rate.  However women are lost from the leadership ladder through voluntary termination at a rate two or three times faster than men after the level of manager or senior manager.

Why the differences, why the lack of women at the top? Unfortunately we live in a society where men and women are socialized into gendered roles and in a system that still values masculinity over femininity*.  Women are encouraged from childhood not to speak up or step up, are expected to take care of others (emotionally and physically), and shoulder the majority of (unpaid) work in the home including childcare. This carries a financial and social penalty. As Wehner et al point out; taking care of children can result in significant loss of both earnings and status.  Entrenched (often unconscious) bias results in women being assessed more negatively than men with the same professional characteristics. This has also been highlighted in academia, where female professors are routinely rated lower than men in teaching evaluations. It may not be a surprise that only about 20% of UK professors are female ; this is mirrored in many other areas.  In addition, women often work in environments with either subtle gender bias or overt sexism (this is being written as the headlines are full of examples of predatory sexual behavior, including in the NHS). All of these barriers hamper women desiring and attaining senior leadership roles.

What about our profession? Allied health professions like the medical radiation sciences are generally classified as semi-professions (as opposed to the so-called classic professions of law, medicine or theology). Many semi-professions have a high percentage of female workers, shifting to (you guessed it) a greater number of men in upper managerial and leadership roles. A while back I was interested in finding out if this general male-dominated leadership trend was true for radiation therapy. Anecdotally I know quite a few male senior managers, seemingly disproportionate to the oft-cited ratio of 80:20 women to men. My (polite) query on FaceBook’s World Wide Radiation Therapist group quickly led to an online argument where I was told “its women like you” that create problems by asking questions about gender bias in the first place! I don’t think this is true. The problem of “too many moustaches” is a universal one in healthcare and beyond – we should all be asking these questions.

  *Aka “the patriarchy



One thought on “Women and healthcare leadership: mind the gap

  1. Pingback: December 13th: Plenty of moustaches but not enough women (BMJ Christmas special) | medradjclub

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