Women Leaders in Academic Medicine: A Chair’s Perspective Sonam Jaglan, MS-4, Tina Wu, MD, MBA New York University School of Medicine Bellevue Hospital Center INTRODUCTION -Eighteen department chairs were interviewed between May 2013-August Twenty-five chairs were originally invited to interview, a 72% response rate. -Each interview was minutes in length with standardized questions, including open-ended questions on their views on leadership characteristics, the barriers women face, why they face them, and possible solutions. -All interviews were recorded, transcribed and remained confidential. -The department chairs were only excluded if they were unable to schedule an interview during that time period. RESULTS Of eighteen departmental chairs, 89% discussed Work-Life Balance as a major barrier to women attaining leadership positions. In accordance, 39% felt that child-bearing years, or “time lag”, is discriminatory against women. 28% felt that women tend to lack self-promotion and negotiation skills (Self- perception). “What do women want? They want to balance work-life, they want a family, but you can’t have everything. Men, despite best efforts are not stressed about those choices.” METHODS Our Goals: 1)Assess the leadership culture in our medical center 2)Understand the perspectives of department chairs on leadership in medicine and, more specifically, women in leadership 3)Investigate strategies institutions can use to promote diversity, support women in leadership positions and foster the development of future women leaders Lack of female mentorship in certain sub-specialties as a barrier was voiced most strongly by the female department chairs. Of the interviews conducted, 100% believed that men and women are equally capable of being effective leaders in medicine and 41% reported that gender entered their thought process when hiring faculty and residents. -More emotional -More sensitive to criticism -Less qualified -Intimidated by environments -Less likely to take risks According to the AMA, 82% of females expressed importance in ability to balance time for family and personal life as compared to 66% of males, which corroborates the opinion of 89% of departmental chairs that work-life balance is a major barrier 4. Experience was another perceived barrier. However, according to the AMA, 45% of women in medicine are over the age of 45 versus 38% of men, which does not support this perceived barrier 5. The availability of female role models and mentorship within specialties is also a major barrier, especially with 60% of women specializing within 6 fields, most being primary care fields. Differences in confidence and career ambition (self-perception) between men and women also prevents women from moving into senior and executive positions and according to the 2006 ACHE report, women appeared to have lower career aspirations than men, with 40 percent of women reporting that they wanted to assume CEO positions as compared to 70 percent of men 6. Our study emphasizes the need for institutionally-based programs to promote women leaders in medicine, to support those already in leadership positions and to foster the development of future female leaders. By instating a program dedicated to women in medicine, institutions are promoting gender diversity, which has been positively linked to positive performance and outcomes 3. These programs should focus on 1) re-entry for those who take leave, 2) mentorship, and 3) addressing specific barriers women may face in their work policies 7. These are key components to promote the success and progression of women in medical leadership positions and to improve institutional level leadership as a whole. CONCLUSION -Not as assertive -Value consensus too much -Less decisive -Less compartmental -Too collaborative Other “barriers” cited in interviews: 1-7 References available upon request. In 1970, <8% of U.S. physicians were women. Since then, the number of female physicians has grown six- fold with 60% of female physicians specializing in 6 fields: Internal Medicine, Pediatrics, Family Medicine, Obstetrics/Gynecology, Psychiatry, and Anesthesiology 1. Despite these dramatic increases in numbers, women are still highly underrepresented in leadership positions in the academic sphere. In 2012, women represented:  47% of first year medical students  46% of residents  37% of medical school faculty  43% of assistant professors  20% of full professors  14% of department chairs  12% of medical school deans In current literature, the most cited barriers to women in leadership positions are: 1)Work-Life Balance, 2) Self-Perception, 3) Experience and 4) Specialty 2 Why is this important? Today, almost half of medical school graduates are women, which promotes diversity within medical practice. According to Catalyst and McKinsey and Co., a higher percentage of women in senior management positions up to a CEO level has been positively linked with better company performance and more positive outcomes 3.

CLICK FOR THOUGHTS FROM THE INTERVIEWS ON: Women Leaders in Academic Medicine: A Chair’s Perspective Sonam Jaglan, MS-4, Tina Wu, MD, MBA Thank you! Experience Specialty Self-Perception Work-Life Balance New York University School of Medicine Bellevue Hospital Center

AAMC, 2012

“I see some [women] who feel very guilty over the amount of time that they spend doing things and feeling like they missed out.” - female department chair “Having children hinders your progress, but I think women should make their own rules.” “The time to get pregnant, be pregnant and have kids is discriminatory against women.” “Both issues with women leaving faculty positions in my department were family- related issues. That might be an issue women have to deal with more than men - going where the family goes over men going where the family goes.” –male predominant surgical field Work-Life Balance

“If anything needs to change, I think, other than obviously recognizing the talent regardless of gender, it’s probably empowering the younger generation to say that, ‘you know, I can do this just as easily as males.’” “What I think women need to do (and men) is not promote themselves, but to give themselves up to the organization. Women are really good at that- way better than men. A lot of times men are egotistical and that is lethal. If again, there is gender bias.” “They don’t want to [be department chairs]. If the goal is to have more women leaders, the key is to develop that interest.” Self-Perception

“Women should support and recruit women in their faculty. There are some departments here run by women who have no female faculty – that’s crazy. Women need to be mentors and role models to other women, just as men are to other men. The only way to see yourself in a leadership position is to see someone else model it.” “There are always going to be more fields that are more male-dominated or female-dominated. You’re not going to change that and I think that’s okay.” “It is hard in a male-dominated society for a female leader to be firm. It’s a challenge they face. An interesting anecdote [is that] more often than not the female chairs that rise to the top usually do so in subspecialties that are dominated, populated predominantly by women – pediatrics, as an example.” Specialty

“I don’t think there is nearly as much discrimination against women. People are going out of their way to find women because everybody is focusing on diversity now.” Experience

SOME FINAL THOUGHTS… Women Leaders in Academic Medicine: A Chair’s Perspective Sonam Jaglan, MS-4, Tina Wu, MD, MBA “You can’t do it all. You give up something to do something more.” “You can’t focus on diversity without being aware of it.” “I don’t think there is nearly as much discrimination against women. People are going out of their way to find women because everybody is focusing on diversity now.” “Women should support and recruit women in their faculty. There are some departments here run by women who have no female faculty – that’s crazy. Women need to be mentors and role models to other women, just as men are to other men. The only way to see yourself in a leadership position is to see someone else model it.” “There are always going to be more fields that are more male-dominated or female-dominated. You’re not going to change that and I think that’s okay.” “It is hard in a male-dominated society for a female leader to be firm. It’s a challenge they face. An interesting anecdote [is that] more often than not the female chairs that rise to the top usually do so in subspecialties that are dominated, populated predominantly by women – pediatrics, as an example.” “I see some [women] who feel very guilty over the amount of time that they spend doing things and feeling like they missed out.” - female department chair “Having children hinders your progress, but I think women should make their own rules.” “If anything needs to change, I think, other than obviously recognizing the talent regardless of gender, it’s probably empowering the younger generation to say that, ‘you know, I can do this just as easily as males.’” “What I think women need to do (and men) is not promote themselves, but to give themselves up to the organization. Women are really good at that- way better than men. A lot of times men are egotistical and that is lethal. If again, there is gender bias.” Thank you! Experience Specialty Self-Perception “They don’t want to [be department chairs]. If the goal is to have more women leaders, the key is to develop that interest.” Work-Life Balance “The time to get pregnant, be pregnant and have kids is discriminatory against women.” “Both issues with women leaving faculty positions in my department were family-related issues. That might be an issue women have to deal with more than men - going where the family goes over men going where the family goes.” –male predominant surgical field New York University School of Medicine Bellevue Hospital Center