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Women stopped from getting to the top

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Women are struggling to make it into the upper echelons of the medical profession despite comprising an increasing majority of those embarking on a medical career.

Australian Institute of Health and Welfare figures show that last year women made up 40 per cent of the medical workforce and 53 per cent of early-career practitioners, including just over half of all specialists in training.

But, despite this, researchers have found that they are failing to progress through to senior positions in representative numbers, comprising less than a third of specialist college board members and medical school deans, 33 per cent of state Chief Medical Officers and just 12.5 per cent of large hospital CEOs.

A study of medical leadership in Australia, published in BMJ Open, has found that women are under-represented in medical leadership roles due to a combination of ill-informed attitudes and inflexible work and career demands.

Through detailed interviews with a sample of 30 medical leaders (22 of whom were men), a team of researchers from Melbourne University, Monash Health and Deakin University found although some thought the representation of women at senior levels would increase because of the pipeline of females entering the profession, the majority – both men and women – identified a series of barriers that prevented women from advancing.

“Most interviewees believed that gender-related barriers were impeding women’s ability to achieve and thrive in medical leadership roles,” the researchers said, and identified three broad impediments – perceptions of capacity, organisational arrangements and professional culture.

The most commonly-cited barrier was parenthood, with several medical leaders referring to an inherent incompatibility between high-level leadership and motherhood.

But several remarked on the tendency of managers, and women themselves, to underestimate their capabilities.

A number of leaders interviewed for the study, Reasons and remedies for under-representation of women in medical leadership roles, reported that women were often “not taken really seriously”, and were consider to be “too feminine” to be an effective leader.

In their findings, the researchers said that, as in other professions, the lack of women in senior leadership positions was justified by a range of explanations including it was “too soon” to see women in these roles, they were too busy with their families, or were not natural leaders.

The researchers said the basis for these explanations was thin, pointing out that women have made up a sizeable proportion of the medical workforce for decades and are still not moving into leadership roles in numbers consistent with their representation in the workforce.

On the career-limiting impact of parenting, they said that “cultural assumptions that childrearing and household responsibilities impede women from entering leadership roles is, at least in part, based on discriminatory social norms”.

They pointed out that inflexible work arrangements made this a structural, rather than inherently biological, barrier. Some of those interviewed for the study suggested that, rather than following a standard linear path, medical careers could be structured to follow a more M-shaped trajectory that would support women to enter, or re-enter, leadership roles at an older age “if that suited their life-course”.

The researchers cited cultural norms and unconscious biases in the medical profession about what a leader should look like, and how they should behave, as another impediment faced by women.

They also identified other institutional impediments. For example, because the responsibilities for childrearing and maintain a household continue to fall disproportionately on women, they tend to gravitate towards specialties that give them the time and flexibility to fulfil these roles, such as general practice and public health medicine.

But these specialties, the report said, tended to have a less influential presence in large health services compared with traditional male-dominated specialities, such as surgery.

“Achieving meaningful change will require us to move beyond ‘fixing the women’ to a systemic, institutional approach that acknowledges and addresses the impact of unconscious, gender-linked biases,” the researchers said. “Revisiting rigid career structures, providing flexible working hours, offering peer support, and ensuring appropriate development opportunities, may all assist women to enter leadership roles.”

Adrian Rollins

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