Women even the odds

Last month, researchers completed the first analysis of the sequence of the female X chromosome, which comprises more than 1,000 genes and 160 million base pairs of DNA. This breakthrough may provide a biological basis for explaining differences between the sexes.

While the unraveling of the Y chromosome in 2003 gave males a laboratory lead over women, this recent advance has allowed women to catch up.

Women are catching up to -- and some would say surpassing -- men in the healthcare industry, too, as more and more climb the ladder to lead some of the industry's largest and most influential organizations.

Patricia Gabow, chief executive officer and medical director for Denver Health, says she believes that, in part, the increasing number of women reaching senior management positions in healthcare may just be a sign of the times. But she wonders if the combination of two qualities present in today's healthcare environment -- that more clinicians are becoming business-minded corporate leaders and the fact that more women are pursuing careers in medicine -- may help explain the trend.

Research indicates that what's good for women is good for organizations, too. According to a study by Catalyst, a not-for-profit organization dedicated to advancing women in business, companies with a higher percentage of women on their senior management teams experienced better financial performance than those with lackluster female representation.

The study of 353 Fortune 500 companies representing 11 industries was based on data from 1996 to 2000. It found that the return on equity was more than 35% higher and total return to shareholders was 34% higher among companies with the highest female representation compared to those with the lowest.

Gabow is one of 25 individuals named by Modern Healthcare as the Top 25 Women in Healthcare.

Improving the percentages

When Gabow began her career, she was one of five women in a class of 125 medical students. In 2003, women made up the majority of medical school applicants for the first time, according to the Association of American Medical Colleges. That same year, 92.1% of registered nurses were women according to the U.S. Labor Department. With women making up the majority of clinicians, females have a better shot at advancing to the executive suite in healthcare organizations that tap those with front-line experience for senior management.

"In general, I don't tend to think about things in terms of gender and I think that has helped me succeed as a woman leader," Gabow says. "For me, really being committed to what this institution stands for and what we do takes the emphasis off of me as an individual. I don't see myself in any way as separated from Denver Health and I think that broader vision immediately takes out the gender issue."

The Denver-based system is one of the nation's largest public health systems with a 266-bed hospital, 11 school-based health centers and nine neighborhood health centers. The system, which boasts nearly 900,000 patient contacts per year, has provided more than $1.4 billion in care to the uninsured since 1992.

While Gabow says she isn't overly focused on the role her gender has played in her career, she is quick to acknowledge that some of the experiences she's had as a woman have prepared her for the challenges of senior leadership. She says raising her two children was some of the best leadership preparation she's had.

"I learned what it was like to always want the best outcome," she says. "You have to treat people fairly and in a caring way, while at the same time setting limits with clear accountability and expectations."

Pamela Pure, executive vice president of McKesson Corp. and president of McKesson Provider Technologies, says the skills women learn while juggling the demands of having both a family and a career are valuable in healthcare. "You can only be successful in healthcare if you can work simultaneously on many complex problems and issues and be tough," says Pure, who is also on Modern Healthcare's list of Top 25 Women.

Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, says she believes some personality traits unique to women have the potential to impact management style. Ultimately, that could change the way care is delivered.

"Women who come to leadership roles often bring an ability to listen and to integrate the various perspectives into a single strategic direction in a way that respects points of view," Lavizzo-Mourey says. "Women who have had to juggle many parts of their lives are extremely well-organized and disciplined, with the ability to manage their time well, and they also have an appreciation for the analytic parts of the job and the interpersonal part of leadership."

Always replacing men

Lavizzo-Mourey, another Top 25 Women designee, has replaced a man in every leadership position she's had, most recently rising from senior vice president and director of the foundation's healthcare group to replace Steven Schroeder in her current position. Schroeder had been the foundation's CEO for 12 years, during which time the foundation's assets grew from $2.9 billion to more than $8 billion. Currently, he is a professor of health and healthcare at the University of California at San Francisco, where he also is director of the Smoking Cessation Leadership Center, which is supported by the Robert Wood Johnson Foundation.

For the most part, Lavizzo-Mourey says she believes that someone new will always bring a different management style to a position than a predecessor, which blunts the gender issue. But she also notes that in healthcare, a large majority of the workforce is female. "You often find yourself in a situation where many of the people you are leading are also women, which makes some of the relationships easier," she says.

Pure replaced Graham King in 2004, when she took her current job at McKesson. She says the transition was easier because King retired and was very supportive of her. "The challenge was wanting to provide the same strong, visible leadership while at the same time developing my own style," she says. King had held the position for five years.

He had been the catalyst to bring Pure to McKesson from the former Shared Medical Systems, where the two had worked together. "Starting on my first day at McKesson, Graham and I were a great team," Pure says. "So when it came time for him to retire, I must admit that I initially had some concerns. Graham is a powerful leader with a strong style and presence. I couldn't fill his shoes; I needed my own.

"I was very fortunate to have Graham as a mentor who was always very direct with his feedback and had one clear intention -- to build a strong management team. He pushed me to be the best I could be," Pure says.

The only woman

When Gabow joined Denver Health 32 years ago, she was the only female faculty member in the department of medicine. And she was chosen to replace a man as the department's chief of medicine, even though there were men in the department who were older and had been there longer. In a time when healthcare was largely run by an "old boys' network," Gabow says that could have been intimidating and uncomfortable.

But one of her colleagues at Denver Health describes Gabow as someone who has perfected the art of delivering battery acid with whipped cream: an ability to give bad news in a way that's not threatening or caustic. She also wonders if she may be perceived as less threatening than her male counterparts, a trait she believes has helped her push her management agenda and perhaps helped her initially cross the gender line.

Thanks to edicts such as "Never keep a woman waiting," women have been given a reputation for being impatient. But Pure says this may be just what healthcare needs. "What healthcare needs today is action," Pure says. "I think women are less patient for results and I'm hoping that with more women running healthcare organizations, the industry may move faster."

"Good, strong leaders by nature push the envelope and push people faster and farther than they would normally go," says Randy Spratt, McKesson Provider Technologies' senior vice president and chief process officer. "Pam has that to a very high degree. She is a very aggressive and speed-oriented person."

Diane Appleyard, president of the Healthcare Research and Development Institute, a think tank with a very select membership of CEOs from major healthcare systems across the country, has seen firsthand that all it takes is one woman to begin breaking down the barriers of the old boys' network. Because a new member can only be appointed when an active member retires, the HRDI has seen slow progress. When Appleyard first took over the institute after her father retired from the post in 1992, no women belonged to the group. Now there are six women out of a total of 40 members.

"It was a big thing for them to consider allowing a woman into HRDI, but it only took one woman (joining) to realize that all they'd have to give up were some of the jokes they might like to tell," Appleyard says.

The HRDI is more progressive in involving women in its membership than other industry professional groups. In 2002, the Lay Administrators Mutual Benefit Society, an all-male organization of hospital administrators, voted to break up rather than include women among its membership. Ironically, the club was first organized in 1953 as an association of hospital administrators who had themselves been excluded from a group of hospital executives who were also physicians (May 13, 2002, p. 38).

More flexibility

Thomas Dolan, president and CEO of the American College of Healthcare Executives, says confounding factors such as differences between generations blur the ability to attribute industry changes to the rising number of women in senior management. He points to workplace flexibility as an example.

"Organizations are adapting and becoming more flexible in accommodating a work-life balance," Dolan says. While this might be because more women require flexibility to balance family and career, "A work-life balance is very important to today's male executives as well," he says.

One of the biggest barriers Lavizzo-Mourey says she's faced is fighting preconceived notions about what women are willing to do to make it to the top. For example, she took on a longer commute in exchange for a major career advancement and returned to work six weeks (rather than three months) after having a baby.

Dramatic increases

Some organizations for healthcare executives, such as the ACHE, have seen more dramatic increases in female membership. According to Dolan, in 1985, 14% of its members were women. Today women make up 40% of the group's 30,000 members. Dolan says he thinks the trend will continue and that in a decade, the majority of healthcare executives will be women. "Sixty percent of students in health administration programs today are women and as they graduate, they will continue filling the ranks of full-time professionals," he says.

The healthcare industry may have some characteristics that make it more amenable to female advancement. According to the 2004 Catalyst study, women accounted for 14.2% of top management in healthcare organizations -- a higher proportion than all other industries in the study.

One reason is that women make up the majority of hospital and health system workers, says Lynn Shapiro Snyder, a senior partner in the healthcare practice of Epstein, Becker & Greene. Snyder, another Top 25 Women designee, points out that women have been able to advance through religious orders on the not-for-profit side.

Frontier opportunity

And when the managed-care industry got started in the late 1960s, it was a frontier opportunity for many people, including women, to advance to senior management, Snyder says. As mergers and consolidation ensued, that segment of the industry also provided a chance for women to become managers and leaders of larger organizations.

Although women have come a long way in healthcare, Snyder says there is still a lot of work to be done. She noticed that once women reach the executive suite, they may find there are only one or two other women with them, a situation that can be alienating.

To support women in these positions, Snyder formed the Women Business Leaders of the U.S. Health Care Industry Foundation in 2001. The group provides camaraderie and female mentoring to those who have trouble finding support within their own organizations. But Snyder's foundation has another goal as well. She says that while women are making inroads in reaching healthcare's executive suites and increasing their visibility once there, their participation on boards of directors has lagged behind. According to a Catalyst census in 2003, women occupied 16.7% of board seats in Fortune 500 healthcare companies, a number she hopes her foundation will augment.

Women's salaries, too, have lagged behind as their careers have gained momentum. For example, white female healthcare executives that were equally educated and experienced in 2002 earned a median salary of $104,000 vs. the $121,400 of their male counterparts, a nearly 17% difference, according to a recent ACHE survey. A similar gap was found between black male and female healthcare executives. Some speculate that as more women populate senior management teams, salaries across the industry will take a hit.

Dolan says that the complexities of healthcare may give women an opportunity to achieve salary equity. "Given how competitive the market is for good talent and how complex hospitals are to run, I don't think that salaries across the board will be depressed and I do think that women's salaries will increase," Dolan says.

What do you think?

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