It is not easy being a woman in an administrative position. The personal and career demands faced by female physician executives often discourage women from pursuing leadership roles, and being a minority in a field dominated by white males presents another barrier. However, there are some who have faced these challenges and proven to be successful.
One such woman is Cynthia Alston, M.D., associate medical director at Blue Cross Blue Shield of Illinois. Alston says she never thought she would end up as an administrator at one of the nation's top insurance companies.
In a white-male dominated field, Alston, 47, is one of the few female physicians in an executive role. The Tampa, Fla.-based American College of Physician Executives says only 10% of its 12,000 members are women and only one-third of those hold senior medical management positions. In 1993, only 5% of ACPE members were women.
Not every physician executive belongs to ACPE so its figures tell only a part of the story. But they seem to correlate with other numbers on medical managers.
For example, a survey last year of 300 physicians by the Tampa-based Physician Executive Management Center, a national physician executive recruitment firm that conducts job searches for healthcare organizations, indicated that 95% of senior management positions are held by men.
Although the percentage of women physicians overall has grown to 23% in recent years, PEMC says the number of women who advance to management positions has not matched that increase. There have been few efforts to calculate the numbers of racial minorities since they are believed to be extremely low.
In her first job as medical director at the Federal Bureau of Prisons in Chicago, Alston came face to face with the issue of diversity. "The environment there is incredibly male chauvinistic, so you're in an environment where it's not so much an issue that you're black as it is an issue that you're a woman," she says.
"The first two years of the five years I was there I spent more of my time fighting with officers and everybody to assert myself. I had to say: 'Guess what? This is my medical unit. This is what I want. This is what will be done.' It was a real good training ground," she says.
Becoming associate medical director at the Blues two years ago was a "really big jump," she says. It was the first time she had all administrative responsibilities with no clinical role involved. She attributes her promotion to her drive and also to being lucky.
Her main responsibilities include overseeing utilization management, being lead medical director for a smoking cessation project, providing information to nurses on new drugs and diseases states, working on appeals, examining fraud and abuse cases, and serving on a medical review unit.
She says she was interested in joining the Blues because she knew it was a good company with a good reputation. "It was also important for me that they were in Illinois so I knew that for me to get promotions I wouldn't have to leave the city," she says. "That was important for me because my family is here, and it is not that easy for me to uproot."
Alston says she and her husband, an attorney, make a good team and have learned to balance work and the care of their two daughters, ages 7 and 11.
Not wanting to uproot family is one of the reasons Alston thinks there are not more women in executive positions. "I have friends who work at some of the nationwide insurance companies. For the ones that are married and have children--it's an issue. It's, 'Yes, I'd like to move. Yes, I'd like to advance. No, I don't want to uproot my family.' It's a difficult decision."
Laura Morris, M.D., is single with no children and feels the lack of women in executive positions is because they choose to raise families. "I think some women make career choices to optimize their personal life," she says. "I don't think (there is a) glass ceiling or that women have been oppressed. They have chosen (that lifestyle)."
Morris, 39, is director of a women's health services center at Goshen (Ind.) Health System and a breast surgeon for the Cancer Treatment Centers of America.
She spends about 40% of her time in the administrative role and 60% in practice.
She says she enjoys her professional balance between administrative and clinical responsibilities and sees her executive role increasing as the women's center grows.
She says there are two reasons she has remained single. "One, I work a lot. And two, it is very hard for a woman who has an executive title to find a man who is not intimidated."
Morris says it would be difficult but not impossible for a woman to combine business meetings and MBA night classes with running a practice and caring for a family. Men make the same choices, she says. Setting priorities and using time management allow physicians to accomplish multiple jobs.
"I have made career choices that have affected my personal life," she says.
But she has no regrets because, she says, it is those choices that have made her so successful in her field. She would like to have a family one day but says at this point the demands of her career have made it nearly impossible.
Doreen Moreira, M.D., served for three years as the president and executive director for the National Center for Women Healthcare and Physician Executives.
"You really have to know what you want rather than respond to perceived societal demands," she says. "The better you become at this, the more you realize that you can have it all, although not always at the same time."
Moreira, 44, is principal and managing partner for Conflict Free Workplaces in Cabin John, Md., a consulting firm that provides communication and conflict resolution services to healthcare organizations.
Moreira acknowledges that the possibility of gender or racial discrimination must be considered. "I think we have to be honest and admit that gender (or racial) discrimination, either covert or overt, can occur. As in any field, there will probably always be a small--hopefully very small--number of people in the workplace who only feel comfortable hiring or supporting others they perceive to be just like them."
The specter of discrimination and the demands of family aren't the only factors
in the lack of women and minorities in senior positions, Alston says.
The biggest reason, she says, is that most physicians just don't consider the possibility.
When they do think about executive positions, "they think about a middle-aged white man," she says. "There are so few of us that unless they are in a company where they see me or one of my friends in another company, we don't hit their radar screen. They just don't think about us. In some cases I think it may even be unintentional."
Sometimes the people who do notice her are not even those in a hiring role. "I have friends who could not believe that I actually interviewed looking rather ethnic. Braids? I'm not exactly the navy blue suit, white blouse, female executive type." When people would ask if she would take the braids out for a job interview, her response was, "I have worn braids for years, and if I interviewed I should hope that the way that I look has no indication on how people view me as a person and on my skills."
"The first time the vice president saw me he looked at my hair and said, 'Your hair is a work of art,' and I laughed," she says.
Another reason there aren't more women in leadership is that "there is not an understanding of what you do everyday and there are a lot of physicians who would really miss seeing patients," Alston says.
In addition, she says there needs to be more encouragement and exposure. "We didn't get exposure to this in medical school," she says. "I have friends who I tell, 'You can do this!' They are hesitant because it is a world that we are not really exposed to."
Moreira agrees. "I've heard some people say that there is a lack of 'advertising' about physician executive careers to women medical students and residents, who tend to have less access to mentoring relationships in their training."
Alston admits there are times when she wishes she had more mentoring. "That (mentoring) is sometimes harder to come by, and I think it's because there aren't that many females that are in this position," she says.
For women and minority medical students who are considering an executive career, she suggests serious thought since there is not exposure to leadership positions in medical school. Second, she advises preparation by taking management courses and learning about the business side of healthcare. "Get your skills set so when the opportunity presents itself you're ready," she says.
Finally, be aggressive and confident and get involved with one's chosen organization. "You've got to think you can do it," she says.
As for the future of women and minorities she predicts, "I think there will be more of us in higher positions." As for her position, she says: "I enjoy it. I like coming to work everyday."