Healthcare, with its large proportion of highly trained and qualified women, has an opportunity to be a leader in workforce gender equity. However, research demonstrates the contrary.
Disparities keep women in medicine from being promoted, published, funded, invited to speak and recognized for their important contributions. Studies show that women are often paid less than men for the same or similar work—even when accounting for variables such as age, experience, specialty, faculty rank, measures of research productivity and clinical revenue.
Each year during the Harvard Medical School women's leadership course that I direct, a strategic initiative is introduced that combines evidence-based medicine with advocacy. This year's initiative, the Be Ethical Campaign, calls on leaders in key gatekeeper groups to use a comprehensive approach to analyze and address workforce gender disparities.
While it seems reasonable to assume that, as scientists, medical school deans and journal editors-in-chief would use scientific methodology to tackle workforce disparities, this has largely not been their approach. Hospital CEOs and other executives are also guilty of not fully directing their resources and business acumen toward solving disparities for women in medicine. One study found that nearly 40% of U.S. medical schools reported no special programs for recruiting, promoting or retaining women, often describing such programming as unnecessary.
Yet, as Dr. Keith Lillemoe stated in his recent presidential address to the American Surgical Association, the “number of outstanding, qualified female candidates is more than adequate to fill every open surgical leadership position in America today.” Leaders who do not adequately address workforce gender discrimination place their institutions at financial risk, as well as at risk of employee attrition, increased burnout rates, reduced quality of patient care, and even litigation.
On occasions in which leaders have attempted to address disparities, too often their methods have been distinctly unempirical, typically involving the assessment of an incomplete set of metrics and often tackling a single issue at a particular point in time, rather than the systemic problem. And progress has often been overblown, presented as a “mission accomplished,” when, in truth, without a comprehensive scientific approach and ongoing analysis, the problem of workforce inequities remains unresolved. For example, why haven't our highly accomplished leaders solved the simplest of parity problems: equitable inclusion of women on hospital, journal and industry boards?
In position statements throughout medicine, discrimination is called out as unethical, and a recent Harvard Business Review article titled “How discrimination against female doctors hurts patients” highlights how patient care can be negatively impacted. In the face of an overwhelming amount of evidence that workforce disparities are not adequately being addressed, the Be Ethical Campaign urges top leaders to take a close look at the research and also take an honest look in the mirror.
The goal is for all healthcare leaders to develop competencies in equity, diversity and inclusion.
This requires that they become knowledgeable about the research on workforce gender equity; avoid making critical thinking errors and blaming women for the disparities they face; demonstrate that women are represented equitably and paid and promoted equitably at every level; use their influence and resources to address workforce gender equity issues with a systematic, data-driven and transparent approach; and continue to develop goals, policies and procedures to successfully address any existing or developing disparities.
Solving gender workforce disparities will require every leader, across the gender spectrum, to accept responsibility for the discrimination that prevents the majority of those they lead and serve to advance and perform to the best of their abilities. Scientific methods and data analysis must be used to advance change, and progress should be documented and transparently reported to all stakeholders.
In short, leaders must step up and take ethical action.
