Leadership I

Gender Bias in Health Care: Glass Ceiling, or Foundation of Sand?

Article · December 13, 2016

As a frequent contributor to medical journals, I was struck by the recent NPR article highlighting the gender gap when it comes to who receives top-billing authorship in prestigious research journals. Women received only 37%.

American health care has made great progress embracing gender diversity and inclusion in the past half century. However, women physicians and scientists live and practice in the context of American society as a whole. Women represent only 21% of executives at Fortune 500 health care companies, and 19% of hospital CEOs, mirroring the low number of women in leadership positions outside of the health care industry.

In her brilliant book Lean In: Women, Work, and the Will to Lead, Sheryl Sandberg wrote about an unequal voice for women in America. What we are seeing in research papers is only one part of a systemic trend in our society, highlighted by Sandberg and others, that limits leadership roles for women in many fields. Gender bias is deeply institutionalized; women and men conform to stereotyped roles and norm. Harvard lecturer Hannah Riley Bowles says that women who push hard on pay negotiations are perceived more negatively than men who do the same thing. Sandberg has also made this point. When women are in the hiring or promotion process, they are judged on their social skills, while men typically are not.

Thus, likability becomes a key attribute for women who want to get ahead in their careers. However, likability does not drive the type of outcomes sought by academic institutions, journals, school superintendents, college boards, or corporate search committees. The implicit bias that we as a society hold — valuing niceness in women and toughness in men — suggests that women aren’t limited by a glass ceiling, but by a foundation of sand. Women can’t find their footing within attributes they bring to professions without seeming to act out of sync with external expectations.

This embedded bias is woven into the industry fabric even as growing numbers of women enter health care and other fields. In 1965, 6.9% of medical school graduates were women. By 1998, this was up to 36%, and from 2005 on has hovered around 50%. It’s a striking comparison to the 56% of women the World Bank says make up the U.S. workforce. Yet only around 19% of corporate board seats in Fortune 1000 companies are held by women. This workforce and leadership discrepancy persists across many fields in the United States.

Scientific research, unfortunately, has followed suit. A BMJ study of female-first authorship shows that despite women approaching parity in medical school, only a third of research studies give women authors top billing in the most prestigious medical journals. And yet, being first author on a paper in a high-impact journal can make someone’s career.

Health care professionals now need to turn the power of research toward solutions. Identifying our own implicit biases and taking action to ensure we are valuing every colleague for what they individually bring to the table is a good start. We should learn from pockets of excellence outside our own institutions: leadership boards with high percentages of women, other countries with high percentages of elected women officials. We should apply our scientific approach, without judgment, to see how and why those organizations have been able to do what we in health care have not, then embed those changes into our own practices. By studying the small things that make a big difference, we can build a strong foundation for our future — not a foundation of sand.

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