Updated: Mar 25
Written By Grace Oliver MS4 and Dr. Alexandra Mannix
Interested in learning What Is Sponsorship?
Be sure to check out part 1 of this 4 part series on sponsorship.
Women have been “leaning in” since Sheryl Sandberg coined the term in her 2013 book (Sandberg, 2013). While there has been some recent backlash regarding the Lean In principles, this book helped shape the current professional culture for American women (Livni, 2018). In 2011, according to Women in U.S. Academic Medicine and Science: Statistics and Benchmarking Report, women represented 47% of accepted applicants, 47% of matriculants, 47% of first‐ year enrollments, and 48% of graduates at all LCME‐accredited U.S. medical schools (Jolliff, Leadley, Coakley, & Sloane, 2012). Despite the fact that women make up approximately half of all medical students and residents, and 1/3 of full‐time faculty, women remain underrepresented in leadership positions.
Before anyone can come in with any Tigges-esque (for more information on this reference check out: Does Every Opinion Matter?) attitudes about female physicians, the literature has been clear: women work just as hard, with equally good (or even better) patient outcomes to men’s. A 10-year review of wage and productivity data of all sectors of New Zealand employers found that gender wage gaps were not aligned with subjective differences in productivity (Sin, Stillman, & Fabling, 2017). An American study put actual sensors on businesspeople at work and found no data support for many of the justifications people have for underrepresentation of women: contribution to projects, time with mentors, and face-to-face time with coworkers (Turban, Freeman, & Waber, 2017). In studies within medicine, we know that even when controlling for productivity and years on the job, women still get paid less and are less represented in leadership (Desai et al., 2016). Not only is it clear that women aren’t inferior workers: evidence in is now revealing that in several settings, female doctors are better than males. Over 1.5 million Medicare patient hospital courses revealed that patients with female doctors had significantly lower mortality and rehospitalization rates (Tsugawa et al., 2017). Over 580,000 patient outcomes in Florida revealed that acute myocardial infarction patients were more likely to survive when their physician was a female (Greenwood, Carnahan, & Huang, 2018).
So here’s where we stand in the US: women are approximately half of medical students and residents, and of the general population. Their work is of equal (or better) quality to that of men. Accordingly, you would think they would be similarly represented in leadership, pay, and publication. Unfortunately, this is far from the case.
As mentioned in part 1 of this series, in 2013, females compromised only 15% of department chairs and 16% of deans at US medical schools (Lautenberger et al., 2014). This fact is especially impactful given that women physicians account for more than one third (38%) of full-time academic faculty ((Lautenberger et al., 2014). Chairs and deans often impact the hiring and promoting decisions of their department or institution, therefore the lack of women in these roles may create a feedback loop propagating this unequal distribution of women in academic medicine.
In addition to female physicians being underrepresented in the highest level (chairs/deans) of academics, women tend to be underrepresented at the other levels of academica. In 2014, of full time academic physicians, female physicians make up approximately 34% of associate professors and 21% of full professors (Lautenberger et al., 2014).
Not only do women not achieve promotions or advancement the same rate as their male peers, when controlling for all factors, “female physicians are significantly less likely to become full professors and are paid lower salaries than their male colleagues” (Nonnemaker, 2000),(Rotenstein, Berman, Katz, & Yialamas, 2018). There does not seem to be systematic policies in place to improve this inequality, so this will likely continue for years to come. According to Arora et al, “between 2003 and 2013, the percentage of female full professors increased less than 1% per year” (Arora, Flores, & Cardin, 2018). Female physicians continue to not be promoted, and this stands true even when controlling for “promotion-worthy” behaviors such as publication rates ((Mariano et al., 2018).
We believe that the leadership gap in medicine perpetuates the leadership gap. With such low numbers of female voices in the c-suite, systemic solutions are likely required to improve the unequal promotion of women. According to Laver et al in “A systematic review of interventions to support the careers of women in academic medicine and other disciplines”: relying on women to advocate for change and promotion without systemic change is unlikely to be effective (Laver et al., 2018). A multifactorial approach is likely required to address the leadership gap, and it should include sponsorship.
Sponsorship became a topic in medicine in 2013 upon the publication of “Sponsorship: a path to the academic medicine C-suite for women faculty?”--the “C-suite” being the uppermost titles in an organization: think CEO, COO, etc. According to the authors “although academic medicine differs from the corporate world, the strong sponsorship programs that have advanced women into corporations' upper levels of leadership can serve as models for sponsorship programs to launch new leaders in academic medicine” (Travis, Doty, & Helitzer, 2013). Since this paper, women in academic medicine have been intentionally implementing this strategy.
According to Patton, “women benefit less from sponsorship than men, which may contribute to a ‘gender gap’ in leadership” (Patton et al., 2017). This implies that female physicians are less likely to be put up for opportunities, therefore making them less productive academically. Not only are women less likely to benefit from sponsorship, they also may experience greater challenges finding mentors and sponsors contributing to long term career disparities (Sambunjak, Straus, & Marusić, 2006).
As women working in medicine, these data are disheartening to say the least. The worries you might have about your career prospects may, unfortunately, not be unfounded. But remember: you are not alone in this. Times are changing. For the first time in US history, a majority of students matriculating to medical school were women. There has been amazing growth of social media networks of women, and we have access to more resources than ever before to help us smash that glass ceiling (including SheMD, of course)! This piece of this series was not written to scare you, but rather to let you know what you’re truly up against.
In Part 3 we will move forward by explaining how to harness the powerful tool of sponsorship to further your career most effectively.
Arora, V., Flores, L., & Cardin, T. (2018, July 27). Tackling the Sponsorship Gap for Women in Healthcare in the #MeToo Era - The Hospital Leader - The Official Blog of the Society of Hospital Medicine. Retrieved August 16, 2018, from https://thehospitalleader.org/tackling-the-sponsorship-gap-for-women-in-healthcare-in-the-metoo-era/
Desai, T., Ali, S., Fang, X., Thompson, W., Jawa, P., & Vachharajani, T. (2016). Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States. Postgraduate Medical Journal, 92(1092), 571–575.
Greenwood, B. N., Carnahan, S., & Huang, L. (2018). Patient-physician gender concordance and increased mortality among female heart attack patients. Proceedings of the National Academy of Sciences of the United States of America, 115(34), 8569–8574.
Jolliff, L., Leadley, J., Coakley, E., & Sloane, R. A. (2012). Women in US academic medicine and science: statistics and benchmarking report 2011-2012. Washington, DC: Association of American Medical Colleges, 1–59.
Laver, K. E., Prichard, I. J., Cations, M., Osenk, I., Govin, K., & Coveney, J. D. (2018). A systematic review of interventions to support the careers of women in academic medicine and other disciplines. BMJ Open, 8(3), e020380.
Mariano, E. R., Dhand, S., Nash, I., Girgis, L., Hodge, N., Suthrum, P., … Yang, M. (2018, July 11). What’s better: mentorship or sponsorship? Retrieved August 16, 2018, from https://www.kevinmd.com/blog/2018/07/whats-better-mentorship-or-sponsorship.html
Patton, E. W., Griffith, K. A., Jones, R. D., Stewart, A., Ubel, P. A., & Jagsi, R. (2017). Differences in Mentor-Mentee Sponsorship in Male vs Female Recipients of National Institutes of Health Grants. JAMA Internal Medicine, 177(4), 580–582.
Travis, E. L., Doty, L., & Helitzer, D. L. (2013). Sponsorship: a path to the academic medicine C-suite for women faculty? Academic Medicine: Journal of the Association of American Medical Colleges, 88(10), 1414–1417.
Tsugawa, Y., Jena, A. B., Figueroa, J. F., Orav, E. J., Blumenthal, D. M., & Jha, A. K. (2017). Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Internal Medicine, 177(2), 206–213.