Crucial Role of Women’s Leadership in Academic Stroke Medicine
2019; Lippincott Williams & Wilkins; Volume: 50; Issue: 6 Linguagem: Inglês
10.1161/strokeaha.118.024788
ISSN1524-4628
AutoresCharlotte Cordonnier, Shelagh B. Coutts, Karen C. Johnston, Natalia S. Rost,
Tópico(s)Healthcare cost, quality, practices
ResumoHomeStrokeVol. 50, No. 6Crucial Role of Women's Leadership in Academic Stroke Medicine Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBCrucial Role of Women's Leadership in Academic Stroke MedicineYou Can't Be What You Can't See Charlotte Cordonnier, MD, PhD, Shelagh B. Coutts, MD, MSc, Karen C. Johnston, MD, MSc and Natalia S. Rost, MD, MPH Charlotte CordonnierCharlotte Cordonnier From the Inserm U1171, Degenerative and Vascular Cognitive Disorders, Université de Lille, CHU Lille, France (C.C.) , Shelagh B. CouttsShelagh B. Coutts Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, AB, Canada (S.B.C.) , Karen C. JohnstonKaren C. Johnston Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA (K.C.J.) and Natalia S. RostNatalia S. Rost Correspondence to Natalia S. Rost, MD, MPH, Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge St, Suite 300, Boston, MA 02114. Email E-mail Address: [email protected] J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (N.S.R.). Originally published7 May 2019https://doi.org/10.1161/STROKEAHA.118.024788Stroke. 2019;50:e149–e152Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 7, 2019: Ahead of Print Academic medicine is at the watershed moment with regard to recognition and reporting of the gender disparity across its every segment and specialty, including subspecialties of neurology. A recent letter to the editor of Annals of Neurology ("Gender inequities in the multiple sclerosis community: a call for action"),1 highlights underrepresentation of women in high-quality research, despite a substantial number of successful senior female academic neurologists and neuroscientists worldwide with extensive experience to lead and to shape the field. This raises the question of whether the stroke community is different? All of us can think of an outstanding stroke neurologist, who also happens to be a woman and a leader in the field—but is she the only one you can think of? The data with regard to representation of women in academic stroke medicine are scarce. But as reported by Guzik et al in a poster presentation at the 2019 International Stroke Conference, women are significantly less likely than men to hold leadership positions, with most prominent disparity noted among invited speakers, moderators, and award recipients. There are only ≈13% of women in top editorial positions of Stroke, with the proportion rising to ≈24% when Section Editors (including State-of-the-Science Nursing Review) are included. Of the 29 National Institute of Neurological Disorders and Stroke–funded StrokeNET regional coordinating centers (https://www.nihstrokenet.org), only 4 (≈14%) are led primarily by women, and ≈25% report shared leadership (women as co-principal investigators). Remarkably, this specific percentage cutoff seems to be recurrent throughout the various business sectors and possibly reflects the global trends in the professional status of women in the society. But are there any unique characteristics of our ever-growing and dynamic field of stroke medicine that might help facilitate advancement of women or is it similarly subject to the forces of the overall health care sector and a mere reflection of academic trends? In this piece, we address the unique challenges women face while developing their careers in stroke medicine; furthermore, we highlight the opportunities for our subspecialty to overcome the statistics and to lead the future with examples of equity, diversity, and recognized contribution to science.Challenge of Visibility and the Glass Ceiling EffectWomen face unique challenges along the arc of their academic careers. In addition to battling gender-specific stereotypes and, more gravely, the realities of sexual harassment, which is now recognized to be highly prevalent in both clinical and laboratory environment, women seek to assure their role as leaders in their fields of expertise. In the past, the scarcity of women in leadership positions throughout the academia has been explained by the pipeline issue; however, women have made up approximately half of the medical school classes around the country for over 15 years, and in 2015, the Association of American Medical Colleges reported that 48% of medical school graduates and 38% of academic faculty members were women. Despite this, the proportions of women in specialties, such as neurology, declined from 54% at instructor level, to 45% at assistant professor level, 35% at associate professor level, and only 19% at a full professor level. The smaller numbers of women in leadership positions are even more concerning. Only 14% of Chairs in all specialties and only 16% of all Deans were women in 2015. Strikingly, the same data demonstrate that women served as interim chairs 20% of the time, interim deans 27% of the time, and assistant deans 46% of the time. These numbers suggest that women were being selected as adequate leaders for support or temporary roles but were much less likely to be selected for permanent leadership positions, highlighting an ostensibly insurmountable hurdle for women in the society known as the glass ceiling effect.The glass ceiling effect has been defined in a recent US Federal Commission report as "the unseen, yet unbreakable barrier that keeps minorities and women from rising to the upper rungs of the corporate ladder, regardless of their qualifications or achievements." Gross underrepresentation of women in leadership positions in the business world—also known as the trouble in the C-suite (where C stands for chief executive)—has been widely popularized in the recent years as one of the root causes of gender disparities throughout the industry. With fewer women leaders, there are fewer opportunities for creative team building, equitable models of networking, and opportunities for mentorship that nurtures diverse talent for the future. There is less precedence for success and fewer role models for future women leaders. Statistics published in the Harvard Law School Forum on Corporate Governance and Financial Regulations in 2018 show that women hold a diminutive percentage of business leadership roles, with only ≈14% C-suite executive, 11% Board member, 3.8% Board Chair, and 4.5% chief executive officer positions held by women. Almost canonically across the different segments and sectors of society, female representation drops more than 50% while moving from the entry-level to top leadership positions. Similar attrition is also noted in the health care sector, where the pipeline of women leaders dries up, with only ≈18% of hospital chief executive officers and 4% of healthcare chief executive officers positions being held by women. Although the data are lacking on the effect of glass ceiling on other minority groups in academic medicine, we speculate that it may be most limiting for the women of color represented in leadership.Consequences of Conscious and Unconscious BiasIn academic medicine, women continue to deal with issues that are limiting their advances including lower rates of academic success as measured by rank (fewer women full professors), funding (fewer National Institutes of Health career development and independent R01 grants), publication record, and recognition of authorship (fewer references for published articles, fewer first and senior author positions), overall recognition of achievement (fewer top scientific awards and invitations to speak nationally), fewer leadership roles in academic environments, lower salaries, and, what is most troublesome, high rates of harassment.2–4 These issues suggest not only pervasive conscious but also unconscious bias against women in academia. Recent data from Doximity (2017) suggested that women doctors earned an average of 27.7% less than their male colleagues, which is about $105 000 less a year. This is true across specialties, including neurology (Figure). In fact, the numbers and trends that have recently been unearthed demonstrate the tangible loss of opportunity for women in science and academia, including financial earnings.Download figureDownload PowerPointFigure. Gender pay gap exists for female physicians in neurology. Data from the 2012 and 2013 Neurology Compensation and productivity report published by the American Academy of Neurology showed that gender pay gap persists across all percentiles of median compensation. Data derived from Zecavati et al.4As neurologists, we were troubled to learn in a series of recent publications the extent of gender disparities in academic rank and publication rate at top-ranked US neurology programs,2 underrepresentation of women physicians in the American Academy of Neurology recognition awards,3 and gender pay gap for female neurologists.4 Although establishing transparency with regard to the issues of gender equity within our field is important, it is even more important for the institutions and the professional societies to take concrete and urgent steps to address it. As an example, the American Academy of Neurology has commenced the Gender Disparities Task Force, which provided important insights into causes of gender disparities within our specialty including compensation, professional advancement, leadership opportunities, and work-life balance. Similar actions should be required from the subspecialty organizations and societies to understand the subspecialty-specific trends and form future directions that ensure equity, diversity, and inclusion within their respective fields.Fight Against Sexual Harassment: Zero-Tolerance PolicyAlthough not specific to neurology, the most disturbing of all recently reported is the issue of pervasive sexual harassment of women in academic medicine. In a survey of 1719 K-award recipients from 2006 to 2009, 30% of women, as compared to 4% of men, reported having experienced sexual harassment.5 The National Academies of Sciences, Engineering, and Medicine have called for fundamental change at our academic institutions with 15 recommendations, which are described as a call to action to collectively resist the tolerance and perpetual behavior that affects leadership, faculty, and staff at our academic institutions.6 A global and uniform commitment to these principles from academic institutions, and with the National Institutes of Health taking leadership through the Working Group of the Advisory Council to the Director on Changing the Culture to End Sexual Harassment, will make for a safer and equitable environment in academic medicine for all. As stated recently by Dr Collins (@NIHDirector), "NIH must do better to address sexual harassment in science." In addition, leadership programs and training by professional organizations, such as the Association of American Medical Colleges's Executive Leadership in Academic Medicine Program for Women and the American Academy of Neurology's Leadership University programs, are providing tools for women in neurology to find and sustain success.Promoting Diversity and Gender EquityWomen's leadership is crucial for the future success of academic medicine and the society, as a whole, where diversity in the healthcare workforce mirrors closely that of general population.7 Corporate success teaches that financial performance is improved in gender-diverse teams, often outperforming non-diverse teams in terms of average economic growth, return on equity, debt/equity ratios, greater market share, higher sales revenue, and increased overall profits.8 We learned recently that women practice medicine differently than men, resulting in patients treated by female physicians having lower 30-day mortality rates (P<0.001) and fewer 30-day readmissions (P 60% of men think that their company is already doing what it takes to improve gender diversity, and 50% of men think that women are well represented in leadership where only 1 in 10 senior leaders is a woman. Another real challenge is the lack of professional infrastructure that promotes women networking, provides official and informal mentorship and sponsorship opportunities for women, and nurtures future leaders. Unlike established, and historically men-predominant professional medical associations, women face the uphill challenge of building from scratch or developing an equitable environment where women support and promote each other, such as WISE (Women Initiative for Stroke in Europe) of the European Stroke Organisation.Call for ActionSo, where do we go from here? In 2017, the number of women enrolled in medical schools in the United States outnumbered men for the first time, and in 2018, women were majority of US medical school applicants, as reported by the Association of American Medical Colleges. In the not so distant future, it is likely that there will be more women neurologists than men. At the same time, stroke will continue to dominate the landscape of neurological disorders of the aging population. Stroke care is becoming more complicated, labor- and resource-intensive, and intimately dependent on the large, highly coordinated and supremely diverse teams. Given these facts, we must attract the best and the brightest in academic medicine to choose careers in stroke, which means enlisting the talent and leadership of women neurologists. However, encouraging young women to choose a career in stroke is just the beginning: mentoring and sponsoring them into leadership positions, as they advance through their career in academia is furthermore important. The simple slogan, "You can not be what you can not see" is a powerful reminder of what future of academic leadership can look like if we focus on making gender equity a reality. Women need to be visible to play their role as role models, and women's voice in academic medicine should be and can be amplified by using a pragmatic approach promoted by Dr Julie Silver (@JulieSilverMD): "1) Invite Her, 2) Cite Her, 3) Quote Her, 4) Sponsor Her, 5) Recognize Her, 6) Pay Her, and 7) Promote Her" (#SheLeadsHealthcare/@Twitter).Like other voices in academic medicine, neurology, and neurological subspecialties, we propose a systematic and concerted effort to promote equity and diversity within stroke medicine. The wealth of contribution from the entire spectrum of talent and expertise can only be attained by using the potential of women and other underrepresented minority groups in leadership roles. Therefore, the stroke community must (1) create more awareness on the state of women leadership in the field, (2) develop a transparent process that promotes leadership opportunities for qualified women at every level of academic institutions, (3) recognize achievements and contributions from women through academic promotions and top scientific awards, and (4) amplify the voice of women in academic stroke neurology by leveraging diversity in the structure of existing and future scientific consortia, guidelines and planning committees, editorial boards, grant review panels, steering committees of the professional societies, and leadership of the neurology departments. To be fully prepared for the future of stroke, we must set the highest standards for excellence in patient care, education, research, and community service. Women neurologists are powerful and equal partners in leading the field toward this future, and the field must find the way to clarify our shared values, set the vision, challenge the process, enable others to act, and model the way for the rest of academic medicine.AcknowledgmentsDr Cordonnier is member of the Institut Universitaire de France.DisclosuresNone.FootnotesCorrespondence to Natalia S. Rost, MD, MPH, Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge St, Suite 300, Boston, MA 02114. Email [email protected]orgReferences1. International Women in MS. Gender Inequities in the Multiple Sclerosis Community: A Call for Action. Letter to the Editor.Ann Neurol. 2018; 84:958–959.Google Scholar2. McDermott M, Gelb DJ, Wilson K, Pawloski M, Burke JF, Shelgikar AV, et al. Sex differences in academic rank and publication rate at top-ranked US neurology programs.JAMA Neurol. 2018; 75:956–961. doi: 10.1001/jamaneurol.2018.0275Google Scholar3. Silver JK, Bank AM, Slocum CS, Blauwet CA, Bhatnagar S, Poorman JA, et al. Women physicians underrepresented in American Academy of Neurology recognition awards.Neurology. 2018; 91:e603–e614. doi: 10.1212/WNL.0000000000006004Google Scholar4. Zecavati N, Oyegbile T, Peeples C, Santos C. Gender paygap exists for female physicians in neurology (P1.343).Neurology. 2016; 86(16 suppl).Google Scholar5. Jagsi R, Griffith KA, Jones R, Perumalswami CR, Ubel P, Stewart A. Sexual harassment and discrimination experiences of academic medical faculty.JAMA. 2016; 315:2120–2121. doi: 10.1001/jama.2016.2188Google Scholar6. Fairchild AL, Holyfield LJ, Byington CL. National academies of sciences, engineering, and medicine report on sexual harassment: making the case for fundamental institutional change.JAMA. 2018; 320:873–874. doi: 10.1001/jama.2018.10840Google Scholar7. Valantine HA, Collins FS. National Institutes of Health addresses the science of diversity.Proc Natl Acad Sci U S A. 2015; 112:12240–12242. doi: 10.1073/pnas.1515612112CrossrefMedlineGoogle Scholar8. Rohner U, Dougan B. Gender diversity and corporate performance. Technical report. Zürich: Credit Suisse Research Institute; 2012.Google Scholar9. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians.JAMA Intern Med. 2017; 177:206–213. doi: 10.1001/jamainternmed.2016.7875CrossrefMedlineGoogle Scholar10. Yedidia MJ, Bickel J. Why aren't there more women leaders in academic medicine? The views of clinical department chairs.Acad Med. 2001; 76:453–465.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Dobele A, Ferguson S, Hartman A and Schuster L (2021) Gender Equity in the Marketing Academy: From Performative to Institutional Allyship, Australasian Marketing Journal, 10.1177/18393349211062269, (183933492110622) Pikula A, Catanese L, Bushnell C, Caso V and Silver J (2020) How to Be Savvy About Gender Disparities in Academic Stroke Medicine, Stroke, 51:9, (e261-e265), Online publication date: 1-Sep-2020.Fahed R, Shamy M and Dowlatshahi D (2020) "It's About How Hard You Can Get Hit and Keep Moving Forward", Stroke, 51:5, (e74-e77), Online publication date: 1-May-2020.Sacco R (2020) Stroke Vision 2020, Stroke, 51:3, (1040-1046), Online publication date: 1-Mar-2020. Silver J (2019) Understanding and addressing gender equity for women in neurology, Neurology, 10.1212/WNL.0000000000008022, 93:12, (538-549), Online publication date: 17-Sep-2019. June 2019Vol 50, Issue 6 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.118.024788PMID: 31060438 Originally publishedMay 7, 2019 Keywordsmedicinewomensexual harassmentleadershipneurologyPDF download Advertisement SubjectsCerebrovascular Disease/Stroke
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