Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 5 , Pages 683-686, May 2007

The Work That Remains at the Intersection of Gender and Career Development

  • Janet Bickel

      Affiliations

    • Corresponding Author InformationCorrespondence to Janet Bickel, Career Development and Executive Coach and Faculty Career & Diversity Consultant, 7407 Venice St, Falls Church, VA 22043

Janet Bickel & Associates, Falls Church, VA.

Article Outline

Abstract 

Bickel J. The work that remains at the intersection of gender and career development.

Building on the study by Wagner et al, this commentary opens with a discussion of the persistence of gender disparities in career development and the challenge of interpreting those disparities. Given the multifaceted challenges facing rehabilitation medicine, facilitation of the career and leadership development of women physiatrists is critical. I suggest 3 areas of targeted action to facilitate the realization of women physiatrists’ intellectual capital: (1) updated approaches to faculty and leadership development and mentoring, (2) more flexible faculty structures, and (3) chair support and accountability. Each member of the rehabilitation medicine community who cares about the future of the discipline is challenged to contribute to the dialogues that are necessary to carry these recommendations forward.

Key Words: Career mobility, Rehabilitation, Women

 

THE STUDY BY Wagner et al1 on the impact of gender on career development and leadership provides a timely wake-up call for rehabilitation medicine. After controlling for all major critical confounding factors, this investigation found that gender remained an independent and significant factor in salary and scholarly manuscript production. This study also showed that fewer women than men are achieving their academic and leadership potential. Corroborating these results, virtually all the other specialties and individual medical centers that have conducted such studies have drawn similar conclusions.

One critical variable, however, is missing from this analysis: career aspirations. Although this study found that women lagged significantly behind men in terms of leadership roles at both the institutional and national levels, it is unclear whether this trend is because women: (1) did not apply because they either lacked the time given their other responsibilities, did not imagine themselves capable of leadership, or were not effectively mentored; (2) were not offered the chance or did not successfully compete for the roles; or (3) declined an offer. As discussed later in this commentary, these possibilities are exceedingly difficult to tease apart. It is worthwhile to note that 1 institutional study2 found that, among medical faculty, there were no differences between men and women in self-reported importance of career advancement or aspirations to hold leadership positions but that women were much less likely to be asked to serve in leadership positions.

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Why So Slow? 

Now that substantial numbers of women have been in the professional pipeline for 3 decades, why do such gender disparities in career development persist? Why has change been so difficult to accomplish?

To begin with, impetus for change is lacking. Women who are not realizing their potential tend to leave quietly or to remain invisible, and the costs associated with their wasted potential remain hidden as well. Second, the many young women now entering medicine, surrounded by women peers and unaware of their predecessors’ struggles, are assuming that all the heavy lifting to achieve gender equity has been completed and that they themselves will not have to settle for less. Most significant perhaps is the observation that many men—alert to the number of women entering medicine—are concluding that gender equity has been achieved. This stand is a “pipeline dream”–– increases in the number of women are not reducing gender disparities in advancement.3, 4, 5, 6

The Wagner1 study has shown, as have all other studies of these phenomena, that women are much more aware than men that the playing field is not level and women face continuing career disadvantages. Hard at work on their own career development and lacking a forum in which to comprehensively examine these issues, men tend to assume that women’s lack of progress stems from a lack of self-confidence, perhaps coupled with lack of appetite for competition or from a preference to devote more of themselves to their families.

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The Challenge of Interpretation 

Interpreting the results of even the best-designed studies on these subjects remains a challenge, with abundant ambivalence about the meaning of gender disparities in career development. Women are just as different from each other as men are and separating the influences of “nature” from “nurture” is almost impossible, especially given the common socialization that physicians experience. I thus conclude that, although this study draws much-needed attention to a critical challenge, the complexity of the multifarious variables affecting career and leadership development and gender differences is such that more studies will not provide better answers.

Take, for example, the finding that, after controlling for all major confounding variables, women physiatrists still earn only 75% of men. Clearly, the dynamics here are not nearly as simple as discrimination or family responsibilities, although women often do have priorities in addition to level of salary (eg, flexible schedule). Women are less likely to negotiate for the necessary resources at the start of their career, resulting not only in lower salary, but also in less space, less support staff, and fewer other resources that can be key to their success.7 Women do not negotiate as frequently or as successfully as men: both men and women negotiators take a harder line against women, making poorer first offers, pressuring women to concede more, and conceding much less themselves.8 This reflects different social conditioning and expectations of women’s worth—complex phenomena in themselves.

Women’s lower frequency and success in negotiating also reflect the strong woman’s “likeability double-bind”: a woman’s influence increases the more she’s liked, but nonassertive women are better liked than assertive ones. Restricted to a narrower range of assertive behaviors than men are, aggressive women are penalized.9 That is, while men are expected to negotiate assertively, strong women negotiators may be perceived as unlikable, which actually interferes with their ability to build relationships key to their work.10

Having a mentor and powerful career advocate is a clear advantage in building professional relationships in the highly political and competitive world of academic medicine. While women faculty are as likely as men to report access to a mentoring relationship, most studies show that women gain less benefit from these relationships in terms of career planning and less encouragement to participate in professional activities outside the institution, and that women are more likely than men to report that their mentor takes credit for their work and that their mentor is a negative role model.11 Successful men who from boyhood have had role models reflecting their aspirations often take this advantage for granted, thereby discounting the extra challenges women face in finding role models and in building developmental relationships.

Men are often not as forthcoming or comfortable with women as with men mentees, which can impede the value of the mentoring women receive. Also at the critical point when their women protégés begin spreading their wings and seeking more independence, some men withdraw their support. Some men seem more comfortable in paternalistic relationships with women (ie, father-daughter) than as equals and some feel threatened by the growing power of the protégé. These are some reasons why women’s informal networks are less extensive and less likely to include superordinates or colleagues from previous institutions.12 Because influence and credibility are tightly linked to visibility, lack of visibility within their institution or their network of colleagues means that it is harder to judge if a woman has the “right stuff” to lead.13

Being underpaid and undermentored seems to translate into a virtual “personal glass ceiling”—that is, women underestimating their own abilities and internalizing the difficulties they face. And as Stephen Jay Gould has remarked: “Few tragedies can be more extensive than the stunting of life, few injustices deeper than the denial of an opportunity to strive, by a limit imposed from without, but falsely identified as lying within.”14(p133) All these factors reinforce each other, resulting in many women losing their ambitions and confidence and hence becoming less likely to successfully compete for raises, publication, and grants.

Even though the interactions of these influences are exceedingly difficult to tease out, this study is timely and important for the following reasons. One, given that 50% of medical students are women, the future of any specialty is inextricably linked to its development of women professionals. Two, women achieving more of their leadership potential will strengthen research, medical education, and patient care.15 Three, the paucity of women achieving senior ranks and leadership positions is becoming more of a liability. Diverse teams outperform homogeneous ones and in natural systems, as diversity increases, so does stability and resilience.16 Three decades after women began to enter the profession in force, however, few board rooms or key committees include more than a token number of women, such that few men have experienced the improved dynamics and productivity when a group is close to half men and half women. A recent study17 of corporate boards found that when a board includes 3 or more women, its overall performance improves because discussions are broadened to better represent concerns of a wider set of stakeholders; because there is more dogged pursuit of answers to difficult questions; and because women employ a collaborative approach, which improves communications.

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The Intersection of Gender and Generational Differences 

Another reason why action is imperative is that many gender and generational differences reinforce each other, that is, many of the career development issues that women have been raising are also increasingly of concern to men in the younger generations. One generational difference of central importance is that Generation X is the first in which both parents were likely to work outside the home and in which parental divorce became prevalent. In part because of these life experiences, Generation Xers are seeking a greater sense of family and are less likely to put jobs before family the way their Boomer parents did. Among Generation Xers, men as well as women are seeking more temporal flexibility than the typical faculty appointment allows and, while committed to their work, are rejecting the pursuit of excellence through personal sacrifice. Compared with their parents, both sexes of the younger generations are also more actively seeking a collaborative style of leadership, a positive work climate, and opportunities for frequent feedback and skill development.18

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Recommendations to Accomplish the Work that Remains 

Improvements to complex systems do not occur naturally or develop out of the coping mechanisms of isolated individuals. The issues that Wagner et al1 delineate are not “women’s issues” —they are “our” issues as a profession because gender differences in career preferences are decreasing and because rehabilitation medicine needs all its members to realize their potential.

Based on my work at over 100 academic health centers (AHCs), I recommend focusing energies in the following directions: (1) updating approaches to faculty and leadership development and mentoring, (2) more flexible faculty structures, and (3) chair support and accountability.

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Updated Approaches to Faculty and Leadership Development and Mentoring 

The professional development needs of women are best addressed within the context of assisting all faculty to realize their potential and to make the most of their faculty appointments. For example, as Wagner suggests: “Development of a mentorship program for residents, students, entering faculty, as well as chairs and senior faculty, may very well have a positive impact on the rehabilitation research enterprise. When implementing these mentorship programs, the specific needs of women within the current culture … should be emphasized.”1(p566)

Mentoring is a professional activity that medical schools should formalize and recognize as a core academic responsibility. Faculty can be taught to improve their techniques of active listening, avoiding assumptions, and combining an optimal balance of support and challenge, thereby maximizing their impact in the limited time available for this activity.

The way in which individual leaders might be able to make the biggest impact is to improve their advocacy and mentoring of women. Men who make the extra effort to help women see their own potential, to connect them to key people, and to prepare them for leadership roles will have the satisfaction of witnessing a great impact on their development.

A primary goal of efforts described above is building a supportive ecology in which collegial relationships develop naturally. In addition to one-on-one mentoring programs, an emerging model is collaborative and peer mentoring programs, for instance, facilitated group mentoring that provides a framework for professional development, emotional support, and career planning.19 This updating of mentoring practices also responds to medicine’s need for new models of mutuality and “facilitative” leadership based on shared authority.20

With regard to the development of leaders, with the generational differences mentioned above and with leadership challenges accelerating, it is risky to assume that the “cream” will continue to “rise to the top,” ready and skilled for tomorrow’s demanding leadership roles.21 Many AHCs are now creating internal leadership development programs.22 (A compilation of extant programs is available from Association of American Medical Colleges’ Faculty Development and Leadership Program.) While women should take advantage of such programs, they also greatly benefit from programs designed to equip them to manage the extra challenges they face. The Executive Leadership in Academic Medicine Program on Women23 and those offered by the Association of American Medical Colleges are worthy examples.

More Flexible Faculty Structures 

As Wagner et al1 note: sex differences in obtaining funding and in research productivity are probably linked to substantially differing personal responsibilities and to women’s being much less likely to have full-time support at home. The model of success in academic medicine is still based on the career trajectories of men not primarily responsible for home life, who completely devote themselves to their careers, and who tend to value independent work over team work.24 While this model no longer fits many young physicians, this “either advancement or family” thinking continues to interfere with academic medicine’s exploration of alternatives. Given that both men and women increasingly seek opportunities that permit robust personal lives and ways to integrate family with professional life, AHCs need to reduce where possible the most disadvantageous features of promotion policies, especially during the decade following residency training when most physicians have young children.

Part-time pathways that can expand and contract as personal issues emerge are vital to making academe competitive with other medical career paths.25 Adaptive structures include nonpunitive less-than-full-time alternatives and adding off- and on-ramps.26 While such options may incur some up front costs, they are less expensive than recruiting and on-boarding replacements. Offering less-than-full-time options and temporal flexibility is effective stewardship of a department’s investment in young faculty in that the availability of such options also builds commitment and loyalty in people who have many decades of active professional contributions ahead of them.

Accountability 

Department heads hold the keys to faculty vitality and to improving faculty-related practices. To be sure, department chairs already have a lot on their plates. But they need to include on their list of priorities ways to increase the percentage of women faculty at each rank. During annual performance reviews, some deans now include chairs’ progress in achieving greater faculty diversity. In particular, administrators and faculty should be accountable for their competencies in mentoring “across differences,” that is, people of a different sex, ethnicity, and career stage. If junior faculty are given the opportunity to evaluate their chairs and mentors on such indicators as “provides timely feedback that both challenges and supports me,” “advocates effectively for my development,” and “inspires me as a role model,” this will build a database that can be used for both summative and formative purposes. Linking effectiveness in these areas to a consequence of value, such as approval of new positions or access to faculty development resources, would add weight to this evaluation.

To accomplish these improvements, department chairs deserve support from their dean’s offices. The most forward-looking schools offer substantial faculty development programs and resources, building partnerships with chairs in becoming better developers of their human resources. They also offer educational sessions on improving mentoring and connection to coaches.27 A staple of leadership development in the corporate world, one-on-one executive coaching has been shown to increase the capabilities of motivated professionals particularly in the areas of accomplishing objectives and improving relationships. Career and executive coaching can also greatly assist women in achieving their potential, especially for those who have lacked effective mentoring and for those just stepping into their first administrative role.

As Wagner recommends, accountability for compensation equity is also key, with departmental leaders checking regularly to ensure that women are fairly paid. For the reasons discussed above, sometimes “fair” can be difficult to determine; but regular examination assures that serious unexplained differences do not go unaddressed. Although paying women less may seem innocuous, such discrepancies in compensation can take down morale, increase attrition, and open a department to legal action; all of these undermine from the attractiveness of academic physiatry to young women.

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Conclusions 

Women are a burgeoning source of intellectual capital, but without targeted action to facilitate its realization, this talent will not reach fruition. As women comprise ever-increasing percentages of the talent pool and as the challenges facing physiatry multiply, access to and realization of this talent becomes more critical.

As Wagner recommends, the rehabilitation community must actively engage in a meaningful dialogue about how to effect necessary changes. I have suggested a number of credible directions. Each member of the community who cares about the future of the discipline is challenged to contribute to these dialogues and actions.

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References 

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 See article p 560

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

PII: S0003-9993(07)00175-X

doi:10.1016/j.apmr.2007.02.038

Refers to article:

  • How Gender Impacts Career Development and Leadership in Rehabilitation Medicine: A Report From the AAPM&R Research Committee

    Amy K. Wagner, Jacinta McElligott, Leighton Chan, Eugene P. Wagner, Neil A. Segal, Lynn H. Gerber
    Archives of Physical Medicine and Rehabilitation May 2007 (Vol. 88, Issue 5, Pages 560-568)

Archives of Physical Medicine and Rehabilitation
Volume 88, Issue 5 , Pages 683-686, May 2007

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