Background: Since 2017, women have made up over 50% of medical school matriculates and nearly 50% of resident physicians in the United States. (1,2) However, only 35% of active physicians and 16% of department chairs are women – a number that has remained stagnant and demonstrates the underrepresentation of women in leadership positions in medicine. (3,4) This leaky pipeline contributes to the gender pay gap, lack of diversity in decision making roles, and inflexibility in workplace culture. (5) We sought to learn about the experiences of women in leadership positions in Hospital Medicine groups, in order to inform how best to advance future women leaders within our field.
Methods: We are conducting a qualitative descriptive study using a content analysis approach. We used purposeful sampling to enroll female hospital medicine leaders from both community and academic programs represented in Society of Hospital Medicine Chapters nationally. To date, we have completed 12 interviews. A semi-structured interview guide was used to explore the following domains: leadership journey, challenges experienced, organizational benefits realized, and recommended interventions to support future female leaders. Interviews were audio-recorded, transcribed, and de-identified for data analysis purposes. A general inductive coding approach was used using ATLAS.ti software. At least three team members coded all transcripts and resolved discrepancies through group discussion.
Results: Women in leadership positions within hospital medicine experience a shared set of challenges during their leadership trajectory. Themes with illustrative quotes include: 1) Imposter Syndrome, “I thought I was keeping the seat warm until someone more suitable came along;” 2) Battling Gender Stereotypes, “Trying to figure out the emotional balance that people want to see,” and “When a woman’s emotions run high people will have a knee jerk reaction and say calm down… (but if you) throw the pendulum too far you are perceived as too stoic and not engaged;” 3) Sacrifice in Work-Life Integration, “The need to be present at home is considered a woman’s responsibility.” In contrast, the women also perceived bringing benefits to their organization, including relationship building, personal investment in team members, and group advocacy, “As women, we are more in tune with people… We want to nurture people and make sure their needs are met.” Actionable interventions to support future women in leadership offered by our interviewees, include: 1) Creating venues to share experiences and offer peer support; 2) Building infrastructure for female sponsorship, “Someone who is speaking for you and about you behind closed doors;” and 3) Re-building Workplace Culture, with a focus on flexibility, “You know our role is so blended…we are parents, we are females, we are physicians…and just not having to be so separate from it is important.”
Conclusions: Interventions to further support women in hospital medicine on their leadership trajectory are necessary to seal the leaky pipeline in a field where 40% of providers are women. A robust program may include access to peer mentorship and female sponsorship, and a conscious effort to rebuild workplace culture with a focus on work-life integration.