Diversity and Inclusion

Bridging the Gap: Gender and Leadership in Emergency Medicine

Emergency medicine (EM) residents face many time constraints: long work hours, endless emails, reading lists, research requirements, and lectures. Free time is an even more precious commodity for those with children or family obligations. Accommodating extracurricular commitments in an already packed schedule may seem impossible, and residents, particularly women, may shy away from leadership opportunities.

What Is the Leadership Gap?

During the past several decades, women have come a long way with respect to equality in the workplace, but there are still strides to be made. In a wide array of fields, women are not proportionately represented in executive leadership.1 Only 25% of executive officers and 4% of chief executive officers (CEOs) of Fortune 500 companies are women. Women occupy just 19% of Fortune 500 board seats, despite comprising 45% of the labor force.2

Since 1980, women have outnumbered men on college campuses and have earned 60% of both undergraduate and master's degrees, and about half of all law and medical degrees (47% and 48% respectively).1,3,4 However, women have not moved up into leadership positions at a corresponding rate.4

The Leadership Gap in Medicine

When it comes to leadership positions in medicine, women hold only 25.5% of leadership positions in medical schools and hospitals, including CEOs, executives, and board members.4 In academia, after accounting for age, experience, specialty, and research productivity, women are substantially less likely than men to attain the rank of full professor.5,6 In EM, women make up 36% of residents, 25% of the active EM physician workforce, and 32% of academic EM faculty - but, for example, only 12.5% of the ACEP Board of Directors.

Why Does the Leadership Gap Exist?

Across professions, many have tried to explain the gap in leadership by citing higher rates of maternity leave and more time spent child-rearing, resulting in more part-time women workers. On the contrary, research has demonstrated that motherhood is not a factor in gender disparity.7 No difference has been found in position, title, and/or earnings among female physicians with or without children.7 Some point to overt discrimination, but there appears to be no single or simple answer to explain the leadership gap. When considering women's obstacles to attaining leadership positions, there exist a set of complex challenges, both external and internal.

Given fewer women executives, women may find fewer models for work-life balance and fewer mentors among women leaders. Additionally, many women will experience gender bias as they attain senior roles and leadership positions. Women, far greater than men, find themselves struggling between being liked or being respected as leaders in the workplace.8 Women also face disproportionate professional penalties for starting and raising families.9,10 Women negotiate less for pay and promotions or choose to opt out of certain opportunities in anticipation of starting a family.1

Why Should We Care About the Leadership Gap?

There is a need to implement processes that support life balance for both men and women. All parties benefit from diversity of gender, ethnicity, belief systems, background, and religion by creating diversity of thought. Since women and men may approach problems differently, increasing the number of women leaders will improve our collective efficacy. Additionally, women leadership has been shown to increase revenues and productivity of organizations, including hospitals.4 Studies of Fortune 500 companies have found that the percentage of women among executives and on boards of directors is positively associated with an organization's financial performance and adoption of a transformational style of leadership.11

Why Should Women Residents Aspire to Leadership?

Given the gender-specific barriers to career satisfaction and advancement, personal enrichment, work-life integration, and recruitment and retention of women in EM, women physicians should take an active role in creating and influencing the policies that affect us. Learning to lead early on expands the opportunities to achieve such a lifestyle and has the added benefit of serving patients and colleagues. Additionally, exploring leadership roles may enhance the enjoyment of residency and allows us to find areas of fulfillment within a specific niche in emergency medicine.

How Can Women Get Involved in Leadership?

Resident leadership exists in many forms, such as teaching, presenting publicly, serving as chief resident, joining a national committee, or serving as a program liason to a national organization. Within EMRA, residents may consider joining the Representative Council or various committees and divisions. It is actually very encouraging that the EMRA Board comprises 42.9% women, and that women lead 32.4% of EMRA's Committees and Divisions. Some may argue that the gap is not necessarily in recruiting leaders early on, but in retaining these leaders.

Fortunately, ACEP offers the American Association for Women Emergency Physicians (AAWEP), which was created to provide a network of support and education for women. AAWEP aims to advance the leadership skills of women emergency physicians and promote mentorship opportunities to women at all career stages. Likewise, the Association for Women in Academic Emergency Medicine (AWAEM) aims to promote the recruitment, retention, and advancement of women in academic EM. For residents, organizations such as AAWEP and AWAEM provide opportunities to network with women leaders and discuss the challenges of leadership including negotiation, time management, self-promotion, and problem-solving. To this end, AAWEP has developed the Leadership Pipeline Project (LeaP) to identify and mentor future women leaders.

What is a Leadership Pipeline?

A leadership pipeline is a model developed to help organizations grow leaders internally. It establishes a framework to identify future leaders, assess their competence, and plan their development. According to the model, senior leaders mentor more junior members through each leadership transition, promoting leaders from within the organization.12 At each step, one develops skills unique to that level, which will be useful later in advancing roles.

Figure 1. Gender and Leadership in Emergency Medicine

ACEP Leadership Position # %
Board of Directors    
Female 2 12.50%
Male 14 87.50%
Female 11 26.19%
Male 31 73.81%
Committee Members    
Female 270 28.10%
Male 682 70.97%
Unknown 9 0.94%
Council Members    
Female 169 26.83%
Male 454 72.06%
Unknown 7 1.11%
Chapter Presidents    
Female 9 19.15%
Male 38 80.85%
Grand Total 1696 100.00%

Source: Publication of AAWEP

Take the Leap!

We encourage women residents to assume leadership positions during residency because we know the satisfaction that comes with continued professional growth. Being a leader during residency requires discipline with one's time and obligations, but rewarding new opportunities make the investment worth the effort. Get involved in education and leadership within your residency, and seek out opportunities in national organizations or special interest groups. Take a leap so that we may start to bridge the leadership gap in medicine!

For more information about AAWEP and the Leadership Pipeline Project, visit acep.org/aawep/welcome.



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