Tackling the Sponsorship Gap for Women in Healthcare in the #MeToo Era

I was recently in a room full of powerful women in healthcare (suffering from imposter syndrome myself) for the Women of Impact annual meeting. There was one comment that stuck out to me that I had only heard in passing but not actively voiced in a meeting. Is the #MeToo movement going to result in a backlash for women leaders? This may sound silly since #MeToo is long overdue and really is about promoting a culture and environment free of sexism and sexual harassment in the workplace for women. I had just seen this strong display of #MeToo on the ESPY awards led by all of the brave women gymnasts on the US Olympic team who suffered atrocities at the hands of a doctor no less.

“To all the survivors out there, don’t let anyone rewrite your story. Your truth does matter. You matter. And you are not alone.”

Tonight, Aly Raisman and her sister survivors brought the #ESPYS audience to their feet. pic.twitter.com/0sVTI0wLUH

— ESPYS (@ESPYS) July 19, 2018

As a result of #MeToo, conversations about women in the workplace are happening in healthcare ranging from in the hospital to the board room. There is a great interest in promoting women in medicine. In the past few months alone, the American Medical Association passed a resolution on gender equity and the American College of Physicians issued a landmark paper about advancing gender equity in compensation and career advancement for female physicians that was published in the Annals of Internal Medicine.

Newsflash: @AmerMedicalAssn passed “Advancing Gender Equity in Medicine” (@DrSinhaEsq & I co-authored) addressing #MedPayGap & more for #WomenInMedicine. Check out the “immediate actions to reduce gender bias”. Credit & huge thx to partners #AMAYPS @Cardiology @AmCollegeGastro pic.twitter.com/m4CTFh8Xtb

— Julie Silver, MD (@JulieSilverMD) June 11, 2018

However, one question remained… are we making progress where it comes to getting women into healthcare leadership positions? While there has been some progress towards more women professors in academia and at the top leadership levels and in board rooms, the progress has been frustratingly slow. Between 2003 and 2013, the percentage of female full professors increased less than 1% per year.

One reason for this glacial pace is a documented sponsorship gap for women in healthcare. In contrast to a mentor, a sponsor is an influential figure who can actively help you advance your career through using their influence to advocate for you. Studies show that women are overmentored but undersponsored. As a woman, one may wonder how does one get sponsored. Well some of it is being in the “room” where it happens. While women may be at the leadership table, are they invited to socialize or have drinks where such opportunities for professional growth may be mentioned or discussed? That is where #MeToo comes in.  In response to #MeToo, some male leaders may be more reluctant to socialize with women outside of the workplace for fears of inappropriate behavior. This could exacerbate the already bad sponsorship gap. So what can women do to close this gap to make sure they are at the table where it happens?

• Actively seek sponsorship. This may sound silly, but that is exactly what I was asked to do by my Chairman who suggested I actively seek a sponsor to nominate me for a top research honor. After looking at the limited numbers of academic faculty who understood my research who were part of this group, I found a familiar name- Sanjay Saint, a hospitalist extraordinaire from Michigan. As awkward as this was, I reached out to him and asked him to straight up be my sponsor, and fortunately, he said yes. It also opened more doors as he invited me to author a paper on sponsorship with not only him, but Vineet Chopra, completing the dream of writing with my namesake (and someone I am often confused with!).
• Advertise your interest in leadership. I have been on search committees that explicitly try to get more women, and invariably the conversation assumes the woman is not movable because of her husband or kids or this is not the right “time” in her life to take on a leadership position. This is a dangerous implicit bias that holds qualified women back as they are not invited to interview due to assumptions of their personal life. Even when not being considered for top leadership positions, younger female colleagues may not be considered to chair a committee because “they have too much going on at home” or give a talk because “it is too hard for them to travel.” This easiest way to overcome this bias is to take control of your narrative by calling it out. When I was coming back from maternity leave, I knew I may fall into this trap. I ended up strategically sending a few emails to let key national leaders know of my continued interest in leadership so I would not be “relegated to the mommy status.” Several of those key leaders called me later to say they had an opportunity that I could help with.
• Highlight your accomplishments. This is particularly uncomfortable for women. In fact, a recent Annals of Internal Medicine piece highlighted that in one residency program, something as simple as “shout outs” tended to be skewed towards the male colleagues not because the females were not doing amazing things like publishing or presenting…but they were not telling anyone. To overcome this, they undertook a systematic way to figure out accomplishments that does not rely on self-report.

Really amazing article highlights what happens when you rely on ppl to report their accomplishments. Men do and women don’t. Not just trainees but Faculty issue too. Why having a ring of women advocating for each other is key! @jeannemfarnan @LaurenFeldMD https://t.co/pe7v0WPZV6

— Vinny Arora MD MAPP (@FutureDocs) July 18, 2018

However, that may not always be possible. If you cannot possibly face advertising your own accomplishment, ask a trusted friend to do it for you. In my own organization, several women I worked with decided if any of us had success, one of the others would share it so it would reach our leadership. The biggest mistake women can make is assume “someone will find out.” In this day and age, information has to be pushed and the best person to push it is you, and if you can’t, ask a trusted friend.

• Build your brand as an expert. I have been struck by how important reputation and brand is for physicians these days. One easy way to build your brand is through the use of social media. While I have been a big advocate of Twitter, the first step is to get a LinkedIn profile so that you can advertise your own work experience and accomplishments. LinkedIn is quickly becoming an important platform for networking about jobs and other opportunities. If you are looking for where to start, look no further than the excellent primer by KevinMD. 
• Be present with a capital P. I have been struck by how many times just showing up and contributing in whatever way possible highlights that you are a potential leader in this chaotic and fast-paced environment. We have all gone to meetings or grand rounds and have been buried in our phone (me included). But the truth is that if you pause to ask a question and show that you were listening and processing, the speaker will often recognize that you were interested and will be interested to know more about you.

While these strategies are focused on the individual, of course true change will not happen until the culture and system change to support more leaders in healthcare. A recent systematic review highlighted that “bottom-up” approaches that rely exclusively on women to advocate for themselves are likely to fail without a “top down” leadership approach. Groups like the 30% club are calling for at least 30% women on boards in the for profit sector. In the UK, the Athena SWAN Charter was established over 10 years ago to “encourage and recognise commitment to advancing the careers of women in science, technology, engineering, maths and medicine (STEMM) employment in higher education and research“ based on a commitment to principles of gender equity and inclusion. Given studies show more female leaders is actually good for business and better for employee engagement, the “bottom line” is that it’s high time to also hold healthcare leaders accountable for the promotion and advancement of women in healthcare.