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      A Qualitative Analysis of Career Advice Given to Women Leaders in an Academic Medical Center

      , MD , 1 , , JD 1 , , MD 1 , , MFA 1

      JAMA Network Open

      American Medical Association

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          Key Points

          Question

          What advice regarding the workplace and management strategies are perceived as useful to women leaders in academic medicine?

          Findings

          In this qualitative study based on responses from 40 women leaders at the Mayo Clinic, we found that advice could be grouped into 4 categories: leadership styles are perceived as having gendered qualities, a strategic process is required to gain leadership skills, conflicts between personal life and the workplace will occur and should not be a deterrent, and leadership pathways for women involve inevitable hurdles.

          Meaning

          The findings of this qualitative study suggest that a long-term view of attaining gender equity for women leaders at academic medical centers will require a combination of programs, including disruptive institutional initiatives and grassroots efforts; 1 approach involves highlighting and disseminating career advice received by female leaders, particularly advice that others have found helpful.

          Abstract

          This qualitative study solicits the perspectives of women leaders on the workplace and cultural changes that need to take place in academic medicine to increase inclusivity and gender equity.

          Abstract

          Importance

          Women in academic medicine continue to face systemic obstacles on their paths to leadership. In addition to improving recruitment and advancement opportunities, academic medical centers must facilitate a cultural shift that ensures sustained leadership pathways for women.

          Objective

          To better understand, from the perspective of women leaders, the workplace and cultural changes that need to take place in academic medicine to increase inclusivity and gender equity.

          Design, Setting, and Participants

          This qualitative study of 40 women physicians and administrators with senior leadership roles at Mayo Clinic, a nonprofit academic medical center and research institution with campuses in Arizona, Florida, and Minnesota, examined participants’ responses to a question regarding their paths to leadership. Replies were submitted between November and December 2018.

          Main Outcomes and Measures

          Women were asked to describe career advice (positive or negative) they had received that was the hardest to accept but, in retrospect, turned out to be valuable.

          Results

          Of 40 participants, 25 (63%) were physicians and 15 (37%) were administrators at Mayo Clinic; 27 (68%) had achieved the role of chair or the administrative equivalent. Career experience ranged from 6 to 40 years. Of the 40 women leaders queried, 38 (95%) provided written responses, which were separated into the 4 following categories: leadership styles are perceived as having gendered qualities, attaining leadership skills involves a strategic learning process, collisions between personal life and the workplace should not deter individuals from pursuing leadership roles, and leadership pathways for women involved hurdles. These categories represented a roadmap illuminating perceptions about the academic medical workplace.

          Conclusions and Relevance

          These findings link generalizable principles to help to drive new strategies for gender parity. Shifting the culture of academic medicine begins with fully understanding impediments to women’s advancement. The advice women leaders recounted offered a roadmap as well as a glimpse of the extra effort required for women to succeed amid some of the system’s limitations and obstacles. A more complete understanding of gender biases may help to shape future programs to expand inclusivity and establish sustained leadership paths for women.

          Related collections

          Most cited references 15

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          • Abstract: found
          • Article: not found

          Sex Differences in Academic Rank in US Medical Schools in 2014.

          The proportion of women at the rank of full professor in US medical schools has not increased since 1980 and remains below that of men. Whether differences in age, experience, specialty, and research productivity between sexes explain persistent disparities in faculty rank has not been studied.
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            • Abstract: found
            • Article: not found

            Faculty perceptions of gender discrimination and sexual harassment in academic medicine.

            Gender-based discrimination and sexual harassment are common in medical practice and may be even more prevalent in academic medicine. To examine the prevalence of gender-based discrimination and sexual harassment among medical school faculty and the associations of gender-based discrimination with number of publications, career satisfaction, and perceptions of career advancement. A self-administered mailed questionnaire of U.S. medical school faculty that covered a broad range of topics relating to academic life. 24 randomly selected medical schools in the contiguous United States. A random sample of 3332 full-time faculty, stratified by specialty, graduation cohort, and sex. Prevalence of self-reported experiences of discrimination and harassment, number of peer-reviewed publications, career satisfaction, and perception of career advancement. Female faculty were more than 2.5 times more likely than male faculty to perceive gender-based discrimination in the academic environment (P < 0.001). Among women, rates of reported discrimination ranged from 47% for the youngest faculty to 70% for the oldest faculty. Women who reported experiencing negative gender bias had similar productivity but lower career satisfaction scores than did other women (P< 0.001). About half of female faculty but few male faculty experienced some form of sexual harassment. These experiences were similarly prevalent across the institutions in the sample and in all regions of the United States. Female faculty who reported being sexually harassed perceived gender-specific bias in the academic environment more often than did other women (80% compared with 61 %) and more often reported experiencing gender bias in professional advancement (72% compared with 47%). Publications, career satisfaction, and professional confidence were not affected by sexual harassment, and self-assessed career advancement was only marginally lower for female faculty who had experienced sexual harassment (P = 0.06). Despite substantial increases in the number of female faculty, reports of gender-based discrimination and sexual harassment remain common.
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              Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce.

              To evaluate factors associated with work-home conflicts (W-HCs) of US surgeons and their potential personal and professional consequences. Cross-sectional study. Members of the American College of Surgeons. Burnout, depression, quality of life, alcohol use, career satisfaction, and career decisions (ie, reduce work hours or leave current practice). Of 7197 participating surgeons, 3754 (52.5%) had experienced a W-HC in the previous 3 weeks. On multivariate analysis, hours worked per week, having children, sex, and work location (Veterans Administration or academic center) were independently associated with an increased risk for W-HC (all P < .01), while some factors (increased age and subspecialty field) reduced the risk. Surgeons with a recent W-HC were more likely to have symptoms of burnout (36.9% vs 17.1%; P < .001), depression (50.9% vs 28.1%; P < .001), alcohol abuse/dependency (17.2% vs 14.4%; P = .003), and were less likely to recommend surgery as a career option to their children (46.0% vs 54.4%; P < .001). Work-home conflicts were also independently associated with surgeons reporting a moderate or higher likelihood of planning to reduce clinical work hours (odds ratio, 1.769) and leave their current practice in the next 24 months for a reason other than retirement (odds ratio, 1.706) after controlling for other personal and professional factors. Integrating personal and professional lives is a substantial challenge for US surgeons. Conflict in this balance appears to be a major factor in their decision to reduce work hours and/or move to a new practice, with potential substantive manpower implications for the surgical workforce.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                22 July 2020
                July 2020
                22 July 2020
                : 3
                : 7
                Affiliations
                [1 ]Mayo Clinic, Rochester, Minnesota
                Author notes
                Article Information
                Accepted for Publication:
                Published:10.1001/jamanetworkopen.2020.11292
                Open Access: CC-BY License JAMA Network Open
                Corresponding Author: Gianrico Farrugia, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 ( farrugia.gianrico@ 123456mayo.edu ).
                Author Contributions:
                Concept and design:
                Acquisition, analysis, or interpretation of data:
                Drafting of the manuscript:
                Critical revision of the manuscript for important intellectual content:
                Statistical analysis:
                Administrative, technical, or material support:
                Supervision:
                Conflict of Interest Disclosures:
                Additional Contributions:
                Article
                zoi200441
                10.1001/jamanetworkopen.2020.11292
                7376389
                32697324
                Copyright 2020 Farrugia G et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                Categories
                Research
                Original Investigation
                Online Only
                Medical Education

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