Curbside Consult with Dr. Jayne 9/18/23

Over the years, I’ve been on a number of panels and attended several forums to discuss the participation of women in clinical informatics. One of the most memorable ones was last spring as part of the CHIME track during ViVE, when the CHIME League of Women presented “Mentorship in Action.” We had a chance to understand how mentor/mentee pairs have been instrumental in boosting the presence of women in healthcare IT.

Just anecdotally, when I look at the composition of leadership teams in non-healthcare IT organizations, it seems like there are more women than I see in my own field, but I don’t have any data to back up that sentiment.

A recent article in the Journal of the American Medical Informatics Association titled “Accomplished women leaders in informatics: insights about successful careers” looked at some of the challenges faced by women in the field. Although the study had a relatively small sample size of 16, they looked at women in both academia and industry.

I wasn’t at all surprised when I read the findings: “We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) ‘Big wins’ in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders.”

The authors also noted that “Sexism is undeniably present, although not all participants reported overt gender barriers” and that “women are underrepresented in scientific dissemination, substantially less likely to be in leadership positions, and have not achieved salary parity with men.”

I also wasn’t surprised at some of the statistics, namely that the majority of academic programs and clinical subspecialty fellowships in biomedical informatics are led by men, at 75% and 83%, respectively. The authors also note that men have also held the majority of leadership roles within the American Medical Informatics Association and have received nearly two-thirds of the awards. The article goes on to say that although the National Institutes of Health has recommended conscious effort to promote gender equality, women continue to cite gender imbalances in leadership hierarchies as barriers to advancement.

The article cites specific examples of the themes, some of which really resonated with me. Regarding the idea that careers in informatics are serendipitous, that’s exactly how I wound up in this field. I was looking for a clinical job close to home, and the one that seemed the best fit also had been identified to be a pilot for the “paperless practice” concept for a large health system. The idea that careers are nurtured by supportive communities rings true for me as well, as women made up the entire leadership team of that project, and we supported each other throughout the project’s lifecycle.

One of the major differences of that team compared to others that I’ve been on is that we understood how each other operated and how each other’s efforts supported the team’s overall goals. There wasn’t any competition, and when one of us achieved a milestone or was recognized for something we did, there wasn’t any sense of someone getting ahead or outshining the rest of the team. We shared in each other’s accomplishments as much as we commiserated when things didn’t go well. We stood up for each other when things weren’t quite right.

That concept wasn’t unique to us, as noted by one respondent who explained her strategy to address subtle sexism in meetings: “A colleague who is male will say more or less the same thing [the female said], and that’s what gets picked up on. I call it out. I say ‘Oh, it’s so great that you’ve taken her idea, and now we have it in front of us.’”

Other respondents specifically called out the lack of female participation on boards, as well as differences in how male and female colleagues were treated by leadership. I’ve certainly seen the latter over the last two decades. Sometimes it’s more subtle, such as male leaders inviting male subordinates to sporting events but not their female counterparts.

But in the most egregious situations, I’ve seen male leaders refuse to meet alone with a female subordinate because of concern for potential accusations of impropriety. Male leaders who follow the latter policy actually create an exclusion zone that prevents females from advancing. I would suggest that if they aren’t comfortable meeting with their teams privately, then maybe they’re not the right person for the leadership role.

Women cited specific situations that continue to occur, including differences between recognition of men and women, financial disparities, and women being “spoken over” in meetings. When I see the latter occur in a meeting and don’t see anyone call it out, it’s hard not to think negatively of the leader who allows such behavior to occur on their watch.

Respondents also noted the importance of “being authentic and genuine, not pretending to know something you do not know or being someone you are not, and being true to oneself” as key to being a successful leader. As far as those characteristics, the idea of not pretending to know something you don’t actually know comes up often in leadership books, specifically with references to the idea that men are more likely to project knowledge they don’t possess versus women who are more likely to admit that they need to research or investigate, with the latter being perceived in some circles as a sign of weakness.

It’s like when I was a young physician in that paperless practice. I mentioned in a media interview that having computers in the rooms was great when I needed to look something up. I thought that idea made me sound progressive and that I was seeking the best information for my patient, but in reality, I was chastised by the sponsoring hospital’s vice president for giving the idea that as a physician I wasn’t all-knowing.

The article arrived in my inbox while I had been reading “The Great Stewardess Rebellion: How Women Launched a Workplace Revolution at 30,000 Feet” by Nell McShane Wulfhart. Although the book is about the unequal treatment of female flight attendants in the early days of commercial air travel, there are still a lot of parallels with what women are experiencing today.

Women are often still expected to behave a certain way and have certain appearance standards that aren’t equally applied to their male counterparts. I’ve seen plenty of examples where a woman’s appearance or hair style are called out in a virtual meeting, where no one ever calls out the man with obvious bed head or the one who just slaps on a ball cap to remedy the situation. I’ve heard comments that women look “tired” and “stressed” on days that they don’t wear makeup, which is just a sad commentary on the state of things.

Even though some of the things I read in the article were disheartening, I’m glad that the ideas it brings up are receiving attention in academic circles. Only when we study an issue can we hope to find solutions.

How does your organization handle gender equity? Does it tolerate obvious imbalances or does it engage when people speak up? Leave a comment or email me.

Email Dr. Jayne.