Deborah Shlian is a board certified Family Practitioner and MBA with over sixteen years of managed care experience as both a clinician and manager who brings a unique perspective to health care searches and consulting. She wrote a monograph for the American College of Physician Executives (ACPE) in 1995, Women in Medicine and Management: A Mentoring Guide. ACPE recently asked her to update the topic; the resulting book will be released in March.
Available in March
Last February, the American College of Physician Executives (ACPE) asked me to update a monograph I’d written in 1995 titled “Women in Medicine and Management: A Mentoring Guide”. At that time, only about 19 percent of physicians in the US were women and I had great difficulty finding more than a few women physicians who held low or mid-management positions and almost none in top management. That was true across the entire healthcare system – academia, government, hospitals, managed care and corporate healthcare organizations.
I finally selected 17 representative women physicians and asked them to write their personal stories including how they chose medicine, why and how they transitioned from clinical medicine to management, and what obstacles they encountered along the way. It was clear from these narratives that for most of them, leadership positions had been unplanned and that few had found role models or mentors to help guide their career paths. There was also consensus that a thick glass ceiling existed within healthcare that was thwarting their ability to move into more senior positions.
When I agreed to update the original ACPE monograph almost two decades later, I expected the situation to be significantly improved. After all women have been entering medicine in increasing numbers since 1995, so that today 50 percent or more of the students enrolled in many medical schools (including my alma mater) are female. Unfortunately, as I researched the latest statistics, I discovered that women physicians are still underrepresented and underutilized in positions of power- especially at the most senior levels.
Barnard College president Debora Spar has labeled the marginalization of US women in senior leadership as a “16 percent ghetto.” While she identified this phenomenon in aerospace, engineering, Hollywood film, higher education and Fortune 500 companies, I learned that Spar’s observations apply equally to women physicians. In 2012, no more than about 16 percent of the the top leadership positions in any area of the healthcare system are held by women doctors.
For my updated book I was able to find 24 exceptional female physicians who have defied the odds by rising to top management posts. The title is “Lessons Learned: Stories from Women in Medical Management” and will be released in March, In it, women like Dr. Ora Pescovitz, CEO of the University of Michigan Healthcare System, Dr. Ellen Strahlman, Senior VP, Office of the CEO, Global Head, Tropical Diseases at GlaxoSmithKline, and Dr. Florence Haseltine, Emerita, Director of the Center for Population Health at the Eunice Kennedy Shriver National Institute for Child Health and Human Development at NIH share their career paths from clinical medicine to leadership within academia, pharma, government, hospitals, provider groups, managed care, consulting and entrepreneurial ventures, including the obstacles and challenges faced in balancing work, family, and personal life.
In the Overview chapter, I explore the barriers women physicians continue to confront in seeking leadership roles. For example, in academic medicine, where only 16 percent of medical school faculty are at the full professor rank and only 13 out of 137 deans of US medical schools are women, productivity (i.e. research publications) is generally cited as the primary reason for the gender gap. Yet in a study by Darcy Reed, MD and colleagues at the Mayo Clinic in the January 2011 issue of the journal Academic Medicine, the authors found that although the academic productivity of women lagged behind men in the early and middle stages of their careers, publication rates were similar between genders in the later stages. Reed concluded that academic productivity in mid-career may not be an appropriate measure of leadership skills for women, stating that: “a paucity of qualified women in leadership positions both deprives organizations of the unique skills and perspectives women bring to such roles.”
The commonly cited reason, apart from sexism, for the relatively poor representation of women physicians in leadership positions in other areas of healthcare -both private and public- has been that women choose not to be leaders, that they lack interest and/or skill in leadership, and that they prefer devoting their time to their families rather than concentrating their attention on professional advancement. While past studies justifying male physicians as administrators claimed that men liked wielding power more than women, there is agreement today that when women have an opportunity to be decision makers as medical managers, they enjoy the role and are successful leaders.
Certainly the women in my book “Lessons Learned: Stories form Women in Medical Management” reflect this attitude. They say they opted for management as part of “their overall career advancement”. Most want to be policy makers, to have an opportunity to provide top management support for medical practitioners and to influence the big picture (how groups of patients receive care as well as the environment in which services are delivered).
At a time when virtually everyone agrees that the US healthcare delivery system needs fundamental change, this book ultimately makes the case for talented women physician executives, articulate in the language of health care policy and business, to be among those leading the way.
As an offshoot of the book, I decided to start a blog called Creative Leaders Forum, inviting anyone interested in exploring leadership issues to either volunteer to guest blog or comment on the posts, hopefully initiating some interesting discussion.