The Leadership Gap in Surgery

As more women medical students choose general surgery and surgical subspecialties as a career, the female leadership gap in these areas has become more apparent. Almost 50% of medical school graduates are women, yet women hold fewer than 5% of surgical chair positions in Thoracic Surgery (Figure 1). Why is there a gap? Is it real or perceived? The perception is real but it may also simply reflect a time lag. Approximately 20 – 40% of surgical and subspecialty residents are female; however 15 – 20 years ago, when most chairs completed training, this percentage was <20%. In addition, there are fewer role models for women than men to consider pursuing leadership positions and some women may not be interested in leadership. The issues may be summarized as such: 1. Few women role models→ few women leaders 2. Lack of sponsors→ few women leaders, and 3. Women may have not wanted to lead.

There are both external (or systems) factors and internal (or personal) factors at play in the lack of women in leadership in surgery. External factors include lack of role models: “You can’t be what you can’t see.” Until women see examples of other women leaders, they may not envision themselves filling those roles. Sponsors are highly important to reaching positions of leadership in many fields. The absence of male advocacy has been shown to be a limiting factor throughout the business world. While mentorship is important for personal growth and well-being, sponsorship is particularly more important for career advancement. Studies have shown that women tend to be over-mentored, but under-sponsored.

Internal factors include the tendency to “lean out,” whereby women remove themselves from opportunities because they anticipate conflict with family and home life (real or perceived). This concept of “leaving before you leave” was discussed in the best-selling book Lean In, as well as a key concept in a previous AWS Blog highlighting the book. Other internal factors may be related to women’s perceptions of readiness for leadership or their confidence or training provided to get the job done. In the business bestseller Leadership and Self-Deception, the authors describe self-betrayal as a limitation to advancement. We must not create our own problems and we must be open to others helping us from being boxed in by our own obstacles. The internal challenges can come full circle to the external solutions.

Now that we understand some factors contributing to the gap, what concrete steps can be taken to level the field? The issue was addressed by Dr. Shanda Blackmon (@ShandaBlackmon), president of Women in Thoracic Surgery

(@WomenInThoracic), in a recent talk at the European Society of Thoracic Surgeons (@thoracic) meeting (Figure 2). To address the external factors Dr. Blackmon’s checklist for male leaders would support the advancement of women in our fields, to help them shatter that glass ceiling. They are as follows:

• • • • • • • • Provide sponsors for women
              • Expose them to role models
              • Show flexibility with family issues
              • Enable networking and same-sex mentorship
              • Be aware of unconscious bias; rid the workplace of sexism
              • Encourage women to take “stretch assignments” and to apply for leadership opportunities
              • Praise successes and critique failures of women and men equally and fairly
              • Practice meritocracy

              To address the internal factors, women should figure out what they want, organize their goals and get out of the proverbial box.

              The future is certainly looking brighter with five recent appointments of women to general surgery chair positions. Now we must not lose the momentum to close the leadership gap. We look forward to welcoming you to the second AWS-WTS joint Tweet Chat, covering the topic of the Leadership Gap for Surgeons. We plan to cover the following topics:

              • • • • • • • 1. 1. 1. 1. What are the factors that contribute to the leadership gap?
                                     2. When does the gap become significant?
                                     3. How can the gap be diminished?
                                     4. What are the three action items for improving the gap?

                                     The Chat will be 6/18/18, 7 pm ET. To participate, be sure to follow @womensurgeons and @womeninthoracic as well as the moderator for this chat @vlitlemd and to tag all of your tweets with the hashtag #AWSChat

                                     We hope that you’ll tune in to our chat to discuss more solutions and share your thoughts and experiences!

                                     References
                                     Lean In: Women, Work, and the Will to Lead, Sheryl Sandberg, 2013
                                     Navigating Your Surgical Career: The AWS Guide to Success, ed. Susan Pories, Nancy Gantt, Christine 
                                     Laronga, Dixie Mills, 2015
                                     Leadership and Self-Deception→ getting out of the box, The Arbinger Institute, 2000

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                                     Dr. Mara Antonoff is a mother of 4 and Assistant Professor in Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center. She is the Website Editor and Social Media Director for Women in Thoracic Surgery. At MD Anderson, Dr. Antonoff is also the Associate Program Director for the Thoracic Surgery Training Program. Her twitter handle is @MaraAntonoff.

                                     Dr. Virginia Litle is a mother of 3 and Professor of Surgery at Boston University School of Medicine. She is a Past President of the Women in Thoracic Surgery. At BU, Dr. Litle holds the titles of Chief of Thoracic Surgery; Director of the Center of Minimally Invasive Esophageal Therapies; Director of the Barrett’s Esophageal Program; and Director of Thoracic Surgery Clinical Research. Her twitter handle is @vlitlemd.

                                     Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.