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Published On May 04, 2017

Policy

Why Aren’t Women Running Hospitals?

Reshma Jagsi suggests that sponsorships may play a big role in the gender imbalance at the top levels of academic medical centers.

Women are entering biomedical research and medicine in numbers never seen before. Yet only 18% of health care CEOs and 16% of medical school deans are women. The gender make-up of journal editors and among chairs of medical departments has also failed to keep pace with the prevalence of women in the profession.

Reshma Jagsi first noticed this gap during her residency training in oncology more than 10 years ago. Now deputy chair in the department of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, Ann Arbor, Jagsi has published several studies looking into the reasons that women aren’t rising to the top.

Her most recent finding, published this month in JAMA Internal Medicine, suggests that relatively few women lead the field because they are less likely than men to be “sponsored”—taken under the wing of senior researchers, who can ensure that they get access to the right career opportunities.

Q: How do we know that there’s a gender problem in medicine? 

A: Much of my research has focused on the people you would expect to become leaders in hospitals—people who received K08 or K23 awards from the National Institutes of Health, which go to support additional training for some of the brightest minds in the field. These individuals have demonstrated high aptitude and commitment, so if men and women who get them end up with different levels of career success, that should be a concern. 

In a 2009 study, we showed that women in this group were less likely to get subsequent NIH grants. In other studies, published in JAMA and Academic Medicine, we showed differences in compensation. About a decade after they received a K award, the women physicians in this group made $12,000 less per year than their male peers—even after controlling for medical specialty, productivity and a host of other factors.

Q: Your recent JAMA Internal Medicine paper is about the role of sponsorship. What is that?

A: Mentors are people who provide young scientists with guidance and support. A sponsor does more than that, putting a little of his or her own reputation on the line to make an opportunity available to a protégé. If a sponsor can’t present their research at an important conference, for instance, they might tap a protégé to go instead.

In recent years, people who study this subject in the business world have focused on how gender differences in sponsorship may help explain differences in career trajectories. So it made sense to consider whether that’s also the case in academic medicine.

Q: What were your findings?

A: We looked at more than a thousand junior faculty members who had received their K awards between 2006 and 2009. We asked them whether they had experienced certain interactions that would be considered sponsorship.

For both men and women in academic medicine, being sponsored was associated with success defined by typical metrics emphasized in the academic promotions process, like publications, grants, and leadership positions. But there were significant sponsorship differences between men and women. More men reported sponsorship experience of any kind. Men with male mentors were most likely to report having had at least one sponsorship experience, whereas women with female mentors were least likely.

Q: What explains the sponsorship gap for women?

A: Unconscious bias probably plays a big role. People in a position to sponsor other individuals are likely to seek out those who remind them of themselves. So it’s not terribly surprising that you see white males often being selected for sponsorship, because those who hold the power in academic medicine still are by and large male.

Another possibility is that women are less actively requesting sponsorship. A request for sponsorship might be considered perfectly appropriate from a man, but seen as unseemly coming from a woman.

Finally, the sponsor benefits from choosing a protégé who is very likely to succeed. Given all the challenges faced by women and minorities, it might be in a sponsor’s self-interest to choose someone who doesn’t have to face those obstacles.

Q: What’s the lesson to medical leaders?

A: As professionals in academic medicine, we haven’t been particularly mindful of this concept of sponsorship. Part of our goal in doing this study was to make people realize what sponsorship is and when they’re engaging in it. Most of us don’t even consciously realize that sponsorship opportunities are a scarce resource that we are in charge of allocating. And when we do this in different ways for male and female colleagues, it has an impact.

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