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The challenge for women physician executives.

The Challenge for Women Physician Executives

The magnitude of change in the number of women physicians has been remarkable. In 1985, there were 74,774 practicing women physicians, 14.6 percent of the total physician population and more than triple the 22,011 women physicians in 1970. While this partly reflects a gradual increase in the total physician population from 312,047 in 1970 to 511,090 in 1985, an annual growth rate of 4.3 percent, the average increase in the number of women physicians was nearly quadruple the overall rate of 16 percent.

Even these numbers slightly underestimate the magnitude of the change, because they do not include medical students. The percentage of women college graduates applying to medical school has tripled since 1970, going from .8 percent to the current rate of 2.3 percent. At the same time, there has been a drop from 4.9 percent to 4.2 percent in the percentage of male college graduates applying to medical school. Although this rapid growth appears to have recently plateaued, women now represent an unprecedented 37 percent of medical school students. [1,2]

Power and Promotion

The bad news is that women are still underrepresented and underused in positions of power. Of the more than 14,000 physicians who indicate that they are in "administration" in AMA statistics, only 11 percent are women. [3] Moreover, the data do not specify the level at which these women physicians manage. Studies of women in academic medicine uniformly show that women cluster in lower level, untenured faculty positions, largely in traditionally "nurturant" specialties and primarily in administrative posts dealing exclusively with student and minority affairs. [1,2,4] Women have been much less likely than men to reach senior professional ranks, occupy departmental chairs, or hold administrative positions in academic medicine. One study compared women's and men's promotion rates and found that women physicians are promoted more slowly than men at all levels of the academic ladder and that an increase in the representation of women in colleges does not ensure equalization of promotion rates. [5]

Women are likewise underrepresented in the highest levels of hospital administration, despite the fact that today there are many more women in mid-level roles.

The commonly cited reason, apart from sexism, for women's poor showing in leadership positions has been that women choose not to be leaders: that they lack interest and skill in leadership and that they choose to devote their time to their families rather than concentrate their attention on professional advancement. As late as 1985, studies justifying male physicians as administrators declared that men like wielding power more than women do. [6] However, I think there is more agreement today that when women have an opportunity to be decision makers as medical managers, they enjoy that role. [7]

In 1982, Korn/Ferry International, in cooperation with the UCLA Graduate School of Management, surveyed 300 women executives at major corporations. [8] Although these were nonphysicians, their responses are similar to those found in surveys of women physician administrators. The women's survey asked respondents to identify "the greatest obstacle you had to overcome to achieve your success." The greatest number (39 percent) replied that it was "being a woman." No other answer even came close. In second place with 11 percent was "lack of confidence."

Although this survey was taken almost 8 years ago and the women polled were relative pioneers in the corporate world (their average age was 46), the problems they encountered have not disappeared. One high-level corporate woman suggests that the reason women are not making it at the top is that the male CEOs of most U.S. corporations have never worked for a woman let alone with a woman, and thus have little knowledge of what a competent female executive can do. [9]

The higher you get in a company, the more you want the people around you to be like you. Rosener calls this a subconscious form of discrimination. [8] Men are used to seeing women in support roles, not running the company, and have trouble getting over this stereotype. This is a "chicken and egg" problem. Men are more likely to accept women in high-level management jobs once they have seen them performing in these roles. At the same time, lack of female role models is frequently cited by women as a handicap for women professionals.

For women physicians, there are varied routes to administration. In 1987, Dickstein surveyed more than 1,200 women physician-administrators in internal medicine, pathology, pediatrics, psychiatry, and public health, the specialties that have traditionally attracted the most women. The women ranged in age from 40 to 60. Twenty-eight percent began working in administration immediately after training, 39 percent after years in practice. Twenty-seven percent began administrative work on a part-time basis, 39 percent full time. Only 21 percent said they chose an administrative role because they wished for it; 26 percent selected administration because of their interest in organizational systems, and 21 percent characterized their appointments as "by accident." [7]

Today, women physicians and nonphysicians can approach management careers more directly. The prediction for corporate positions for nonphysicians is that, within the next 10 years, the fastest track for women will be general management. This is because there has been gradual recognition of the fact that the best CEOs need a generalist's view of the organization rather than that of a finance, marketing, or production specialist. Likewise, I believe, the best physician managers will be trained in more general medical fields, such as family practice and internal medicine.

To get a better picture of the current status women in medical management and the roads that women typically take to their management positions, I interviewed several women physician executives. All of the women I interviewed said they enjoyed management and had opted for their management positions "as part of their overall career enhancement." Most said that their desire to be managers grew out of a desire to be a policy maker and the chance to provide top management support for medical practitioners and to influence the larger picture. In addition, at least one noted the emerging importance of professional roles in managing the technical complexity of various cost-containment programs. A few said they joined management out of "frustration with what's happening in medicine today" or because they see erosion of physician control over patient care.

Are Women Better Managers?

Over the years, much has been made of the differences between male and female managers. Historically, the perceived differences have been used to keep women out of management. But now it has become fashionable to say that the differences are beneficial, that women will complement men in the management ranks and bring a healthy balance to business.

The basis for declaring distinctions between male and female managers--whether used to exclude or encourage women--is suspect at best. When you review the literature, you find that often only opinions or anecdotes rather than data are given to support such claims. Where there has been some data analysis, it is often based on comparing women and men in general or those from occupational groups other than management or at different levels of management. The few studies that have actually looked at men and women in comparable managerial roles have concluded that there are more similarities than differences.

Several researchers recently found that very few personality differences exist between male and female executives. [12] Based on analyses of tests measuring personality dimensions, intelligence, and behavior in problem-solving groups, the researchers concluded that women executives are just as able as men to lead, influence, and motivate other group members; to analyze problems; and to be task-oriented and verbally effective. However, extensive interviews with participants from both sexes, as well as with insiders at their companies who were responsible for identifying and selecting executives for top positions, showed that women had to jump through more hoops and prove themselves in ways that were very different from the men.

Stereotypical perceptions of differences between the sexes seemed to lead to unrealistic expectations of women executives. Women had to show their toughness and independence and at the same time depend on others. They had to be seen as different, "better than women" as a group. Yet they couldn't go too far and forfeit all traces of femininity, because that would make them too alien to their superiors and colleagues. In essence, their mission was to do what wasn't expected of them, while doing enough of what was expected of them as women to gain acceptance. The conclusion is that the environment for women is qualitatively different than the environment in which men operate.

How Can Women Move Up?

I've put together some tips that I've gathered from both my own experience and that of other women physicians and nonphysicians in management roles.

Strive for excellence. Look for ways to polish your skills and use them as building blocks to move ahead. The physician manager must have an understanding of the details of the business of health care, including finance, accounting, strategic planning, information systems, organizational behavior, human resources, and relevant legal issues. Even if you have a formal degree, you will need to integrate your reading and study with experience. So, take every opportunity to obtain practical experience within the organization. The medical world is full of committees, task forces, etc. that can offer an exposure to administration, working with people and systems, and problem solving.

Educate yourself about your organization, whether it be an HMO, a private medical group, a corporate environment, industry, a university hospital, etc.

Network with people, both inside and outside the organization, whom you can tap for information and support.

Take the initiative. Don't expect any handouts. In the corporate world, upper management promotes people who see and seize opportunities, so be on the lookout for projects you can take on. If you see something that needs changing, develop a plan and present it to senior management. Whenever possible, take on projects that make you visible.

Be a risk taker. Be willing to grab opportunity where and when you find it. Whenever you read profiles of people who've had high-level management positions, you find that they generally got where they are by taking some risks. A big element of risk taking is changing jobs and taking on new assignments. For women, having supportive spouses and families is critical.

Select the right subordinates. If you're a middle manager, the personnel you select will determine how well-suited you are for senior management. Senior managers are generally judged not by how well they do, but by how well their staff does. Senior managers must present a clear vision of the future of their organization. They need to be leaders for change.

Find a mentor. This is not always easy, but a good mentor can make all the difference in moving up.

I believe that if physicians are to protect the profession, they must be represented by physicians who articulate in the language of other health care policy makers. I also believe that women should be among those leaders. Women now make up a third of medical school classes and are moving into clinical areas traditionally off limits to women. The challenge for the future is for women physicians to also move into top management positions.

REFERENCES

[1] Martin, S., and others. "Careers of Women Physicians: Choices and Constraints." Western Journal of Medicine 149(6):758-60, Dec. 1988.

[2] Bickel, J. "Women in Medical Education: A Status Report." New England Journal of Medicine 319(24):1579-84, Dec. 15, 1988.

[3] Physician Characteristics and Distribution in the U.S. Chicago, Ill.: American Medical Association, 1986.

[4] Braslow, J., and Heins, M. "Women in Medical Education: A Decade of Change." New England Journal of Medicine 304(19):1129-34, May 7, 1981.

[5] Wallis, L., and others. "Advancement of Men and Women in Medical Academia: A Pilot Study." JAMA 246(20):2350-3, Nov. 20, 1981.

[6] Talbott, J., and Bachrach, L. "Administrative Psychiatry: What Sort of Job Is This for a Woman?" Administration in Mental Health 12(4):253-63, Summer 1985.

[7] Dickstein, L. "National Survey of Women Physicians in Administrative Roles." Journal of the American Medical Women Association 42(4):108-11, July-Aug. 1987.

[8] Korn, L. The Success Profile. New York, N.Y.: Simon and Schuster, 1988, pp. 157-85.

[9] Hurd, J., Personal Communications, 1989, 1991.

Deborah M. Shlian, MD, MBA, recently left her position as Director of Primary Care, UCLA Student Health Service, Los Angeles, Calif., to form Deborah Shlian and Associates, a medical management recruiting and consulting firm. She is an associate member of the College's Forum on Women in Medicine and Management.
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Author:Shlian, Deborah M.
Publication:Physician Executive
Date:Mar 1, 1991
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