Recruitment and Retention of Women to Leadership Positions in Medicine

1. Recruitment and Retention of Women to Leadership Positions in Medicine Texas Tech University Health Sciences Center 2nd Annual Cultural Competence Seminar April 12, 2013 Elizabeth L. Travis, Ph.D., FASTRO Associate Vice President, Women Faculty Programsetravis@mdanderson.org www.mdanderson.org/womenfacultyprograms

2. Women M.D. and Ph.D. graduates 1966-2010 medical school science & engineering NSF http://www.nsf.gov/statistics/wmpd/tables.cfm and AAMC https://www.aamc.org/data/facts/enrollmentgraduate/

3. Women Faculty in Medical Schools & Universities/4-Year Colleges, by Rank and Field: 2010 Women, Minorities, and Persons with Disabilities in Science and Engineering: 2013, National Science Foundation (NSF) and AAMC Women in U.S. Academic Medicine: Statistics and Benchmarking Report (2011-2012)

4. Women faculty leaders in science and medicine • In NCI-designated cancer centers1 (2012) • 12% of directors • In medical schools2 (2011) • 12% of medical school deans • 14% of department chairs • 22% of division/section chiefs • In science & engineering3 (2010) • 29% of presidents, provosts, chancellors • 30% of deans, department heads and chairs (1) NCI: http://cancercenters.cancer.gov (2) AAMC: https://www.aamc.org/members/gwims/statistics/ (3) NSF: http://www.nsf.gov/statistics/wmpd/2013/tables.cfm

5. Other professions: Women represent: • 18% of the U.S. Congress • U.S. is 72nd of 189 countries for % of women legislators, behind France, Germany, Afghanistan and Pakistan • 20 of 193 (10%) world leaders • <20% of top positions in business, law, journalism • 3% of CEOs of Fortune 500 companies • 5% founders or SAB members in 14 biotech companies • <10% members of SABs of 500 biotech companies since 1976 • But 10-30% of academically active PhDs Knowing Your Value: Women, Money, and Getting What You’re Worth, Mika Brzezinski, 2010

6. Does leadership gender matter? • Departments chaired by women • 89% (8/9) - gender-balanced • gender equity across ranks/tenure status • Departments chaired by men • 30% (13/47) - gender-balancedBUT • > 50% are non-tenured and in junior rank • Significant relationship between chair gender and gender ratio ranking of departments (p=0.004) Gender-balanced (36% to 67%), Female Minority (18% to 35%) and Female Token (0% to 17%) MDACC Faculty Academic Affairs (January 09)

7. Women leaders: • Better suited for the contemporary workplace that values: • Empowering others • Collaborations/ Teams • Sharing information • Rewarding employees • Improves the bottom line1: • - Better financial performance for companies • - Diverse backgrounds for committees • - Patients prefer physicians who look like them (1) The Bottom Line: Connecting Corporate Performance and Gender Diversity, Catalyst, 2004 (2) Cheung FM, Halpern DF, Women at the Top, American Psychologist, April 2010, Vol.65, No.3, 182-193

8. Why should women want to LEAD? • Open doors for others (sponsors) • Signals female friendly culture • Role model for other women • Bring unique qualities to the job

9. Where are the women leaders? 12% of deans are women (N=14) Sr. Associate Dean/ Vice Dean 143 (32%) Assistant Dean 239 (44%) Associate Dean 352 (37%) Why are they not advancing? Why are they not in senior leadership positions? How can we change this?

10. Navigating through the labyrinth “It is not the glass ceiling, but the sum of many obstacles along the way” Demands of family life Gender bias ? Resistance to women leaders Underinvestment in social capital Leadership style Eagly AH, Carli LL., Women and the Labyrinth of Leadership, Harvard Business Review, 2007

11. Unconscious bias Implicit biases are: pervasive unknown predict behavior differ between individuals People have stereotypic associations linking • males with science/careers • females with liberal arts/family • Harvard Implicit Association Test (IAT) • https://implicit.harvard.edu/implicit/demo Source: Project Implicit, https://implicit.harvard.edu

12. Schema: • Expectations or stereotypes associated • with members of a group that guide • perceptions and behavior. • Blind auditions • Evaluation of CVs • Evaluation of resumes • Evaluation of job credentials • Evaluation of fellowship applications • Letters of recommendation • Critical mass reduces dependence • on schemas (30 - 40%) Unconscious bias and gender schemas STRIDE Program at the University of Michigan, Strategies and Tactics for Recruiting to Improve Diversity and Excellence

13. Leadership bias Cultural stereotypes are stacked against women as leaders. Why? It’s because of behavioral traits. Women are construed as COMMUNAL, seen as nice, friendly, socially skilled and egalitarian. Men are considered AGENTIC. They’re described as dominant, assertive, tough-minded and take-charge types. AGENTIC traits are associated with LEADERSHIP Agentic Communal Santovec, Mary Lou. (2010, December). Women’s Metaphor: From ‘Glass Ceiling’ to ‘Labyrinth’. Women in Higher Education, 19(12), 1-2.

14. Double-bind penalizes women leaders Women leaders find themselves in a double bind1. If they are: highly communal → criticized for not being agentic enough highly agentic→ criticized for lacking communion Do they have “the right stuff” for powerful jobs? “Think-leader-think-male” mindset2: Men → largely seen as leaders by default Women → seen as going against norms of leadership/femininity i.e.Women can’t win, with men or women! • Eagly AH, Carli LL., Women and the Labyrinth of Leadership, Harvard Business Review, 2007 • The Double-Bind Dilemma for Women in Leadership: Damned if You Do, Doomed if You Don’t, Catalyst, 2007

15. Recruiting women leaders: Policy matters! • Search committee must be inclusive (35% women/minorities) • AVP reviews search committee members prior to approval • AVP serves as voting member on all search committee Women/minorities on short list sent to the President

16. WFP role in leadership searches • Be Proactive! • Provide list of women/minority faculty to serve on search committee • Identify potential women candidates • Encourage women to be candidates • Educate search committees • Recruit everywhere all the time! • Outcome • Initially had to remind search committee chairs to suggest women and minority members. No longer necessary! • Lack of women candidates now noted by all committee members, close to double the number of women leaders in 4 years • RESULT: Number of women leaders more than doubled in 6 years • Increase from 15% (n=12) to 28% (n=27)

17. Preventing unconscious bias • Inclusive search committee membership >30% women/minorities • All key people in search process take IAT test • Create an objective/structured interview process • Use behavioral interviewing • Be aware • - unconscious bias in letters of recommendation • - cultural differences affect first impressions of candidates • Allow time to review candidates, gender bias creeps in when hurried Corrice, A. Unconscious Bias in Faculty and Leadership Recruitment: A Literature Review, Analysis in Brief, AAMC, 9(2), August 2009

18. Identify them early and groom them • Career development opportunities • Mentors and sponsors Grow Your Own! Diane Bodurka, M.D. VP Karen Lu, M.D. chair Varsha Gandhi, Ph.D. chair Stephanie Watowich, Ph.D. associate dean Michelle Barton, Ph.D. Dean, GSBS Valerae Lewis, M.D. section chief Sharon Dent, Ph.D. chair Elizabeth Grimm, M.D. scientific director, Moonshots

19. Career development programs provide an introduction to the knowledge and skills needed to succeed in academic medicine locally taught by MDACC women faculty who attended national career development programs. Modeled after GWIMS AAMC career development programs Driver: Needs of women faculty are sufficiently unique to warrant targeted programs Rationale for in-house program: • “Pay it forward”/return on investment. • Past attendees are showcased, practice leadership, hone presentation skills • Demand is high for AAMC programs: Not all applicants are accepted • Program costs minimal Outcome/Impact: • 50 women faculty attendees, all present at end of 5 hr. workshop • Program rated very satisfied by attendees • 100% would recommend to colleagues Comments from attendees: • Programming was highly relevant • Programming allows junior women faculty to feel highly supported • Participation of executive leaders signaled support of women faculty

20. Demands of family life Decision makers often assume that married women/mothers have domestic responsibilities that make it inappropriate to promote them to demanding positions. Eagly AH, Carli LL., Women and the Labyrinth of Leadership, Harvard Business Review, 2007

21. A baby or a lab coat? Half of women with salaries ≥$100K & top executives → NO children Only 1/3 of women who began research careers w/o children become mothers Tenured women are twice as likely as male counterparts to be single 12 yrs after obtaining their doctorates. Presence of children Marriage Premium for men - stability and responsibility- economic advantage in workplace Motherhood Wage Penalty for women - opposite effect- less $ than comparable women w/o children and men in general Cheung FM, Halpern DF (2010) Women at the Top: Powerful Leaders Define Success as Work and Family in a Culture of Gender, American Psychologist, 65:182-193

22. A baby or lab coat? • Women twice as likely as men to not pursue tenure-track careers if they are have or PLANNING! to have children • No other factor accounts for as much leakage of women from the research-professor pipeline. (1) Inequality Quantified: Mind the Gender Gap, Helen Shen, Nature, March 7, 2013 (2) Williams WM and Ceci SJ, When Scientists Choose Motherhood, American Scientist, 100(2), 138, 2012 (3) Goulden, M., K. Frasch and M. A. Mason. 2009. Staying competitive: Patching America’s leaky pipeline in the sciences. Center for American Progress

23. Is it a system-level problem? • Women who have made it and the men who work for them think that all they need to do is: • urge young women to be more like them • think differently • negotiate more effectively • rather than make major changes in the way their companies work • Young women might be much more willing to lean in if they saw better models and possibilities of fitting work and life together. Anne-Marie Slaughter

24. Balancing the scale: NSF initiative • Women comprise a significant fraction of the STEM talent pool • They have difficulties in balancing demands of career and life without adequate institutional support. • Utilizing women’s talent and potential in STEM fields is critical to the national’s future success. • NSF’s Career-Life Balance Initiative aims to: • enhance – and implement new – gender-neutral, family-friendly policies • eliminate some of the barriers to achieving career-life balance • engage the academic community in additional actions to integrate the family and professional responsibilities of scientists and engineers.

25. Workplace flexibility isn’t just a women’s issue. • It’s an issue that affect the well-being of our families and the success of our businesses. • -- President Obama • White House Forum on Workplace Flexibility • March 31, 2010 Work-life Balance and the Economics of Workplace Flexibility, Executive Office of the President of the United States, 03/2010

26. Work life balance! THEN NOW Carol Greider and her children, Gwendolyn and Charles Nobel Laureate in Physiology or Medicine (2009) Marie Curie and her children, Iréne and Eve Nobel Laureate in Physics (1903) and Chemistry (1911) www.nobelprize.org

27. Two Body Recruits • PROBLEM Couples comprise 32% of medical school faculty • Women more than men consider partners’ careers as primary (21% vs. 5% ) • But 50% men vs. 20% of women consider their career primary • Difficulty of finding 2 competitive academic jobs • Refuse offers if partners not accommodated • Women are less likely than men to seek out new leadership positions • Fewer women enter a dual hire as the 1st hire in a couple • RESULT → More difficult to move women (1) Dual-Career Academic Couples: What Universities Need to Know, Stanford University, Michelle R. Clayman Institute for Gender Research, 2008 (2) Girod et al. Academic Couples: Implications for Medical School Faculty Recruitment and Retention, J Am CollSurg, 212(3); 310-319, 2010

28. Recruiting & retaining dual-career couples Academic couples are more productive and potentially mobile component of the medical workforce • How do institutions achieve a hiring advantage? • Establish guidelines, clear practices/policies increase transparency, fairness,speed of hiring process • Ask question early in search process regarding dual careersAre there any challenges we need to be aware of? • How to increase diversity and capitalize on a broader range of talent in the medical pipeline? • Recruit women and URM as 1st (rather than 2nd) hires Girod S, Gilmartin S, Valantine H & Schiebinger L, Academic Couples: Implications for Medical School Faculty Recruitment and Retention, J Am Coll Surg, 212(3); 310-319, November 2010

29. Sponsorship Levels the Playing Field

30. “As you move up within an organization, it’s important to have the sponsorship of someone who has enough leverage in the organization to make things happen, otherwise it won’t be effective. In most senior level jobs, you need SPONSORSHIP to make it to the very top.” Elizabeth J. Smith General Manager IBM Corporation Source: Hewlett SA, Marshall M and Sherbin L, The Relationship You Need to Get Right, Harvard Business Review. 10/2011

31. Famous women: Who were their sponsors? Sarah Palin Elena Kagan (John McCain) (President Obama)

32. Sponsorship is Focused on advancement! Predicated on power! • Active support by someone who • is highly placed in the organization • has significant influence on decision-making processes or structures • advocates for, protects and fights for the career advancement of an individual Foust-Cummings H, Dinolfo S, Kohler J. Sponsoring Women to Success, Catalyst, 2011

33. Sponsor… Different breed of cat Sponsors open doors… Ibarra H, Carter NM, Silva C. Why Men Still Get More Promotions Than Women. Harvard Business Review. September 1, 2010

34. Mentor? Coach? Sponsor? “Acoachtells you what to do, a mentor will listen to you and speak with you, but a sponsor will talk about you.” Kathy HopinkahHannan National Managing Partner Diversity and Corporate Responsibility KPMG LLP US Source: Fostering Sponsorship Success Among High Performers and Leaders, Catalyst, 8/2011

35. Women are over-mentored and under-sponsored 13% of women have sponsors compared to 19% of men1 Without sponsorship, women are less likely than men to be appointed to top roles and more reluctant to go for them2 Men are 46% more likely than women to have a sponsor1 Although women may be getting support and guidance, mentoring relationships aren’t leading to nearly as many promotions for them as for men. (1) Hewlett, SA et al.Sponsor Effect: Breaking Through the Last Glass Ceiling, Harvard Business Review, 12/2010 (2) Ibarra H, Carter NM, Silva C. Why Men Still Get More Promotions Than Women. Harvard Business Review. 9/1/2010

36. Measurable Impact of Sponsorship Overall sponsor benefit on career: 22% to 30% Hewlett, SA. The Real Benefit of Finding a Sponsor, Harvard Business Review, January 26, 2011

37. Why do women lack sponsorship? Individual fail to build relationship capital Systemic would be backers do not come forward

38. Under-invest in SOCIAL CAPITAL • Work/life balancing act leaves little time for socializing with colleagues and building professional networks • Critical to promotions, particularly to leadership • Social capital may be more important than other leadership skills/achievements These influential networks are mostly men---- Eagly AH, Carli LL., Women and the Labyrinth of Leadership, Harvard Business Review, 2007

39. LEAN IN • Think big: men are more ambitious • Women underestimate their performance • Don’t leave before you leave • Nobody has it all • Excuses and justifications won’t get you anywhere • Success and likeability positively correlated for men, negatively for women • Men compromise less than women to “balance” success and personal fulfillment

40. Why do women need sponsors? • Provide women the self-confidence to apply for challenging assignments • Help women to truly value their accomplishments and realize their full potential • Advocate for and assist women to be proactive in their pursuit of hot jobs in organization • Help women to overcome their reluctance to self-promotion and to assert their competence • Encourage women to raise a hand for "stretch” assignments rather than wait to be asked

41. Needed: More than a few good men!

42. Leaders matter… • Encourage top executives to sponsor 2-3 future leaders, including women. • Instill a mind-set of “paying it forward,” every woman sponsored will sponsor others. • Embed effective sponsorship of women into the profile of successful leaders at your company • Show your wider commitment by talking with top female talent Source: Barsh J, Devillard S & Wang J. The Global Gender Agenda. McKinsey Quarterly. 11/2012

43. Sponsorship- A viable option in academic medicine and science? • Corporate sponsorship programs producing results • AHCs can adapt aspects of the corporate model • Groom women faculty to compete for “hot jobs” - • highly visible projects, mission-critical roles, international experiences • Appoint high potential women to key committees • Train them to serve as chairs • Appoint women to editorial boards of professional organizations

44. A Renaissance Man Harold Shapiro, Ph.D. President Princeton University (1988-2011) • Identified talented women • Gave them high-visibility assignments that broadened their skills and positioned them to advance • Encouraged women to ask for what they deserved “Giving women chances isn’t just fair, it’s smart management… You’re overlooking half of the available talent, and you don’t get the best people to help you do your job.” Source: Hymowitz C. Ivy Leaders Thank One Man For Inspiring Women Presidents. Bloomberg Businessweek. 10/12/2012