What Does it Take for Women to Attain Leadership in Anesthesiology?

Women holding leadership positions in healthcare remain relatively few, paralleling the gender gap found in other industries.  However, even amidst the dearth of women leaders healthcare-wide, anesthesiology in particular stands out as a specialty in which there are significant disparities in the representation of women in leadership roles.

The process of attaining leadership is neither straightforward nor transparent, and few resources describe it.  And while previous studies have focused on the barriers women confront in attaining positions of leadership in medicine, few have probed the process of leadership emergence itself.  In one recent qualitative study published in Anesthesia & Analgesia, a team of researchers sought to examine how women currently in leadership roles in anesthesiology had been able to reach their career pinnacles.

Women leaders by the numbers

It is well-known that most nurses in the United States are female.  The US Bureau of Labor Statistics confirms that 89% of the nursing workforce is comprised of women; however, when it comes to executive leadership positions, the numbers still lag.

From a purely dollars and cents perspective, the fiscal health of companies with women in leadership roles has been demonstrated: a study in 2016 by the Peterson Institute for International Economics surveyed 21,980 publicly traded companies in 91 countries and concluded that companies which had female leaders in top positions of corporate management had increased profitability.

This increased economic outcome achieved by the inclusion of women on corporate executive boards in corporate America extends to healthcare institutions, demonstrating the value that women in healthcare leadership can bring.  A 2015 study by the American Journal of Medical Quality (AJMQ) found that 44% of the boards of high-performing hospitals included at least 1 nurse as a voting member compared to 11% of low-performing hospitals.

Even though the AANA cited as recently as 2016 that 59% of nurse anesthetists are female versus 41% male, women in leadership roles in the anesthesiology specialty are notably lacking.  Women remain underrepresented in top roles in anesthesia beginning with the gender gap reflected in the halls of academe.  In 2020, the American Association of Medical Colleges (AAMC) reported that the total percent of female professors in academic anesthesiology was 21% versus 79% for male professors.

Further, in the United States in 2020, AAMC reported that 16% of academic anesthesiology chairs were women; the national average for this position held by women across all academic specialties is 21%.

Female representation in leadership positions of the American Society of Anesthesiologists also remains relatively low. A 2014 survey of the group’s house of delegates showed that fully 79% of those serving in these positions were men.

What makes a leader?

So, what characteristics and experiences have contributed to the “success trajectory” of those women who have seemingly beat the odds and broken through?  Are there commonalities they share that may have led to their success?  In initiating their study, the researchers from the Department of Anesthesiology, University of Central Florida, Nemours Children’s Hospital, Orlando, Florida, and the Departments of Anesthesiology and Perioperative Medicine and Social Sciences, at Augusta University, Medical College of Georgia, Augusta, Georgia, sought to elicit the answers via 3 primary questions:

• What are the external or internal forces necessary for career advancement for women?
• What was the study participants’ leadership acquisition process?
• How may gender bias have affected these women’s careers?

Sources and voices

To respond to these queries, the Team explored the leadership pathway from the perspective and life experiences of women leaders in anesthesiology in both the US and Canada.  A list of 31 female leaders in anesthesiology was generated using the following resources: the ASA website, the Association of Academic Anesthesiology Chairs, and the ASA Committee of Women in Anesthesiology.  Invitees were comprised of current and former presidents of national societies, chairs of academic anesthesiology departments, or influential contributors to anesthesiology, and subsequently selected based on their experience and leadership accomplishments.  The secondary source of data were the participants’ curricula vitae.

The final list included published authors, American Board of Anesthesia (ABA) examiners, and hospital executives.  Ultimately, semi-structured interviews were conducted with a total of 26 women in leadership positions in anesthesiology.

Mentor early and often

Analysis of the data resulted in the development of 4 central themes related to career pathways for these women in leadership:  personality traits, leadership preparation, gender-related considerations, and leadership acquisition.   Each theme was then examined in depth to determine what common qualities had been necessary for individuals to advance in the field and the pathway they had taken to successfully attain positions in anesthesia leadership.

The findings of the study showed that early-career, high-value mentorship, and sponsorship were the 3 crucial factors in leadership acquisition.  Most participants (n = 20; 76%) had benefitted from mentors early in their careers—many of those mentors coming from high echelons in the field.  In fact, of those respondents who mentioned early mentorship, 13 (65%) cited that their mentors were “high-value mentors,” which the study authors defined as individuals in positions of power or authority such as a chair or division chief.

Having what it takes

The researchers found that the participants possessed traits in common which included adaptability, a strong work ethic, “grit,” and perseverance.

These character traits, the women leaders noted, had helped them to overcome the instances of bias they encountered in their careers, even including occasionally “being held to a higher standard or overly scrutinized, undervalued, and dismissed.”  Throughout the interviews, the women leaders emphasized their ability to reframe failures and obstacles as opportunities for growth.

They also related experiences that further fostered achievement of their career goals.  In addition to early mentoring, other experiences most often credited were leadership courses, networking, sponsorship and, interestingly, self-promotion as their careers progressed.

The power and peril of ‘Me’

While not deemed to be one of the 3 key elements leading to the success they had achieved in their field, self-promotion was cited by many participants as having been a factor.

Self-promotion tends to come more easily to men than to women, the authors note.  This does not mean that women lack the necessary experience, talent, or confidence to toot their own horns.  Rather, they write, women who self-promote can face a “double-edged sword”: they increased others’ perceptions of their self-confidence—but sometimes at the cost of discrimination when they are perceived to run counter to gender stereotypes.  As such, the authors observe, sometimes women’s self-promotion “can elicit backlash effects that have both social and economic penalties.”

Door opening

In summary, sponsorship was found to be the chief factor contributing to participants’ leadership acquisition in anesthesiology.  The authors identify a sponsor as someone who has “power to advocate publicly for the advancement of talent” and define sponsorship as “an episodic, transactional relationship that focuses on the visibility and talent of a protégé.”

Based on their participants’ experiences, the authors conclude that “leadership acquisition requires sponsorship.”  While leadership courses, networking, and hard work are all prerequisites for attaining a role of leader, the authors contend, “they may not ultimately lead to promotion or leadership positions.  Someone must open the door.”

As such, they advocate, “the specialty of anesthesiology should invest in the future of women’s leadership.  Formal sponsorship programs at local and national levels are needed.  With equal opportunities for [such] sponsorship,” the researchers conclude, “women in leadership will not be an exception.”

Don’t miss the often-riveting first-hand accounts the female anesthesia leaders related about their rise to the top in “Gender Gap: A Qualitative Study of Women and Leadership Acquisition in Anesthesiology” at https://pubmed.ncbi.nlm.nih.gov/35550391/