March 27, 2019

Women in Leadership

In the last few years, there have been numerous articles written about valuing women leaders in emergency medicine (EM).  In fact, back in 2012 in EP Monthly, Dr. Michael Silverman and his wife, Eleanor Silverman, DSC, wrote an article that outlined the unique qualities a female physician leader brings to the table. It was an excellent overview of the current underrepresentation of woman in the higher ranks of medicine and emergency medicine. 

This article is not meant to rehash all the inequalities of representation in workforce versus leadership.  Instead, my goal is to give you a very personal story that speaks to the “why do it” and a possible outline of “how.” There are many paths to take to leadership, some scripted and some ad hoc, and all can be very rewarding.

I didn’t enter leadership as a result of well-mapped 5- and 10-year goals. I was not in an EM interest group as a medical student and did not rotate through numerous prestigious programs. I dabbled as a student representative to the AMA, but my path to emergency medicine was more circuitous. In fact, my entry into medicine itself was a bit unusual, beginning 4 years after finishing a B.A. in anthropology. I entered a unique medical school model, finishing my first year in Alaska, with 8 other bright-eyed students, before being one of 180 in Seattle during my 2nd year. My path through school was atypical. I spent half of my 3rd year in Hailey, Idaho, and extended out another year to study community health and tropical medicine in Thailand. My passion for EM was built upon an amalgam of experiences to that point, and I felt lucky to match at Denver Health’s residency in emergency medicine only days after the birth of my daughter. 

There was no intentional trajectory that led me down the leadership track. But during my 3rd year of residency, only days after the birth of my son, I made a choice that launched me in leadership. I applied for one of the chief resident positions. There were people on the selection committee who questioned my motives and my sanity. Why would a tired resident with a toddler and a newborn want to be chief? Doesn’t she want to spend more time with her children? That sentiment alone was maddening to me. We often frame the leadership roles of women much differently than we do for men, suggesting that there has to be a choice between leadership and family. I fought the perception that a woman can’t be a good mother, daughter, sister, or partner, and still be successful. That feedback solidified my aspirations.

One year of chief residency almost drove the passion out of me. I struggled to learn the art of work/life harmony and the practice of a powerful “no” that isn’t apologetic. Many of us of the female persuasion have difficulty with unapologetic boundaries, and that is a critical component of success. Coming out of residency, I said no to academics, realizing the burn out potential. I convinced myself I would join the ranks of pit docs and worker bees, satisfy my needs in other ways. 

For better or worse, my subconscious had other things in store for me. Somehow, my mouth kept opening and saying “yes” to committees, to projects, to teaching opportunities. This landed me as medical director of a large emergency department and part of the leadership team for a 55-shareholder company of emergency physicians. 

The message in all of this is, even if leadership isn’t on your career horizon, look inside yourself and ask questions. Do a personal values assessment to understand what your current priorities are and how taking on a leader role fits with those. If you naturally migrate to being a problem solver, you find yourself helping peers, answering questions, and raising your hand to volunteer, then leadership may be the right path for you.

Women face unique barriers in their aspirations as leaders. It’s hard to be late to a meeting because you were pumping and feel a group of medical professionals, trained to know the benefits of breastfeeding, pass silent judgment. It’s hard when your kids have a crisis at school, and you have to clear your schedule to address that. And if you don’t have kids, there is still judgment: will she want to get pregnant? Why doesn’t she have kids? One of the most frustrating barriers of all is the double standard – what is perceived of as strength in a man is often labeled something much different in a woman:  bitchy, overbearing. 

In one study in Harvard Business Review of military evaluation of leaders, the words used to describe women were much more negative than ones used to describe men. The only positive traits that stood out were “compassionate” and “organized.” These were not the qualities that were recognized, overall, as those of a strong leader, and yet we are witnessing repeatedly the success of the women who’ve walked before us. 

So, you’ve decided to navigate this world, to have your voice be heard and practice the delicate balance of home and life, and you’re wondering what comes next. I would recommend a step-wise approach. Figure out what clicks with you and find the appropriate conduit for channeling that energy. If you love quality work, credentialing, and scope of practice questions, then the medical staff leadership route may be for you. Consider running for a position on your hospital’s credentials committee or a quality committee. Jump in and see if this rings true.

Maybe you’re a policy-wonk and love all things legislative. Consider engaging with your ACEP state chapter. Go to your state medical association’s legislative day. Find your way to the national ACEP Council meetings.

Perhaps you’re an innovator, the technological guru to whom everyone turns. Consider partnering with clinical informatics in your hospital. Physicians are critical in leading the change needed in a workable EMR. Much of this work can lead to an exciting “newer” physician role in medicine - chief medical information officer (CMIO.)

Finally, maybe it is the business-end of things that makes your head turn. You have a penchant for numbers and business plans. No matter what model your group practice falls into (practice management group, employed, private democratic group), you can find ways to be active and engaged. Perhaps ultimately the practice of medicine is not your penultimate goal, but the business of medicine, with a future as a CEO or CMO of a medical group or hospital.

There are numerous pathways to the realms of leadership within emergency medicine, and what does that have to do with women in the leader ranks of EM? I just want to share a few tidbits of advice – don’t abandon the traits which define you. Embrace compassion, communication skills, empathy, and learn to utilize those strengths and find your own voice. Do not be afraid to advocate, voice your opinion, and don’t automatically defer or back down. Remember, you are a leader, an innovator, and you belong here.

Ryan Keay, MD, FACEP

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