Discussion
The gender gap remains visible in academic medicine, particularly within
leadership and traditional metrics of academic productivity. There is
much work to be done to remedy gender discrimination; however, knowing
what remedy will work is proving to be a daunting challenge. In the#heforshe movement, confusion abounds. In this paper we argue
that many efforts aimed at supporting, advancing, advocating, and
promoting women are not met with success. Not only do some of these
efforts miss their intended target, but some of them also actually
perpetuate discrimination they seek to thwart.
Clearly, allyship is not always straightforward, and it is becoming
increasingly clear that simply inviting women to the table is not enough
to overcome the complexities involved in achieving gender equity. Allies
may get confused and possibly frustrated when their efforts fail to meet
with success. This is a problem if allies eventually give up, or, worse,
critics of equity initiatives find evidence confirming that attempts at
equity are pointless. To effectively support the important work that
allies do, there is an urgent need to broaden our focus beyond asking
women to the table when it comes to leadership positions and other types
of recognition. We need to understand the psychosocial context in which
women make decisions about their careers, identifying the multitude of
reasons ‘why women say no’ when they encounter opportunities for career
advancement. Until we address these complexities, the goal of ending
gender discrimination will be unattainable; we can’t afford such
failure.
For women academic clinicians there are challenging decisions involved
regarding the use of time. There are very clear, but often implicit,
value statements regarding the importance of research activities,
compared to clinical education, administration, along with a lack of
acknowledgement for family caregiving responsibilities. Evidence
suggests that the dominant clinical and academic culture typically
benefits people with fewer responsibilities outside the clinical
context; historically, those have been men. If we hope to change the
culture, we have to first understand why it exists and how it
contributes to gender inequity. The standard academic contract defines
expectations around research, education, clinical practice, and
leadership. However, decisions about promotion center on research
productivity. Further, these expectations ignore additional
responsibilities and roles that also need to be managed, such as
coaching, mentoring, being a caregiver, etc. Several studies have
documented the gender gap within time spent on
research6,18, family or caregiver
responsibilities49,59 and
teaching/mentorship.53,55 This translates into
inequitable evaluations of many women who create a balanced academic and
personal portfolio, compared to many men who tend to prioritize their
own scholarship. Barring a change in values and the way these types of
productivity are valued, our search for reasons women say no to more
traditionally prestigious opportunities reveals a simple factor of time;
how can they possibly say yes if they are already so busy?
We’ve laid out the issues surrounding stereotypes about women.
Stereotypes are oversimplified, inaccurate and often harmful
representations of large groups within society. Stereotypes
compartmentalize unique individuals through categories that reduce their
complexity to a few characteristics, mis-represent who they are,
constrain their activities and prevent them from accessing fair
compensation and the power to make change. Stereotypes cannot account
for the complex and intersectional identities (and the power relations
imbued in them) that individuals take up or are saddled with in
different moments. We recognize that we have taken to task binary
stereotypes that construct only “woman” and “man”. These binary
stereotypes are harmful for others beyond women, which can undermine the
very existence of those who identify as non-binary or trans and that
these stereotypes categories impact people differently when they are
also subject to discrimination and stereotypes based on other aspects of
their identity, such as race, sexuality, or dis/ability (for example).
The intersectional impacts of gender and other stereotypes deserve
significant attention, and we believe that the advancement of women can
only be just when we address all aspects of intersectional
discrimination across equity-deserving groups. Figure 2 and the
supplemental digital appendix provides some scenario-based summaries of
the literature and highlight some key tactics and strategies that allies
might use.