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.