Some of the reasons in the thought bubbles represent subjective beliefs,
and some represent practical constraints on material resources, such as
finances and time. In our own examination of reasons behind ‘why women
say no’, we identified strongly with constraints on time. Although the
ally’s thoughts indicate a genuine desire to recognize her expertise,
accompanied by acknowledgement of the need to sponsor women, he is not
considering the significant material constraints that limit her ability
to accept the invitation. Recognizing a need to illuminate these
barriers and build capacity amongst allies, we looked to the literature
to determine if there is evidence that, compared to men, women have less
time for career advancement opportunities, such as research and
leadership. To deepen our understanding of this phenomenon, we then
sought to explore why women might have less time for research and
leadership, compared to men. And particularly, in cultures where gender
equality is the norm, how are gender disparities maintained? Finally, we
offer practical guidance on how allies can help, going beyond simply
extending more invitations to women to address the psychological and
material barriers that undermine women’s ability to say “yes”.
Methods
Our critical review draws on diverse literatures to seek out more
nuanced explanations for why women say no, or, more specifically, why
they cannot say yes, to opportunities for career advancement. When
conducting critical reviews, researchers do not seek a comprehensive
accounting of everything that has been said on a topic; rather, they
draw on expertise within the team and consult with experts outside the
team to select perspectives that best inform their questions and that
have the greatest potential to shift their field’s thinking on their
topic.47
Our team is comprised of three academics who identify as women and are
active in medical education. We have worked and trained at different
institutions in Canada, trained in different disciplines, and hold
different family statuses, racial identifications, and career stages.
Dr. Monteiro is a mid-career researcher, trained in cognitive psychology
– a perspective that greatly informed our discussions. She identifies
as a person of colour and parent to young adults. Dr. Chan is a
practicing academic physician in emergency medicine. She is an active
health professions’ education researcher who identifies as being in her
mid-career. She has also held many leadership positions at her
institution and at a national level. She identifies as a person of
colour and her observations and experiences during her climb through the
ranks of leadership greatly impacted our conversations. Dr. Kahlke is an
early career researcher with a young family. She holds a PhD in
Education, and her sociocultural perspective helped to balance and frame
our focus on literatures from cognitive psychology. Spurred by an
interest in the anecdote presented above, we began this review by
consulting our own lived experience of the gender gap and discussed the
reasons that women might say “no” when faced with an opportunity that
might be seen as beneficial to our career advancement. Differences in
our intersectional identities were critical in generating robust
discussions that resulted in identification of myriad reasons why
different women might say no. Our different disciplinary perspectives
also informed our understanding of the problem, and the literatures we
consulted.
We then turned to the literature to explore evidence for our shared
belief that women have less time for these “opportunities” because
they have greater time demands in other areas. We asked: do women have
less time for career advancement opportunities, such as speaking
engagements, research, and leadership? We drew on robust literatures
from Psychology (cognitive, industrial, and educational), Sociology,
Health Professions Education, and Business to confirm that competing
pressures on women’s time negatively impacts their decisions about
career advancement opportunities. This evidence is described in detail
in the first section of the results below.
We then turned to these same literatures in search of potential
explanations for why this gendered imbalance in available time for
career advancement has proved so persistent, asking: why might women
have less time for career advancement opportunities? And how are these
disparities maintained? Finally, in effort to recommend novel and
evidence-based solutions to remedy the gender gap in our field, we
asked: how can allies help? To address these questions, we engaged in an
iterative cycle of refining the problem through group discussion,
identifying new search directions, and returning to these literatures.
In this way, our searches and analyses were intertwined. For example,
some search directions proved less relevant to our evolving research
questions and were dropped from our analysis. In keeping with critical
review methodologies, other perspectives were determined to be
particularly fruitful, such as stereotype theory from cognitive
psychology, which offered insight into the mechanisms that contribute to
the persistence of the gender gap, and cause women to say ‘no.’ Thus
stereotypes literature forms the backbone of our findings related to
these three questions.
Results
Do women have less time for
career advancement opportunities, such as research and
leadership?
In addition to evidence that women receive less recognition for their
research and fewer invitations to collaborate in research and engage in
leadership activities, our analysis of the literature from psychology,
sociology, business and medicine supports our argument that women say no
to these opportunities because they disproportionately take on other
tasks that are not as well recognized, specifically those related to
caretaking in their personal lives or supporting others at
work.11,37,48 Studies showing differences in
well-compensated clinical hours between men and women are mirror images
of studies showing differences between men and women in time spent on
supporting others. 49,50 For example, women are more
likely to sacrifice work responsibilities to care for children/family;
globally, 75% of unpaid work is done by women, including child and
elder care.4,51 Women are more likely to spend their
time acting as an academic mentor49, a pattern that
extends even to ‘ghost advising’; or serving as an academic mentor
without explicit recognition. 52 These mentoring and
caretaking activities are critical to the functioning of academia and
society more broadly, but they come at great cost to women. The result
of this imbalance in labor is clear - women are slower to advance their
careers because they have less time to spend on well recognized and
compensated research and self-promotion/tenure seeking
activities.49 On average, women simply don’t have the
same amount of time to commit to applying for and acting in leadership
positions, preparing for keynotes, or engaging in other time-consuming
but high profile academic activities. Without careful consideration for
how to distribute these commitments and recognition of these
contributions equitably, women may continue to say no to the very
opportunities that can close the gap.
Why might women have less time
for research and
leadership?
It is crystal clear that the problem is not women’s capability; studies
consistently demonstrate equal cognitive capacity of men and women in
all types of academic, managerial, mentorship and leadership
activities.4,34 Indeed, several studies have
highlighted benefits of including women in
leadership.53 Our analysis of the literature also
suggests a reason why these disparities persist: women spend more
time on tasks that help others because of society’s expectation of them
and of their male colleagues. In part, women help others more because
men are not expected to help. In other words, women and men
continue to perform stereotyped roles.11,18,20,33,37,48,54 Historically, women in most
societies have been expected to play a nurturing family- and
community-oriented role while men develop identities outside the home
through their career or talents.4,33 These
expectations persist today. For example, in personal or home contexts,
women are expected to, and do, manage reminders and to-do lists, while
men contribute less to these activities, and experience less societal
pressure to do so.54 Socialization into these domestic
roles reinforces expectations that women will commit their time and
energy to the benefit of the community over individual career
advancement.54
Why should these outdated notions have such a powerful hold over our
behavior today? Many believe, in fact, that these expectations no longer
hold true and should not drive behavior. 44,55 And
although gender roles have certainly evolved, with more women working
outside the home in diverse careers, there remain powerful gender
stereotypes rooted in these traditional expectations; the stereotype of
women as nurturing and less suited for leadership positions (thought to
require assertiveness) is even stronger today than it used to be.34,55,56 Stereotypes, which are learned from birth and
entrenched as early as 6 years of age, form societal expectations and
limitations around how men and women should or should notbehave.9,57 For example, stereotypes characterize
female academic clinicians as more nurturing, while men are
characterized as brilliant assertive leaders. 9,58,59As a consequence, women are ushered into underrecognized supportive
roles that are often disguised as opportunities, but limit opportunity
for further advancement; these decisions are often reactions to the
stereotype that men have the required characteristics for
leadership.9 For example, women are often invited to
deliver Grand Rounds, which have local impact, but are overlooked for
keynote speaker engagements at international conferences.9,60–62 Conversely, women may avoid higher profile or
highly competitive situations, such as vying for keynote speaker
engagements or senior leadership positions, because of their
self-perceived lack of assertiveness, a perception which may be
confirmed by their mentors.15
How are these disparities
maintained?
Breaking with such firmly entrenched stereotypes has
consequences.60,62 These consequences can be
perpetrated by others in a social environment (e.g. criticism ) or
through self-sabotage (e.g. self-doubt). Social consequences generally
occur because women are rarely expected in high profile roles and they
are burdened with a greater need to prove themselves and demonstrate
their expertise. Women often face social consequences such as doubt and
criticism when they venture into leadership positions, which are seen as
stereotypically male.63,64 For example, colleagues and
search committees cast doubt on women’s qualifications when they apply
for senior leadership positions because women do not “look like
leaders”.44,57,65 Women leaders are often criticized
for their leadership styles, which may not fit the stereotypical male
style. 44,66 This puts women in positions taking on
the extra labor of convincing search committees and co-workers that they
are assertive enough, or ‘male,’ enough.62,63,63,67,68 Conversely, women are expected to have
better interpersonal skills compared to men, and are held to a different
standard: whether rated as a teacher, clinician, scientist or leader,
women are criticized more harshly if their interpersonal skills are
perceived as weak, while men are not.57,69
Myriad other findings contribute to a picture that explains why women
often say no: women leaders or keynotes may be dismissed as a token
representative, with more credit given to their male colleagues (ref;
Matilda effect; invisible women). Women also report feeling a lack of
support and fear of reprisal from co-workers if they take a job others
see as clearly intended for a man.70 Women are
encouraged to step up and lean in, but there is little recognition for
the risks they take and heightened barriers they face when doing
so.48 Realistically, who would want the hassle of
‘advancing’ one’s career by competing for a new role, with unlikely
success and high professional and social
consequences?60,71 And when in doubt regarding the
potential outcomes of trying something new, people often revert to the
familiar. 72–76
Women have developed several strategies for navigating these challenges
covertly, while still trying to achieve their personal goals. However,
these strategies are not designed to correct stereotypes. For example, a
woman might head off negative reactions to her advancement from
colleagues by suggesting she is only taking someone else’s (typically a
male mentor’s) advice.33,34 She might also emphasize
her femininity so that her more ‘masculine’ leadership style is not
appraised too critically.33,34,77,78 By contrast,
Glick et al. demonstrated that when women highlight characteristics and
accomplishments often perceived as ‘masculine’, they improved their
ranking in competition for leadership positions, compared to those who
highlighted more ‘feminine’ accomplishments. 67Influential masculine characteristics included statements about
stereotypical male hobbies and interests. However, giving one’s CV a
masculine makeover is not an appropriate solution as this still
prioritizes the male stereotypes as the preferred model for leadership,
rather than challenging this problematic hierarchy. Similarly, embracing
the feminine stereotype is equally harmful. Both adaptations fail to
address the inequities in how we value activities critical to academia
and society, and the systems that prevent women from progressing in
their academic careers.
Other studies suggest that women may try to “fit in” to systems that
value stereotypically masculine traits by self-silencing, or choosing
not to take on inequity.4,33,77 Rather than altering
the system, these strategies rely on women’s acquiescence to the status
quo. In another related strategy, women may disengage from mainstream
and stereotypically masculine spaces by seeking the safety of
microcultures to avoid constant criticism or a feeling that they don’t
fit the mold.4,34,77 Microcultures can create safe
spaces for underrepresented groups, but can also serve to diminish much
needed visibility and equitable access to mainstream spaces and
opportunities.34 Finally, to offset the pressures
created by societal expectations, women occupying leadership or other
spaces of power may prioritize work life balance more than their male
counterparts. These decisions may help them navigate the pressures they
face when they choose not to align with prescriptive stereotypes.
However, those decisions may also hinder further promotion, as women
again sacrifice time that they could use to advance better rewarded
career metrics in a traditional merit or reward systems.
Alongside the external pressures and consequences involved in
challenging stereotypes, there is a self-sabotaging phenomenon described
in the psychology literature as stereotype threat. 79For example, a common stereotype of women, (noted in published work
since the 1990s but present in academic discourse for decades prior to
that) is a belief that women are weaker at learning and mastering
concepts in mathematics.57,80,81 When placed in a
competitive context requiring math skills, women often perform poorly,
or choose not to compete at all.81 This phenomenon is
not related to ability, as it occurs even for women with exceptional
aptitude and knowledge of the domain.57,80,81 A more
modern conceptualization of this phenomenon is imposter syndrome .82,83 All individuals who identify with a negative
stereotype are susceptible to the phenomenon of stereotype threat, with
the primary explanation being a sub-conscious drop in confidence and
performance. The evidence suggests that knowledge and fear of being
compared to a negative stereotype causes people to lose confidence and
inadvertently confirm the stereotype. Decades of research on stereotype
threat reveal its impact in domains such as sports84,
leadership 85,86, and communication
skills.87 For example, women, who are aware of the
negative stereotype regarding women and some sports, may opt out of
competitive sports activities altogether. Men are not
immune88; in one study, men were observed to perform
in ways that were less empathetic, or caring, when primed with the
stereotype that women are more nurturing than men, compared to men who
were not primed with this stereotype.89 Even as women
venture into non-traditional roles, the phenomenon of stereotype threat
may serve to support harmful stereotypes.90,91
How can allies
help?
Allies, whether men or women, need support and guidance to be effective.
Recommendations for addressing the impact of stereotypes and stereotype
threat require specific and concrete actions, not vague
guidelines.4,34 Critically allies need support to help
them and others understand the mechanisms that will lead toequity between genders, which are very different from initiatives
that recognize equality between genders; believing that all
genders are equal is not enough to reach gender equity when there are
real material barriers hindering women’s advancement. Allies are
critical in helping amplify and recognize the contributions and
perspectives of women and underrepresented groups.
The key recommendations from the literature:
- Recognize, consult, and support women when they are uniquely
positioned - recognize that an invitation to apply may not be enough
to counterbalance disproportionate negative fallout that women often
experience,4
- Create supportive microcultures (that actually impact
mainstream),4
- Set expectations & realign merit systems,92
- Actively seek out women for more traditionally male
roles,55
- Actively seek out men for more traditionally female
roles.55
Our Supplemental Digital Content (Appendix 1) outlines some ways that
people in various leadership positions can support women and other
underrepresented groups. In hoping to close the knowing-doing gap, we
have grouped the suggestions by leadership roles that are common to the
academic clinical environment. We then follow each recommendation with a
worked example, or continuance of the vignette, to demonstrate how
allies can take action.