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Women’s Leadership in Medicine During the Pandemic

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Written by Dr Melissa Wheeler and Dr Laksmi Govindasamy.

Are we witnessing a ‘glass cliff phenomenon’ or finally seeing a rising tide?

Key points:

  • Globally, women make up the majority of the health workforce. 59% of medical, biomedical, and health science graduates are women.
  • Yet health services and organizations have persistently been led by men.
  • After decades of gendered leadership gaps, there has recently been an influx of elected female leaders of medical specialty colleges.
  • The glass cliff phenomenon, whereby women are precariously appointed as leaders in times of crisis, helps explain this shift

Despite female medical graduates now consistently exceeding parity, there are persisting inequalities in women’s participation in some medical specialities and in leadership roles overall. This gap reflects a range of factors, including female doctors’ experiences of bias, discrimination, and harassment within broader organizational structures that perpetuate gender inequities. An important avenue for medical leadership is within specialist colleges, perhaps most visibly through the role of president. These organizations shape education and training for the next generation of doctors and play a key role in advocacy within and beyond the health system. At the close of 2021 in Australia and Aotearoa New Zealand, female presidents-elect and presidents led the medical colleges representing General Practice, Physicians, Surgeons, Emergency Medicine, Anaesthetics, Psychiatry, Intensive Care, Medical Administration, and Dermatology. While we welcome and celebrate these individual achievements, it raises the question as to whether this represents a sustainable organizational shift or simply individual exceptionalism?

The Glass Cliff: A Brief Introduction

Imagine a woman in a senior position who has successfully shattered the invisible barrier— commonly referred to as the ‘glass ceiling’—only to find herself in a risky position, perched on a precarious ledge, which has been dubbed the ‘glass cliff’. The glass cliff phenomenon arose from recent social psychological research that demonstrates that women in leadership roles often experience a second wave of discrimination, in that they are evaluated less favorably and criticized more than their male counterparts, even when they are performing at the same levels.

In addition to greater scrutiny (from colleagues, from subordinates, from the media), another relevant area of research led to formulating the concept of the glass cliff. It is one that highlights the greater tendency for women (and people from minority backgrounds) to be appointed to leadership positions in times of crisis or periods of increased risk. During such times, people may consciously or unconsciously search for different kinds of leadership traits, relying on different stereotypes of what it means to be a leader, as compared to times of relative stability. A crisis period indicates the need for a change, as well as a desire for certain characteristics in a leader— understanding, empathy, beneficence—that are more stereotypically associated with stereotypical femininity.

Precarity and Failure

Once women assume leadership, having surmounted assumptions of a perceived ‘lack of fit’ and other obstacles encompassed in the glass ceiling, the glass cliff adds extra pressures, including the perceived expectation of failure. In somewhat of a self-fulfilling prophecy, as women are more likely to be promoted to corporations and political parties already in downward trajectories, failure is of course more likely than in lower-risk appointments. And failure can confirm some assumptions and negative perceptions about women’s competence in leadership, fulfilling some people’s expectations that women do not inherently make good leaders. It is interesting to note that men are more likely to reject these ‘golden opportunities’ seeing them for more of what they really are, ‘poisoned chalices’—rejections that incur fewer penalties (e.g., redundancies) compared to when women turn them down. This distinction between golden opportunities and poisoned chalices and the consequences of declining point to another layer of precarity for women aspiring to lead.

COVID-19: Two Years of Crisis (and Counting)

The COVID-19 pandemic years, a period of ongoing global crisis since 2020, may see more women worldwide in leadership roles, as observed in the rise of women leading medical colleges. This rise may be associated with the glass cliff phenomenon, as there is more demand for female-stereotypic qualities, such as empathy and care for others, and in combination with the tendency for women to be appointed in times of crisis, known as the ‘think crisis, think female’ tendency. It is important to recognize the potential precarity of these elevations and to provide the support needed to see the benefits of these stereotypically feminine traits, giving these women the best chance possible to enact real change and to thrive instead of fail.

Leveraging the Golden Opportunity and Avoiding the Poisoned Chalice

Organizations can provide support in terms of organizational and structural changes that accelerate and contribute to lasting and sustainable diversity and inclusion initiatives, such as recruitment, selection, retention procedures, and leave-flexible work policies. Strategies can include prejudice reduction strategies (such as unconscious bias training), direct-affirmative action (e.g., targets and quotas), or bias mitigation and nudging tactics (such as CV de-identification or blind auditions).

The benefits of supporting women who have taken up precarious leadership opportunities are plentiful, but we will highlight two as examples. As the common saying goes, a rising tide lifts all boats, the benefits extend beyond the individual women who have been elevated. With adequate support, organizations will be able to embrace the diverse perspectives offered by the newly appointed leader and give themselves the best chance of changing the circumstance and current trajectory that led to the high risk or crisis situation in the first place. Another benefit is more future-looking. The next generation of girls and women will have more visible women in leadership as role models to look up to, an important indicator of what can be achieved and what to aspire to. This representation is especially important for women and other minority groups in medicine as increasing physician diversity plays a valuable role in the provision of quality and culturally safe care. There is an ongoing role for advocacy from peak bodies, including medical colleges, due to the need to expand considerations of gender equity beyond binary gender focus and towards broader inclusion, taking into account people’s intersectional identities and the added complexities and obstacles faced.

The health sector is not the only industry grappling with the gap between participation and diversity in senior leadership and the challenges imposed by the ongoing COVID-19 pandemic. However, it is a unique time in that this current cohort of female medical leaders may preside over a generational opportunity to leverage the pandemic crisis to contribute to health system reforms that improve equity, accessibility, and quality of care for all. Similarly, the pandemic may create an impetus to acknowledge longstanding physician well-being issues, including addressing systemic bullying and harassment. While celebrating their individual achievements and the symbolism of their representation in often male-dominated spaces, we should also support them to implement the kinds of organizational changes required to ensure this is a rising tide that lifts all boats, not just for other women but for all marginalized and underrepresented groups in medicine. This would be the most valuable legacy of all.

References

Govindasamy, L. S., Terziovski, M., Wheeler, M., Rixon, A., & Wilson, S. (2021). Gender equity in emergency medicine: Five years on, where are we headed?. Emergency Medicine Australasia. https://doi.org/10.1111/1742-6723.13910

Sojo, V. E., Wood, R. E., Wood, S. A., & Wheeler, M. A. (2016). Reporting requirements, targets, and quotas for women in leadership. The Leadership Quarterly, 27(3), 519-536. https://doi.org/10.1016/j.leaqua.2015.12.003

Ryan, M. K., & Haslam, S. A. (2007). The glass cliff: Exploring the dynamics surrounding the appointment of women to precarious leadership positions. Academy of management review, 32(2), 549-572. https://doi.org/10.5465/amr.2007.24351856

Mousa, M., Boyle, J., Skouteris, H., Mullins, A. K., Currie, G., Riach, K., & Teede, H. J. (2021). Advancing women in healthcare leadership: A systematic review and meta-synthesis of multi-sector evidence on organisational interventions. EClinicalMedicine, 39, 101084. https://doi.org/10.1016/j.eclinm.2021.101084

agly, A. H., Makhijani, M. G., & Klonsky, B. G. (1992). Gender and the evaluation of leaders: A meta-analysis. Psychological bulletin, 111(1), 3. https://doi.org/10.1037/0033-2909.111.1.3

Fisher, A. N., & Ryan, M. K. (2021). Gender inequalities during COVID-19. Group Processes & Intergroup Relations, 24(2), 237-245. https://doi.org/10.1177/1368430220984248

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