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IN PRACTICE: What Does Gender Have to Do With It? Why the AAN Wants to Break Neurology's Glass Ceiling for Women

Avitzur, Orly MD

doi: 10.1097/

In 2013, Janet Yellen became the first female chair of the Federal Reserve, arguably Washington's most powerful official. Today, a female CEO is running General Motors, Hewlett-Packard, IBM, PepsiCo, Xerox, and Yahoo, and one third of the Supreme Court justices are women. Women currently hold 18.5 percent of the 535 seats in Congress, 20 percent of the 100 seats in Senate, and 18.2 percent of the 435 seats in the House of Representatives, and many predict that we'll see the first female US president after the 2016 elections.

Yes, we've “come a long way, baby” since 1968 when Phillip Morris first used that catchy slogan to dedicate the Virginia Slims brand of cigarettes to professional women as a viable market segment. Yet, in some ways, medicine remains one of the final frontiers of progress. A 2013 report examining the Association of American Medical Colleges (AAMC) data on faculty at US medical schools from 1997 to 2008 found that women accounted for only 14.7 percent of professors, 9.2 percent of chairs, and 9.3 percent of deanship positions..

Moreover, despite the fact that 48 percent of medical school graduates and 37 percent of medical school faculty are women, women physicians and scientists remain noticeably underrepresented in academic medicine's highest-level executive positions, known as the “C-suite,” — a slang term for the highest-level executives in an organization. This statistic has held steady for the past six years at 12 percent, and is equal to the percentage of National Cancer Institute programs led by women (8 of 66).

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While the numbers may not be much better for women in neurology, the AAN has been working for the past several years to reverse that trend. A concerted effort has been underway to ensure greater representation by women in positions of leadership on committees, the board of directors, and in other key roles.

In 2013, 50 percent of the neurologists recruited to the Emerging Leaders Forum (ELF) were women; the 2014 ELF class maintains that parity. One-third of the 2013–2015 AAN board of directors are women, as are 37 percent of the directors of the AAN Institute. Still, only one of the AAN's 33 presidents has been a woman — Sandra F. Olson, MD, filled the post between 2003 and 2005 — and since its inception in 1875, only three of the 129 American Neurological Association presidents have been women.

“One of my long-term goals that I consider particularly important is to increase diversity on the Board and in other leadership positions within the Academy,” not only with women, but also with more African-Americans and Hispanics on the Board of Directors and in officer positions, AAN President Timothy A. Pedley, MD, told Neurology Today. “While several of our most important committees are now led by women, I find it embarrassing that between A.B. Baker in 1948 and me in 2014, there has been only one woman who has served as AAN president. Other minorities occur with even less frequency at all levels,” he pointed out.

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In an effort to further encourage more women to become leaders, the Academy has developed for the first time a workshop at this year's AAN annual meeting specifically focused on AAN women in leadership. [See “How to Join the Women in Leadership Program” for more information.] Why the need for a dedicated session on women neurologists? Allison Brashear, MD, MBA, course director and chair of the department of neurology at Wake Forest Baptist Medical Center in Winston Salem, said: “We know that women lead differently than men, and studies have shown that diverse teams function better.”

Dr. Brashear, who has attended several different leadership programs, said that they helped her define her leadership style and understand other perspectives. She has also worked to build those skills among members of her faculty as she believes that a department functions better when the leadership skills of all members are enhanced.

“Indeed, it's when we begin to mentor others that we best develop our own mentorship skills,” said Barbara Hoese, president of the Inventure Group, a leadership development and executive coaching firm. Hoese, who is co-directing the full-day course, has designed it as an experiential workshop, which will present the challenges women face, and focus on their strengths and successes.

“The afternoon session will begin with a panel of women who've been down the same path as the participants and can share their own experiences,” she said. Having worked with the ELF program, she has observed a keen awareness of the value of diversity in the Academy's efforts and recruitment of women. “As to why women are so often underrepresented in senior leadership positions, studies show that it's not that women don't want those roles,” she said, “but rather that they are less willing to deal with the bunk [politics] and to engage in behavior that they perceive as unethical to accomplish those ends.”

Women tend to shy away from confrontation, especially when they have to have difficult conversations, she said, but they can be taught to use those instances to build relationships instead of tearing them down.

However, the gender variance has traditionally been impervious to career development, mentoring, and coaching efforts, according to a recent treatise on the subject in the AAMC journal, Academic Medicine. The article concluded that female physicians are not much better off in this respect than they were a decade ago. Studies have suggested a variety of reasons for the void in top leadership, the authors reported, including conflicting life, family, and work priorities; lack of self-efficacy and confidence; feelings of marginalization and isolation; insufficient mentoring; and failure to build relationship capital.

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Lisa M. DeAngelis, MD, chair of the department of neurology at Memorial Sloan-Kettering Cancer Center since 1997, recently completed a term as AAN vice-president. She pointed out that it's not a single issue that accounts for the dearth of women neurologists in senior leadership positions — it's a multitude of issues.

“The fall-off of women up the academic ladder is similar to that in all of academic medicine and the STEM (science, technology, engineering, and mathematics) fields,” she noted, “and if you have women falling off the academic ladder, then their opportunities to gain leadership positions diminish correspondingly.” This is especially common during the early to mid-career years, she said, when many women feel they are unable to take on the early leadership positions due to family responsibilities, and ultimately, fail to acquire those skills needed for senior leadership positions.

Opportunities don't always present themselves at the right time, and often, when they do arise, women don't think that they are ready, Dr. DeAngelis said. “I would not have elected to become a chairman when I was turning 43, but I knew that if I did not take it then, I was not going to get another chance,” she said, cautioning that women need to understand that it is possible to miss the boat.

Many women simply sell themselves short, she pointed out. “There are few things you can change about outside factors, but you can change your subconscious bias against your own qualifications.” Her advice to women in neurology? “Don't be afraid. Not everything you do will be successful and there are some things that you won't be good at, but you can learn from your mistakes and not make the same mistake twice.”

All the senior leaders interviewed agreed that finding a mentor is essential for young women. Merit E. Cudkowicz, MD, MSc, chief of the neurology service at the Massachusetts General Hospital (MGH), credits her mentor and predecessor, Anne Young, MD, PhD, with encouraging her to accept leadership roles early in her career. “She sent me to leadership training classes that helped me understand that there was a whole science to leadership,” she said. “She also understood how to find balance, and told me that I didn't have to work all the time.”

Dr. Cudkowicz, who became department chair in 2012 while still raising teenagers, running a research laboratory, and co-directing the MGH Amyotrophic Lateral Sclerosis clinic and the Neurological Clinical Research Institute at MGH and Partners HealthCare System, encourages young women to find opportunities to lead, whether it be a committee or a research group. “Each experience allows you to gain new skills, and by observing others, new ideas,” she said.

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While several specialties have addressed the challenges of underrepresentation of female leadership in their publications, a PubMed search did not yield comparable reports or data relating to neurologists. But a closer look at two specialties — one dominated by women and the other, in which women have barely gained a foothold — paints a vivid picture of the gender gap in medical fields.

In 2012, the American College of Obstetricians and Gynecologists reported that in the previous year, although more than 80 percent of all obstetrics and gynecology residents and fellows were women — and they should have held 71 of the total 194 leadership positions based on the proportion of women entering residency during the mean graduation year — they actually held only 41 of those leadership positions.

More strikingly, a report in the journal Urology, states that as of January 2012, 1467 (8 percent) of the 18,172 American Urological Association members were women and 536 (6 percent) of the 8637 of board-certified urologists were female. However, female urologists occupied only 1 percent of all urologic academic positions and the percentage of academic female urologists who had reached full professorship positions was only 19 percent compared with 31 percent for all female academic positions.

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Participants in the AAN Women in Leadership program, taking place Monday, April 28, will learn to apply knowledge to roles as leaders in hospitals, communities, state medical societies, professional organizations, or in political action. To apply, submit your CV and a short statement about why you would benefit from attending the program by the April 4, 2014, deadline. (The program will not offer CME credit, but selected recipients will receive complimentary registration for the course.) Applicants can apply online at or by e-mail:

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•. Yu PT, Parsa PV, Hassanein O, et al. Minorities struggle to advance in academic medicine: A 12-year review of diversity at the highest levels of America's teaching institutions. J Surg Res 2013 15;182(2):212–218.
•. Travis EL, Doty L, Helitzer DL. Sponsorship: A path to the academic medicine C-suite for women faculty. Academic Medicine 2013;88(10):1414–1417.
© 2014 American Academy of Neurology