Women in medicine need to put in more effort than men to gain senior leadership roles, given limitations and obstacles in the system, new research shows.

The findings of the US study are backed by Australian medical leaders, with one leading specialist commenting that many Australian women doctors with the ability to achieve senior roles were not always supported and either didn’t apply or missed out on key positions.

The study analysed career advice given to 38 women physicians and administrators with senior leadership roles at the prestigious Mayo Clinic. Researchers asked the women what career advice they had received that was the hardest to accept at the time, but, in retrospect, turned out to be valuable.

The women’s responses about advice they received fell into four categories:

• Leadership styles were perceived as having gendered qualities: women were advised to avoid apologising for their decisions and to “take the credit” for successes.
• Attaining leadership skills involves a strategic learning process – women had learned to be more assertive, to be strategic, to be empowered and control their position
• Personal life and workplace will collide, but the conflict should not be a deterrent to pursuing a leadership role
• Leadership pathways for women involve inevitable hurdles and require courage to follow or ignore advice

The responses showed that “deep-rooted cultural changes were needed to retain women in high-level roles” the authors wrote in JAMA Network Open.

In Australia, only around 30% of deans, chief medical officers or medical college board or committee members are women, and women make up just 12.5% of CEOs in large hospitals, according to a recent perspective on women in leadership by Professor Helena Teede, Executive Director of Monash Partners Academic Health Services Centre. That is despite women long achieving gender parity in medical school admissions.

Professor Simone Strasser, Clinical Associate Professor at Sydney Medical School, University of Sydney and a senior staff specialist in gastroenterology and hepatology at Royal Prince Alfred Hospital, said despite key differences in academic medicine in the US and Australia, many of the obstacles identified in the US study were also present here.

Comments by the US women studied about women needing to be assertive, claim ownership and not always be content with working behind the scenes resonated, she said.

“In Australia, as elsewhere, a lot of the solid background work in academic and clinical medicine, and administrative roles is done by women who don’t ‘toot their own horn’. I guess there is a fear that they will be looked on unfavourably if they do take credit and strive for self-promotion. In contrast, it would seem that this is less of an issue with men in similar roles in the profession.”

Professor Strasser, who is President of the Gastroenterological Society of Australia, suggested women didn’t need to change their style to be ‘more masculine’ to achieve leadership, but they did need to have confidence in their abilities and what they bring to leadership positions.

“I think the perception of leaders needs to change to incorporate the strengths that women bring –a diversity of opinion and approaches is invaluable to change the culture.”

And while there is no entrenched system of mentorship in Australia, her advice to women was to find a mentor – not necessarily in the same speciality or hospital.

Professor Strasser said there was a lot of concern among trainees and junior consultants about when to fit in having a baby, but she agreed with comments from women in the US study that:“there’s no right time to have a baby”.

“You just MAKE it work out,” is exactly what I tell people who ask,” she said.”Make the system work for you. And work to improve the system so it does work.”

Professor Strasser added that her comments applied not only to women, but to anyone who “wasn’t a middle-aged white male”. Despite our diverse, multicultural community and medical workforce, there is marked under-representation of many types of people in senior roles, she said.