Women are underrepresented in leadership positions across a wide range of industries, and medicine is no exception. Although the number of women in full-time faculty positions has gone up during the past decade, the Association of American Medical Colleges (AAMC) found that female physicians in academic medicine are overwhelmingly likely to be instructors as opposed to holding positions like dean, department chair, or full-time professor. More specifically, the AAMC found that women comprise a mere 18% of all medical-school deans, 18% of department chairs, and 25% of full-time professors.

According to Dr. Sasha Shillcut, MD, MS, Professor and Vice Chair of Strategy and Innovation at the University of Nebraska Medical Center’s anesthesiology department, these inequities are due to a dearth of academic medicine organizations that actively seek to recruit women in positions of leadership. Without active recruitment, women will continue to be underrepresented. Furthermore, Dr. Shillcut adds, female leaders need continued support and mentorship following recruitment in order to secure their success. In particular, women recruited to the most lucrative medical specialties, where women have conventionally been underrepresented, are often subjected to a lack of support and mentorship.

In a report from the Association of Pulmonary, Critical Care, and Sleep Division Directors, researchers noted several contributors to gender inequality and inequity in leadership roles, including a lack of women in leadership positions. Other factors included poor retention of women in leadership roles, a greater number of family responsibilities for women, the gender salary gap, and “gender climate” (implied and perceived biases).

As a result, female physicians often find themselves fighting an uphill battle from day one. Consider the example of cardiologist Dr. Yasmine S. Ali, MD, MSCI, FACC, FACP, who directed two different divisions at an academic hospital. Despite her high-level position, Dr. Ali significantly lacked administrative support. What’s more, she had barely any mentorship and very little schedule flexibility. Like many other physicians with whom Dr. Ali is acquainted, this combination of issues ultimately led Dr. Ali to leave her job and open a private practice.

Unfortunately, many physicians and other healthcare professionals maintain biases without even being aware of them, with these implicit biases serving as one source of ongoing gender inequities. According to an article in The Permanente Journal, gender inequities have been present for millennia, with women expected to assume the role of homemaker and caregiver while men served as leaders and workers. Authors of the article note that implicit biases play a part in women’s sluggish advancement, more negative evaluations, underrepresentation in leadership roles, pay inequity, and imposter syndrome (self-doubt).

Rectifying inequities in academic medicine is possible, even with their deep-rooted history. However, it will depend on a concerted effort from the healthcare community to raise awareness and take action.