Addressing unconscious bias for female clinical academics
2016-04-01

In Australia, opportunities for female leaders in Industry, Government and many professions have lagged behind countries with similar cultures and history, such as New Zealand and the United Kingdom. Recent awareness of this issue in Australia has been noted by an increase from one to five female cabinet ministers this year1 as well as elected female Premiers in several States and territories, a female Governor General and Prime Minister and several leaders of Industry all in the last 5 years. Furthermore, the Australian Government introduced legislation into Parliament (2012) to improve the Equal Opportunity for Women in the Workplace Act to support employers to remove barriers to the full and equal participation of women.2 So how are we going in academia? It must be acknowledged that gains have been made compared to 5 years ago. Some Australian universities now have female Vice Chancellors. There have also been calls within universities to consider promoting talented women into appointments, leadership and speaking opportunities, supported recently by the Science in Australia Gender Equity (SAGE) initiative.3 In reality, it is well known that both female academics and female clinicians are poorly represented in leadership positions across academia and health. Female clinical academic leaders are even more scarce. The ability to change this requires an understanding of the size and nature of the problem and its causes. Until recently, these were unknown, however the manuscript by Jenkins et al.4 in this issue of Internal Medicine Journal sheds some light on this issue. This analysis consisted of a gender-based analysis of physician-researchers in Sydney. It appears that more female medical graduates are completing PhDs yet publish less relative to their male peers. It is unclear why this is occurring; time off for childcare responsibilities, traditional cited reasons for career non-competitiveness, are not the explanation.5 In terms of senior leadership roles, Jenkins’ analysis noted that for Project Grants awarded in 2013, physician-researchers only lead 21% and of this small group only 20% were female. The important question is are there fewer grant applications from women or lower success rates among women applicants? Data specifically pertaining to physicians are not readily available, but there is certainly concerning evidence that there are fewer female applicants at senior research levels. National Health and Medical Research Council Fellowship applications for women in 2014 were equal or even exceeded male applicants at early career development levels, but thereafter the number of women applicants was substantially lower than men. This was at levels of Senior Research Fellowship (60–70% male), Principal Research Fellowship (70% male) and Senior Principal Research Fellowship (approximately 90% male) (public lecture, Dr Anne Kelso Translational Research Institute Queensland, October 2015). Given the medical workforce is 50% female, these disparities are striking and unconscious gender biases may well be playing a role. Unconscious gender bias arises in multiple forms.6 Most obviously, it occurs when a leader or institution is ‘blind’ to it, not having experienced, or not being aware of, the barriers that many women and other minorities face. It is also subtly evident in the differences in words used to describe high performing academics. A scan of references for academics demonstrates use of the terms ‘star’, and ‘stellar performers’ to describe men whereas ‘diligent’, ‘hardworking’ and ‘loyal’ are more often used for women. This can be the case even when the two have performed equally well on the usual metrics of grants and publications. These gendered differences in wording matter when a university is looking to shortlist a high profile academic.7 Observationally, start up, salary rates and relocation packages for senior clinical academic women are poor compared to men; recruitment processes are not always transparent.8 As a general rule, women are less likely than men to self-promote leading to obvious delays in career progression of women compared with men. Women often do not apply for promotion until it is long overdue and women tend not to apply for jobs unless they meet 100% of the criteria, compared to men who apply when they meet 60% of the criteria.9 Further, more junior organisational roles in universities, often led by women, can be satisfying and fulfilling by contributing to workforce training, but often are not springboards for promotion or leadership. The Stanford School of Medicine notes that women spend on average 8 h more per week in these activities compared to their male colleagues.10 Working at these roles at the expense of the more valued roles such as research may considerably hinder career progression. In our experience, clinician academics also find that once such roles have been accepted, it becomes difficult to hand them on to others. What are potential approaches to these issues? Firstly, talented women need to be encouraged and sponsored to apply for leadership roles and promotions.11 A very deliberate effort needs to be made to put forward names of women when positions become available on editorial boards, university senior committees and speaker engagements. We have noted that some national clinical meetings can be almost devoid of invited female clinical academic speakers. In the area of promotions, consciously raising women's names at meetings is another important step to overcome unconscious biases. Not only that but also taking into account both career disruptions and the woman's achievements relative to opportunity (as now nominally assessed by NHMRC) should counter any quick judgement that the woman in question is not senior enough or does not have a track record that is good enough. An interesting approach taken by the Stanford School of Medicine has been to develop a new programme that issues bankable credits for administration and teaching responsibilities that can then be used for research grant-writing support or support for home responsibilities including meals and house cleaning.12 Further examples include organising cover for departmental roles to enable attendance at conferences or providing more direct family support to enable overseas travel for meetings. Such strategic use of funds and powers by leaders to support colleagues with family commitments is commendable and it will be interesting to monitor their success. Many male academics and clinicians we have talked to are very supportive of change because they see the inequity in opportunities for their partners or daughters, and the benefit of adding women to their senior leadership teams. Indeed, some men highlight gender inequity in their own blog posts. In the corporate world, many men have also championed change.13 Interestingly, the notion of ‘quotas’ to increase female representation on company boards has been debated. Notwithstanding that not all agree with this strategy, the number of women on boards has increased14, 15 and at the very least it seems to be a viable short-term solution. We ask, should this approach be translated to the clinical academic context? Specifically, do we need to mandate quotas for women speakers at national conferences, woman-led category 1 funding applications, and leadership of research boards? An additional strategy is to instigate a ‘visibility’ process. Specifically, developing an on-line data repository reporting the conference gender balance (i.e. percentage women in the audience, percentage women plenary, percentage women invited, percentage women selected, percentage women organising committee) would provide inroads into making more conscious the bias. Gender inequities in clinical academia have been recognised, but we need to hasten the pace with which we address it. Professor Jennifer L. Martin (University of Queensland Institute of Molecular Biosciences) provided references and constructive comments and solutions. Ms Joanne Knight (University of Newcastle) provided administrative support and editorial assistance.