Every doctor needs a wife: An old adage worth reexamining

Organizational policies, practices and culture

Women represent half the medical workforce but are underrepresented in leadership roles [5].

Salary inequities exist between men and women doctors [5].

Flexibility policies (job-sharing, part-time work, stopping a tenure clock are rare and using them is associated with stigma) [26, 41].

Traditional metrics of productivity (clinical dollars, research grants) may underestimate women’s contributions (service, teaching, committees, mentoring, collaborative research) [11].

Women physicians approach their work differently, taking more time with patients and adhering to guidelines more. Some studies show improved patient outcomes for patients of women doctors [31, 33].

Work centric culture and unrealistic expectations on the part of colleagues may play a role in high rates of attrition among women physicians [10, 34].

Gender bias may result in discrimination, hostility and underestimating work done by women [11, 25, 29].

Work-home conflict

For women in academic medicine, ‘satisfaction is balance’ [20].

Real and perceived trade-offs exist for women between work and non-work life, parental and work roles, and delaying a family for the sake of not falling behind professionally [10].

Women physicians spend more time than their male peers doing domestic work [10].

Women more likely to work part-time or take time off for life events. There may not be an ‘on-ramp’ for doctors who take an ‘off-ramp’ [9].

Both men and women increasingly question narrow definitions of professional success, favouring more flexibility and engagement in non-work roles [10, 19].

Role models and community

More women enter academic medicine than men, but leave in disproportionate numbers before achieving the rank of associate professor [6].

Women balance goals at home and work and often have separate identities within these different spheres [34].

Women physicians report feeling isolated, invisible and marginalized [34].

Women leaders may cope with these challenges by self-silencing and creating micro-environments which do not lead to broader culture change [34].

Women leaders may be penalized in terms of social approval for professional competence when their behaviour violates gender expectations [11, 13].

There is a lack of role models and sponsors [9, 25].

Women of colour report being in a ‘double bind’ as outsiders [38].

1. Effective mentors for women need not be women themselves.

2. Mentors should engage in both relational mentorship (coaching, advice) but also in concrete sponsorship (promoting mentee and identifying opportunities for advancement).

3. Help mentee to clarify values and goals in both personal and professional spheres. Encourage reflection on personal style and conflicts between approaches needed for success in these different arenas.

4. Discuss time management and look for ways to help balance work and life activities.

5. Challenge barriers that may reflect the mentee’s perception that they do not ‘fit’ a particular role. This may be the influence of stereotypes.

6. Look for professional development opportunities that exist through professional societies, especially those involving group work and networking with mentors [19, 41].

7. Identify institutional obstacles and discuss how these can be strategically navigated.

8. Encourage use of flexibility policies when they exist. Explore perceptions of stigma around making use of these options.

9. Coach women through career setbacks. Successfully navigating these leads to empowerment, resiliency and acceptance [20].

10. ‘Push out’ professional development opportunities to promising women rather than assuming these women will identify their own potential or suggest themselves for these roles unless they are overqualified.