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World Gastroenterology Organisation
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More Women Leaders: Patching the Leaky Pipeline

Christina M. Surawicz, MD, MACG

Christina M. Surawicz, MD, MACG
Professor of Medicine, Division of Gastroenterology
Associate Dean for Faculty Development
University of Washington School of Medicine
Seattle, Washington, USA

In the US, women represent 50% or more of medical school class students and are represented in growing numbers in all fields of medicine, though more in some than others (Pediatrics compared to General Surgery for example). Yet the numbers of women in leadership roles in all areas has not kept pace with this trend. While we have many more women in all fields of gastroenterology we still have relatively few women leaders in private practice or in academic medicine or in industry. Why is this? Two explanations are often given. One is that there is a “glass ceiling” ; that is that women can advance to a certain level but are not able to go higher because they cannot break through an invisible barrier called the “glass ceiling.” The other explanation is that there is a “leaky pipeline”; that is that we are losing women leaders along the way as they drop out on paths to leadership. Whatever the reason, there are definite barriers and challenges for women that must be addressed. I will focus on three barriers: biology, conscious bias, and unconscious bias.

1.    Biology

I use the term biology broadly to encompass the role of women and family. The prime years for child bearing and child rearing coincide with advanced training and early career and thus conflicts inevitably arise. We must find ways to minimize that conflict; this will help everyone, not just those with families. Some solutions include part-time work options and flexible work schedules, generous parental leave programs, hiring locums, and high-quality, affordable, available, convenient day-care for those with children. In Sweden many of these programs are available; Sweden ranks 4th of all nations in gender equity according to the Global Gender Gap Report of 2014, a report of the World Economic Forum that measures equality in areas of economics, politics, education and health. Equitable pay, equitable resources (such as staff and secretarial support) and flexible promotion policies for those in academic medicine are also important. I must also mention the importance and power of mentoring, including peer-mentoring.

2.    Bias

Both conscious and unconscious may hamper progress for women. One example of conscious bias is the stereotypical view is that men “take charge” and women “take care.” Moreover, there can be a bias that some perceived “traditional” male traits are seen as a better fit for leadership: dominance, confidence, and self-reliance. However, some traits traditionally associated with women make good leadership skills as well: empathy, interpersonal skills, flexibility, and inclusiveness and often lead to excellent team building. Moreover, there are many different leadership styles, such as authoritarian, delegative, democratic, transactional, and transformational. Different styles are often needed in different situations and a good leader will adapt accordingly. We need to recognize that these biases exist, to make sure that women candidates are included in all job searches, and to think beyond “traditional” models of leadership. Women have asked me if they should alter their styles: my advice is to be true to your own values and strengths. A woman does not need “to be more like a man” as Henry Higgins sings in the musical “My Fair Lady.”

3.    Unconscious Bias

The biases we have but of which we are not aware constitute an additional barrier. One example of unconscious bias was demonstrated in a recent study in which 127 men and women science professors (biology, chemistry, and physics) were asked to evaluate a fictional résumé of an undergraduate student applying for a job. The résumés were identical except one was a man and one was a woman. The results were very surprising to me—and disheartening. The woman student was viewed as less competent and less hirable than the male student, and was offered a lower salary and less career mentorship. This was true for both men and women professors. The only bright spot was that they liked the woman applicant more. 1 Research shows that we all have implicit unconscious biases, and that we cannot get rid of our unconscious biases. Thus we must recognize these facts; we must educate ourselves and others and put in place programs to limit bias, such as in search committees. For more information on unconscious bias, I highly recommend the book, “Blind Spot: Hidden Biases of Good People” by Banaji and Greenwald 2.

The good news is that traditional gender roles are changing, bias against women leaders is decreasing and everyone wants more women leaders. Let’s continue to support one another in our professional lives, and mentor junior women and students in the pipeline. Let’s look to our professional societies for ongoing support and opportunities. Finally let’s remember that we are so lucky to be in our professions; with all its challenges; it is and will always be a privilege.


  1. Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proc Natl Acad Sci USA 2012;109(41):16474-16479.
  2. Banaji MR, Greenwald AG. Blindspot: Hidden Biases of Good People. Delacorte Press 2013.