NOTES FROM THE ASSOCIATION OF MEDICAL SCHOOL PEDIATRIC DEPARTMENT CHAIRS, INC.

Developing Women Leaders in Medicine at the Grass Roots Level: Evolution from Skills Training to Institutional Change

University of Washington Department of Pediatrics, Childrens Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105-0371. Reprint requests: Elinor A. Graham, MD, MPH, Harborview, Department of Pediatrics, 325 9th Ave, Box 359774, Seattle, WA 98104.

(J Pediatr 2007;151:1-2)

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Lesson 1: Start With Sharing, Networking, Skill Building, and Inspiration and Include All Women Pediatricians in the Region In an attempt to address these gender disparities in pediatric leadership at a local level, a group of women pediatricians, with strong support from the Chair of Pediatrics at the University of Washington, established the Puget Sound Women’s Pediatric Society (PSWPS) in 2001. An invitation was sent to all women pediatricians, residents, and fellows in the local region inviting them to participate with a questionnaire about their interests, issues, and ideas for programs and speakers. A steering committee was formed from interested pediatricians, with a balance between those in community and academic physicians and included fellow and resident trainees. A mission statement was developed: “To foster and encourage leadership among women in pediatrics in the Puget Sound area and to support their professional and personal development.” The steering committee created a statement of guiding principles that emphasized the importance of uniting women in academics and in community practices, organizational inclusiveness and transparency, promotion of leadership models and roles that fostered a balance between personal and professional lives, and commitment to use of leadership skills to advocate for the health and well-being of children and their families. Activities have included 1 to 2 dinners yearly, with each attended by 40 to 80 women/session and half-day skill-building workshops. The dinners have included time for socializing and networking. Prominent national physician leaders have spoken to the group at the dinners including Dr Joycelyn Elders, former U.S. Surgeon General; Dr Barbara Barlow, former head of pediatric surgery at Harlem Hospital; Dr Iris Litt, Director of the Robert Wood Johnson Fellowship program; Dr Judith Hall, former Chair of Pediatrics at Vancouver BC Children’s Hospital; and Dr Jane Schaller, former Chair of Pediatrics at Tufts and Executive Director of the International Pediatrics Association, the first African American woman Washington State Health Officer, and the first woman athletic director at the University of Washington. These dinner events have focused on the life trajectories of these amazing women leaders and have been both inspirational and intimate, with opportunities for participants to speak from both their hearts and minds. Other events have included panel discussions on child health advocacy and work/ life balance with local pediatric leaders. Each year, skill-building and personal development workshops have been held, usually as half-day workshops on Saturday mornings, and each has been

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omen remain underrepresented in medical leadership positions in the United States in spite of gender equity in medical school enrollment. This underrepresentation exists even in the field of pediatrics, where women constitute more than half of all pediatricians and where the trend toward female predominance is increasing.1 Women represent 66% of pediatric trainees2 and 63% of pediatricians taking the American Board of Pediatrics certifying examination for the first time.3 In spite of their numbers in pediatrics, women are underrepresented in leadership positions both in academic and community pediatric organizations. Women direct only 15 of 140 North American pediatric departments and represent 21% of full professors in pediatrics.2 The American Academy of Pediatrics (AAP) also suffers from gender inequity. Currently, 6 of the 14 (43%) of the officers and directors of the AAP are women. But only 6 of 24 (25%) of the 2006 AAP National Conference Planning Group were women, and only one third of faculty listed for that conference were women (33 out of a sample of 103 or every fifth person listed in the conference faculty directory). Within Washington State, the current state chapter of the AAP has only 1 woman officer out of 5, and only 2 of the 9 trustees are women. There has only been 1 woman president in the history of the state chapter. Lack of conditions that promote gender equity in pediatric leadership is found in both academics and community pediatrics. The experience of 1 local center working to change these conditions and lessons learned from this process are shared below. We envision that there will be many such local efforts at the grass roots level, before we see a wave of institutional support to bring about national and societal changes that will eliminate underrepresentation of women in pediatric leadership positions. These culture changes will occur if the younger generation of pediatricians are supported in their expectations for family-friendly careers and see real models of institutional support in their training and in the jobs available to them in both academics and community pediatrics.

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ELINOR A. GRAHAM, MD, MPH, CAROL A. WALLACE, MD,

attended by 10 to 20 participants. Topics have included negotiating skills for physicians, communication styles, applied meditation, child health advocacy, mastering information overload, and efficient retrieval of electronic information. Participants have affirmed the usefulness of the skills taught in these workshops in both their personal and work lives.

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Lesson 2: This Is not Solely a Women’s Issue Men have been invited to participate, as well as women, and come both as pediatricians interested in the topics and as partners of women physicians. The organization has come to view itself similar to a group such as the League of Women Voters, an organization of women that sponsors events and forums open to both sexes to benefit the entire community. In the case of PSWPS, the goal is to bring more balance into the lives of pediatrics and to develop skills to make them more effective leaders in pediatrics and advocates for child health. Work/life balance and having an opportunity to share equally in child rearing is an issue that is important to men, as well as women. As we have moved into addressing institutional change, male pediatricians, especially those in the academic setting have increasingly lent their support, ideas, and passion to this effort.

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Lesson 3: You Don’t Need a Lot of Money to Start the Process Rolling or to Keep It Moving Funding for activities of the organization was obtained from an initial grant of $10,000 from the Children’s Hospital and Regional Medical Center (CHRMC) and continued by donations from women pediatricians and small grants from supporting individuals and companies. Donated funds go into a “Women’s Leadership Fund” at CHRMC. Events are priced to cover costs and to subsidize participation by residents and fellows. PSWPS operates on a budget of $3000-5000 per year. Over the last year, the Chief Operating Officer of CHRMC agreed to support a part time administrative support person to coordinate this process.

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Lesson 4: Opening Pathways for Women to Assume Leadership Will Require Profound Institutional, Cultural, and Societal Change Two years ago, our steering committee felt that it was time to move from inspirational talks and skill-building workshops to initiate institutional change that would promote work/life balance in pediatric careers. Important issues, such as the impact of pregnancies during pediatric residency and the continuing lack of on-site quality child care, maternity, paternity, or elder care leave, and flexible work settings in both community and academic settings, among others, were focal points for our discussions. Similar issues were raised by a national task force addressing challenges to women pediatricians.4 Successful solutions to these barriers will benefit both men and women and will foster movement of women into positions of leadership. Lesson 5: Develop a Proactive and Inclusive Process to Address These Issues at the Institutional Level We recognized that changes were needed in both academics and community pediatrics but decided to address the academic setting initially. The leadership of both CHRMC and the Department of Pediatrics in the School of Medicine were concerned about these issues and agreed to approach the issues of family support 2

Graham, Wallace, and Stapleton

structures, flexible training and work settings, academic advancement, and midlife career transitions in a proactive and investigative manner. Over the past year, work groups were established with the charge to investigate best institutional practices to support work/life balance in pediatric careers. The work groups addressed (1) family support structures such as on-site child care and parenting and elder care leave, (2) flexible training and work settings to accommodate family and personal needs, (3) academic advancement and promotion issues, and (4) facilitating midlife career transitions into academics by experienced clinicians and researchers at a time in their lives when family responsibilities may be less demanding. The work group investigations culminated in a symposium where these issues were discussed in small interactive groups, and recommendations for institutional change were presented to administrators of the Department of Pediatrics and CHRMC. Dr Bonita Stanton, a major champion of developing women leaders and Chair of Pediatrics at Wayne State University, was invited to be the keynote speaker for this symposium. Her moving presentation promoted a lively discussion with the pediatric community and an open exchange with administrators. The process has unfolded a road map for institutional change to support work/life balance for pediatricians. The leadership of the Department and the hospital are now working with an implementation committee that will actualize and monitor the recommendations that came out of the symposium work groups. See Table for a summary of selected recommendations and measurable action outcomes (available at www.jpeds.com). Community pediatricians have now developed a task force that is looking at similar issues as they relate to their own practice settings. They are developing a score card of “family-friendly” practice features that residents and fellows can use as they seek jobs in the community sector. Changing expectations of job-seeking pediatricians will help change what is available in community practices. The community task force also plans to take discussion and sharing of information about “family-friendly” practice features to the annual meeting of the Washington State Academy of Pediatrics to promote statewide awareness of this issue. With the help of the PSWPS and the many committed people who joined this process, institutional change that supports physicians who want and need more balance between their work and personal lives will occur. These changes will allow women to move more easily into positions of leadership in pediatrics both in academics and in national pediatric associations. If change happens at the local level, more rapid changes at the national level will follow. It is anticipated that this process can serve as a model for other institutions and organizations faced with the similar challenges. The authors want to dedicate this commentary to the memory of Gail G. Shapiro, MD, an outstanding pediatric allergist and nationally recognized woman leader in her field who helped establish PSWPS and was an active member of its steering committee until her untimely death during heart surgery in August 2006. References available at www.jpeds.com. 0022-3476/$ - see front matter Copyright © 2007 Mosby Inc. All rights reserved. 10.1016/j.jpeds.2007.02.054

The Journal of Pediatrics • July 2007

Table. Selected recommendations and measurable action outcomes Work group

Recommendation

Family support structures

On-site child care

Flexible training and work

Clear policies on part-time work and parental leave Increase promotion recognition for mentoring Faculty making this transition need extra orientation and support

Academic advancement Facilitating midlife career transition into academics

Measurable action outcomes Addition of on-site child care to new research facility and all future new buildings Policies written, discussed, and posted on faculty and resident web sites Establish a department of pediatrics faculty mentoring award Peer counseling group set up to mentor/ provide guidance to these faculty

REFERENCES 1. Physician Specialty Data: A Chartbook. Washington, DC: Association of American Medical Colleges; 2006. https://services.aamc.org/Publications?showfile.cfm?file⫽ version67.pdf&prd_id⫽160&prv_id⫽190&pdf_id⫽67. 2. Women in U.S. Academic Medicine: statistics and medical school benchmarking 2004-2005. Washington, DC: Association of American Medical Colleges; 2005. http:// www.aamc.org/members/wim/statistics/stats05. 3. Jones MD Jr, Stanton BF. Women in pediatric subspecialties. J Pediatr 2004;144:143-4. 4. http://www.ambpeds.org/site/education/education_FPO_newsletter.htm.

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