Women leaders’ career advancement in academic medicine: A feminist critical discourse analysis

Academic medicine involves physicians, researchers, and educators in a tripartite overlapping mission of medical education, research, and practice. Gender parity remains a serious issue in academic medicine. Women have occupied 50% or more of the seats in North American undergraduate medical programs for decades. However, despite interventions by higher education institutions globally, women have not advanced to senior leadership positions at corresponding rates. Women are also less likely to advance in their academic medicine careers than men; for example, they are less likely to achieve the rank of full professor and less likely to remain in the field. Existing gender equity initiatives are clearly not achieving intended levels of inclusion for women in the field. We require research to identify gaps and barriers currently unaddressed by existing gender equity initiatives in academic medicine. Women in the field have often been isolated from and pitted against one another and measured against male-associated leadership ideals while required to perform exceptionally in order to be considered deserving of inclusion. Gender equity is often equated with pregnancy and childrearing, which obscures other barriers experienced by women, as well as the diversity of women as a group. Women who ascend to leadership are often required to achieve more than male peers. These “superwomen” are then help up as evidence that gender parity has been reached. However, women leaders continue to be evaluated in relation to gendered norms that disadvantage them. These norms are compounded by informal hiring practices and social spaces that exclude women from existing opportunities. At the same time, differences in access among women, and the voices of those women absent from the field altogether, remain unacknowledged and invisible. Identifying barriers embedded within local, institutional, and professional cultures is required if we are to achieve authentic inclusion in academic medicine. Dominant and resistant discourses alternately enable, restrict, and/or resist the achievement of gender equity in this sphere. Barriers to gender equity in academic medicine extend far beyond gaps in women’s career trajectories related to (assumed, expected) maternity leave and child raising. Gender equity requires moving beyond individual level factors and policies to critically consider local, regional, and institutional norms, assumptions, and practices. It involves calling into question a narrow definition of “woman” that overlooks intersecting differences related to race, gender, class, able-bodiedness, and sexuality, and obscures the ways some women are multiply disadvantaged and excluded from the field.