Imposter syndrome a 'major cause' of health’s gender pay gap

Institution-led imposter syndrome is a major reason for the lack of women in medical leadership, according to one expert, and new approaches are needed to place the burden of change on institutions.

Despite the growing number of women working in medicine, they are not necessarily making it into health leadership positions, according to a senior clinician interviewed by InSight+.

“We’re in the paradigm that was generated by older generations, that doesn’t apply today,” noted Professor Helena Teede OAM, an endocrinologist and director of Monash University Centre for Health Research and Implementation. “What we know is that the concept of ‘merit’ doesn’t take into account relativity to opportunity, is used to perpetuate bias and privilege.”

Professor Teede’s work is focused on creating equity in health institutions based on research, and establishing the Monash Centre for Health Research and Implementation.

“We’ve got more women than men in health care, and increasingly we have more women than men in education and higher degree research. But they’re not leadership roles,” Professor Teede said.

“We’re talking about any marginalised group — including gender and race. We’ve been thinking that individual women don’t want careers and aren’t putting themselves forward or nominating themselves for awards — as if it’s a personal behavioural trait. And that is clearly a flawed premise.”

The problems are institutional as well as social, according to Professor Teede.

To advance the cause, she has established the national Advancing Women in Healthcare Leadership Initiative, which focuses on increasing the number of women in health care leadership.

“The primary purpose of the centre is to deliver solutions to real world and real health system and real community problems through research,” she said.

Imposter syndrome is a systemic issue

Professor Teede said that most of the work being done is focused on creating equity through re-thinking imposter syndrome.

“So, I’ve been running a women’s leadership program now for about 10 years and one of the things that I hear every single time from the women in the room is that they feel they have impostor syndrome,” Professor Teede said.

Some of the work of the Centre is focused on creating equity through re-thinking ‘imposter syndrome’ and understanding what the drivers and implications are in terms of women careers, according to PhD candidate Daisy Morris, a colleague of Professor Teede.

“We have thought that it’s the fault of the individual, and you need to fix the individual. But it’s got nothing to do with personality. If you have a different skin colour, if you look different to the current power dynamics, you will be disadvantaged, and you’ll feel like an impostor,” she said.

Research shows that women approach leadership differently, according to Professor Teede.

“There are randomised control trials showing that if you randomly allocate women versus men into policy roles, that you have more equitable policies and better health outcomes where women are in those places. They work more collectively with their community and have better health outcomes for those who are most disadvantaged,” Professor Teede said.

Breaking down the paradigms

Professor Teede said that these new ways of thinking are being seen to have an effect in society.

“We are breaking down those paradigms and moving to a more collective community workplace approach,” she said.

“The policy changes we’re seeing in a federal government level are really quite impactful and inspirational. You can see some great things like the Women’s Gender Equity agency, and the Victorian Commission for Gender Equity. When organisations have to report on the gender equity and on their pay gap, all of a sudden, it’s the CEO’s problem.”

Economic opportunity

Professor Teede said that things have changed in Australia since the most recent federal election.

“Australian women went from being the highest educated in the world — which we still are — but fell to 70th for relative economic opportunity. We’ve gone back up to 40th in two years, because of some of the policy changes we’ve seen,” Professor Teede said.

“I want to emphasise this is not a battle of men versus women. This is a significant cultural shift that a lot of people are uncomfortable on and have to go on the journey. This is not the fault of the individuals who have the most influence at the moment — they are lucky. But we need to call it for what it is and balance it out.”

Study shows women physicians outperforming male colleagues

The University of Tokyo recently published research that showed that female patients treated by female physicians had a lower mortality and lower re-admissions than male patients treated by male physicians.

The study reported that, “for female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%).”

Professor Teede said this study is just one in a growing body of evidence showing women in medicine doing as well as, if not better than, men in medicine.

“The fact that we have this research, and many other examples that show that female doctors have spent more time with their patients have better outcomes – whether it’s surgical, prevention, etc – and are paid less, because they spend more time with their patients – it’s an indication that look, we’re good enough. Actually, we’re very good, we always were good, we may even be better,” said Professor Teede.

“We no longer need to prove this anymore. Rather we all need to get on with creating an equitable system and workplace where we can all thrive and deliver the best care and outcomes for our community.”

Professor Teede said that seeing women in leadership will continue to improve the gap.

“The more women we have in those positions, the more people see what they may want their careers to look like,” she concluded.

Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.