Amid concerns women in medicine face a “glass cliff” when trying to obtain leadership positions, experts say this can be overcome by addressing systemic and structural barriers in the health care industry.

For the first time, the gender pay gaps from nearly 5000 Australian private sector employers have been released by the Workplace Gender Equality Agency (WGEA), finding women continue to be paid less than men in the medical, health care and medical research sectors.

The data revealed the median total remuneration gender pay gap for the Healthcare and Social Assistance sector was 6.1% in 2022–23.

They broke this down into more specific subsectors, highlighting that Medical and Other Health Care Services had a 16.4% pay gap, Hospitals had a -3.5% gender pay gap (in favour of women), Residential Care Services had a gap of 3.8% and Social Assistance Services had a gap of 5.7%.

Of every sector analysed (not just medical and health), the largest pay gap in favour of men was in the Medical and Other Health Care Services subspecialty.

In analysing the data, they converted part-time and casual salaries into annualised full-time equivalent earnings and also excluded the salaries of CEOs and Heads of Business.

The Association of Australian Medical Research Institutes (AAMRI) analysed the Medical Research Institute sector and found the average median total remuneration gender pay gap was 9.4%.

AAMRI’s CEO Dr Saraid Billiards told InSight+ that the results in her sector showed that more needs to be done.

“We know that there’s still a long way to go and there’s certainly variability within our sector. In a way that’s good to see that some are really pushing the boundaries of trying to achieve that equity,” she said.

Medicine's gender pay gap revealed  - Featured Image
The largest pay gap in favour of men was found in the Medical and Other Health Care Services subspecialty (Gorodenkoff / Shutterstock).

Women in medicine hit a career “glass cliff”

Women in medicine face a persistent “glass cliff” when trying to obtain leadership positions, according to a Perspective article published in the Medical Journal of Australia (MJA).

Although more women took on medical leadership positions during the coronavirus disease 2019 (COVID-19) pandemic, there appears to be a “glass cliff phenomenon” in Australia, Dr Melissa Wheeler and Dr Laksmi Govindasamy wrote. 

Women tend to be appointed to leadership positions in times of crisis, where they are often put under increased demands, they argue.

“The glass cliff phenomenon, drawn from the glass ceiling concept, refers to the tendency for women and other minoritised people to be appointed to leadership positions in times of crisis, compared with periods of stability,” Dr Wheeler and Dr Govindasamy wrote. 

“This is because, when circumstances are bad, change is both desired and needed, and women and other minoritised people are often pushed forward as visible signals of change.”

How can we change it? First step, don’t blame individuals

Although it may be tempting to call out individuals or organisations, experts say that is unlikely to change anything.

According to Chief Investigator on the Advancing Women in Healthcare Leadership, Professor Helena Teede, the problem is not about individuals, it’s about the system.

“We’ve been talking about equity for decades but the reason it hasn’t changed is we’ve just basically blamed individual women in the system and left it up to them or blamed individual men for being part of the problem,” Professor Teede said.

“We haven’t recognised this is simply a cultural systems workplace problem. The barriers are in the systems that we have, they’re in the workplaces and environments they’re in.

“This is not a battle between men and women. It is a social and cultural construct and it’s embedded in the systems and the policies that we work within. Which means it is totally fixable.”

Dr Billiards agreed.

“I know that there was a period of time where there were a lot of programs in place which were designed to fix the women,” Dr Billiards said.

“But I think what they’ve realised is that’s not the problem. It’s actually about fixing the system.

“Leadership training, and mentorship and all of those things are good. But it’s also at that systemic level to ensure that there is equity across all genders and ensuring that there’s opportunities for everybody moving forward.”

One way AAMRI is working on this is through their Gender equity, diversity and inclusion (GEDI) Strategy and Action Plan.

Part of that action plan is changing the measure of success to encourage a diverse workforce to reach promotion in the sector. She said a good proportion of medical research institutes have taken additional metrics into consideration.

“So it’s not just about the numbers of publications or the numbers of grants you’ve got, it’s also about leadership, the contribution to other activities that are part of the ecosystem,” she said.

Professor Teede agreed.

“I used to be a believer that merit was about ‘have you been overseas and done your Cardiology Fellowship, have you presented at conferences, have you written 15 papers?’ because they were our markers of merit. Actually, they’re just markers of privilege. Merit is about understanding who is the best fit for the job,” she said.

The importance of women in leadership

One of the most striking observations from the report was that employers with more women in leadership positions were more likely to have a neutral gender pay gap.

“Employer gender pay gaps decrease as the proportion of women in management increases. The goal for employers should be gender-balance in management, that is at least 40% women and men,” the authors wrote in the WGEA snapshot.

The age-old question is how to get more women into leadership positions. According to Professor Teede, it’s nothing to do with capability. Instead, the leadership structures that exist are less appealing to some women.

“It’s not necessarily a problem of them not stepping up and taking these roles. They’re not motivated to take those roles because the way the roles are constructed and the lack of support and childcare and policies that we have don’t make them appealing. They don’t have the motivation and then there’s all these barriers in system that prevent them from having the opportunity,” she said.

In medical research, those structural barriers are slowly changing.

“I think the days of being a part-time researcher, and that not being accepted has changed. Employers are much more accepting of researchers who need to work part time, for example,” Dr Billiards said.

However, leadership in the sector is still male dominated. Out of the AAMRI member organisations, only 17% of CEOs are women, despite 68% of the professional workforce being women. Eighty-five per cent of their board chairs are men.

Diverse and strong leadership will ultimately improve health care

Although improving the gender leadership balance is crucial, Dr Billiard also highlighted the importance of strong leadership regardless of gender.

“Having good strong leaders who are willing to take this stand [is] really critical,” Dr Billiard said.

“We’ve had some really good strong advocates in our sector. This means including everyone, regardless of gender, race and sexuality, in the discussion.

“When there are seminars, lectures, presentations, when you’re talking about gender bias, or you’re talking about gender equity, or diversity and inclusion, the majority of the time, the largest proportion of individuals in the room are women.

“I think it’s getting men into the room to listen and to understand and then to advocate to their colleagues that this is an issue. And it’s not an issue that would threaten their existence.

“What it does is it creates a more productive, more innovative, more successful sector by having diversity of minds around the table.”

A new push

A renewed push is under way to improve the disparity of women in medical leadership through the Advancing Women in Healthcare Leadership (AWHL) initiative, funded by the National Health and Medical Research Council (NHMRC).

The AWHL initiative is explored in a Perspective article by paediatrician Dr Jenny Proimos and colleagues, published in the MJA.

A key focus of the AWHL initiative is recognising the role played by member organisations, including professional associations and medical colleges.

Eight colleges and member organisations partnered with the AWHL to explore the systems and policies they have in place to help advance women in the field.

The feedback from member organisations on the AWHL initiative has been very positive, with more funding now secured from the NHMRC.

Extensive engagement continues with member organisations as one way to improve the representation of women in health care and medical leadership.

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