Leading for change

There are some things in the world which seem so frustratingly obvious to me that I find them difficult to discuss, or to write about, because I have to suppress my negative emotions…issues such as health inequality, climate change, “Closing the Gap”, Mental Health care. These are issues where, in my mind, we have the data and science, we have the case for change, the ethical or moral clarity, we have the resources, but we do not seem to have the collective will to implement the solutions, to embed the changes needed and follow a new path to a better place.

They are all issues I care deeply about. They are big issues with clear cases to act, to advocate, to change. The solutions are complex, but that should not stop us acting.

However, whatever frustration I have with these problems, there is one more on the list…women and the ongoing challenges and barriers women face…. in leadership, in career inequity, in career progression and opportunities, pay inequality… the biases, the discrimination. And more..much more…domestic violence, abuse, sexual abuse.

This piece is about medicine and our health systems.

We all have those moments when we know things have to change…those “OMG” moments. When I threw my hat in for the ACEM President position, I had already declared that there were issues I wished to address. Addressing the barriers and improving the supports for female Emergency Physicians to advance their careers, to step into leadership and management roles within emergency medicine was one of those. There was acute awareness of this problem and I was keen to do what I could to support change; to advocate for better.

But I was made even more aware very early on, in my “Pres L-plate” days, that this was urgent. We had invited Taj Hassan, the then RCEM President, to visit the ACEM offices. When we lined up with Taj and the Board for a photo, I looked left…all men. I looked right…ditto. “ACEM, we have a problem….”

So, we set about creating change. We developed new working groups and management goals to drive that change and, over recent years, we have come a long way. The current Board is very different to the one I stepped on to. Many of our committees and working groups have seen much more balanced representation (although others have some way to go) and, of course, our next ACEM President is Dr Clare Skinner. Our current Board has more women than men. AWE (Advancing Women in EM) is core to ACEM, NoWEM is driving change and supporting new and developing leaders, and our Faculty Boards have more balanced representation. I am pleased that this has been achieved during my time on the Board. Clearly, there were many people who contributed to this; I’m just happy to have played a small role.

However, the system in which we all work, has so much more to do. ED leadership is far from being gender balanced, with only about 20% female directors. In other hospital units, it is a similar picture, with men dominating senior clinical and medical leadership roles, and staying in those roles for many, many years; a job for life it seems.  Approximately only 30% of those roles are occupied by women. Of hospital CEO’s, less than 20% are women in the lead.

It is obvious that medicine and associated health industries are no better, and in many cases, worse than other industries.

In an editorial in the MJA in 2019, Professor Helena Teede wrote of credibility, capability and capacity as the challenges women need to overcome to achieve gender equity in leadership roles. But there is one more C-word… Chromosomes…namely the Y one.

  MEN…ARE...A…BARRIER…

We only have to look at the halls of our hospitals, the libraries, the names in AMA buildings and adorning the board rooms and hallways of the Colleges….men. Men with white coats, white hair, with mahogany desks in expansive offices and generations of privilege to realise that men are a barrier to the success of women in attaining leadership roles. We have put up the barriers, we have created the hurdles and stand on the other side of the glass ceiling looking down, ready to patch it up when it looks like cracks are appearing. 

Now, I realise that this is not all men.…that there is a generational change coming which I hope is more progressive than the last, which recognises the overt privilege of being male in medical careers and bends over backwards to even up that ledger and ensures that we reach equity in opportunity, in pay, in career structure, in respect, in leadership roles. And, in medicine and surgery, there is a need to address a culture where there remains an expectation regarding gender roles and the sacrifices which need to be made to achieve career goals; a culture where you need to push and are pushed; working dusk to dawn and forsaking everything else which makes life, well, life….family, relationships, personal development. So, we need to ensure equity in parenting leave, respect part-time careers, and allow opportunities for ALL genders to maintain and embrace harmony in family and work life. We must see an end to the sexism and misogyny which is clinging onto existence in health. These issues are alive in medicine, but it’s time put end that harmful and harming culture.

These gender issues, the sexism and discrimination are not unique to health care and hospitals. In politics, in business, in religious institutions and many other areas, we are all acutely aware that men cause harm to women, mentally, emotionally, physically. The horrible story, the sexual assault, of Brittany Higgins in Parliament House has, I’m sure, brought back horrific memories for women in the health industry.

In healthcare, we are meant to be champions of care for all, to treat everyone as equals, to provide care regardless of race, religion, culture, sex or sexual orientation. But we don’t. We have our unconscious biases, our conscious biases and, in many cases, overt and unincumbered discrimination.

Today, in 2021, we need to address these issues and make this history. In health, we need to lead that charge.

Why? Well, because it’s 2021.  But also, I have no doubt that, given the opportunity, women in healthcare will make, in fact already do make, a very strong case that they will be excellent leaders, better agents for change, a change that our health system needs. Leaders who are smart, who are team-focused, who have empathy, who are strong…leaders who care.

So, its time that we, men who are or have been in leadership roles, looked to succession planning, looked to identifying the next generation of leaders we need in health care and hospitals, support a change and champion that change. And, when you do start, remember that having a Y-chromosome is not a leadership attribute…..