Gender bias is still a factor in pulmonary and critical care medicine. Just 26.8% of critical care physicians in the United States are women. In medicine overall, women publish less than their male counterparts and are often paid less.

“We also have a pipeline problem in our specialty,” said Andrea Braun, MD, FCCP, Assistant Professor of Medicine-Pulmonary at Baylor College of Medicine. “Less than one-third of our trainees are women, and the numbers have not improved in the past decade. Women in medicine have poorer health outcomes, higher rates of burnout, and depression. There are interesting data showing that patients have better outcomes if they have been treated by a female physician.”

Dr. Braun moderated a panel discussion on Advancing the Careers of Women in Pulmonary and Critical Care Medicine. The entire discussion is available to registered CHEST 2021 attendees through October 1, 2022.

One of the most persistent barriers to women in medicine is not recognizing the unwritten rules and expectations for advancement and success. Men don’t recognize those unwritten rules either, but men are more often mentored, sponsored, and coached as a matter of course than women. The first step in countering that bias is to create a network of mentors, sponsors, and coaches for women.

“Both mentors and sponsors are key professional relationships,” said Margaret Pisani, MD, MPH, FCCP, Assistant Professor of Pulmonary, Critical Care, and Sleep Medicine at Yale School of Medicine. “You may need multiple mentors and sponsors throughout your career, starting with peer mentors and faculty at your own institution who can help and advise you.”

Mentors are particularly important early in a career, she continued. A mentor’s role is to impart knowledge and wisdom that can shape and transform a career.

Sponsors tend to be transactional or episodic relationships, providing career assistance with recommendations or opportunities for specific tasks, such as a new position or a volunteer opening. Neither mentors nor sponsors appear by magic.

“Making yourself known is crucial,” added Carey Thompson, MD, MPH, FCCP, Chair of Medicine and Chief, Pulmonary and Critical Care Medicine at Harvard Medical School, Mount Auburn Hospital. “Mentors and sponsors come from the relationships you develop at your institutions, in societies like ATS (American Thoracic Society) and CHEST. Relationships come from making yourself known.”

Developing leadership skills is another key step in career advancement. Successful leaders have emotional intelligence, networking, negotiation, time management, and other skills.

“These skills are not intuitive,” Dr. Thompson said. “You have to study and learn them to move up the ladder.”

It is also important to become involved, both in your own institution and at the society level. Say yes more often than you say no, Dr. Thompson advised.

“When you say no a lot as a junior, people will not ask you anymore,” she warned. “You have to work to have a shot at showing you are a leader before you attain a leadership role. The more often you say yes, the more opportunities you will have to advance.”

Advancing women’s careers is a common goal as well as an individual goal for every woman in medicine, she continued. Gender bias is self-reinforcing. Selection committees composed largely of men are more likely to select other men. Every woman who advances has an opportunity to help reduce that often unconscious bias.

“As we get more women in leadership roles, we have more role models, more pathways to advance,” Dr. Thompson said. “Giving back is important. And lifting others up is one of the tricks of the trade.”

Leading by example is another important strategy.

“We should advocate for policy change, and we should model change through our everyday interactions,” said Jennifer McAllister, MD, FCCP, Professor of Pulmonary, Critical Care and Sleep Medicine, The Ohio State Wexner Medical Center. “We must hold ourselves and others accountable for lapses, like those occasions when a moderator introduces male speakers as ‘Doctor’ and female speakers by their first name. We need to call people out. We, as women, have the responsibility to lead by example.”

Women also have a responsibility to reject the traditional female role of victim.

“Being a victim does not work in your favor,” said Mangala Narasimhan, DO, FCCP, Senior Vice President and Director of Critical Care Services, Northwell Health and Professor of Medicine, Donald and Barbara Zucker School of Medicine. “Build your skills, shine, be visible for yourself. You can’t rely on people who look like you in our current world, but you can be the confident person that you are to advance your career.”