How Did They Get There? What Perspectives From the Top Tell Us About Developing Women Leaders in Academic Anesthesiology.

Abstract

See Article, page 6 There is well-documented evidence of the persistent underrepresentation of women in academic medicine, leadership in academic medicine, academic anesthesiology, professional societies, and editorial boards in North America.1 Such documentation focuses on quantifying underrepresentation, but does not shed light on strategies that might be used to mitigate the low numbers of women in the upper echelons of academic medicine. In this issue of Anesthesia & Analgesia, Basile et al2 report the findings of 26 semistructured qualitative interviews conducted with women leaders in academic anesthesiology. The authors focused their interviews on respondents’ personal qualities and perceived barriers and facilitators to advancement into leadership roles to identify common factors that contributed to individual success. Study participants included national society presidents, department chairpersons, American Board of Anesthesiology examiners, hospital executives, and published authors, either practicing or retired in the United States or Canada. The study used a constructivist grounded theory approach, an established qualitative research method that employs iterative surveys, interviews, or focus groups to collect the perspectives of study participants and “construct” a theory a priori to explain a process or phenomenon of interest.3 The authors found that the respondents’ insights coalesced into 4 themes: personality traits, leadership preparation, gender-related considerations, and leadership acquisition. While some identified factors (including adaptability, perseverance, family concerns, and experiences of gender bias) were personal and potentially less generalizable, respondents also noted the value of external activities, such as self-promotion, networking, and formal leadership training during their careers. Respondents also identified 2 related resources, “high-level mentorship” and sponsorship, as crucial factors for leadership development and attainment of leadership roles. It is important to note that this window into leadership is limited in part by the absence of perspectives from women who applied for but did not attain leadership roles, those who are in early stages of their careers (eg, junior faculty and trainees), and those who left anesthesiology and/or academic medicine. By focusing solely on those who have achieved high-level leadership roles, the study may also reinforce perceptions of exceptionalism facing individuals who have objectively thrived for decades in a challenging environment. That is, these women leaders may be viewed as intrinsically different from peers without leadership roles. When women leaders are rare but visible, this misperception serves to reinforce the myth that qualified women don’t need or benefit from systemic career development support. It also isolates women leaders from peers and risks intimidating junior colleagues and mentees who view leadership roles as unattainable without extraordinary skills or extreme personal sacrifice. SPONSORSHIP IN ACADEMIC MEDICINE Despite these limitations, the study introduces readers to rigorous qualitative research, which remains rare in anesthesiology, and offers an opportunity to reflect on a key but often unacknowledged factor in leadership attainment: sponsorship. While the value of quality mentoring is well established in academic medicine and is also noted in this study, many participants uniquely noted the importance of a distinct and crucial but less recognized resource for career advancement: sponsorship (including sponsorship from powerful and connected “high-level mentors”). While some authors have argued that sponsorship is a form of short-term, goal-directed mentorship,4 others consider them complementary but distinct.5,6 In this editorial, we reflect on sponsorship and propose multilevel solutions to increase and improve sponsorship for women in academic anesthesiology. The authors identified sponsorship as the “leading factor contributing to leadership acquisition.”Figure.: Personal, institutional, and professional society roles in effective sponsorship. CV indicates curriculum vitae.As junior and midcareer academic anesthesiologists, we personally benefitted from sponsorship in our career paths; it has opened doors to competitive training and leadership development programs, research funding, writing and research projects, teaching opportunities, new jobs, and committee and leadership roles. We also acknowledge that sponsorship, as currently practiced, is inconsistently and inequitably distributed. Unlike other career development and leadership acquisition tools, sponsorship requires active (though sporadic) investments of time, personal reputation, and, in some cases, additional resources (such as dedicated nonclinical time) by supervisors, leaders, and mentors with a strategic focus on specific opportunities (eg, committee membership, speaking opportunities, or leadership training programs) necessary for career advancement.5,6 It is predicated on the availability of accessible, well-connected, and supportive individuals willing to act as sponsors, sufficient familiarity of potential sponsors with the individuals that need sponsorship (described sometimes as protégés,7 though this term implies a longitudinal relationship), and a system of incentives that encourage sponsorship. A paucity of willing and effective sponsors may plausibly increase gaps in access to leadership opportunities between departments, institutions, or specialties. Historically, sponsorship has arisen from personal relationships developed in settings that typically excluded women and other minoritized groups (eg, golf outings). For this and other reasons, sponsorship availability, form, and effectiveness vary by protégé gender.7 While women leaders may feel personal responsibility to reduce gender gaps in leadership through active sponsorship, the gender imbalance in senior leadership requires that men also sponsor women. Intentional sponsorship is also an opportunity to promote other forms of equity.6 At worst, the need for sponsorship may serve as the basis for gossip, coercion, or forms of patronage (eg, “paying back” sponsorship with other work of value to the sponsor alone), which are potentially harmful to career development and career satisfaction.8 Suggestions for best practices for sponsorship have been described, including thoughtful matching of potential protégés with opportunities, setting clear communication and performance expectations, and formal institutional sponsorship programs—but are not in widespread use.5 Aspiring leaders in academic anesthesiology are likely to benefit from sponsorship within in their field, but, depending on their chosen career path, they may also find effective sponsorship from other specialties or disciplines (for example, among hospital administrators or university leadership). IMPROVING ACCESS TO SPONSORSHIP Despite these challenges and limitations, if we accept that sponsorship remains an effective if underutilized factor in the development of women leaders in academic medicine, we propose pragmatic solutions for junior faculty anesthesiologists seeking leadership opportunities, their leaders and supervisors, and departments, institutions, and professional societies in which they work (Figure). With intentional practice, we believe that such efforts may improve access to sponsorship and leadership roles for aspiring women leaders in academic anesthesiology. UNDERSTANDING AND PREPARING FOR SPONSORSHIP OPPORTUNITIES Junior and midcareer faculty may optimally position themselves for future sponsorship to achieve leadership roles through intentional self-promotion. While self-promotion may feel uncomfortable or inconsistent with an individual’s personality or values, it is an essential skill in academic career development and one that can be practiced both authentically and effectively to solicit sponsorship.9,10 Being prepared to share skills and expertise with an up-to-date curriculum vitae, a list of prepared lectures and a brief “elevator speech” help potential sponsors identify and remember early career faculty as critical stakeholders and prospective future contributors (eg, “Dr Vail is an expert in transplant donor management”). Opportunities for self-promotion may be spontaneous or formalized, most commonly in the processes of annual review and promotion and tenure assessments.11,12 No matter when or how such opportunities may arise, junior faculty members should recognize that requests for sponsorship may strengthen their applications. These requests may be explicit in application materials (eg, required letters of recommendation from specific stakeholders), but potential sponsors may need explicit requests for sponsorship. In either case, timely notification, frequent reminders, and comprehensive support materials (such as a copy of the program notice and draft language for requested letters of recommendation) may increase the likelihood of successful sponsorship. SPONSORSHIP BY INSTITUTIONAL LEADERS For individuals in formal and informal organizational leadership roles (that is, sponsors and potential sponsors), fostering effective sponsorship begins with recognizing that one’s career likely benefitted from sponsorship and that sponsorship that develops internal talent may also strengthen institutions.6 Successful institutional leadership development and sponsorship programs typically include participation of senior executives, competitive and transparent application processes, longitudinal sponsorship experiences, and workshops to disseminate best sponsorship practices to institutional leaders.5,6 Senior leaders should understand that effective sponsorship requires intentional organizational support8 and can set expectations that all department leaders engage in active sponsorship by considering it a performance metric or condition of continued leadership. When available opportunities for internal advancement are scarce, leaders may consider whether required succession planning, explicit quotas for committee representation, open calls for available leadership positions, or term limits may offer needed leadership opportunities and foster diversity.13 Sponsorship may be incentivized through formal recognition of effective sponsors with awards or other incentives (for example, paid travel to attend an award ceremony honoring a protégé). For divisions, departments, and universities, sponsorship’s full breadth of challenges and opportunities cannot be understood or addressed until sponsorship activities are measured and reported. PROFESSIONAL SOCIETIES AS SPONSORS AND FACILITATORS OF SPONSORSHIP For professional societies, Basile et al recommend developing formal local and national sponsorship programs, which may address documented imbalances in access to effective sponsors. Some specialty societies have developed programs translated from successful business models.14 In addition to offering interinstitutional sponsorship and mentorship opportunities, societies may offer junior faculty leadership training programs and establish rules and quotas for committee participation and conference programming (eg, a “no manels” policy) needed to expand the pool of opportunities actually available to underrepresented groups.15 Societies may directly sponsor junior members by offering early career awards and profiling them in society publications and social media. Society-sponsored speaker bureaus or detailed member directories offer accessible opportunities for self-promotion. Societies may consider developing or modifying internal performance metrics to extend beyond standard measures (such as membership size and conference attendance) to include measures of society-facilitated sponsorship and members’ career advancement. In this new study, Basile et al offer perspectives on key factors that have helped women in academic anesthesiology become organizational and thought leaders. The work encourages us to reflect on the role of sponsorship in our career trajectories. It inspires us to examine how we, as individuals and members and leaders of departments, institutions, and societies, may augment our sponsorship efforts through organizational change. DISCLOSURES Name: Emily A. Vail, MD, MSc. Contribution: This author conceived the editorial, drafted the manuscript, and critically revised the manuscript. Conflicts of Interest: E. A. Vail is a mentee and protégé of Dr Lane-Fall. Dr Lane-Fall has sponsored Dr Vail for several key roles, including speaking invitations at national meetings, a committee role in a national society, and writing of this Invited Editorial. Dr Vail is supported by grant number K12HS026372 from the Agency for Healthcare Research and Quality. Name: Meghan B. Lane-Fall, MD, MSHP. Contribution: This author conceived the editorial and critically revised the manuscript. Conflicts of Interest: M. B. Lane-Fall is supported by grant number K12HS026372 from the Agency for Healthcare Research and Quality. This manuscript was handled by: Edward C. Nemergut, MD.