When Taking Pay off the Table: A Qualitative Study of Gender Equity for Academic Leaders in the US Military.

Abstract

Although gender inequity persists globally in academic leadership positions, the United States Military has equitable pay and, in academic pediatrics, has equitable gender representation in leadership positions. To better understand how the US Military framework affects physician leaders, pediatricians were interviewed to illuminate the factors that facilitated their success and what barriers they faced in their career. In 2022, following institutional review board approval, semi-structured interviews were conducted with 13 total participants (69% female, 31% male) serving as general pediatricians or pediatric subspecialists in the US Military. These pediatricians were in leadership positions of military academic medicine across seven graduate medical education (GME) sites. The interviews examined the leaders' perceptions of facilitators and barriers to their success. The authors analyzed the interviews using Acker's theory of gendered organizations as a theoretical framework, which explains embedded gender roles within work environments. Drawing on the theory of gendered organizations, the authors identified that participants described several facilitators to their success, including the availability of mentorship/sponsorship, inclusive leadership, and early and persistent exposure to women leaders in GME training and beyond. Because medicine's ideal worker was normed around the traditional roles of men, men observed and women experienced barriers to leadership success around issues related to childbearing, maternity leave, and microaggressions. This study revealed that equitability for pediatric GME leadership in the military heavily relied on structures and support created by former leaders and mentors. Isolating these structures within a unique context of military academic medicine can illuminate physicians' experiences to address barriers and better support equitable leadership roles in both military and civilian academic medicine.