In 1993, when Ruth Bader Ginsburg was appointed the second woman to serve on the Supreme Court, I was nine years old and growing up in a house and a community that made this seem the norm. I now recognize the magnitude of this appointment. It took another three men and 16 years before the third woman would be appointed.  However, it is her journey to the appointment over a 40-year career starting with simultaneous law school and motherhood in the 1950s that is truly remarkable. Last month, The New York Times published the essay, “Ruth Bader Ginsburg’s Advice for Living,” an excerpt from her recent book, My Own Words, in which  she focuses on how she overcame gender challenges while reaching the top of her profession in a man’s world. Though much has changed in gender roles in the professional world, unfortunately not enough has. Twenty-three years after her appointment, as a young physician, I still identify with the hurdles she has overcome that lay ahead on my career path.  

In medicine, it is well documented that we have gender disparities in our academic leadership. In 1990, when ~50% of medical school graduates were women, there was hope that this would equate to more women in positions of leadership and that women would become equal contributors to the field of research. In a 2014 AAMC report on the state of women in medicine, it is noted that despite a continued 50% female graduation rate over the past 24 years, we haven’t come close to equal representation of female physicians in leadership roles.  In the US, only 16% of medical schools’ vice deans are women (1).  In academic medicine, women make up a smaller portion of tenured professors, on average publish fewer articles, and are likely to have a lower H-index.  Interestingly, if the data on publications is adjusted to compare women who don’t have children to men, there is no statistical difference (2).  This suggests that child bearing has a significant impact on career trajectory.  As there was no difference between men with or without children, it also is apparent that it has a different trajectory on male and female career paths.  As one female physician and vice president of research points out, when plotting her own life on a graph, her publication productivity was virtually a flat line over the 5 years that her three children were born.  After that, her productivity exponentially increased and her promotion to professor took three quarters of the time it took her to reach associate professor (1).  Though clearly she has overcome the hurdles, many don’t.  Some studies speculate that the early years of academic productivity that typically overlap with our childbearing years are paramount in career trajectory and may have long lasting effects that contribute to why things don’t equalize later on.  

The challenge of work-life-balance and career advancement has been, and continues to be, universal to the professional woman. In her essay, Justice Ginsburg notes fear of going to law school because she had an infant to care for.  Had it not been for her father-in-law who suggested that if she wanted to be a lawyer, she would figure out a way to do both, she might not have gone to law school then or ever. To balance her responsibilities she split her workday into the time before 4pm and after her daughter’s bedtime. In between was dedicated to her daughter. She credits this time away from her studies as making her a better law student. Maybe there is a silver lining to our childbearing years and the many directions we are pulled in that gives us a balance we have not yet effectively harnessed. Or maybe these are the stories we tell ourselves to get through it.

At a recent American Association of Women Emergency Physicians (AAWEP) meeting this past week at ACEP, two Academic Emergency Medicine chairs offered opposite advice on childbearing. One said she tells women to have children early so that they are more available to focus on their career after having had their kids.  The other stated he recommends waiting to have children until their academic career is already in progress, stating it may be easier to step away without losing ground.

In Justice Ginsberg’s case, she had her second child 10 years after the first. In effect she tried the early and late approach and was successful with both. Regardless of when you have children, something all AAWEP speakers that day seemed to agree upon is the need to prioritize your time; the things you can’t do—be in two places at once—or don’t enjoy doing should be outsourced.  This means enlisting child care to allow you time to get your work done or hiring someone to clean your house, do your laundry or prepare your meals. For Justice Ginsburg this included a nanny and a husband who took on the role of lead cook, something she hated to do.  

The final challenge in career advancement Justice Ginsburg touched on is the professional support we need to get to the next level. She shares that at the time she graduated from law school, the combination of being a woman and having a young child was generally prohibitive of getting a job as a clerk in a federal court. If it were not for what she calls the “heroic efforts” of one of her professors, she never would have gotten the job. Justice Ginsburg had a sponsor long before we were talking about “sponsorship.” Most are familiar with “mentorship” and think of it as important for career advancement. The new hot topic in the world of executives is “sponsorship.” Both have the goal of helping you succeed, but they do it in different ways. Mentors offer advice and guidance while sponsors advocate for you and put themselves on the line on your behalf (3). Dr. Azita Hamedani, Chair of the Department of Emergency Medicine at the University of Wisconsin, stated in her recent keynote address at the AAWEP meeting that we don’t find sponsors, they find us for the work we have done. Though data does not show that mentoring provides objective career advancement, she acknowledges that women probably benefit from cultivating both forms of relationships; mentorship for guidance while navigating your career and sponsorship for concrete career advancement. Justice Ginsburg even attributes her final appointment to the Supreme Court as a result of the sponsorship of her husband who lobbied important members of the legal community and state senators on her behalf.  

Much has changed since Justice Ginsburg walked this road, and she is one of many who has paved the way for women to follow in her footsteps as judges, CEOs, department chairs or deans. There are more women in positions of rank than 30 years ago, but it is not enough. We are still jumping through the same hoops of balancing when to have children, how to balance both shifts—at home and at work—and how to make the professional relationships that lead to our promotion. As we move forward, it is our responsibility as women physicians to not only jump the hurdles, but to cut them down until they are the same height as the ones our male counterparts seem to more easily walk through.


  1. Rochon PA., Davidoff, F., & Levinson, W., (2016). Women in Academic Medicine Leadership. Academic Medicine, 91(8), 1053-6. doi:10.1097/ACM.0000000000001281. PubMed PMID: 27306972.
  2. Raj, A., Carr, P. L., Kaplan, S. E., Terrin, N., Breeze, J. L., & Freund, K. M. (2016). Longitudinal Analysis of Gender Differences in Academic Productivity Among Medical Faculty Across 24 Medical Schools in the United States. Academic Medicine, 91(8), 1.
  3. Forum FL. Mentorship vs. Sponsorship, and how to maximize Both. Forbes. October 2, 2015. Accessed October 23, 2016.