“It is not easy to be a pioneer… but oh is it fascinating!” – Elizabeth Blackwell

Our specialty requires leaders. We are sitting in a firestorm where non-physician interests, both within our profession and external to it, are pushing for and achieving control of our compensation, daily work experience, and our patients. Our institutions, companies, and organizations need to respond on our behalf. Whether you are in academics or community, in an independent, regional or national EM partnership, or a hospital or corporate employee, this is an essential time for you. The question is, who are our “institutions, companies and organizations?” They are us. But starkly missing when you look at the executive leaderships around you, are the women of Emergency Medicine.

Emergency medicine residency programs are now graduating 36% women, EM’s active physician workforce is 25% women and 32% of our academic EM faculty. However, as has been discussed broadly in academics, only 13% of our full professors are women. What may not have been expressed as directly is that our large organizations and companies show marginal percentages of senior leadership. By review of online accounts of senior leadership, it appears that percentages of women are as follows: ACEP board of directors (20%), ACEP chapter presidencies (19%), AAEM board of directors (18%), EMCARE executive and regional leadership (9%), USACS (13%), CEP America (10%), Team Health (8%). My former group, an independent democratic group of 40 docs, ranged between 0%-22% female leadership during my tenure.

While these numbers may seem small, they are pretty inline with most boards in the non-medical “business world.” The 2020 “Women on Boards Gender Diversity Index” of Fortune 1000 companies showed that 17.9% of corporate directors were women, and even though women in the companies “did not differ on the experience-based qualifications of board tenure or corporate tenure, women insiders (did) hold fewer directorships of other corporations, hold less powerful corporate titles, occupy disproportionately more staff functions, are less likely to be top earners of the corporation, and earn considerably less than men inside directors.”

I’m not going to wax poetically or politically on why women are not represented in leadership except to quote international business consultant Whittenberg-Cox: “The real reasons that women are not moving up do not lie primarily with women. They are embedded in systems that have evolved over decades and reflect the values, motivations and views of a male majority. None of this is done intentionally or even consciously. It is simply the result of history and corporate evolutions. But so long as these issues remain unseen, they form an intractable barrier to a more inclusive work environment.”[1]

What I do want to talk about it is why it is important to get our women to step into leadership roles. Here are a few thoughts:

  • Companies with women in senior management consistently outperformed industry medians and having a woman on a company board in one study decreased a company’s bankruptcy rate by 20%.[2],[3]
  • In a study of publicly shared companies during the last decade’s recession showed that more balance on the boards of these companies had less volatility through the cycle post 2008, and the share price performance of companies with at least one woman on the board would have outperformed those with no women on the board.[4]
  • An analysis of FTSE-listed boards found that operational performance and share prices were both higher in the case of companies where women made up over 20% of board members than those with lower female representation.[5]
  • Companies and boards with women in executive leadership may be more successful because it brings synergy of management style and analytical approach. McKinsey et al looked at key organizational performance drivers and matched them with 360 degree evaluations from thousands of managers and found the women were superior in five of the nine top indices (participation, inspiration, development, role model and rewards) and equal in two (effective communication and intellectual stimulation).[6]
  • Another theory based on social identity is that the presence of an “other” in collective decision making creates a dynamic where the “out group” members (in this case, women) are more active in demonstrating their distinctiveness and will therefore create more comprehensive, and not as rapidly consensual, decision making process.[7]
  • When women negotiate on their own behalf, they do more poorly than men. However, when they are negotiating on behalf of others, they do much better than men. And when women negotiate without expectation set ahead of time, they do poorly, but when women negotiate after being told they are good at it, they do much better than men.[8]
  • When women in the Obama administration started “amplifying” each other (repeating women’s ideas and giving credit in order to force men in the room to acknowledge female contribution), it demonstrated that there is tremendous power in women supporting other women, and ended up with more women being called upon by the administration and counterbalancing some advisors.[9]
  • Perhaps the best overall review of gender diversity improving corporate performance can be found in The Catalyst[10], there are too many jewels to count!

We are at a crux in our specialty where we are at a point where we have to overcome systemic disempowerment by insurers, governments, administrators, other specialties and corporate powers. Physicians must now advocate for ourselves in order to earn our rights in reimbursement, in representation amongst specialties, in insurance and legislative disputes, and in the markets for hospital and contract alignment. In order for these decisions to be made comprehensively and representing all stakeholders views, a diversity of thought, style, opinion and approach must be utilized. “It is our responsibility as women to be our own best advocates and champions,” comments Megan Healy MD (AAEM Board of Directors). Rebecca Parker MD (ACEP President) adds, “Women need to champion each other to become leaders. Forming support groups and support networks to not only problem solve through the barriers, but also break through social norms are crucial. We also need to bring in our male colleagues and show them some of the implicit bias that’s out there for women in leadership, and give them training.”

If we aren’t at the table with our male colleagues, we all lose.   Let’s aim high to get high. The time is now.


[1] Wittenberg-Cox, A. (2008) Why Women Mean Business: Understanding the Emergence of our next Economic Revolution. John Wiley & Sons.

[2] Roy Adler, “Profit, Thy Name Is … Woman?” Miller-McCune (February 2009)

[3] Nick Wilson and Ali Altanlar, “Director Characteristics, Gender Balance and Insolvency Risk: An Empirical Study,” Social Science Research Network (2009)

[4] Gender Diversity and Corporate Performance. Credit Suisse Research Institute. August 2012.

[5] Yilmaz Alguden, “Why Boards Need More Women.” Harvard Business Review (June 2012)

[6] Women Matter 2: Female Leadership, a competitive edge for the future. McKinsey and Company. October 2008

[7] Guoli Chen, “Why do Corporate Boards Need More Women.” Insead Knowledge (December 2014)

[8] Vicki Slavina, “Why Women Must Ask (The Right Way): Negotiation Advice From Stanford’s Margaret A. Neale.” The Muse

[9] Jenavieve Hatch, “How The Women On Obama’s Staff Made Sure Their Voices Were Heard.” Huffington Post (Sept 2016)

[10] Why Diversity Matters. The Catalyst Information Center. July 2013