His opportunity, her burden: A narrative critical review of why women decline academic opportunities

Abstract

ObjectivesThis paper stems from a desire to deepen our own understanding of why women might ‘say no’ when allies and sponsors offer or create opportunities for advancement, leadership or recognition. The resulting disparity between representation by men and women in leadership positions, invited keynote speakers and publication counts in academic medicine is a stubborn and wicked problem that requires a synthesis of knowledge across multidisciplinary literature. Acknowledging the complexity of this topic, we selected a narrative critical review methodology to explore reasons why one man's opportunity might be a woman's burden in academic medicine.MethodsWe engaged with an iterative process of identifying, reviewing and interpreting literature from Psychology (cognitive, industrial and educational), Sociology, Health Professions Education and Business, placing no restrictions on context or year of publication. Knowledge synthesis and interpretation were guided by our combined expertise, lived experience, consultations with experts outside the author team and these guiding questions: (1) Why might women have less time for career advancement opportunities? (2) Why do women have less time for research and leadership? (3) How are these disparities maintained?ResultsTurning down an opportunity may be a symptom of a much larger issue. The power of social expectations, culture and gender stereotypes remains a resistant force against calls for action. Consequently, women disproportionately take on other tasks that are not as well recognised. This disparity is maintained through social consequences for breaking with firmly entrenched stereotypes.ConclusionsPopular strategies like ‘lean into opportunities’, ‘fake it till you make it’ and ‘overcome your imposter syndrome’ suggest that women are standing in their own way. Critically, these axioms ignore powerful systemic barriers that shape these choices and opportunities. We offer strategies that allies, sponsors and peers can implement to offset the power of stereotypes.

Thinking organizationally and longitudinally to understand gender disparities in academic medicine

“…[2][3][4][5] Ever-present scripts of domestic obligations, identity taxation, stereotype threat and imposter phenomenon, alongside promotion pressures come to light through a critical narrative review of literature on why women say no-or more precisely, 'why they cannot say yes to opportunities for career advancement'. 1 Western stereotypes that 'men' are for leadership and 'women' are for caregiving are steeped in organisational cultures of academic medicine [6][7][8] and account for WHY disparities are maintained, at least in part. [9][10][11] The assumption that adding more women to the physician workforce will overpower deeply embedded gendered and racialized cultures and create more equity is also called into question in the findings of Monteiro and colleagues.…”

“…For example, to create the kind of organisational level change Monteiro and colleagues. 1 recommend, layering organisational theories with LQR can develop a specific type of gendered and racialized organisational scan to specify what inequities are present and how these inequities are manifesting, as well as drafting a plan for how to challenge these norms with an eye on how long it will take to make change. Moreover, longitudinal qualitative research can cast light on when points of inquiry change, asking even if it is possible for women to say no given the pressures to say 'yes' to so many 'opportunities'.…”

“…Moreover, longitudinal qualitative research can cast light on when points of inquiry change, asking even if it is possible for women to say no given the pressures to say 'yes' to so many 'opportunities'. 30,31 Finally, like Monteiro and colleagues, 1 we implore allies to think systemically about these problems, use their positions organizationally to address the problems, and also act individually to understand that saying no to opportunities is based on unique experiences of each woman in academic medicine.…”

“…The recent critical narrative review by Monteiro, Chan, and Kahl 1 makes visible the unseen, complicated internal dialogue in which many women engage when requested to participate in a ‘great opportunity for career advancement’. This dialogue can be even more complicated for those with intersecting identities of race, ethnicity, LGBTQIA+ and so on 2–5 .…”

“…Western stereotypes that ‘men’ are for leadership and ‘women’ are for caregiving are steeped in organisational cultures of academic medicine 6–8 and account for WHY disparities are maintained, at least in part 9–11 . The assumption that adding more women to the physician workforce will overpower deeply embedded gendered and racialized cultures and create more equity is also called into question in the findings of Monteiro and colleagues 1 . Offering more opportunities does not necessarily lead to greater representation and promotion for women in academic medicine 12–14 …”