Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Glass Ceilings: Anyone Have a Sledgehammer Handy?

​Crack! That's the sound of progress. How many cracks will it take before the glass ceiling shatters?

​Remember the old TV commercial where a boy poses the following question: "How many licks does it take to get to the Tootsie Roll center of a Tootsie Pop?" The answer is provided by a professorial owl: "Let's find out." He demonstrates: one lick, two licks. He then abandons the laborious licking. Crunch! He bites the pop, sending sugary fragments flying. He has indeed arrived at (and eaten) the chocolatey center and answers, "Three." 

Like a mediocre lollipop that may need too-many-to-count licks to get to the preferred treat in the middle, how many cracks in a glass ceiling must be patiently observed and counted before it shatters completely? I guess the answer depends on how tough the glass is, how long one is willing to wait, and whether one elects (like the three-licks-only owl) to "facilitate the process." 

No matter your political leanings, you've surely heard the recent glass ceiling-cracking news: Nearly 100 years after ratification of the 19th Amendment to the U.S. Constitution, granting American women full voting rights, for the first time in our nation's history, a woman, Hillary Rodham Clinton, is the presumptive nominee of a major political party for president of the United States. Although dozens of other countries are or have been led by a woman, it's certainly newsworthy that a woman may be the next so-called leader of the free world, arguably the most powerful person on planet Earth. If elected, Clinton will follow in the footsteps of two-term POTUS Barack Obama, a history-maker himself as the first African-American elected to our nation's highest office. It may be one woman's turn to place her name and her story on the next milestone along the path of inexorable progress toward dismantling barriers to people reaching their full potential, in the most exulted modern experiment in democracy known as the U.S.A. Whatever the outcome of Election Day this November, the fact that a woman is one election away from the Oval Office will forever appear on the timeline of American history. Many women have waited for decades to cast their votes for a woman (at least in part) precisely because she is a woman and to shatter that elusive ceiling. 

How about women in radiology? If my state of New Hampshire was recently represented entirely by women in the U.S. House of Representatives, U.S. Senate, and state governorship, if a woman is one step closer to busting through the highest glass ceiling, then surely there is no reason that women cannot occupy more leadership positions in radiology. 

The authors of the 2014 ACR Workforce Survey concluded that women are in the minority among practice leaders (in roles like chair, president, vice chair, or board member): 10 percent of women were in leadership roles, compared to 17 percent of men. Perhaps that does not seem that big of a relative difference at first glance, but in absolute terms, it's statistically significant (p <.01). Since the survey data showed women constitute only 22 percent of the radiologist workforce, women only hold 15 percent of leadership positions to men's 85 percent. Maybe 15 percent of all leadership positions compared to 22 percent of all radiology jobs doesn't seem like much of a difference either. Maybe women should just be satisfied with 15 percent. Leadership need not be proportionately representative, right?

Let's compare that to education: In 2011–2012, approximately 76 percent of public school (elementary and secondary) teachers were female, but only slightly more than half (approximately 55 percent) of the school principals were female (and less than half at the secondary school level). And only 20 years earlier, three-fourths of principals were male. So even being in the majority doesn't necessarily translate to proportionate representation in leadership positions for women. 

The 2015 ACR Workforce Survey shows that although women represent 21 percent of radiologist (essentially unchanged from the 2014 survey), the age distribution of women radiologists skews younger: 10 percent are women >65 years, 24 percent are 35–45 years old, and 32 percent of radiologists are <35 years. So younger women are choosing radiology at higher rates, a welcome trend, but what does the ACR want the future of radiology to look like? What percentage of radiologists should be female? There's no answer that I can find, but in order to maintain or improve diversity, I assume it's not less than the current percentage. 

Is it enough to simply encourage women to be leaders and not place undue barriers to leadership? Or should there be a deliberate effort to change the status quo? Change has already happened, but should we be satisfied with the current pace of progress? We've all heard of disruptive technologies. Is it time for disruptive diversity? If natural change is unacceptably slow, with the need for commissions, committees, meetings, research, etc., about diversity, then why can't change be facilitated? 

If we want female role models to encourage more women in the future to seek out leadership positions and increase the ranks of female medical students entering radiology residency, then why not disproportionately over-represent women in leadership positions in radiology on purpose for a limited time as part of a proactive strategic plan? I'm bracing for the naysayers to pounce, decrying quotas, affirmative action, and preferential treatment for female radiologists. But like the lollipop story, if we really want a specific result, it may come more quickly if we take bold, decisive action like the owl did: Crunch!

"Well-behaved women seldom make history." — American historian Laurel Thatcher Ulrich

Are you ready to take a sledgehammer to that glass ceiling and smash it to smithereens? Together, let's make history. Instead of bemoaning suboptimal diversity in radiology, let's choose right now to make radiology as diverse as we want it to be by insisting upon inclusivity. In other words, put intentional policies in place to achieve diversity. Inclusivity is action. Diversity is the outcome of inclusivity. 

Additional Resources 

Read more about one academic practice's plan to promote female faculty development and leadership. 

Find out more about ACR's Commission for Women and General Diversity strategic plan as well as ideas about how to improve diversity. Learn about the two committees that comprise the commission: the Committee for Women and the Committee on General Diversity.

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Wednesday, 24 April 2019

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