I am the Director for the Anesthesiology Critical Care Medicine Fellowship and the Vice Chair for Education at the Department of Intensive Care and Resuscitation, the Anesthesiology Institute at the Cleveland Clinic. I'm also the incoming Chair for the Committee on Diversity, Equity, and Inclusion at the Society of Critical Care Medicine, and I'm going to be talking about how to succeed when you are the only woman in the room. Now, learning objectives for this presentation are that by the end of this presentation we would be able to elaborate on the current status of gender disparity in medicine, list the challenges that only women face, and list various strategies to succeed when you are the only woman in the room. First of all, looking at why do women find themselves as an only in the room. This data from the AAMC shows the gap between male and female applicants to U.S. medical schools from 1981 to 2019. Parity with respect to number of female applicants was achieved briefly in 2003 to 2005, and as of 2018 to 2019, about 50.9%, more than half of the applicants were female and 49% were male. If you look at the other, you know, the pie chart which is there right next to this graph, you see that about 35.8% of the physicians in practice are women as compared to 64% of men. Even though we surpass the number of women who are entering medical school right now, we do have lesser women faculty members. This chart that was published in December 2021 by the AAMC displays a 30-year trend in percentages of permanent, interim, and active chairs and deans at all the U.S. medical schools by gender. If we look at the chart that is there on our left, women comprised about 2% of all the deans in U.S. medical schools in 1992, a really dismal number, which kind of improved to about 12% in 2010 and now about 24% in 2021. And this chart on the right, which is about department chairs in U.S. medical schools from women comprising about 5% of department chairs in 1995, which improved a little bit to about 14% in 2010, we are at about 22% in 2021. Although this trend is improving, it is nowhere close to where we need it to be to achieve parity and equity. Now looking at women in leadership positions in medicine, so looking at academic medicine, gender differences in academic medicine, their retention rank and leadership comparisons from the National Faculty Survey was published in 2018 in academic medicine. They looked at about 1,273 faculty members across 24 U.S. medical schools for about 17 years, and all these schools were balanced for being either public or private and all four AAMC geographic regions. What they found was that despite adjustment for publications, women were less likely than men to make professor, remain in academic careers, or attain leadership positions. This other study, which was published in 2020, is fairly recent. It was published by Richter et al. They looked at women physicians and their promotions in academic medicine. Over 500,000 graduates from 134 U.S. medical schools were followed over a 35-year period. And there too, not to our surprise, women were less likely to be promoted to the rank of associate or full professor or be appointed department chairs as compared to men, despite being matched for publications, their research output, and their clinical revenue that was generated. And this is not just isolated to medical schools and physicians. About 60% of pharmacy school graduates are women, when we see now that 0% of retail chain pharmacy CEOs and only about 36% of large national pharmacy and drug association CEOs are women. So, the disparity and the inequity is pretty glaring. And the story is no different in corporate world and in the world of CEOs. In the Women in Workplace report, which was published in 2021 by McKinsey & Company and Leenan.org, we can see that despite small increases in number of women in entry-level positions, there is a huge lag in the positions held by women in the role of vice president, president, or in the C-suite levels. Furthermore, it is important to recognize that women of color and other intersections seem to have more of these challenges and a wider gap to cover than white women. Now, looking at the representation of women on editorial boards of journals or in leading these editorial boards. One study that I want to highlight here was published in 2021. It's about the sex distribution of editorial board members among emergency medicine journals. They looked at 73 journals. Out of 46 editorial chiefs, there were only four women. And out of 1,477 editorial board members, there were only 241 women. Looking at the under-representation of women on radiology editorial boards, again, fairly recent publication in 2019, out of about 3,000 to 4,000 first authors and about 9,500 editorial board members, they saw that women comprised about 29% of first authors, about 20% of senior authors, and an abysmal about 13% of editorial board members. And one other important publication I do want to highlight here, which was published again, very recent in 2021, it was about the representation of women among editors-in-chief of leading medical journals. In this cross-sectional study, they found that women represent one in about five editor-in-chiefs of major medical journals. And overall, about only 21% of editor-in-chiefs were women. There were five categories or specialties where there were no women editor-in-chiefs at all, which included dentistry, anesthesiology, allergy, ophthalmology, and oral surgery and medicine. And in about 27 of 41 categories, less than one-third of the editor-in-chiefs were women. For example, I just want to highlight critical care, and it's one in 10 editor-in-chiefs were women for critical care medicine journals. Finally, looking at societal leadership, and again, studied very recently, published in November 2021, gender distribution in the boards of intensive care medicine societies was looked at and published. They did an analysis of board members and presidents of all societies, which were associated with the ESICM. There were 65 presidents and 820 board members. They found that only 10 presidents, so about 15%, and about 231, which is about 28% of board members were women. So looking at all of these things, be it medical school faculty, deans of U.S. medical schools, chairs of departments, CEOs in the corporate world, editorial board membership, societal leadership, we have a lot of gap that we need to cover. And this is precisely the reason why lots of women find themselves, when they do get the opportunity to be at the table, when they do get an opportunity to be in the room, they tend to find themselves to be the only woman in the room. Now what are the challenges that are faced by only women? So McKinsey & Company and Leanin.org surveyed about 279 companies and over 64,000 employees, and about 20% of the women who were surveyed shared that they were often the only woman in the room. And it was more likely for those women to experience that their judgment was questioned, they were often mistaken for someone who was junior, and they were subjected to unprofessional and demeaning remarks. Women are more likely to face microaggressions at the workplace as compared to men. And even when we look at the intersection of women, as compared to white women, black women are four times more likely to face these microaggressions, Asians about three times more likely, and Latinas are two times more likely to experience them. So even when we're talking about women, we have multiple intersections where we have women who are more underrepresented, women of color, women with disabilities, women who are mothers, they all experience more of these microaggressions and more of these challenges as compared to white women who do not have these intersections. It has been noted that more than 60% of women who work experience microaggressions at work. And this number increases to about 90%. It's pretty astounding when they are an only in the room. Only and double only women in the room tend to face more challenges, microaggressions, bias and discrimination. For example, like I mentioned before, women with color, women with disabilities and mothers, they seem to be subjected to increased scrutiny. Like all of their successes, successes and failures are under a microscope, their competency is more frequently questioned. And they also fear and feel that they would be judged about taking advantage of options like working from home or utilizing the option of flexible hours. And they do tend to be uncomfortable sharing personal issues if they're the only woman in the room, leading to a lack of support and eventually being burnt out from their work. And also it is important to highlight that mothers who work with other women are more likely to stay on in their job if you had other women with you than if you were an only on the job. So now going on to what can these only women do to succeed in the roles that they are in? First of all, speak up when you're the only woman in the room, speak up and voice concerns when they do occur. It is important that you express your opinions, especially in the areas of your expertise with confidence. And more importantly, when you do have the opportunity to sponsor and bring more diversity into your team. Secondly, exude confidence before an important meeting or a presentation, especially if you're the only woman in the room. Try to calm down and meditate before your talk or your meeting. Give yourself a pep talk and get into your power position. Stock up on the knowledge on your conversation and dress for success. Language and conversations are very important for communication. And sometimes we don't recognize how important these words are and the language that we use. It is important to use assertive language and to avoid qualifiers. For example, saying something like, oh, maybe I guess I could versus saying confidently, yes, I will do this. I've often heard this, you know, I'm not, you know, I'm really not the expert, but maybe versus saying that I believe this will work well because of this and this. To use the assertive language and to avoid qualifiers. Avoiding fillers in a conversation. Not to look for validation. For example, saying something like, I'm hoping, I hope I'm making sense to you and to actually just say the statement and to avoid over apologizing for something that you don't need to apologize. And this is something that women tend to do often. And it's important to speak clearly without fillers, confidently with clarity. It's important to enhance your knowledge and expertise in your area and to showcase and highlight your abilities when you can. Find your crew. Find your support. Be it within work and outside of work. People who will support you and raise you up. Find your coaches. Find your mentors. And find your sponsors. And a lot of it, I do believe, that doesn't rest only with the women. Individuals. Because, yes, we do try to find them. But the structure is not there and it also falls on your institution and your organization and your department to create a structure where women can find these coaches and mentors and sponsors who are there around you to lift you up and bring you to the table when you're not there and when you don't have the opportunity to be there and speak for yourself. To have the people who will do that for you. And most important of all is to believe in yourself. To have that unshakable belief that you are competent, trustworthy, and dedicated. That's probably the most important thing for us women to do when you're the only woman in the room to excel and to succeed. And it's important to remember this rule of three. When you're creating a team, when you're creating a group, to not just have one person as a minority, one person as a woman, one person as a person of color, because it really doesn't help if you have just one person there. Because when you're one, you almost assume and you tend to speak for the entire group that you represent and the rest of the group also sees it that way. And when there are only two people in a particular group, who are people of color, who are women, who are underrepresented minority, they tend to agree with each other and the rest of the group sees that as collusion sometimes. But when there are three people, that is like the critical number, the critical mass. When you have three people of color, three people who are underrepresented minorities, three women in the group, then everyone can speak for themselves. So something to keep in mind is when you have the opportunity to create your team, to create your group, to create your department, to make sure that you have more than two, three or more people from an underrepresented group who are there in your group that you're creating to increase the diversity and truly realize the impact and value of the diversity that it brings. Now looking at the path forward, onlyness is difficult, but sometimes can be a lever to move the world. Sometimes seeing the only woman can inspire other women to join the team, to do what they are doing and to be a part of that group. If you are a man on the team who has a only woman, reach out to her, support her. And if you're in a leadership role, support, mentor, sponsor the women on your team. And most important of all, get more women on your team, at least three women on your team. I'd like to close up with a quote by Kofi Annan about gender equality, where he says that gender equality is more than a goal in itself. It is a precondition for meeting the challenge of reducing poverty, promoting sustainable development, and building good governance. Thank you for this opportunity and hope all of you are having a fantastic Congress.

women in medicine

gender disparity

leadership positions

microaggressions and biases

strategies for success