Women are underrepresented in leadership positions in medicine, in part, from the “glass ceiling” (an invisible barrier to advancement) (1), the “leaky pipeline” (the loss of women along the path to advancement) (2), the “broken rung” (the very first “step up” from junior level to an initial leadership position less frequently offered to women) (3), and the “labyrinth” (the advancement of women but with routes that have additional known and unknown challenges creating “twists and turns”) (4). Although not specifically addressed in this article, there should be recognition that women in underrepresented racial/ethnic minority groups as well as the LGBTQ+ community may have additional barriers (5, 6), some of which may be countered through the recommendations provided here.
Per the 2018–2019 State of Women in Academic Medicine report by the Association of American Medical Colleges (7), women comprise 48% of medical school graduates and represent 41% of faculty of medical schools, yet only 29% of division chiefs and 18% of department chairs and deans are women. These disparities extend to nephrology as well (8). Among nephrology and affiliated societies, leadership by women has been infrequent. Since its inception in 1966 until recently, the American Society of Nephrology (ASN) has had only four female compared with 51 male presidents; the International Society of Nephrology (ISN) has had only three female compared with 24 male presidents since its inception in 1960; and three women presidents out of 24 have led the National Kidney Foundation (NKF). The American Physiological Society (APS), first founded in 1888, with its notable Renal Section, has had 8 women of 92 presidents, with the first elected to serve in 1975 (Dr. Bodil M. Schmidt-Nielsen, a comparative physiologist who studied the kidney). Of five leading nephrology journals, one has a female editor-in-chief, and only about 20% of deputy or associate editors are women. Despite these grim statistics, this has been an historic year. For the first time ever in nephrology, the current presidents of all three organizations—ASN, ISN, and APS—concurrently are women (Drs. Susan Quaggin, Agnes Fogo, and Jennifer Pollock [whose expertise is also in nephrology], respectively). This is a triumph to be celebrated and a testament that women are and should be promoted as accomplished leaders and visionaries.
Striving for gender equity in leadership should be a high priority for organizations and will benefit all key stakeholders, men and women alike. In a study of elderly hospitalized patients, those treated by female internists had lower mortality and lower rates of readmissions compared to those cared for by male internists (9). Research in other industries has shown that women's presence in leadership is associated with a more participatory leadership style and greater motivation, innovation, and productivity (10).
Whereas leadership may be defined as “the act or an instance of leading” (11), an even better working definition considers the qualities or characteristics of a leader. Some well-known traits of a good leader include integrity, self-awareness, gratitude, influence, empathy, courage, respect, ability to delegate, and being an effective communicator. These characteristics allow an individual to lead in any environment, as the position of a leader does not necessarily require a title. Not everyone will become president of ASN, ISN, NKF (current president-elect is Dr. Sylvia Rosas with her term as president to begin in October 2022), or APS, but anyone can be appreciated and recognized for her or his leadership qualities to advance policies that are important to her or his organization. Leadership skills are best intentionally learned and honed with practice, and in the following sections, we have outlined some ways in which women in nephrology can position themselves to attain leadership positions.
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, LaDonna KA “Rising to the level of your incompetence”: What physicians' self-assessment of their performance reveals about the imposter syndrome in medicine. Acad Med 2018; 93: 763– 768. doi: 10.1097/ACM.0000000000002046 10.1097/ACM.0000000000002046
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