• 1.

    Loden M. 100 women: ‘Why I invented the glass ceiling phrase.’ BBC News, December 13, 2017. https://www.bbc.com/news/world-42026266

    • Search Google Scholar
    • Export Citation
  • 2.

    Hayes J, Kuo I. Fixing the ‘Leaky Pipeline': More women leaders in medicine. Medscape, March 29, 2019. https://www.medscape.com/viewarticle/910968

    • Search Google Scholar
    • Export Citation
  • 3.

    Coury S, et al. Women in the workplace 2020. Mc-Kinsey & Company, September 30, 2020. https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace

    • Search Google Scholar
    • Export Citation
  • 4.

    Eagly A, Carli LL. Women and the labyrinth of leadership. Harvard Business Review, September 2007. https://hbr.org/2007/09/women-and-the-labyrinth-of-leadership

    • Search Google Scholar
    • Export Citation
  • 5.

    Eckstrand KL, et al. Applying organizational change to promote lesbian, gay, bisexual, and transgender inclusion and reduce health disparities. LGBT Health 2017; 4:174180. doi: 10.1089/lgbt.2015.0148

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Mansh M, et al. From patients to providers: Changing the culture in medicine toward sexual and gender minorities. Acad Med 2015; 90:574580. doi: 10.1097/ACM.0000000000000656.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Association of American Medical Colleges (AAMC). 2018–2019 the state of women in academic medicine: Exploring pathways to equity. https://www.aamc.org/data-reports/data/2018-2019-state-women-academic-medicine-exploring-pathways-equity

    • Search Google Scholar
    • Export Citation
  • 8.

    Lederer E. Women in nephrology today. Clin J Am Soc Nephrol 2018; 13:17551756. doi: 10.2215/CJN.07650618

  • 9.

    Tsugawa Y, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med 2017; 177:206213. doi: 10.1001/jamainternmed.2016.7875

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Lorenzo R, et al. The mix that matters: Innovation through diversity. Boston Consulting Group, April 26, 2017. https://www.bcg.com/publications/2017/people-organization-leadership-talent-innovation-through-diversity-mix-that-matters

    • Search Google Scholar
    • Export Citation
  • 11.

    Merriam-Webster. “Leading.” Last updated August 22, 2021. https://www.merriam-webster.com/dictionary/leading

  • 12.

    Farkas AH, et al. Mentorship of women in academic medicine: A systematic review. J Gen Intern Med 2019; 34:13221329. doi: 10.1007/s11606-019-04955-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Pfund C, et al. Defining attributes and metrics of effective research mentoring relationships. AIDS Behav 2016; 20 (Suppl 2):238248. doi: 10.1007/s10461-016-1384-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Chrousos GP, Mentis A-FA. Imposter syndrome threatens diversity. Science 2020; 367:749750. doi: 10.1126/science.aba8039

  • 15.

    Campbell KM, et al. Releasing the net to promote minority faculty success in academic medicine. J Racial Ethn Health Disparities 2020; 7:202206. doi: 10.1007/s40615-020-00703-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    LaDonna KA, et al. “Rising to the level of your incompetence”: What physicians' self-assessment of their performance reveals about the imposter syndrome in medicine. Acad Med 2018; 93:763768. doi: 10.1097/ACM.0000000000002046

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Woitowich NC, et al. Gender-specific conferences and symposia: A putative support structure for female physicians. J Womens Health (Larchmt) 2020; 29:11361141. doi: 10.1089/jwh.2019.7859

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Sandberg S, Scovell N. Lean In: Women, Work, and the Will to Lead, 1st ed. (Knopf), 2013.

Leadership Opportunities for Women in Nephrology

  • 1 Susanne B. Nicholas, MD, MPH, PhD, is with the David Geffen School of Medicine at the University of California, Los Angeles. Nisha Bansal, MD, is with the University of Washington, Seattle. Leslie Gewin, MD, is with Vanderbilt University Medical Center, Nashville, TN. Lisa M. Curtis, PhD, is with the University of Alabama at Birmingham.
Full access

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.

Lead early

In early career stages, it is often a misconception that leadership is something that happens later in a career when a certain level of accomplishment is achieved. In fact, leadership can and should happen early and throughout a career trajectory. Finding opportunities as a nephrology fellow, in clinical practice or in research, may offer opportunities to identify strengths and weaknesses or likes and dislikes that may translate into future career opportunities or prevent wrong turns. As women and men transition to their first post-training position, it is tempting to focus on just getting to the next step, whether that is getting promoted, getting the first federal grant, or establishing the practice. Although these milestones are all essential to advancement, they don't preclude finding opportunities to contribute through leadership. Just as there is a need to identify a niche within research, finding a way to lead with a new role or to bring a new idea to fruition can be equally important to your long-term goals. Paths often diverge from original plans, and these additional roles may position individuals for novel opportunities that were not imagined at the start of a career. In later career stages, this early exploration may position individuals with prior experience and a track record that can open doors to additional, more elevated leadership opportunities. Whenever these leadership opportunities are undertaken, increasing experience may combat “imposter syndrome,” as discussed below, and increase willingness to accept new opportunities.

Mentors are beneficial

For women in nephrology interested in pursuing leadership positions, it is important to seek out mentors and sponsors who can support or help in developing your vision for your career path. An excellent mentor (whether peer-peer, near-peer, or senior) will nurture and respect you, as well as provide enthusiasm, listen attentively, and direct you on approaches to advance your career. Be aware that as a mentee, it is your responsibility to foster the relationship, as well as initiate and arrange regular meetings. Be flexible when identifying mentors. Although your role model(s) and mentor(s) may not physically look like you, they may possess the relevant qualities that you admire, such as confidence, humility, courage, and leadership. More men than women are in leadership positions, and men may have different insights than women due to their individual experiences, so having mentors of either sex may be advantageous. Women and underrepresented minorities are typically less likely to have a mentor (12, 13), and thus, actively and intentionally pursuing these relationships is of paramount importance. On the other hand, your sponsor, typically a more senior-level individual, will actively promote, advocate, and boost your career by including you in professional networks and introducing you to key individuals in your field. She or he will suggest participation in programs you may not have considered and will push you toward positions that are aligned with your long-term goals. This can serve as an enormous boost to your career advancement, so accept the challenge whenever possible. Identifying sponsors willing to support you is enhanced through active network development and visibility at conferences and meetings. Be familiar with the expectations of mentors and sponsors as well as your role in promoting and fostering these relationships, as they will be highly beneficial to keeping you focused and on track, particularly when the relationships are continually nourished.

Seek opportunities

The timing of advancement to leadership positions will vary. In order to guide your decision in pursuing leadership roles, you should research the qualifications of the intended position to determine whether they are within your trajectory and seek advice from others who have either been in the position or are currently in the desired position. Finally, seek out objective and impartial recommendations from trusted colleagues. Depending on your professional career track, become more informed about the possibilities and opportunities within your local, regional, and national organizations. Continually visit their respective websites to know when new prospects for specific leadership roles become available. Keep your resume and curriculum vitae regularly updated (e.g., monthly) so that you are equipped and prepared for the right moment(s). Make your colleagues, mentors, and sponsors aware of your aspirations to enhance your reach to opportunities. Women in Nephrology (WIN) provides opportunities for mentoring at all academic levels and actively sponsors its past and current members for available leadership roles in nephrology.

Beware imposter syndrome

Women offered leadership opportunities may experience the imposter syndrome (14). The imposter syndrome is the feeling that a person is ill prepared and doesn't really deserve the position being occupied. It is present among both genders but is more prevalent in women, especially in those of underrepresented minorities in medicine/science (15), and is common among physicians and scientists. The imposter syndrome generates anxiety and emotional distress in the potential leader. Transitioning into a new role may exacerbate these feelings of self-doubt, as there is naturally a learning curve for new work environments and tasks (16). Overcoming the imposter syndrome is critical to the confidence and creativity required of successful leadership.

Choose wisely

When embarking on a new leadership opportunity, several challenges must be addressed. First, the decision of whether to accept the leadership position is critical. Taking on a new leadership role often requires relinquishing other duties or activities, both professional and personal. A leadership opportunity may be exciting, but the decision to accept/reject should take into consideration how the position fits into a professional's overall career goals as well as an individual's personal commitments. For instance, a physician-scientist may be presented with a leadership opportunity in clinical operations. However, if the scientist's overall career goal is to build a strong research program, such a leadership position will not further the individual's overall career goals. The “balance” between personal and professional responsibilities may be tilted differently at points along your career trajectory and necessarily will inform these decisions. Distinguishing between the reluctance to accept a leadership position due to imposter syndrome or due to realistic evaluation of priorities is challenging but if considered carefully, can lead to confidence in the decision. Discussing career opportunities with role models or mentors holding positions that you are considering helps with this decision. A strong professional network can facilitate this process, but some women may lack the senior professional contacts or may not have role models who face similar professional and personal challenges, thus making the path forward less clear or increasing the chances of turning down leadership opportunities.

Be resolute

Other challenges in accepting a new leadership opportunity include both self-advocacy and self-investment to strengthen the likelihood of success. New leaders should be proactive in asking for the resources they need to carry out their leadership tasks. Women often do not feel empowered for self-advocacy and may be hesitant to demand the support the job requires. A new leadership position often requires a new set of skills, and courses in leadership (Table 1) are valuable tools to ensure professionals are prepared for their new roles. Attendance at gender-specific conferences related to professional development has been shown to improve self-advocacy and leadership skills among women physicians (17).

tbl1

Education is key

Finding the right position or role in which to say “yes” requires the same diligence as finding your niche. Leadership may involve “soft” skills that are not typically taught in either medical or graduate student training. Many resources exist that offer education in these soft skills at various career levels. Formalized commercial programs may be directed to different levels of careers, involve different amounts of time investment, and may be open to all registrants or may require nomination or selection for the opportunity (Table 1). Common among these programs is the opportunity to explore self-awareness of strengths and weaknesses, but they may also extend to real-world implementation. Individual institutions may have leadership programs as well, but caution should be advised in discerning the difference between leadership and management. Both components may be integral to a role, but leadership often requires more of an intentional “stretch” to achieve.

Over its 35+ years' experience, WIN has always placed a high value on the dissemination of information about leadership. Its programs on career development have included the nuts and bolts of private practice and academia but also sessions related to skills attainment and practical tips in finding and succeeding in leadership roles. A new offering from WIN that began in 2020 is a 1-day Leadership Conference dedicated to sessions pertinent to leadership in a variety of career tracks across the pipeline (Table 1). A strength of this program is that the speakers include a mixture of well-known leaders in nephrology and those at all levels of the workforce pipeline. This open event gives participants the opportunity to engage in networking and to find role models and sponsors for different careers within nephrology. Developing a network is often the best way to identify sponsors and advocates, in addition to mentors, who are essential to gaining visibility that then leads to future opportunities for leadership. Whatever resources are accessed, gaining this essential leadership training should be a continuing education experience as challenges change throughout the trajectory of a career. As noted by Sheryl Sandberg, “The ability to learn is the most important quality a leader can have” (18).

Finding ways to lead, at all levels, expands the dynamic range of the work, enhances career fulfilment for women in nephrology, and contributes to success of organizations. This is the perfect time for us to collectively promote women into leadership positions across all areas of nephrology.

References

  • 1.

    Loden M. 100 women: ‘Why I invented the glass ceiling phrase.’ BBC News, December 13, 2017. https://www.bbc.com/news/world-42026266

    • Search Google Scholar
    • Export Citation
  • 2.

    Hayes J, Kuo I. Fixing the ‘Leaky Pipeline': More women leaders in medicine. Medscape, March 29, 2019. https://www.medscape.com/viewarticle/910968

    • Search Google Scholar
    • Export Citation
  • 3.

    Coury S, et al. Women in the workplace 2020. Mc-Kinsey & Company, September 30, 2020. https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace

    • Search Google Scholar
    • Export Citation
  • 4.

    Eagly A, Carli LL. Women and the labyrinth of leadership. Harvard Business Review, September 2007. https://hbr.org/2007/09/women-and-the-labyrinth-of-leadership

    • Search Google Scholar
    • Export Citation
  • 5.

    Eckstrand KL, et al. Applying organizational change to promote lesbian, gay, bisexual, and transgender inclusion and reduce health disparities. LGBT Health 2017; 4:174180. doi: 10.1089/lgbt.2015.0148

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Mansh M, et al. From patients to providers: Changing the culture in medicine toward sexual and gender minorities. Acad Med 2015; 90:574580. doi: 10.1097/ACM.0000000000000656.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Association of American Medical Colleges (AAMC). 2018–2019 the state of women in academic medicine: Exploring pathways to equity. https://www.aamc.org/data-reports/data/2018-2019-state-women-academic-medicine-exploring-pathways-equity

    • Search Google Scholar
    • Export Citation
  • 8.

    Lederer E. Women in nephrology today. Clin J Am Soc Nephrol 2018; 13:17551756. doi: 10.2215/CJN.07650618

  • 9.

    Tsugawa Y, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med 2017; 177:206213. doi: 10.1001/jamainternmed.2016.7875

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Lorenzo R, et al. The mix that matters: Innovation through diversity. Boston Consulting Group, April 26, 2017. https://www.bcg.com/publications/2017/people-organization-leadership-talent-innovation-through-diversity-mix-that-matters

    • Search Google Scholar
    • Export Citation
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    Merriam-Webster. “Leading.” Last updated August 22, 2021. https://www.merriam-webster.com/dictionary/leading

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    Farkas AH, et al. Mentorship of women in academic medicine: A systematic review. J Gen Intern Med 2019; 34:13221329. doi: 10.1007/s11606-019-04955-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Pfund C, et al. Defining attributes and metrics of effective research mentoring relationships. AIDS Behav 2016; 20 (Suppl 2):238248. doi: 10.1007/s10461-016-1384-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Chrousos GP, Mentis A-FA. Imposter syndrome threatens diversity. Science 2020; 367:749750. doi: 10.1126/science.aba8039

  • 15.

    Campbell KM, et al. Releasing the net to promote minority faculty success in academic medicine. J Racial Ethn Health Disparities 2020; 7:202206. doi: 10.1007/s40615-020-00703-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    LaDonna KA, et al. “Rising to the level of your incompetence”: What physicians' self-assessment of their performance reveals about the imposter syndrome in medicine. Acad Med 2018; 93:763768. doi: 10.1097/ACM.0000000000002046

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Woitowich NC, et al. Gender-specific conferences and symposia: A putative support structure for female physicians. J Womens Health (Larchmt) 2020; 29:11361141. doi: 10.1089/jwh.2019.7859

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Sandberg S, Scovell N. Lean In: Women, Work, and the Will to Lead, 1st ed. (Knopf), 2013.

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