As Stanford Medicine observes Women in Medicine month, one department chair shares how she has promoted gender equity for her faculty.
Above every desk she’s occupied for more than two decades, Mary Leonard, MD, chair of pediatrics at Stanford Medicine, has tacked the same handmade bookmark.
Mom, it says at the top, followed by a list composed by her daughter:
Nice, beautiful, very intelligent … Easy to love, easy to hug.
In the middle of the list, however, is this item:
Too much kidneys.
Leonard’s daughter, Claire, now 30 years old, made the bookmark as a preschooler. At the time, Claire had evidently heard a bit too much about her mom’s work with children with kidney disease.
“I asked her if she remembers making this,” Leonard said, chuckling. “She does not.”
Since assuming her leadership roles at Stanford Medicine in 2016 (she’s also physician-in-chief at Lucile Packard Children’s Hospital Stanford), Leonard has been figuring out how to achieve gender equity in the Department of Pediatrics. She approaches the work with scientific rigor — leading initiatives that are data-driven and evidence-based, with transparency both about what’s going well and where more work remains. She also brings her perspective as a mom, someone who describes combining a career as a physician-scientist with raising young kids as both “unbelievably hard” and “worth it.”
“I remember when I was mid-career faculty and I would talk openly about how hard it was during panel discussions or career development workshops for junior faculty,” said Leonard, the Arline and Pete Harman Professor for the Chair of the Department of Pediatrics. “I got a little worried that I was being too public and vulnerable. I think it’s now much more accepted that we can have those conversations.”
Such openness is a key part of enabling women to advance to the highest ranks of academic medicine, she said. Her own career began at Stanford: She graduated from the School of Medicine in 1989, where she also met her husband. They moved to Philadelphia together for residency training, where she took her first faculty role, and where they started a family.
As she has advanced into leadership roles, keeping the “too much kidneys” bookmark above her desk has reminded Leonard to maintain open dialogs with faculty and staff at all stages of career development, helping them figure out how to strike the right balance between a demanding professional path and other important facets of their lives.
Looking closely at the data
Across the country, the majority of pediatricians are women, and the proportion of women in academic pediatrics means that, in some respects, the field has better gender equity than other medical specialties. But there’s more to do. For instance, women only make up approximately 25% of pediatric department chairs nationally.
When Leonard took over as department chair, one of her biggest equity concerns was faculty compensation. Research shows that gender gaps in compensation are still common in academic medicine.
Drawing on her background in biostatics, Leonard analyzed the department’s compensation data in several ways, starting by comparing salaries for male and female faculty who are in the same subspecialty and at the same rank. She also analyzed whether there were differences between genders in the speed of earning promotions, or in bonuses.
“We’re big enough that we can run multivariable regression models on this data,” Leonard said. “So far, on all of our analyses, there have been no gender differences in compensation or time to promotion.”
When Leonard started, she heard concerns about gender imbalance at higher ranks in the faculty lines, a common problem at all academic institutions. Over the last seven years, the proportions of women in associate and full professor positions across all lines in the Department of Pediatrics have risen significantly, reflecting the department’s efforts to systematically sponsor women for professional development programs, leadership roles and promotion.
Another data point that caught Leonard’s attention was maternity leave. At her instigation, the School of Medicine expanded family leave benefits for clinician educators to match what was offered to the professoriate, an improvement in benefits that required buy-in from all clinical departments.
Building a supportive department culture
The local culture of individual academic units plays an outsized role in promoting women’s advancement in academic medicine, according to research from the University of Pennsylvania’s medical school, where Leonard was a faculty member for 17 years before returning to Stanford in 2014.
In other words, many factors that foster gender equity are controlled at the department or division level, rather than via one-on-one mentoring or through university-wide policies. Such factors include appreciation for work-life balance, freedom from gender bias, support from the department chair or division chief, and equal access to resources — everything from lab and office space to input on leadership decisions.
Early in Leonard’s tenure as department chair, inspired by this research, she launched a task force on department culture and engagement. The Department of Pediatrics is large, with 18 divisions and over 500 faculty, and the task force found that the local culture wasn’t the same for everyone. Division chiefs had different levels of leadership skill and ability to advocate for their faculty. Leonard worked with Tait Shanafelt, MD, chief wellness officer for Stanford Medicine, to implement leadership training to improve chiefs’ coaching skills, sponsorship and advocacy for faculty development.
Sponsorship is a key part of Leonard’s approach; it is a tactic for helping early- and mid-career faculty develop skills that will equip them for the next level of career development, including stepping into leadership roles. Leonard has created a database of local and national awards and professional development programs and encourages her division chiefs to recommend their faculty, both women and men, for these opportunities. As an example, over the last two years, Leonard worked with Paul King, CEO of Packard Children’s, to successfully nominate four women faculty on behalf of Packard Children’s for the Executive Leadership in Academic Medicine and Executive Leadership in Health Care programs run by Drexel University College of Medicine. Such national-level programs build leaders’ skills and professional networks beyond their home institutions, preparing them to assume leadership roles at the highest levels of academic medicine.
Leonard and her colleagues also established initiatives such as support groups for women concerned with work-life balance, and an intervention sponsored by Stanford WellMD and led by Ritu Asija, MD, clinical professor of pediatrics, to improve the transition back to work for faculty returning from parental leave. They’ve made practical changes to help people balance work and parenting, including scheduling all department-wide meetings at lunchtime to reduce conflicts with school and childcare drop-off and pick-up times. They have supported the Pediatric Coaching and Mentoring program for early career faculty (which serves both men and women), as well as a women’s peer mentorship program.
In recognition of her efforts, earlier this year, Leonard received the Stanford University Faculty Women’s Forum Outstanding Leader Award, which acknowledges a faculty leader for an outstanding record of developing a culture of including and promoting women faculty.
“Improving gender equity is just one aspect of our work to build a diverse workforce in pediatric medicine,” Leonard said. “Ultimately, we believe that work will pay off in better medical care for children and families.”
