I did not start out my professional life in medicine; I started out in corporate finance. All along, since I was a teenager, I had been volunteering with underserved women in a variety of capacities. In my twenties, I realised that what I really wanted to do was help the healthcare system respond better to women who were traditionally marginalised. That’s what drove me to go to medical school.

For my first decade in medicine, including my training and then early faculty, my focus was in developing medical education curricula and improving hospital systems to better serve women who are experiencing gender-based violence or intimate partner violence. Along the way, I started to become more and more involved with helping my women colleagues advance in their careers. Medicine seemed to have a gender equity problem in terms of harnessing the talents of its incredible women as a workforce resource.

According to the data, although women have represented a significant proportion of medical school graduates, graduate medical trainees and faculty for the last four decades, they are still tremendously underrepresented in the leadership pipeline. Only about 18% of medical school deans and 30% of C-suite healthcare leaders are women. So, I’m still working with a marginalised population, but it just happens to be based on career advancement, particularly leadership within medicine and science.

In the US, women represent about half of medical school graduates and graduate medical trainees, and over a third of faculty and physicians. Unfortunately, as one progresses up the leadership ladder, those numbers diminish tremendously. For example, in academic medicine, the highest rank one can achieve is professor of medicine. Only 26% of full professors are women. That is shockingly low, given the evolution over the last four decades in terms of the pipeline of women coming forward. And when we look at intersectionality and women of colour, the data is even more concerning.

These organisational barriers are secondary to two elements. One is the cultural context in academics and medicine and science and healthcare, which lends itself to these disparities. The second element is policies, practices and patterns of interaction that inadvertently benefit men and disadvantage women.

Let’s unpack the first element. What women experience now, in academic medicine in particular, is second-generation gender bias. I did not coin this term; it’s been written about in the literature for at least a decade. Second-generation gender bias is different from the sexism that existed, for instance, before Title VII and Title IX in the US. It’s not overt; it’s embedded in our unconscious expectations and stereotypes of women, women leaders, and how men and women should behave.

These biases manifest in a variety of ways that we have observed through rigorous peer-reviewed research. For example, in academic medicine and science and healthcare, women tend to be shunted into gendered career paths: more consultative roles, rather than roles that have budgetary or managerial responsibilities. Second-generation gender bias is also the driver behind the fact that women tend to be assigned non-promotable tasks, efforts that benefit the organization but are not relevant for individual performance evaluation or promotion. Women tend to be evaluated more negatively or harshly; they tend to be paid less, and they often experience double binds and backlash when behaving like traditional leaders.

There are two domains in which organisations can move the needle. One is culture change. There’s been a lot in the business literature written about this, and a critical aspect of culture change is stating the aspiration. Organisations and organisational leaders in academic medicine, science and healthcare need to overtly state that one of their goals is to cultivate a culture that supports the success and advancement of women in medicine and science.

The second element of culture change is for organisations and leaders to create psychological safety, or safe spaces, within their institutions to have frank discussions about progress. Are we meeting this goal? And if not, why not? And the third element is hiring. The data show that both men and women have implicit biases against women leaders, or women in medicine and science, with regard to particular activities or fields or ambitions. As organisations, we need to hire more inclusively.

The second domain, which is equally important as this more high-level culture change, is noticing and changing practices and patterns of interaction in the workplace that inadvertently disadvantage women and benefit men. That means paying attention to those touchpoints around recruiting, hiring, advancement, compensation evaluation and promotion where gender biases can emerge.

There are evidence-based differences in how women “perform” differently, and potentially more effectively, than men within the clinical realm. Data has consistently emerged showing that women physicians deliver a higher level of quality outcomes and are better at doctor-patient communication.