Melissa J. Danesh, Nicole Golbari, Martina Porter and Alexa B. Kimball* say that when medical institutions hire leaders, external female candidates have an extra disadvantage.
While 70 per cent of firms still promote from within to fill the CEO’s chair, increasing numbers of employers have looked outside for their new chief executives in recent decades, reasoning that they can leverage their experience in another domain to promote innovation, learning and high performance.
The literature is mixed on how these external hires do, but it does seem that insiders have a slight edge.
We were interested in whether large academic medical centres adhere to the still-dominant preference for internal leadership hires, since the complexity of the healthcare endeavour might favour them and, if so, whether that pattern worked for or against female candidates, who are currently underrepresented in the top ranks.
To find out, we studied 13 leading academic medical institutions and looked at the hiring history for 185 department chairs and 13 deans and found that people in both roles were slightly more likely to have been hired externally (56 per cent and 54 per cent respectively).
However, while male deans outnumbered female deans by three to one (a ratio that’s still common across healthcare leadership) we were surprised to find that only three of the 10 male deans had been internally promoted, while all three of the female deans had.
These are small numbers to be sure, but they are statistically significant.
As such, this gender skew in academic medicine is unlikely to be due to chance and raises important questions.
Why the inclination toward hiring female leaders from within?
One possibility is that unconscious biases against women are stronger when a female candidate is not personally known in an institution.
Though the literature in health care that speaks to this point is sparse, several studies in other sectors show that men are given preferential attention from external recruitment and hiring practices while women in the external labour market are more likely to be rejected for higher level jobs.
Many employers have focused on ensuring a fair process for internal hires, but recent studies show that external hiring practices are rampant with gender discrimination that promotes disparities among top leadership.
Gender bias in external hiring isn’t just unfair; it might also put the organisation at a disadvantage.
Studying a different industry for his book Chasing Stars, Boris Groysberg of Harvard Business School showed that among externally hired Wall Street investment bankers, women appeared to bear the pressures of a new work environment better than their male counterparts.
External male new hires tend to suffer a decline in their performance after the move, while external female hires do not.
Our findings raise concerns about gender bias in the recruitment and hiring of leaders at leading medical institutions, and these organisations should seek to both understand and develop remedies to address it.
This challenge has become even more pressing as the number of women entering medical school surpassed the number of men this year.
Though the medical field has succeeded in erasing gender discrimination at the school admissions level, it must redouble its efforts to correct continued imbalances at the top.
* Melissa J. Danesh is a dermatology resident at the Harvard Combined Dermatology Residency Training Program. Nicole Golbari is a medical student at Stony Brook University. Martina Porter is an Instructor of Dermatology at Beth Israel Deaconess Medical Centre. Alexa B. Kimball is CEO and President of Harvard Medical Faculty Physicians and Professor of Dermatology at Beth Israel Deaconess Medical Centre.
This article first appeared at hbr.org/2019/11
