A Proactive Approach to Dismantling Inequities for Women in Medicine

When Amy Sullivan, PsyD, ABPP, participated in a two-year leadership program in Cleveland Clinic’s Neurological Institute in 2016, she studied employee engagement, beginning with a review of related Press Ganey survey scores. She discovered that female professional staff in the institute and across the organization were the least engaged of all categories included in the survey, which included male and female professional staff, nurses and other employees. That led to further investigation and a correlational analysis of the topic.

“What we are finding is not just at Cleveland Clinic. It is similar at healthcare institutions across the U.S.,” says Dr. Sullivan, Director of Engagement and Wellbeing in the Neurological Institute and Director of Behavioral Medicine in Cleveland Clinic’s Mellen Center for Multiple Sclerosis. “Women have reached parity in graduation rates from medical school, but they haven’t come close to parity in leadership development.”

Dr. Sullivan is the lead author of a recent article in the Journal of Health Service Psychology examining lower engagement, leadership inequity and burnout of women in medicine. The paper presents several evidence-based efforts that psychologists can lead to address these ongoing issues.

Factors and implications of low engagement and burnout

There is a clear relationship between low engagement and burnout, which can negatively impact patient care and clinicians’ health and well-being, as well as contribute to high rates of physician turnover, says Dr. Sullivan.

“One of the major contributing factors is a higher stress level at home for women, who often serve as the hub of the household,” she says. “Many women never really turn that off. Then they come to work — where they are highly committed to their careers — and experience additional stress.”

In addition, women in medicine may not feel as valued as their male counterparts. “There is still this marginalized status and discrimination, which comes in all different forms, such as not having a seat at the leadership table, inequity in pay, harassment, microaggressions,” Dr. Sullivan says. “There is so much women in healthcare have to overcome.”

Three tips to begin addressing the problems

Dr. Sullivan posits that psychologists are well positioned to lead efforts to combat burnout and increase engagement because of their training in and skill with communication, empathetic listening, programmatic development and organizational systems. She offers three tips for colleagues who want to tackle the issues:

• Conduct a rigorous study of the problem. The 2021 Medscape National Physician Burnout and Suicide Report shows a 10% increase in the number of women reporting burnout over the prior decade, totaling 51% in 2021. In addition to understanding national numbers, it is important to collect data from one’s own healthcare institution and let it guide one’s decisions.
• Perform a needs analysis. “There is no one-size-fits-all solution. Every healthcare institution has different needs,” says Dr. Sullivan. “Do a needs assessment to figure out what is lacking and how you can make things better, and then add programming based on those needs.”
• Get buy-in from leadership. Sullivan says she has full support from Cleveland Clinic Neurological Institute Chair Andre Machado, MD, PhD, and that this buy-in shows the importance of this work to other leaders in the institute. “In my role as Director of Engagement and Wellbeing for the institute, I attend all the leadership meetings, reminding others of the importance of language, actions and programming as well as the importance of engagement and burnout,” she says. “For example, if we talk about recruiting, I ask about retention efforts. When we talk about adding extra hours, I ask how we plan to ensure the well-being of staff. Without our prize possessions — our caregivers — there is no Cleveland Clinic.”

Programmatic interventions that are making a difference

Dr. Sullivan says burnout and engagement interventions should focus on four levels — national, organizational, unit/team and individual — and that actions can trickle down from one level to another. “It’s multidimensional,” she explains. “We can’t just look at issues from the individual perspective.”

Cleveland Clinic’s Neurological Institute has put in place several programs based on its needs, which are constantly evolving. They include:

• A diversity leadership cohort. Now in its third iteration, this cohort began with women and has expanded to include marginalized or underrepresented people in medicine. Each of the seven participants in the cohort selects a project to work on related to an OKR (objectives and key results) tied to their center or the institute.
• Multidisciplinary engagement committee. The committee, which has approximately 60 members, works on identified areas, which shift depending on needs. The five current areas of focus are respect, recognition, communication, wellbeing and retention.
• Town hall meetings. These quarterly meetings led by Neurological Institute Chair Dr. Machado include a 20-minute discussion on critical topics, followed by open discussion. Recent topics have included burnout and engagement.
• A book club. The 20-minute discussions are held during lunch. The club is currently reading former Duke basketball coach Mike Krzyzewski’s book, Leading with the Heart. “The book club is a great way to get the group engaged across the Neurological Institute because we tend to be siloed in our individual centers,” Dr. Sullivan notes.
• Research projects. In 2020, the Neurological Institute teamed with two other Cleveland Clinic institutes on a study comparing standard and flexible scheduling. They are now completing a one-year follow-up. “We found that caregivers who have flexible scheduling or autonomy over their schedule seem to have more control over their workload and less perceived work-related stress,” Dr. Sullivan observes.
• Individual psychotherapy. Dr. Sullivan meets with physicians who are feeling burnt out and their spouses in confidential sessions and, if necessary, connects them with appropriate resources offered by Cleveland Clinic.

Dr. Sullivan believes this commitment to engagement, in combination with multifaceted programming, is making an impact. “By putting programming in place at the Neurological Institute, we’ve seen our women physicians become more engaged,” she says. “It’s not a competition, because we want our men to be just as engaged. But it’s something we are keeping a close eye on.”