Put your hands up

Hi everyone – my name is Clare Skinner and I’m the Director of an Emergency Department.  


I consider myself incredibly lucky.  I absolutely love my job.  For me, there is so much personal and professional satisfaction in leading a team of fantastically clever and committed clinicians.  My role requires me to use my head, my hands and my heart.  I oversee clinical policies and procedures; I organise the team from the recruitment and rostering perspective; I supervise and mentor students, junior medical officers and trainees as they move along their career paths; and, best of all, I set the culture for the entire department.  I feel enormously proud that I am actively working to improve experiences of the ED for hospital staff, patients and their carers.  The sense of agency I feel from being in a leadership role contributes massively to my personal wellbeing.


There’s one big problem. There aren’t enough women doing my job. Only twelve per cent of Director of Emergency Medicine positions across Australia and New Zealand are currently filled by women.  Why does that matter?  Because there is irrefutable evidence that women perform very well in management roles, and that female leadership benefits not only women, but everyone – it lifts the whole enterprise.  Chances are that our health system is missing out on the contributions of many capable and talented women and is all the poorer for it. 


So, why don’t we have more women in leadership roles in Emergency Medicine?  Part of the problem is visibility – the notion that ‘you can’t be what you can’t see’.  I’m lucky. I grew up as a trainee in NSW,  where I could observe inspiring female ED Directors at work – Janet Talbot-Stern at RPA, Sue Ieraci at Liverpool, Gayle McInerney at Auburn, Liz Swinburn at Mona Vale, Trish Saccasan-Whelan at Goulburn, Kate Porges on the Central Coast, Carolyn Hullick at John Hunter, Mary McCaskill at Westmead Kids, and Sally McCarthy at Prince of Wales (and other amazing women, then and subsequently – hooray!).  In my part of the world, being Director of an ED was something that a woman with brains in her head and feet in her shoes could aspire to.  Sadly, that does not seem to be the case in other states and territories, many of which can count the number of female ED Directors past and present on less than the fingers of one hand, if at all.


The vicious cycle of bias, assumption and confidence is a huge problem.  Women are far less likely than men to be considered for leadership positions in the first place – implicit gender bias assumes that ‘she wouldn’t be interested’, or ‘she is too busy with her family’.  Women are less likely than men to actively seek out management roles or take part in networking with a view to potential career progression, and women are far less likely to self-nominate for leadership positions.  Even when women are actively invited to take on a leadership role, they are less likely to consider themselves a suitable candidate than a similarly qualified and experienced man (imposter syndrome, anyone?).  I put this challenge to you NoWEM raft – next time a leadership opportunity arises in your workplace, instead of thinking of all the reasons you can’t do the job, think ‘why not?’.  Or, if you’re not available, actively suggest to a female colleague that they apply for the position, then tell them how awesome they will be.  (And tell them again a few days later too.)


Women in leadership roles are often perceived and treated differently to men.  A woman with strong opinions might be considered ‘bossy’ while a man is ‘assertive’.  A man who misses a meeting is ‘busy’, while a woman is ‘not coping’.  There is a widespread misapprehension that women are too emotional or highly strung to be good managers – which is absolutely, one hundred per cent, not the case.  When I think about my day-to-day work, there are many aspects of my job that positively require characteristics which are considered stereotypically ‘female’ – such as emotional intelligence and a nurturing approach.  Ironically, it is likely that men who possess these traits are also overlooked for promotion.  The only way we will challenge these flawed assumptions is to have more women in management positions, and to make female leadership normal, not ‘other’.  It should not be remarkable that a woman is the Director of an Emergency Department, it should be commonplace.


And while we’re on the topic of ‘other-ness’, I am very aware that as a white, heterosexual, upper middle-class woman from Sydney, I am highly privileged, and I am playing the game of life on only the second degree of difficulty.  I am aware that the bias and assumptions I face at work pale in comparison to those experienced by my colleagues who are considered more ‘other’ by the medical mainstream – due to diversity of sexuality, race, primary language, religion, appearance or physical ability.  I strongly believe that if we don’t take active steps to achieve gender balance in our specialty, to redress representation of the ‘minority’ that is actually the majority, then we do not stand a chance of achieving genuine diversity of leadership, so no-one is ‘other’.  There is evidence that gender-balanced boards drive organisations to attain more widespread diversity, so gender balance on the ACEM board and major entities is an important first step on the road to genuine representation of the ACEM membership and the population we serve.


With this in mind, Kim Hansen and I have worked together to establish the Advancing Women in Emergency (AWE) section within ACEM.  The section aims to give women a formal voice in the ACEM governance structure and to ensure that the interests of female fellows and trainees are represented in college decision-making.  AWE will strive to specifically promote and support female leadership in ACEM and Emergency Medicine – through mentorship, education and networking.  AWE was formally established at the end of 2018 and executive positions will be advertised soon.  ACEM fellows and trainees of all genders who are interested in promoting female leadership are invited to join the section via the following link: https://acem.org.au/Content-Sources/Advancing-Emergency-Medicine/Advancing-Women-in-Emergency-Section


It is early days for this exciting initiative.  If you would like to be on the executive, or to mentor other women, please put up your hand. Go on – do it!  You’ll be awesome.  You really will.

- Dr Clare Skinner, Guest blogger for NoWEM


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