Since the publication of the book Lean In, written by Sheryl Sandberg, chief operating officer of Facebook, there has been increased public scrutiny on the role of women in the upper echelons of business.1 For those of us in academic positions, this was welcomed but with the simultaneous realization that business and academia are quite distinct.
On the positive side, there have never been such immense opportunities for men and women alike to enter such a rewarding field as oncology, where truly major therapeutic breakthroughs are occurring at breakneck speed. Similarly, medicine as a field has welcomed women into all specialties, yet although women comprise 47% of medical school graduates, the percentages deteriorate for women in academic faculty positions (38%), full professorship positions (21%), or leadership positions (department chairs or deans, 15%-16%).2
For those of us in senior positions, we are keenly aware of the limited number of female role models for our younger counterparts, and we continue to be concerned that women are opting out of what can be an extremely rewarding career simply because they don’t have proper guidance and are uncertain about the pathway forward. Available data demonstrate a gender gap across multiple measures of academic success: academic position,3 publication productivity,4,5 representation on editorial boards,6 and likelihood of leadership positions in medical societies.7 In writing this editorial, we were quite surprised that compared to other fields, such as business, science, technology, engineering, and mathematics, there are limited data on the metrics of women in academic oncology outside of that which is available at individual institutions.3-7
Oncology-Specific Data Collection Efforts
In 2013, the European Society for Medical Oncology conducted an exploratory study on the challenges facing female medical oncologists.8 Interestingly, the study found that although teams are composed of a majority of women in most cases (57.6% versus 31.6% of teams are composed of a majority of women and men, respectively), the managers of the team are most often men (60.1%) versus women (39.9%). When asked what the three greatest challenges are for women in progressing their careers, they were: (1) work–family balance (58.7%), (2) perceptions of men as natural leaders and women as team members and supporters (50.5%), and (3) cultural gender prejudice because of misconceptions about the family and domestic responsibilities of women (38.7%). These data substantiate what many of us have suspected and support planned endeavors at ASCO to begin to collect data in a prospective manner on gender representation and challenges in all facets of oncology.
The issue of work–life balance is without a doubt the one that strikes at the heart of every early-career oncologist considering a career in academics and, of course, is not restricted to women. However, the choice of whether to even pursue academic oncology for many women is based upon perceived fear that family life will be compromised, whether children are involved or not. Interestingly, the men that we have mentored have these same concerns, but our perception is that these concerns are rarely the deciding factor in making a career choice.
To effectively address the fear of compromising family life, at least three things need to happen. First, there need to be more female role models that represent a wide diversity of lifestyle choices so that women have access to mentors and role models that more closely resemble their own path forward. Second, there should be more resources available to women and men alike that educate aspiring faculty (at the fellow level, at the latest) on time-management skills, balancing family life, and ways to manage and negotiate the challenges of academic life without sacrificing valuable family time. Third, institutions need to develop policies that support flexibility and enhance work–life balance for physicians of both genders and create a culture that destigmatizes use of those policies.9
Women comprise 47% of medical school graduates, 38% of academic faculty positions, 21% of full professorship positions, and only 15%-16% of academic leadership positions (department chairs or deans).
Work–family life balance is one of the greatest challenges for women in advancing in their careers.
Mentoring and sponsorship are paramount to a successful academic career, especially for women in academia.
Mentors and Sponsors
For every early-career oncologist, whether still in training or junior faculty members, the role of mentorship is considered paramount to a successful academic career. Mentoring fellows and faculty has been, without a doubt, one of the most rewarding parts of our respective careers. In fact, last summer, in conjunction with the American Association for Cancer Research (AACR) and ASCO, we initiated a women’s networking group at the Methods in Clinical Cancer Research Workshop in Vail, Colorado, that was very well attended and received.
Here at the 2015 ASCO Annual Meeting there is Women’s Networking Center (room S502) with programming focused on professional development, and AACR has sponsored the Women in Cancer Research group for many years.
Interestingly, one of the dominant themes observed in the Vail Workshop was the lack of guidance on negotiating the first job offer, a skill that neither of the authors of this editorial feel particularly adept at, even to this date. Although not really gender specific, we think that women often come into a faculty position with a somewhat distinct background and set of priorities and often don’t have a colleague or mentor to consult with—and this needs to change. Perhaps as suggested in the paper by Sambuco et al., all junior faculty should routinely receive training in formal negotiation where concepts such as principled versus positional negotiation are introduced.10
In another recent book about women in business,11 the concept of sponsorship versus mentorship is raised. We think that this book should be required reading for all junior faculty, but it is particularly important for women. The concept is that a mentor is the day-to-day person who provides feedback and guidance to a mentee who is generally in their field of expertise, while a sponsor is often someone in a more senior position who enlists the help of a mentee on projects that lead to recognition and career advancement for both. For example, this could be involvement in scientific meetings, writing major reviews or book chapters, and participating on committees and study sections. Sponsors tend to choose mentees who look as they do, and men inherently access this—even without meaning to—as a result of the greater preponderance of men at senior levels. There just aren’t enough women at the senior levels of academia, and women can be a bit too focused on finding that perfect mentor to help them navigate the intricacies of academic and family life, leading them to miss out on opportunities to access senior faculty for sponsorship.
What Can Women Learn from the Business World?
Although much of what has been written about pertains to the corporate world, there are some very useful take-home messages for women in academic oncology from books such as Lean In.1 For example, women need to take an active role in leadership, build confidence, and believe in their own abilities. Women too frequently hesitate to accept challenging opportunities until they are certain they have all of the required skills, while men jump in and assume personal success. Likewise, there are a couple of attributes of high-performing women that can be limiting, such as the desire to be liked in order to be a successful leader and striving for perfection in all aspects of work and life, which can lead to early burnout, stress, and leadership attrition.
Although we have focused on the challenges of women in academic oncology and have suggested that there exists a gender-segregated world of faculty, we both have prospered in this environment and, in fact, have greatly benefitted from lifelong friends and collaborators who we do not view through the lens of gender. Academic life has never been so varied and full of opportunities for faculty who embrace lab, clinic, translation, or a mix of those, and everyone who takes care of patients with cancer has the continuing sense of mission and urgency.
Furthermore, there are growing opportunities for leadership training, such as ASCO’s Leadership Development Program, which is available to both men and women. (For more information on ASCO’s Leadership Development Program, read the Expert Editorial by Dr. Melissa Dillmon in the ASCO Daily News). Oncology organizations, nationally and internationally, are committing to the academic success of their junior physicians. We are optimistic that career development and mentorship of women early in their careers will help narrow career gender disparities. Women in academic oncology are increasingly partners in this endeavor at all levels of seniority, and from personal experience, we can honestly say that our children and spouses have added and gained value from our engagement in this field.
The next step of the future, assuming women have been fully integrated into academic oncology at all levels, is to focus on ways in which we can retain and reward faculty of both genders at a time when funding is challenging and health care is changing. Our greatest fear is that we lose valuable members of the academic research community because of a lack of resources to alleviate burnout, discouragement, and increasing clinical workloads. Academia is but one path to alleviate the burden of cancer, but we must institute changes in order to maintain the diversity of approaches that we have in academia, industry, and community. Thus, the future path forward is one where we not only individualize patient therapy, but we also individualize faculty experience.
About the Authors: Dr. Eckhardt is professor of medicine/oncology and holds the Stapp/Harlow Endowed Chair for Cancer Research at the University of Colorado School of Medicine on the Anschutz Medical Campus. She is also the associate director for translational research at the University of Colorado Comprehensive Cancer Center. She has been an ASCO member for 21 years, serving as a member of the Board of Directors, New Drugs in Oncology Seminar Planning Committee, ASCO Connection Editorial Board, and ASCO-AACR Clinical Methods Workshop Program Committee, among other commitments.
Dr. Von Roenn is the senior director of the Education, Science, and Career Development Department at ASCO. She continues to serve as an adjunct professor of medicine/hematology-oncology at Northwestern University. She has been an ASCO member for 29 years, and she has previously served in many leadership positions, including as chair of the Cancer Education Committee, Leadership Development Working Group, and Professional Development Committee.