People Helping People: Fostering, Supporting, and Empowering Women Leaders in Neurology

Gender equity in the field of neurology remains a pertinent topic of discussion, with numerous papers, letters, and studies published seeking to address, or at least point out, disparities between men and women. In 2016, the American Academy of Neurology (AAN) enlisted a Gender Equity Task Force to provide recommendations to address the issue, with members identifying 9 topics for consideration, including confronting bias, improving transparency, promoting different practice options to support work-life balance, and developing mentors.¹

Programs aimed at increasing access for women are driven by an understanding of the need for a more diverse workplace, as well as efforts by women to help fellow women. A need to “pay it forward” also permeates the space, as women and men alike work to tackle biases and increase representation across the breadth of neurology. While data suggest the persistence of inequities, particularly in terms of leadership opportunities and pay, women in the field have observed changes over the course of their careers, principally when it comes to the opportunities afforded to women and the breaking of some—but not all—glass ceilings.

Sensing a Shift

Kathleen B. Digre, MD, FAHS, FAAN, FNANOS, distinguished professor of neurology and ophthalmology, John A. Moran Eye Center, chief, Division of Headache and Neuro-Ophthalmology in Neurology, adjunct professor of obstetrics and gynecology, and adjunct professor of anesthesia at the University of Utah, in Salt Lake City, entered the field of neurology more than 3 decades ago, during a time when there were very few women in the room, let alone in positions of leadership. In both the AAN and the academic-focused American Neurologic Association (ANA), however, Digre has observed a “tremendous change,” in part because of more women entering the field and the resultant larger pipeline. Key drivers of this shift, she said, are the development of programs that assist neurologists in finding a path towards leadership.

"When I first started out, it was like, ‘Welcome! We’re happy you’re here, but we’ll be running the show,’” Digre told NeurologyLive^® about the historic attitude in neurology.

“I think [now], we’re realizing that we need to keep a lens of equity, diversity, and inclusion over everything that we do, and make sure that we’re giving opportunity to everyone, regardless of their sex, or gender, or race, or socioeconomic background,” she added.

With the need for a more diverse workforce at the forefront, including women, persons of color, members of the LGBTQIA+ community, and others, organizations have been forced to look inward at their processes, ratios, and who is at the table. According to Jessica Ailani, MD, FAHS, FAAN, director, MedStar Georgetown Headache Center, and associate professor of neurology, MedStar Georgetown University Hospital, the benefit of upping the number of females is due to the unique strengths they often bring to their practice.

“Women have a different role in the workforce,” Ailani told NeurologyLive^®. “For what I do, in particular, taking care of patients with headache disorders, a predominant portion of our patients are women, and so they really feel very comfortable coming to see another female provider because they can talk about many of the issues they have.”

Ailani asserted that the progress made in achieving this more diverse population in the workplace comes from those already in leadership and administration, which she has noticed in her own system at MedStar. Although true for Ailani’s experience, it may not necessarily be the same at all institutions, bringing to mind the adage of women helping women. By helping those who may not have been offered opportunities or those who may experience imposter syndrome in a field historically dominated by men, women neurologists are able to pay it forward as they come into more senior roles.

“You just don’t get a scorecard here that says, ‘This is how you get to leadership,’” Digre said. “There’s an element of helping to be guided, and there are mentors along the way, and there are promoters—people who actually promote you in an organization.”

Having served as president of the North American Neuro-Ophthalmology Society from 2002-2004, making her the first female president since the organization’s inception in 1980, and president of the American Headache Society, of which she was the second female president, from 2018-2020, Digre is a staunch advocate for promoting women to move forward in the careers and creating opportunities for leadership development. Mentorship is vital for women in neurology, but the idea of acting as a promoter is something that Digre advocates for, as the role differs from that of a mentor in stepping up and nominating women for positions of leadership. Unlike mentors, who are there to guide and advise, by Digre’s definition, promoters actively leverage their position to assist others in advancing their careers.

“A promoter is somebody who is willing to step out and say, ‘Boy, this person is really terrific; you should consider this person for this position.’ I think we need more of that, especially in academic neurology and in our organizations. Women can play that role—men have played that role along the way, but women can too,” she said.

Opportunities for Aspiring Female Leaders

“A promoter is somebody who is willing to step out and say, ‘Boy, this person is really terrific; you should consider this person for this position.’ I think we need more of that, especially in academic neurology and in our organizations. Women can play that role—men have played that role along the way, but women can too."
– KATHLEEN B. DIGRE, MD, FAHS

Digre cited a program she participated in over 20 years ago, Drexel University’s Executive Leadership in Academic Medicine, which aims to incite an interest in leadership for women. The year-long, part-time fellowship is designed specifically for women faculty across health care, including medicine, dentistry, public health, and pharmacy.

“It really put me on a path that allowed me to see the way toward leadership and made me understand that I could have a role not only in my own institution in my department, but also at my university, my school of medicine, my home university, and also in national organizations like North American Neuro-Ophthalmology Society and the American Headache Society,” Digre explained.

Another such program is the AAN’s Women Leading in Neurology Program, of which Irene A. Malaty, MD, Barbara Padgett Dein Professor of Neurology, and director, Parkinson Foundation Center of Excellence and Tourette Association of America Center for Excellence, Fixel Institute for Neurological Diseases, University of Florida Health, was part of the inaugural class, graduating in 2018. Designed for women who are mid-career, the program assists participants in confronting gender disparities, addressing pitfalls and challenges that women may face, whether that is raising a family, communicating with others in leadership—be it men or women—further equipping them with strategies and tools to combat issues that are specific to women in the field. Accepted participants are paired with mentors and communicate with a leadership coach, building a network of camaraderie and support for those involved. The timing of the program is opportune, Malaty told NeurologyLive^®, helping women at a point in their career where they may have more agency and a firmer understanding of their individual and professional goals.

Malaty, who also served as president of the Florida Society of Neurology leading up to joining the AAN program, stressed the importance of mentorship and sponsorship, which she also experienced as a member of the AAN Science Committee. While there is a need for expanded programs for professional and personal development, connecting on an individual basis is vital, with Malaty highlighting the importance of women helping women, and helping others in the field general.

“In the day-to-day life, it’s also important that people provide opportunities, consider people, and encourage people,” Malaty said, attributing her involvement in the AAN program to a ‘nudge’ from a male friend. “Encouraging one another, male and female, and encouraging one another and every human to help each other—see talent, cultivate talent, support, nurture—I think those are critical components.”

Challenges of Motherhood and Family Life

The unique experience of women necessitates attention as well, including the role that family can play in any career, but particularly for those in medicine. While becoming a mother is not a universal experience for women neurologists, for those who do want to raise children, issues arise when it comes to maternity or parental leave—which lacks standardization in the United States—as well as childcare upon returning to work.

“If you're going to have a family, you're either giving birth, or you're adopting a child, or you're involved in that process,” Ailani said. “If you're in an academic center, you might get a set number of weeks of leave. But what if you're running your own private practice? You might only take off a few weeks.”

“It was the perfect pivotal point where, in the beginning of one’s career, you take a lot of opportunities, and you wait for them to come, and you walk through doors that open—at least some of us do. At some point, it’s important to stop and say, ‘Which doors do I want to walk through?’”
– IRENE A. MALATY, MD

“I've been in situations where I have friends who work for themselves, and they've only taken off 4 weeks of work, and then had childcare actually in the office brought in with them—it sounds like it's fantastic, but if you've had children, [you know] that is a very, very difficult time. Imagine the baby in an exam room next door with a nanny and you’re seeing patients next door, being distracted. It's very hard,” she added.

Within the medical field, Ailani pointed to the fact that paternity leave is not normalized, so being in a 2-physician household can generate additional issues when it comes to support, particularly for younger parents who may not have the financial stability to hire help. Balancing family life is something that the AAN program addresses as well, as not all women have children, but everyone has responsibilities outside of the workplace, necessitating an evaluation of individual priorities, according to Malaty.

For those looking to advance their career, having a family can also impact perceptions, Digre said, noting that while progress has been made, there are still “barriers to thinking” when making assumptions of women, and specifically mothers’, capabilities. Historically, she said, if offered a position of leadership, you were expected to take it on, no questions asked. With a new perspective and understanding of the importance of work-life balance, organizations have adapted to the notion that women, and people in general, have changing circumstances that may rightfully impact their ability to fill certain roles at certain times.

“Letting the woman decide whether she can take on that role or not might be the better way to do it, and then making opportunities across the board for everybody to apply for and letting people who want to step forward, be able to step forward,” Digre said. “There's still a glass ceiling there—I don't know that we've blasted past it, but I think we've definitely made a lot of headway.”

More Work to be Done

Malaty, Digre, and Ailani all expressed positive outlooks on the field of neurology and its awareness of the strength that women leaders can provide, with the caveat that stereotypes persist regarding family lives and traditional roles associated with parenting, as well as the issue of pay disparity between the sexes. According to data from Doximity's annual Physician Compensation Report, in 2021 alone, the difference in compensation between men and women child neurologists was approximately $47,177.80 annually, with men’s salaries averaging $295,375.80 and women’s salaries coming in substantially lower at $248,198. In general neurology, the difference was even more staggering, with men’s salaries averaging $352,102.80 and women’s salaries coming in at $296,361.70, for a difference of $55,741.10 (TABLE).²

“Over the past 15 years, there's probably been more of a balance in the number of women represented, but there still are major discrepancies, particularly with regard to pay; there's been a lot of recent attention to pay disparities,” Malaty said. “Also, as the rank ascends, there's less and less balance, and there are many different reasons in terms of why women are underrepresented in higher rank positions, but I think there's still a lot of room for improvement there.”

An article published in the Postgraduate Medical Journal in 2020 discussing both racial and gender disparities in the field confirmed that they remain prevalent. Compared with women, men occupy a majority of chairperson (9.7% vs 90.3%), professor (16.9% vs 83.1%), associate professor (32.9% vs 67.1%), and assistant professor roles (43.2% vs 56.8%). Investigators, led by Sidra Saleem, MD, department of neurology, University of Toledo College of Medicine, in Toledo, Ohio, confirmed that this ratio has increased for female faculty, namely at instructors and assistant professor levels, but their underrepresentation in chairperson roles is evident.³

In light of the shortage of neurologists in general in the US, as well as an observed higher burnout rate for women neurologists, addressing gender disparities in leadership may be the key to lowering rates of attrition in the field.A report from the AAN’s 2019 Transforming Leaders Program outlined the “large mismatch” between the number of patients who require neurologic services and the neurologists available to meet this need in the United States, which is attributed to an aging population and the resultant increase of those at risk of developing neurologic diseases.^4,5

Overall, the need for community pervades these conversations, as a collaborative effort affords opportunity, and women helping women—people helping people—enables growth and aids in shifting outdated perspectives. This is facilitated by mentors and sponsors who can pay it forward, continuing the cyclical motion of recognizing women’s potential and assisting them in attaining the professional level they aspire to.

“The more you learn how it takes action to keep things running, to improve things, to address difficulties, and the more tools that you learn, the more you're able to contribute,” Malaty said. “The more people that you meet, the more opportunities emerge.”