As part of gathering my thoughts on the topic of diversity and leadership last week, I did an informal one-minute survey of colleagues in my network using Survey Monkey via email, Facebook and Twitter. They were asked to participate if they are a physician with any type of leadership role in an academic medical center in the U.S. They were told that the purpose was informal and meant to gather thoughts on the topic of physician leadership and diversity to prepare for a panel discussion at a national conference. The survey ran for seven days and it was anonymous and confidential. The questions asked were the following.

1. What % of your leadership effort/time is spent overcoming real or perceived diversity factor (vs. actual leading)? It’s hard to separate but please give your best estimate. Options were 0%, 1-10%, 11-20%, 21-30%, >30% and ‘Other’ with a free text option.

2. How many elements of diversity do you have? (gender, color, country of origin, sexuality, any other). Options given were None, 1, 2, 3, >3, and ‘Other’ with a free text option.

3. Any other thoughts you want to share, with a free text option.

A total of 55 people participated in the survey. Here are the results:

Number of RespondentsPercent Leadership Effort for Diversity
Number Elements of Diversity 0% 1-10% 11-20% 21-30% >30% Grand Total
0 1 1 2
1 16 6 1 23
2 1 5 4 2 12
3 4 4 2 1 11
>3 3 4 7
Grand Total 2 29 18 5 1 55

I ran a regression and the R2 was 0.85 with a p-value of 0.0000, which indicated that increasing number of self-recognized elements of diversity was significantly associated with a greater proportion of leadership effort spent overcoming the real or perceived ‘diversity factor.’ See graph in the picture.

Here are the comments that were not specific to the respondent’s institution.

“We have a lot of work to be done in removing our unconscious bias and fears regarding increasing diversity. I often see instead of stepping back and considering the system we want to create we tend to fall on the way traditionally things have operated. Flexibility, communication and openness to change will be the key to improving our current paradigm.” “At the physician-leader level, we are still equating diversity to “numbers” rather than ideas. We don’t validate that diversity exists in multiple domains- including country of origin, upbringing and life experiences. Within the Hispanic community, as an example, there are many areas of commonality but also diversity. We don’t discuss LGBT issues. Within the LGBT community, there are many dimensions of diversity. As an example, if one of our physicians were to transition, from gender, we would be utterly unprepared. This isn’t even within the realm of possibilities for some people, yet it is real life and other industries have led the way.” “I suspect the amount/percent of time we spend overcoming these factors is less a reflection of what is needed, and more a reflection of our own decision to address it or not. Some choose to spend more of their outward/action energy on this (which likely pays off with increased effectiveness), while others such as myself more minimally address it when absolutely necessary. It might be interesting to explore what motivates one to address these issues more/less than another. Of note, not addressing it as much in leadership practice does NOT mean that it is not constantly on a person’s mind either. This is a very nuanced discussion.” “This is in my mind the most pressing issue in all of medicine.” “Women are under-represented. Women of color/origin are SIGNIFICANTLY under-represented.” “We need more role models! We are getting there slowly.” “I am often left out of leadership discussions due to my accent.” “My short height is a significant disadvantage.” “I have come to appreciate that diversity now encompasses more than gender, race, national origin and includes other distinctive elements that reflect how we were raised, where we studied and who influenced us. Think of it as the social determinants of diversity. Sometimes our zip code is more important than our color or gender.”

“Even in specialties like Ob/Gyn, where our trainees are overwhelmingly women, we’re still nowhere near the 50% mark in leadership positions.” “Definitely challenging. The unconscious bias is way more than the conscious, hence hard to fix. The problem is that we are trained to “phenotype” patients, and we do it all the time in non-patient interactions too unbeknownst to us. And there are times when “diversity” awareness gets in the way of management- it seems like everything we say and do can be perceived as “being biased” by someone at any given moment. Sigh. The good news is that at least we have made a start.” “The diversity/minority tax is real and elements of it are quantifiable (e.g. amount of time spent mentoring other minoritized faculty and trainees, and committee work) -institutions can start by accounting for this work in terms of protected time and consider it for promotion and tenure.” “Female Professors are rare, Female Professors in leadership positions are even more rare and the more factors you add the rarer it gets.” “The young woman factor is also a hurdle…” “Your first question was a little opaque to me. I wasn’t sure whether you were talking about issues related to my gender or to gender/diversity issues within my leadership purview. I might have given different answers to the two different questions.” “It’s hard to know how much it plays into being able to lead effectively. Gender differences are easier to perceive but is someone biased against me because of my race or religion or something else? I wouldn’t know if that explains challenges.” “Women do not support each other. Most of my leadership issues are with other women leaders.” “Diversity is a function of diverse leadership.”

Very interesting responses and definitely a lot to think about. I will let you interpret these results for yourself. Diversity does go well beyond what is visible externally, as shown very nicely in the iceberg picture generously contributed by my colleague Dr. Reeni Abraham (reference for picture: http://www.brookgraham.com/WhatWeDo/Iceberg.aspx) Lastly, I want to say how much I appreciate those of you who participated in the survey and contributed your thoughts. Each of us can reflect on these results and incorporate some of these thoughts into our leadership work and perhaps become a bit more intentional in addressing diversity and inclusiveness.