Fiona Godlee: Where are all the women?

Fiona Godlee It’s only since taking on this job that I’ve noticed how few women speak at medical conferences. It seems to me that half the time I’m the only woman on the programme and the other half I’m in the audience listening to an all male line up. I don’t believe in tokenism and anyway, given all the talk of the feminisation of medicine, it shouldn’t be necessary.

After all, two of the six major general medical journals (BMJ and JAMA) now have women editors-in-chief, which can’t be entirely down to exceptional individual talent.

So where are all the women speakers? What’s going on? My guess is three things: there are still fewer senior women than men in certain fields, conference organisers don’t know about them or don’t bother to find out, and those women that are asked are more likely than their male counterparts to say no.

What’s to be done? One senior academic I know will only accept an invitation to speak if the organisers invite at least one other woman onto the programme.

Another friend is drawing up her own Emily’s list of women who can speak on various topics. A third has made a vow to say yes to everything on the grounds that the men she hears speaking, not all of them brilliantly, don’t seem to suffer from self doubt so why should she. There are risks to this strategy.

A colleague did an audit check of their organisation to check how many committees had women on them. He was pleased to find that there was a woman on every one, until he discovered that it was the same woman. One can only speculate about the effect of all these committees on her academic productivity.

For my part, I’m going to increase my network of excellent women so I can name an equal number of men and women when asked for suggestions by conference organisers. And although I hate to be a bore, I’m going to raise the issue whenever I find myself the only woman on a panel. What with this and my commitment to ask to speak via video link, the invitations may dry up. So be it. More time to read and write.

What do you think? Have your say on the blog.

Fiona Godlee, Editor in chief, BMJ

  • I am glad to read your arguments. I think that organisers of conferences (I also work for a company, Nature Publishing Group, that runs conferences) should make extra efforts to ensure that speakers are representitive. Similar arguments apply to the shockingly low numbers of women awarded prizes and so on. Another reason, in addition to some of yours, I hear for fewer women speakers at conferences is that there are fewer senior women than men, so women are disproportionately asked, and therefore tend more often to say no. This is certainly the experience that some of our commissioning editors say they have, when they ask women to write review and other articles — though when I have commissioned sets of articles myself, I can’t say I have had this problem at all!

  • “Representative”, sorry for my inadvertent spelling error.
    Incidentally, I do not argue for a quota system. I believe there are plenty of excellent women scientists and medics who can be asked to speak or write, without any reduction in quality over the current preponderance of male speakers and authors.

  • Richard Smith

    Dear Fi,

    Stand up comedians and after dinner speakers also tend to be male, although female comedians are making progress.

    I was once part of a discussion among men and women at the Stanford Business School about the cause of the glass ceiling. The conclusion was that men were much more able to talk confidently about something they knew little or nothing about, whereas women were reluctant to do so.

    So I’d rather see men copying women rather than the other way round. And aren’t there far too many conferences anyway? Lao Tzu said: “Those who speak do not know/Those who know do not speak.”

  • Dear Fi

    I enjoyed your blog post, and it reminded me of the recent study that looked at the representation of women on editorial boards of medical journals over 35 years ( Clearly you and Cathy de Angelis are exceptional. Even to 2005 the results were pretty grim, with only 16% of editorial board members in major medical journals being women. In 35 years there have been only 8 female editors-in-chief! (Although at PLoS, not included in this survey, the chief editors of the two flagship journals are women). Interestingly, Canada and Britain come out better than US journals. And having a woman editor in chief didn’t mean the journal was more likely to have female editorial board members.

    To me this does provide more evidence of a glass ceiling for the increasing numbers of female medical graduates and women entering careers in science. And I think we fuel that by asking the “same old” senior male academics to be on our scientific programmes, advisory committees, and editorial boards. By doing so we reproduce the idea that these are the only experts.

    I’m not at all convinced there are not enough qualified women to act in these posts. Like you, I’m going to try harder and nominate women for our editorial boards and the scientific programmes I’m involved with.

    Best wishes
    Jocalyn Clark
    Senior editor, PLoS Medicine; former assistant editor, BMJ

  • Anna Donald

    Dear Fi,

    I’m surprised and disappointed that this is still true. In my experience women of our age and older, in general, are less confident speakers (because, catch-22, they have had less chances to speak and so less practice) and often aren’t as ‘funny’ as some men, because it’s too scary to be publicly witty (this brings to mind the Harry Enfield dinner party skit in which women must speak only of soft little kittens, not, heaven forbid, venture theories on the gold standard). There are many notable and hilarious exceptions of course.

    But being funny shouldn’t be the criteria for speaking at conferences! It’s very encouraging that you can do something about this. I think too, as every year passes, such a gender bias will look more and more naf and the balance will change because organisers won’t want to look so fuddy-duddy and there will be plenty of confident women available to speak. The women among my UCL medical students seemed at least as confident publicly as the men. They were, of course, 10 years younger than me. With your contribution hopefully we won’t have to wait that long for change.

  • Lorna Gibson

    Dear Fi,

    Thanks for your interesting blog. I’ve just got back from a conference which sounds just like you have described – a line up of mainly men with a sparse smattering of female speakers dotted about the programme.

    Apart from the lack of female speakers at conferences, I think your blog has highlighted another important issue – the apparent lack of female role models in academic medicine. The Health Policy and Economic Research Unit at the BMA published a report( profiling 29 academics who had been nominated as role models by their colleagues. Only 8 were women. Next year my fellow students and I have to arrange a short medical research project. Looking down the list of supervisors, it’s the same story as before. Male supervisors leading the way and only a few women getting involved.

    I agree with yourself and Maxine that tokenism is not the way forward. I hope that some of your suggestions for increasing women’s involvement in conferences will help to raise the profile of women in medicine, which still seems to be, unfortunately, a man’s world.

  • Felicity Goodyear-Smith

    Dear Fi

    This is a very interesting observation. It is not an experience I have noted in attending primary health care conferences in New Zealand nor in Australia. I have quickly reviewed the presenters, key note speakers and panelists at several conferences (for example a Cochrane Symposium and conference of the RNZCGP) and the programmes indicate a general balance of male and female speakers.

    General practice academic circles in Australasia are becoming increasingly feminised and this is reflected in who presents at conferences.

    NZ was the first country in the world to give women the vote. Maybe we are also leaders in giving women the floor.

  • Mandy Abushama

    I fully agree with you that women are rarely represented in conferences other than the juniors sessions . The reasons must be similar to that leading to minimal representation of women at the Royal college of Obstetricians and Gynaecologists ,that there is no policy of positive discrimination for women in a male dominated club.
    Another reason is that there are hardly any meetings during the summer . The time when women can combine travel with family commitments . Not very many women can or even wish to travel all over the place for a few days at a time leaving children behind. It is only in the states that a few meetings happen during the summer .

  • Plenty women in educational related conferences in my experience. Will do informal poll at this summers batch.
    Running a couple scientific meetings next month, so it is notably by the low number of women delivering scientific work but they are there… Hopefully, this will now change as more ACF trainees come into UK academic sector. 70% graduates are female.
    In music (classical) plenty of very high caliber soloists and ensembles. The all female string quartete been around now for couple decades…

  • Now I am an old and diseased man, as a consequence I am working exclusively with computers without attending and speaking at Italian Congresses, as usually in the past decades. I remember that I meet once numerous women, who spoke in so fascinating way, but your information gehnerally were OLD to me. In any case, they were really nice!

  • Mark Wilson

    The absence of women speaking at medical conferences is likely an expression of a larger societal dynamic. That seems to be the case in Canada and the US.

    A friend who is the CEO of a national members based organization recently noted to me that she has met many exceptional women in her sector but unfortunately few have acquired seats around her members Board tables. A Canadian report( 2007 Catalyst Census of Women Board Directors) found that women’s representation on corporate boards in Canada remains remarkably low. Interviewees in the report stressed that reliance on informal “old boys’ networks” continues to be a significant factor in how new board directors are recruited. In the US a similar problem has been noted and is addressed in the recent book No Seat at the Table: How Corporate Governance and Law Keep Women Out of the Boardroom,”

    A gender glass ceiling seems to cut across different professional sectors of society

    Perhaps the issue “Where are all the women” should be a topic in its own right at a medical conference. It would then be difficult not to have women speak on the issue. Clearly something needs to be done for this important issue to attain a higher public profile. While this blog is clearly a useful first step perhaps a larger social forum for publicly profiling the issue, networking and hashing out strategic approaches might also be useful.

    Mark Wilson

  • Dear Fi,
    in my former comment there are two trivial errors.
    I wrote “your” information, instead of THEIR; “gehnerally” and not generally! In addition, I admitt that not ALL women were “really nice”.

    I should agree with cancelling both of messages.
    Please, excuse me.

  • Clodagh Loughrey

    I think this is a situation which is changing. The national scientific meeting of the Association for Clinical Biochemistry took place a few weeks ago in Birmingham. Seventeen out of 63 symposium speakers and 2 out of 6 plenary lecturers were women. Considering the age spectrum of the speakers (several at or approaching retirement, mostly men), I think this was a reasonable female representation. I was the chair of the Scientific Program Committee and another 2 of the remaining 5 committee members were women. I must have a look back at previous years’ programmes (chaired by men) to compare…

    A footnote: 2 female speakers had to think carefully before committing as the meeting took place in midst GCSE season. No male speaker brought this up!

  • Kay Dickersin

    Thank you for taking this on, Fiona. There are so many things to say I hardly know where to begin.

    First, speaking at conferences. There are a number of aspects to this issue. For about 20 years, I have been keeping track of speakers at the annual meetings of Society for Clinical Trials (SCT), a society for which I now serve as President. I don’t have actual numbers but I would guess that women make up 30-50% the membership of the SCT. The data have been consistent over the years: women make up about half of the contributed paper speakers, and much smaller proportion of the invited sessions. The situation with session chairs is perhaps improved, with somewhat more women serving in this role nolw than in the past. The cynic in me wonders if having a woman as a session chair but not an invited speaker is an “easy” way to add women to these sessions. I am afraid I am rather a pest on this topic — that more women need to be invited speakers. And I know it is not easy. In our role as the US Cochrane Center, we have run many conferences and workshops. When we think of who we want on the program, we tend to name men first. These are the people who are best known in our field. But women don’t stand a chance of becoming well known if we do not include them on the roster and give them the chance to show their stuff. This isn’t just a man-woman problem by the way, we also tend to favor the people who are senior, often not giving juniors the chance early in their careers. Bringing more people into the discussion, be they women or junior investigators, broadens and enriches our thinking and increases the field’s impact on change for the good.

    In addition, it is important to see our “own kind” included in a program and up on the podium–it is a kind of encouragement and invitation to be part of the conversation. Even if you are not a minority, a woman, or a “young” person, you probably look at a meeting roster and make a decision to attend as much as by who is speaking as by the topics covered.

    The second aspect to speaking at conferences is speaking up. Who goes to the microphone to ask questions? Very few women. This is part of being recognized as a contributor and we women cannot expect recognition without this effort on their part. (That doesn’t mean I am encouraging speaking up for its own sake!)

    And where are the women editors? Recently, I wrote a letter to the joint editors-in-chief of a journal in my field, asking them about their journal having editors-in-chief who are all men and associate editors who are also all men (they have since added a woman). I am sorry to say that none of the editors, who I count as friends, have answered my note (though their managing editor did). When I captured one of the editors-in-chief in person recently and asked him about the situation, he responded that (1) they asked some women but got turned down, and (2) there aren’t enough women for the upper level positions. Hmmm.

    Our 1998 study of women as editors of epidemiology journals (Dickersin K, Fredman L, Flegal K, Scott JD, Crawley B. Is there a sex bias in choosing journal editors? Epidemiology journals as an example. JAMA 280:260-264, 1998.), we found that women do not serve in the higher level editorial roles, even though they are first authors and referees about 30% of the time. When we asked our colleagues for comments on early drafts of our paper, the women just laughed at our findings. “So what else is new?” they said. And we often heard stories from women of their being reliable and much-used referees for a journal but passed over when new associate editors were added. We met with two types of responses from the men (1) their feelings were hurt, because in their minds they were trying to be inclusive or (2) they were angry with us. But they did raise two issues that we had not thought of at that time and which I believe are right on, first that women turn down invitations more often and second that women don’t ask to be included as an editorial board member. The latter was an eye-opener to me, I hadn’t known it would be ok to self-nominate. I still wonder how it would be perceived and if a woman’s self-nomination would be perceived as pushy or “what is she thinking?”.

    So, I am doing something about the problem. In response to my editor friends who say there aren’t enough senior women to choose from, I have solicted names of senior women in clinical trials, internationally, using a survey of my colleagues. That list is now ready for prime time and I will be sending it to Fi and my journal editor friends. Women, if your name is not on it, and it should be, please self-nominate! I have already given the list to an editor of a journal looking to revamp his editorial board. I encouraged the men at a recent meeting related to this journal to discuss the journal to generate a similar list of potentially eligible men, the other half of the presumptive candidates. (Interestingly, when I got the minutes of the meeting, there was a call for nominations and no mention of the list that was handed out at the meeting.)

    Finally, a comment about being boring on this topic (in response to Fi’s brave statement). Let me say, to start, that I am definitely one of the most boring people in the world on the issue of women’s participation and equal opportunities. It is painful to always bring up the same issue, knowing the groans and rolled eyes that will follow. But I will die knowing I did my part to move things forward. But isn’t there a way we can join together to work on the issue, and not just raise the problem one person at a time? At recent meetings I have attended, women, especially senior women, have been noting that things seem to be getting worse, not better, in terms of being invited into the inner circle. The women at a recent Cochrane Collaboration meeting, for example, discussed how best to handle the apparent worsening of situation and the ignoring of our repeated requests for more representation on the podium (as invited speakers) and in leadership roles. Should we form a woman’s caucus, which would almost surely meet with derision but which might be effective? Should we continue to remind our colleagues of their responsibility to include women as key speakers, for each meeting we organize? We noted that it is easier for the senior women to be vocal, while the junior women are reluctant to raise a protest. This is a sad situation, though understandable. We all need to be part of the change that is needed, not just senior women. In the Cochrane Collaboration, for example, Paul Garner and Paula Waugh have organized regular reviews of women’s participation and they provide real data that monitors our progress. Thank you Paul and Paula!

    OK, Fi, I’ve said enough (for today).

    Let’s all join together with Fi to be part of the solution. To quote Eldrige Cleaver (1968), “What we’re saying today is that you’re either part of the solution or you’re part of the problem.”

  • Jane Flint, British Cardiovascular Society Council for Women in Cardiology

    I recently wrote a rapid response 21st April, following the debate on the feminisation of medicine debate run in the BMJ, on the theme that the NHS and profession should lead a societal change in attitude towards shared responsibility for family care, which would further release women to show enthusiasm for leadership and other prominent roles on committees including journal boards and conference speaking. Your identification of the ‘Where are the women?’ theme in relation to conference and journal involvement at senior level is a useful and timely rejoinder to maintain the vital profile of this continuing issue. The ‘Women in Academic Medicine’ report 2007 and the implementation of the Equality Act 2006 in the NHS from 2007 demand that we pursue the issue with initiatives that will necessitate leading women being invited to participate more proportionately in all areas of professional life. A conference on this subject is not such a way out idea!

    Jane Flint
    BCS Council Elected Representative to promote women in Cardiology

  • thanks

  • Mary E Black

    We passed a landmark today in this weeks BMJ – the majority of the obituaries are of women (5 out of 8). The obituaries are the place I go to see how other women created their careers in medicine – they are fascinating.

    I also had a personal landmark a few weeks ago – the first time I have been asked to speak at an event organised by the Royal College of Physicians UK. Granted I was also on the organising committee – although frankly most of the speakers were a done deal before I joined up. The end result had the usual gender gradient as we proceeded through the day – older white men, then younger men, then a woman or two, and the last speaker on this conference on international health was the sole (male) black speaker actually from a developing country. I am simplifying but the trend was very clear.

    I have spent four years as an international advisor for the RCP, sitting on an INVITED committee that has just doubled its representation of women (from 2 out of 80 or so to 4 out of 90 or so). The serried ranks of male portraits in the RCP lead me dashing for refuge to my favourite table in the restaurant under one of the only three images of women in the entire building, (unless you pretend the guys in wigs are really girl). As for the annual College doling out of prizes, invited lecturers and chairs of various events – few women ever make an appearance. And they are often the same recycled few women.

    Colleagues sometimes ask why I continue to bother – the answer lies in my sense of duty, the fact that I enjoy the College and the collegiality concept, my belief we should change things rather than complain and my certainty that if we do not then the next bunch of women and men coming through will still have to do this thankless task. But most of all my belief that this is all just wrong.

    How to change it?

    1. Just do it. East Birmingham Hospital in 1986 had a dinner club for junior doctors – with speeches. Each speaker handed over to the next person by name. No women were ever called. One day I just stood up and spoke. I bombed, but gradually I got better. Many years later I am pretty good, embarassment over, seasoned, a former graduation speaker at Harvard. I am funny. I have my own voice. Call me if you need a woman to give the toasts or the keynote. Any topic will be just fine. I talked about pigs once for a bet.

    2. Stop apologising. (Most) men don’t.

    3. Get on the finance committee. If you are going to be in demand as the token woman on the committee circuit, milk it and get the most powerful committee you can. Or one you really care about. Avoid the all woman committee set up to improve things for women. Unless it has a multi-million dollar budget and serious power.

    3. Apply for leadership positions. I came second this year in the search for the new head of the faculty of health sciences at the University of Cork. No other woman has ever got that far in academic medicine in Ireland. In fact, as far as I can gather, no woman has ever applied. By writing this, I hope more women will. In Cork the interview was exhilarating, colleagues supportive, the entire experience a positive one. I will never be scared of something like that again.

    4. Work for UNICEF. This is an organisation where gender does not matter, in fact there is a slight positive bias towards women in the senior roles.

    Why should we change things?

    My doctor mother and i plan to picket our church discussions on whether women can be priests or not ( we are still waiting for the Catholic Church to officially hold the debate). We will wear our white coats and hold a banner saying “They once said we could not be doctors”. Why? Because we think this must be said.

    You see, I want my daughter to live her life without the need to have her gender protesting banner constantly ready to be waved. For her, and for my son, I want gender to be a non-issue. I want them to see role models in all genders, shapes, ages, sizes and colours.

    I want them to open the BMJ and not routinely look for familiar patterns in the obituaries.