Accomplished women leaders in informatics: insights about successful careers

Abstract

We sought to learn from the experiences of women leaders in informatics by interviewing women in Informatics leadership roles. Participants reported career challenges, how they built confidence, advice to their younger selves, and suggestions for attracting and retaining additional women. Respondents were 16 women in leadership roles in academia (n = 9) and industry (n = 7). We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) “Big wins” in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders. Sexism is undeniably present, although not all participants reported overt gender barriers. Confidence and authenticity in leadership point to the value offered by individual leaders. The next step is to continue to foster an informatics culture that encourages authenticity across the gender spectrum.

INTRODUCTION

The path to gender equality is long.^1–6 Progress in advancing equity is apparent, but women continue to report sexual harassment, stereotyping, and bias.^7–11 Women are underrepresented in scientific dissemination,¹² substantially less likely to be in leadership positions,^5,13,14 and have not achieved salary parity with men.¹⁵ Though less likely to lead federally funded proposals, once funded, women continue their success with equal longevity to men.^16,17 Men lead the majority (75%) of the academic programs and clinical subspeciality fellowships (83%) in biomedical informatics.¹⁸ Within the American Medical Informatics Association (AMIA), men have held 56.8% of leadership roles and received 64.1% of awards.¹⁸

The National Institutes of Health (NIH) recommends leadership commitment to gender equality, establishing gender-related metrics, and increasing transparency and accountability through tracking and reporting systems.^18–21 AMIA is actively promoting career development for women through social events, panel discussions on gender specific challenges, and committees such as Women in AMIA (WIA) that focus on advancement of women in biomedical informatics. Even so, female AMIA members continue to report gender-specific challenges of deep-rooted gender power hierarchy and bias.¹⁰ The 2021–2022 Women in AMIA Leadership Program scholars completed a capstone project designed to give scholars real-life leadership experience that promotes the program goals to increase women’s leadership across the informatics ecosystem.²²

Objectives

As participating WIA scholars, we leveraged qualitative methods to characterize experiences of women leaders in informatics.

MATERIALS AND METHODS

We developed an interview guide (Supplementary Appendix S1), recruited women leaders in informatics, collected and transcribed interview data, and completed a thematic analysis.

Participants

Women in leadership roles in academia and industry were invited to participate by email. Interviews were conducted, audio-recorded, and machine-transcribed by virtual meeting platform. Transcripts were deidentified and verified for accuracy. The procedures were designated nonhuman subject research by the University of Utah Institutional Review Board (IRB 00152438).

Data analysis

Our team coded 3 transcripts by consensus using Dedoose qualitative software and derived a codebook.^23,24 Additional transcripts were coded by masked pairs. We resolved discrepancies, grouped similar codes together, and generated themes in iterative group discussions (see Figure 1).

Figure 1.

Data analysis process.

RESULTS

Sixteen women leaders agreed to participate (Table 1). Thematic results are described below.

Table 1.

Participant demographics

Category	Number / %
	(n = 16)
Professional setting
Academia	6	37.5%
Industry	5	31.3%
Academia to industry	2	12.5%
Industry to academia	3	18.7%
Education level
MD	4	25%
PhD	9	56.25%
MD PhD	2	12.5%
Masters	1	6.25%
Career stage
Mid	8	50%
Advanced	8	50%
Participant leadership roles
Academia roles
Chair/Director of Informatics Program	5	31.3%
Director of Informatics Center	4	25%
Industry roles
Chief Medical Information Officer	2	12.5%
Clinical Informatics Lead	1	6.25%
Clinical Informatics Fellow	1	6.25%
Founder Informatics Start-up Organization	2	12.5%
Senior Vice President	1	6.25%

Theme 1: Careers in informatics are serendipitous and nurtured by supportive communities

Informatics was often discovered in a synergistic way as part of other roles and experiences. One participant described their introduction: “So, like many people, I basically came to informatics serendipitously.” (P17) Suggestions to attract and keep women in informatics included involving women early in life (eg, middle school) and career, and targeting female-dominated fields such as nursing. Personal backgrounds influenced a philosophy for career pursuits:

So you have two ways to make progress … You either fight the system and build resiliency through the fight, or you just succumb to the system and make the most of what you have the best way you can. (P15)

Another participant talked about specific demands of an academic career and devoting time to academic skill investment:

The advice I’d give is take the job with less money, spend the time, learn the skills, put the effort in so you come out with a competitive skillset that serves you well for the rest of your career. (P12)

Participants addressed challenges including concerns raised by young women about career achievement:

They think if they are dedicated to their work they can’t have a social life or family and kids. They are intelligent enough to succeed. I think it’s just they need confidence that you’re not going to lose the rest of your life if you’re in the field. (P11)

There was a tension regarding women having career and family with some leaders offering reassuring messages for young informaticians that balance is achievable; whereas others highlighted challenges and proposed career commitment might vary by life stage. The importance of support (eg, from a life partner) was stressed by some. Many participants reported not having specific mentors, but role models included leaders who were successful, interesting, committed to excellence, and good humored.

Specific strategies to change the sexist culture included communication to address covert sexism in meetings:

A colleague who is male will say more or less the same thing [the female said], and that’s what gets picked up on. I call it out. I say ‘Oh, it’s so great that you’ve taken her idea, and now we have it in front of us’. (P16)

Women in later stages of their careers were more willing than those in mid-career to take risks, change jobs, and ask for opportunities, titles, and salaries they felt they deserved.

Theme 2: Challenges in leadership roles are profoundly related to gender issues

Participants noted an increase of women in leadership and a more collegial atmosphere in informatics but described common experiences with gender biases. One participant said “When I sit on the board I’m the only female. Definitely there [are] still some gender problems, right? We are present as females in the field, but definitely it’s still a male dominated field.” (P11)

Participants reported difficulty feeling confident and a widespread experience of “imposter syndrome.” “I’ve seen so many other people who get into positions and do the same things, and they’re impostors, too!” (P1)

Participants noted that male colleagues received better treatment. “I was puzzled by how my male colleagues were treated. They do something small, and oh, my God, they are glorified to the skies. That’s how it is.” (P3)

There were indications that things have changed compared to the past: “Even back then I was getting yelled at by some of my peers. There was the joke that I was like Joan of Arc—never had one woman pissed off so many men.” (P7)

Participants highlighted the importance of taking responsibility for decisions, including accepting criticism, as important for leaders. Leadership was described as something one could fall into due to willingness to take on attendant responsibilities:

If you’re gonna tell people what to do you’re gonna end up in a leadership position. If you’re in a room where no one wants to make a decision, and you’re the person who is willing to make the decision, you’re gonna end up in a leadership position. (P8)

Leadership included learning how to support other women, building team consensus, and enjoying leading roles.

Theme 3: “Big wins” in informatics careers were primarily about making a difference

Study participants were inspired by making a profound difference within informatics, a system, and patients’ lives. Some differences included identifying sources of racial disparity and influencing policy and procedures to change disparity. One participant relished discovering the medical system complexity which is essential to making a systemic difference:

To see all the details … to see how complicated it was underneath … I’d imagine it was like a neurosurgeon’s dream about when they start getting into neurosurgery, and they start seeing the complexity of the brain and everything behind it. You start peeling back the layers of bureaucracy in the healthcare system to find out it’s not just the IT. It’s not just the processes. It’s all of it—and everything in between. So the nuances in the complexity are what pulled me in. Who doesn’t like a good puzzle? (P7)

Some participants changed direction, from academia to industry:

I went from being a faculty member and feeling like I was just chasing these dollars, and I couldn’t see the impact of anything …. I feel like when I end my career, my expectation is that I and my company will have made some real, significant progress in bringing technologies to the market that will transform how quality is measured. (P2)

Theme 4: Women leaders highlighted lessons learned about resilience, excellence, and personal authenticity as important for future women leaders

Participants reported planning, preparation, and skill development were crucial for success. Resilience was built through toughness in the face of failure experiences, self-care and building on your personal strengths. Comments captured a tension between self-promotion and humility. One participant said, “I guess my philosophy is that people will recognize you for your good work as long as you’re humble about your work.” (P14) Another participant commented on gender differences related to self-promotion.

Men by nature are more self-promoting than females. They asked for what they are due. Females shy away from doing that. Over time I got out there and said, “This is what I need, and this is what I should get.” I went after what I deserve. (P11)

Participants reported the importance of self-awareness and recognizing one’s own strengths. Rejection was particularly common in academia: “You apply for grants you don’t get them … and then finally you apply for a grant, and you get it. You have to get accustomed to rejection.” (P13) Engagement in a support community, exercise, and stress management were also resilience factors reported.

Additional quotes are provided in Table 2 and in Supplementary Appendix S2.

Table 2.

Participant quotes

Code category	Quote
Theme 1: Careers in informatics are serendipitous and nurtured by supportive communities
Career path	I was a physician and reached out to the pathology department who had informatics as a new offering. Now I’m the founder and Chief Medical Officer of a new company implementing informatics solutions. (P11)
Role model	My boss has been my main mentor. She’s been here for 25 years. A female manager in corporate America 25 years ago is impressive. She had to almost be like a man in the role. There were norms for how women should behave and how men would behave. Now we accept the gender differences and figure out how to navigate them together. (P18)
Theme 2: Challenges in leadership roles are profound related to gender issues
Gender barriers	As someone who has been in the clinical environment I can relate to people mentioning challenges in the environment. Speaking the same language gives you credibility. But against me is that I am female, my religion, and I’m not a native speaker. So, there are lots of things against me. (P11)
Leadership surprise	Sometimes they give the most respect to someone who is shouting loud, or recognition by appearance. Some of my colleagues appointed people because they are young and good looking. That is still happening. But I think now there is a platform for us to question, so that is good. (P3)
Theme 3: “Big Wins” in informatics careers were primarily about making a difference
Big Win	I think the biggest win is to see the effect in helping an actual patient. Adding that extra piece where we actually make a difference in a patient’s life is what keeps me going. At the end of the day you’re here to help someone. (P11)
Meaningful impact	The COVID case reporting project was a meaningful impact. It was a lot of thoughtful, purposeful, and principled work. The CDC called asking if we could implement it, and in 6 weeks, we marched through the implementation. Now we’re talking about implementing it for 20 more conditions. We’re operating on the ground where the rubber meets the road. We are trying to address real problems. It’s fun. You’re not done until you make the difference. (P10)
Theme 4: Women leaders highlighted lessons learned about resilience, excellence, and personal authenticity as important for future women leaders
Advice—Authenticity—Resiliency	I didn’t give myself permission to be who I was. I kept trying to pretend to be certain things in certain areas. It’s exhausting to do that. So, being authentic is my advice. I had to get where I am through that journey and telling myself to hang on, that things will get better. (P8)
Resilience	I’m a woman, queer, in IT, and a physician. I am different—an odd duck. I feel pressure to deliver. There’s continuous pressure. How do you manage it? You just have to be resilient. (P7)

DISCUSSION

Our findings suggest individual formative experiences contribute to women’s strengths as informatics leaders. Our participants found inspiration in the impact of their work on healthcare processes, clinicians, and patients’ lives. Positively impacting trainees by supporting their skillset for career advancement was also rewarding.

The picture for women leader participants was not entirely positive. Participants expressed frustration at differences between recognition and prominence of men versus women in the field. Financial disparities, fewer women in leadership positions, palpable discomfort when women are in leadership roles, and women being ignored and “spoken over” in meetings were all mentioned repeatedly. It is important to consider that experiences of sexism happened across careers of participants, with some events occurring years previously. However, it is notable that participants concluded sexism still exists, albeit more covert than in the past. Women who saw themselves as “other,” such as being queer, reported additional pressure. Women leaders reported opportunities to support younger women and raise awareness among male colleagues about sexist behaviors. This suggests the informatics culture will continue to move toward greater gender equality across the gender spectrum.

Our findings correspond with findings of Griffin et al¹⁸ who reported on male domination in biomedical informatics and other work reporting continuing gender disparities across science, academic medicine, and healthcare.^25–30 Participants highlighted younger women colleagues’ fears about balancing family and career goals, which is consistent with other research indicating gender roles at home and women’s noncareer goals may exacerbate gender inequity in academic and professional careers.^31–35 Participants reported leadership strengths similar to other studies such as capacity for nurturing and empathy.^36,37

Being authentic and genuine, not pretending to know something you do not know or being someone you are not, and being true to oneself was described as “critical for successful leaders.” Reflecting on her career, one participant said, “I learned very early in my career that being the best at what you do is what’s going to get you somewhere.” (P15) This focus on excellence is consistent with views of science as a meritocracy—a view that can perpetuate inequities if the recognition of excellence and rigor is conflated with the practice of excellence and rigor.^13,38 Principled leadership was the norm for participants. Authenticity in healthcare leaders is associated with enhanced trust and less burnout and compassion fatigue (indifference to needs from emotional overload), suggesting a powerful route to support teams in compassionate high performance.^39–41 To meet this goal, it is crucial to foster an informatics culture that encourages authenticity across the gender spectrum.

We believe our findings offer valuable insights that can aid organizations in creating supportive environments for women leaders in informatics. These insights can be used to develop mentorship programs that address specific needs and challenges women leaders face, while also providing ongoing professional development opportunities.

CONCLUSIONS

Our findings indicate advanced skills, authenticity, confidence, resilience, being capable of silencing nay-sayers (including your own negative inner voice and beliefs such as “imposter syndrome”) and fostering community connection are imperative to advancing to success in informatics leadership. Supporting aspiring women leaders in these skills by shifting our informatics culture to celebrating all genders is key to the transformation of healthcare. The insight of women leaders can direct us to strategies of transformation.

FUNDING

This research received no specific grant from a funding agency in the public, commercial, or not-for-profit sectors.

AUTHOR CONTRIBUTIONS

All authors were involved in conceptualizing the project, formulating the study design, developing the interview guide, and nominating, soliciting and interviewing study participants. VLP, BP, SB, and JMB performed the data analysis. VLP and JMB were major contributors in writing the manuscript. All authors reviewed the manuscript for content and understanding.

DISCLAIMER

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA or the US Government.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This project was reviewed and approved by the University of Utah IRB (No. 00152438). The University of Utah IRB protocol was also reviewed by the University of California San Diego IRB and Idaho State University IRB who agreed with the quality improvement nonhuman subject designation. Participants provided verbal consent to participate and to be audio-recorded during the interview.

SUPPLEMENTARY MATERIAL

Supplementary material is available at Journal of the American Medical Informatics Association online.

CONFLICT OF INTEREST STATEMENT

None declared.

DATA AVAILABILITY

Interview transcripts generated and analyzed during the study are not publicly available due to participant privacy and IRB regulation.