Dr Sally Ayesa
Thoughts on women in clinical radiology leadership
It has been a while since I have posted here! I thought I should start to share some of the projects I have been engaged with since I took a hiatus from blog writing. Based on the amazing feedback I am hoping to get back into posting. I will start with sharing some of our recent work advocating for improved gender diversity in radiology.
I was privileged to be invited to join the discussion on the state of women in radiology leadership at the recent RANZCR ASM. My speech is below if you are interested in joining the conversation. Links to the published articles are provided at the end.
"Thank you to the organising committee for inviting me to speak this morning and share some of the work that myself and some phenomenal colleagues have been working on the past 12 months.
This conference marks the first anniversary of when I truly started to get angry. While I have always been aware of the role my gender played in my radiology career it had always been fairly self-directed and introspective. Up until last year, I looked at it as a problem that I largely needed to navigate alone.
In 2021 when COVID kept the radiology community at arms-length, I sat in my home office attending the RANZCR ASM virtually. As a newly minted representative on one of the many subcommittees that makes up the faculty of clinical radiology, I should be in this session. As the outgoing president thanked the various branch committee members across Australia and New Zealand for their service in 2021, I looked at the New South Wales branch to see if I recognised any of the names – piqued by my own self-interest. I noticed some familiar names, but also noticed was that out of all of the representatives for our state, across trainees and senior radiologists, there was not one female name. And this, made me angry.
I am so proudly from New South Wales, raised in Sydney’s north-western suburbs in the heartland of Australia’s largest city. Yet here, there was no voice like mine to speak on behalf of the type of radiologist I was or the unique issues that I faced in my training or the early stages of my career as a specialist. Out of the 14 members of our state committee, there was not one voice for my gender despite women making up one third of the radiology workforce.
As time would reveal, I was not the only one who was angry about this.
Anger in women, particularly professional women, is often looked upon as an ugly emotion. Among leaders, a double-bind applies. Men in leadership, by traditional standards, are praised for being charismatic, assertive and aggressive when they need to be, and applauded for their showcases of strength. On the other hand, women are expected to adhere to the social expectations of feminine behaviour; exhibiting communal traits such as caring, consideration and empathy. Professional women are expected to hold their emotions in check. An angry woman? Not a good look.
Pausing here, I would like to borrow the words of some other inspirational women starting with proud feminist Clementine Ford from her book “Fight like a girl”. She urges her readers that it is okay to be angry:
To a world that instructs women to be passive and conciliatory, anger is a terrifying thing. Anger is unpredictable. It’s uncontrollable. People are afraid of women’s anger because they are afraid of confronting its source – inequality, violence, degradation, dehumanisation, misogyny. If you don’t want to accept that these things exist, you won’t want to accept the validity of women’s feelings of rage about them.
Julia Gillard and Ngozi Okonjo-Iweala’s book on “women and leadership” was almost titled (to excuse my language) “She’s a bit of a bitch”. Instead, they dedicate a whole chapter to this notion exploring the hypothesis that “as a result of unconscious bias, it is generally assumed that women with power are unlikable”. This is just another reason for us to keep our emotions and our anger in check, another reason that could deter potential women leaders from standing up for what they believe to be right or exercising their right to be assertive and strong. Another reason why young women look at leadership positions and decide that maybe it just isn’t for them. To borrow Jamilla Rizvi, we are conditioned to believe that our success is dependent on us looking nice and behaving nicely so that everyone will like us.
This time around, I was done with screaming into the void and quietly stewing on my own fear of speaking out – this is just not on. It is time that we acknowledged this discrepancy in gender representation among our leaders in the faculty of clinical radiology, and started to make change.
I started a conversation with a few of my radiology heroes, and we started to share ideas. We were going to start writing and we were going to put our anger into words. Here I would like to thank my first collaborators Dr Emmeline Lee, Dr Jane McEniery, Dr Laura Hill & Dr Cassie McCloskey for helping me bring our very first paper to life. Just published online in JMIRO, we crunched the numbers. We looked at radiology leadership from the very top to the branches to show that our gendered representation in clinical radiology was not good enough, and it wasn’t just a New South Wales problem. In fact, two other branches also had no female representatives. No branch achieved parity of gender representation. In 2021, not one branch was headed by a woman. In 2022, no woman clinical radiologist sits on the board.
From this work and collaboration, the first abstract I am presenting at this conference was born -authored with the phenomenal Dr Emmeline Lee, our host for this session morning. It is no longer a question of whether a gender gap in radiology representative leadership exists, but now what we can do about it.
We lose women from the leadership progression pathway at a higher rate than men for so many reasons, often related to unseen barriers and unconscious biases existing across organisational and institutional levels, influencing the culture and values which inform leadership selection. In addition, unconscious bias exists at a personal level for many women for two main reasons. Firstly, women may not envisage themselves as capable of undertaking a leadership role and secondly, they may simply decide that the challenge is too hard or unappealing and choose to opt-out. I certainly acknowledge that leadership is not for everybody, and I am not advocating to push every woman into a leadership role for the sole purpose of improving diversity. But what I would like to see, is that more women choose to engage and do not negatively self-select from their own self-perceptions, or simply because the road looks too hard. And believe me, looking at a “boys club culture” that sometimes needs to be broken into, I don’t blame women who decide it isn’t for them.
Any actions to tackle diversity – of all forms, not just gender - will need to be implemented concurrently and engage all levels of the radiology community, from the RANZCR board and faculty Council all the way down to individual members. Improving gender diversity has the potential to benefit the decisions that we make as a community and College, all the way down to our workplaces and patient care.
Strategies to move towards this could include the establishment of a formal women in radiology committee within the college to foster engagement, events and mentorship, and the celebration of women role models increasing their visibility to more junior faculty. I know for me personally that as a junior medical student and even junior doctor I never saw myself as a radiologist – I couldn’t be it, as I hadn’t seen it. This was until l I unexpectedly encountered a woman reporting CTs at Bankstown Hospital one day, then followed by accidentally finding myself in the audience of an inspirational head and neck lecture by Dr Robin Cassumbuoy short time later. These women were my earliest role models and I owe my career to them. Borrowing again from Julia Gillard and Ngozi Okonjo-Iweala, “Exposure to women in leadership roles enables women and girls to see that the door is open and encourages them to step through it”.
The second abstract which I will be presenting at the conference was borne out of another conversation with a hero of mine, Dr Cathy Hayter. She too felt that the representation of women across Australian and New Zealand clinical radiology needed a closer look, focusing on the subspecialty interest groups, Cathy herself being a musculoskeletal radiologist and proud member of AMSIG. I present this abstract with the full knowledge that Cathy has been the driving force behind this research, with the article born out of this data recently been published in JMIRO. The numbers we crunched for the different subspecialty groups found that poorest gender representation was encountered in interventional radiology (only 7% women), and musculoskeletal imaging and interventional neuroradiology (where there are 13% women). As expected, the “female” specialties of obstetrics and gynaecology and breast imaging were predominantly women however it was wonderful to see that abdominal imaging and thoracic imaging groups both had greater than 50% women members – which was discordant with data from North America where these specialties are dominated by men.
Similar to initiatives targeting greater gendered representation in clinical radiology leadership, tackling this issue will require multiple concurrent strategies and will take time. Foremost, grassroots efforts to increase awareness of radiology among medical students as a viable option for women will be paramount, as well as showcasing interventional radiology and musculoskeletal imaging to junior women doctors and trainees to inspire them to become a part of these wonderful and fulfilling subspecialties.
So after a year of actively engaging in research and conversations about gender diversity in clinical radiology, am I still angry? Yes I’m still angry, but I am also more informed and more connected with my community of like-minded people – not only women - who support this issue and are looking towards change. It has given me the platform for further collaborations which are working towards gender diversity with RANZCR itself and Radiopaedia - an organisation that I am very proud to affiliate myself with. Hearteningly, I have found both committed to starting conversations and striving towards a radiology community embracing diversity of all forms – gender, ethnicity, sexuality - all equally important.
Thank you to RANZCR for offering me the opportunity to speak this morning and supporting our efforts so far. And thank you to all of you here this morning joining in the conversation with me."
Ayesa, Sally L., Jane C. McEniery, Laura S. Hill, Cassie E. McCloskey, and Emmeline H. Lee. "Navigating the glass labyrinth: Addressing gender diversity in Australian and New Zealand representative radiology leadership." Journal of Medical Imaging and Radiation Oncology (2022). (Published ahead of print)
Hayter, Catherine L., and Sally L. Ayesa. "Female representation in radiology subspecialty interest groups in Australia and New Zealand." Journal of Medical Imaging and Radiation Oncology (2022). (Published ahead of print)