“In the future, there will be no female leaders. There will just be leaders.” — Sheryl Sandberg [1]

This month’s commentary by Dr. Pfeifer and colleagues [2] addresses the issue of gender representation in pediatric radiology, specifically examining gender-related trends in pediatric radiology leadership and in Society for Pediatric Radiology (SPR) annual meeting participation. The authors point out that pediatric radiology is poised to achieve the gender balance that eludes most other radiology subspecialties, and they define strategies to develop female leaders in pediatric radiology.

Gender balance in pediatric radiology and pediatric radiology leadership is about more than just equity and doing the right thing (though that is also important) — it is about doing the smart thing, something that will enable individual pediatric radiology practices and the specialty itself to thrive.

Our diversity, gender and otherwise, makes us smarter and more capable. Researchers in organizational behavior and theory have studied how groups of people perform on a variety of tasks and found that it is possible to measure the collective intelligence factor of a group [3]. In one study, groups were tested on tasks that are highly reminiscent of challenges that we as pediatric radiologists encounter on a regular basis:

  • solving visual puzzles (e.g., complicated MRI),

  • brainstorming (e.g., research ideas),

  • making collective moral judgments (e.g., ethical practice questions) and

  • negotiating over limited resources (e.g., anesthesia availability for sedated imaging).

These researchers found that a group’s collective intelligence factor predicts the group’s performance on these tasks to a greater degree than the group members’ average or maximum individual intelligence [3]. More interesting, in this study, the collective intelligence factor was positively and strongly correlated with the proportion of women in the group, with subsequent work by these same researchers showing an enhanced collective intelligence factor in diverse groups, independent of the individual group members’ intelligence quotients (IQs) [4]. Maybe this explains why mixed-gender authorship teams have more citations than single-gender teams in both radiology and other disciplines [5].

The benefits of maintaining gender balance extend to our patients, too. Analysis of nearly 2,000 original research articles published in three major U.S. radiology journals over a 5-year period shows that researchers publish more often on topics related to their own gender [6], highlighting the need for our specialty to diversify and reflect our patient population. Gender reporting in radiology human subjects research is frequently ignored, with one study showing that nearly 10% of articles published in seven major radiology journals did not specify the gender distribution of subjects and that only one-quarter of those that included subjects of both genders reported gender-based results [7]. Female researchers are more likely to include gender analysis in their research, uncovering differences in disease behavior and treatment response between males and females [8].

The implications of gender on the delivery of radiology clinical services have been largely unexplored. Literature on the role of gender in patient–provider relationships shows differences in the way male and female physicians communicate as well as differences in the expectations and needs of male versus female patients [9]. It stands to reason that patients might feel more comfortable being examined by, sharing problems with, and asking questions of physicians with whom they identify by gender. This is yet another reason to maintain diversity in our group that mirrors the children we serve.

Pfeifer et al. [2] make the important observation that although there has been recent progress toward gender equity in pediatric radiology leadership, there is room for improvement. The challenge of balancing career and home responsibilities has been invoked as a major obstacle in the development of female leaders [10]. Although Generation Xers are regarded as having a strong sense of shared responsibility for parenting and domestic obligations, according to surveys of early career physicians published within the last 6 years, married women with children spend substantially more time on domestic and parenting responsibilities than their male peers and have primary responsibility for a greater number of household tasks than their male colleagues [11, 12]. Institutional investments to improve work–life integration can provide all young physicians, particularly women, with the potential to find career success and allow them to pursue leadership roles. Hospitals should offer on-site child care, provide lactation facilities for nursing mothers, and finance infrastructure such as home picture archiving and communication systems (PACS) and dictation systems. Of course, cultural shifts, such as allowing flexibility to work from home when needed (e.g., when a child is ill) and avoiding scheduling meetings at times that conflict with family responsibilities, are also required. Some professional societies have begun offering child care arrangements and lactation facilities at national conferences to afford parents the opportunity to participate [13].

Women must also realize that even if they elect not to pursue leadership roles during their early careers because of family obligations or personal choice, there is nothing to prevent them from doing so in mid- or late-career years. As Dr. Ella Kazerooni explained, women “do not have to do everything at the same time.... By the time women are able to take on responsibility, they often believe that time has passed them by.... It is important for women to know that they do not have to do things on the same time track or the same trajectory as their male counterparts…. Time has not really passed them by” [14].

Pfeifer et al. [2] note that coaches, mentors, sponsors and role models are imperative in nurturing future leaders. Increasing the number of visible female mentors and role models, such as full professors, division chiefs, department chairs, professional society leaders, and journal editors, is likely to encourage women to choose careers in pediatric radiology, which will, in turn, keep an open pipeline from which to cultivate future female leaders. However, because time spent on mentorship translates to less time on the traditionally rewarded activities of teaching, research and administration, departments need to encourage mentorship efforts by providing time, recognition and training to those involved [14].

Developing female leaders requires hard work from men and women and cultural changes on the individual, institutional and societal levels. But increasing the number of female leaders in pediatric radiology doesn’t just benefit women — it benefits everyone.