Intended for healthcare professionals


Making medical leadership more diverse

BMJ 2021; 373 doi: (Published 26 April 2021) Cite this as: BMJ 2021;373:n945
  1. Shannon M Ruzycki, clinical assistant professor12,
  2. Susan Franceschet, professor3,
  3. Allison Brown, assistant professor1 2
  1. 1Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
  2. 2Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
  3. 3Department of Political Science, University of Calgary, Calgary, Canada
  1. Correspondence to: S M Ruzycki Shannon.Ruzycki{at}

Shannon Ruzycki and colleagues examine why women and minority groups are under-represented among medical leadership and call for quotas to improve diversity

The medical profession has faced criticism for its lack of diversity. This lack of diversity is harmful to healthcare workers12 and patients.3 Despite increases in the number of women admitted to medical schools in many countries, the proportion of under-represented minorities, including ethnic minorities,4 people with disabilities, and members of the LGBT+ community, remains low56 or unmeasured. Furthermore, despite equal numbers of men and women in medical school, women remain under-represented in leadership and decision making positions, suggesting that numerical equality alone will not improve the diversity in medical leadership.7 Intentional action by institutions is required. Mandating inclusion of women and people from under-represented minorities, a mechanism that has been successful in the political and corporate worlds, could be an effective means to diversify medical leadership.

Lack of diversity perpetuates lack of diversity

Gender and ethnicity based disparities in medicine have been documented for over 30 years.8 Disparities in promotion,9 compensation,1011 discrimination,1112 and harassment13 that disadvantage women and racialised physicians have been found in every setting and specialty where such inequities have been studied.

Disparities are partly the results of barriers that disproportionately disadvantage women and under-represented minorities. The persistence of these barriers to entering leadership positions for female and under-represented minority doctors is likely to be both a cause and consequence of under-representation in leadership. The criteria for holding decision making roles are often based on years of experience, which disadvantage junior doctors, a group that includes more women and racialised physicians. This leads to over-representation of historically advantaged groups in leadership (fig 1).

Fig 1

Demographic mismatch between age and sex among practising doctors in Canada, 2018. Men are more …

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