Closing the Gap: Women Leading Healthcare
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“A lot of the chief medical officers that I work with and some of the CEOs are women, so it’s refreshing to see more women at that table, but I think in true corporate world, it’s still more of a minority.”
Lisa P. Shock, Vice President of Clinical Strategy and Operations at Evolent Health
Women drive healthcare. They are the industry’s biggest consumers and workers. They serve as caregivers in their homes and make most decisions for their family’s health. Why is it, then, that of the 40 Fortune 500 healthcare companies, not a single one is helmed by a woman?
The dichotomy of women’s involvement in healthcare versus their leadership in healthcare is stark. Women account for more than three-quarters of healthcare practitioner occupations, according to the Bureau of Labor Statistics. While this fact seems encouraging, it becomes apparent that female healthcare employees are highly concentrated in support or lower-level roles.
For example, nearly 90 percent of healthcare support employees are women. Women account for 97 percent of dental hygienists, yet 30 percent of dentists; 90 percent of nurses, yet 38 percent of physicians; 72 percent of health services managers, yet 27 of chief executives.
“I always knew I wanted to be in healthcare. I always knew I wanted to take care of patients. But back in my day, it was either nurse or doctor. There wasn’t any middle,” explains Lisa Shock, vice president of clinical strategy and operations at Evolent Health, a company that works with value-based care hospitals to improve patient outcomes.
Shock began her healthcare career as a physician assistant in Roxboro, North Carolina—a rural town near Raleigh. While she now lives in Raleigh and works in a corporate setting, Shock still drives an hour north to treat patients at a community nursing facility.
Shock was the first in her family to get a degree—a bachelor of arts in neuroscience from Colgate University. “I didn’t have any guidance or role models,” she recalls about the early days of her career. Shock then headed to Duke University to obtain a master of health sciences as a physician assistant (PA).
Physician associates (or physician assistants, not to be confused with medical assistants) are licensed medical providers who diagnose and treat patients in a variety of settings. The primary differentiator between PAs and physicians is that the former work in conjunction with a doctor while the latter can work on their own.
“For me, being a PA has afforded me the blessing to learn medicine and work on a collaborative team,” explains Shock. Today, she manages more than 100 employees and collaborative team-based care is a cornerstone of her work. Her goal at Evolent Health is to improve physician, practice, and patient engagement through value-based care and accountable care organizations.
“The premise of value-based care is giving patients high-quality care at the right place and at the right time in their journey towards health,” explains Shock. “In the old world, I got paid for what I did. In the value-based world, I’m not necessarily getting paid for individual things but for the outcome.”
She uses diabetes as an example. When a patient with diabetes has his or her condition under control, is taking the proper medications, and is not going to the emergency room, the patient’s doctor is rewarded for that.
While still in its infancy, this model will gain more prominence as we learn more about behavioral health and what drives people to get care, according to Shock. By placing financial responsibility on providers, accountable care organizations will have a higher stake in improving the delivery of care and patient outcomes. Furthermore, this model may help strip some of the corporate properties out of the healthcare industry.
The Business of Healthcare
Since the 1980s, the healthcare system has undergone a massive consolidation. Smaller physician practices and healthcare facilities have been consolidated into larger physician groups or acquired by hospitals. Last year, hospitals acquired 5,000 independent physician practices. As the healthcare system becomes increasingly consolidated, it becomes much more difficult for doctors to maintain their independent practices.
This is one of the explanations for the rise in the role of the healthcare administrator and other administrative and management staff in the industry. However, it may also help explain the lack of female representation in leadership.
When looking back at the Fortune 500 list, less than 5 percent of companies are helmed by CEOs. However, according to a report by Rock Health, a seed fund investing in digital health startups, 11 percent of CEOs—and one-third of executives—at American hospitals are female. This begs the question of whether a more corporate workplace is less diverse from a gender standpoint.
Shock suggests that this may be the case. “In the value-based care world, there’s a lot of female leadership. A lot of the chief medical officers that I work with and some of the CEOs are women, so it’s refreshing to see more women at that table, but I think in true corporate world, it’s still more of a minority.”
According to Rock Health, at hospitals with female CEOs, the portion of female executives nearly quadruples. The report also notes that 60 percent of chief nursing officers—the most common executive role for female leaders—are women, which is much higher than the average. However, when looking at the nursing profession as a whole, women make up more than 80 percent of the workforce, so once again, we’re confronted with this trend where female representation is much lower in higher ranks. So if the issue is not a pipeline problem, what is it?
Structural Bias in Healthcare
One of the barriers is the implicit level of trust men are afforded in the industry, according to a 2018 study. Men often immediately trust each other, but women have to earn that trust, which is usually an unconscious bias rather than a deliberate one. This creates inner circles to which women do not always have access.
“There’s something that I reference here in the South, but it’s not necessarily just a Southern thing—I call it the good old boys’ network,” explains Shock.
Shock recalls an instance in a previous organization where she was put in charge of hiring a second employee to work alongside her. She was doing the work for two people, and the chief leader asked her to interview prospective candidates. When a leading male candidate emerged, her boss—who was also male—was prepared to make the candidate an offer that was $30,000 higher than her salary.
“I was like, does this mean I’m getting a $30,000 raise?” she explains about when she confronted her boss. Her boss had no explanation for the discrepancy considering the two employees would be doing the same work. Ultimately, the company did not hire anyone for the job and Shock continued to do the work of two people.
The fact that women are consistently underpaid compared to their male counterparts is nothing new; a 2010 study of the salaries of graduating medical residents revealed that men were paid $16,000 more than women. A 2012 JAMA article found that there was a $13,000 discrepancy between mid-career male and female researchers. And a recent Society of Academic Emergency Medicine report noted that female faculty and chairs are paid 10 to 13 percent less than comparable male peers. Emergency Physicians Monthly, which detailed these studies in its own case study, explains that there are many reasons for this, including how each gender negotiates.
Shock also mentions the implicit bias that men are afforded when it comes to their leadership capabilities. “Just because you’re a physician doesn’t mean you’re a natural leader. A lot of times, in healthcare that happens. People say, ‘oh, you’re a doctor, you should be a leader.’ That doesn’t really translate,” says Shock.
“In my opinion, there are leadership competencies that are needed to be a successful leader, and those include things like emotional intelligence and the ability to work collaboratively and the ability to promote your team’s individual development plans without thinking about how you’re going to look.”
For Shock, those leadership capabilities need to be developed. She attributes two elements to her leadership development: having mentors and a business coach.
Shock’s first experience with a business coach was when she won a competition for female entrepreneurs in 2008, called Make Mine a Million $ Business. At the time, she was the owner of a small practice in Roxboro. Four months postpartum, she attended the event in Charlotte, North Carolina. “They only took ten winners, and I was the tenth name that they called,” she recounts.
The prize package included coaching sessions, which marked a turning point for her. They helped her understand business ownership in more depth and learn about what leadership on a bigger level would be like. Since then, Shock has found a more permanent coach, who has helped her through various professional hurdles.
“My coach is someone who I can be my most raw, original, authentic self with and she knows me so deeply. She will forcibly put a mirror to me and say ‘you’re falling back into an old pattern’ or ‘you’re not being assertive enough here’ or ‘you are letting someone walk all over you,’ or ‘you’re not being confident,'” describes Shock. “She’ll push me in directions—and I let her because that’s her role—and I know that I’m continually improving because I do that. That has been an absolutely critical ingredient for me.”
The other ingredient to which she attributes her success is having mentors. She met her first mentor at Duke University while earning her PA degree 20 years ago. “She really pushed me to not just go to work and come home. Not that taking care of patients isn’t wonderful and beautiful work, but to go beyond that and serve the profession and serve the greater good for whatever it was that turned me on and was my passion.”
Shock met her second mentor in her first practice. She says he pushed her to do more than the baseline and showed her that she had the potential to be a leader. Today, Shock has another unspoken mentor for patient work at Evolent Health—one in the C-suite. She has made it a point to surround herself with influential leaders who will help her succeed. On the flip side, Shock pays it forward with her colleagues, young professionals, and students.
“I love making connections and being a matchmaker. If somebody comes to me and says, ‘I want to learn more about human resources,’ I’d be like, ‘I know eight human resources people who are great. Let me connect you.’ I love doing that stuff,” she confesses.
Shock gives a lecture at Campbell University every year in the physician assistant program on contract negotiations, where she unpacks the Emergency Physicians Monthly case study. She also reviews her students’ contracts and pushes them to negotiate.
“Especially for women—we’re the ones who have the babies; we’re the ones who take the maternity leave,” she says. “I know that I’ve made sacrifices and made decisions in my career because I have two kids. I’ve had times that I’ve not reached my earning potential, and I could say that my salary today is less as a consequence.”
For Shock, the biggest benefit of having gender parity in healthcare leadership would be the increased prominence of emotional intelligence. As she sees it, the major issues in healthcare revolve around communication—either with patients not completely understanding certain concepts or doctors not transcribing something clearly for a nurse to understand, among other miscommunications.
“I think women work harder to actively listen and to ensure literacy on the other side of the conversation,” says Shock, which is how health literacy became one of her passions. For her, if more women were at the forefront of healthcare facilities, “communication would be improved, emotional intelligence would be improved, and that would cross functionally help teams work better.”
As healthcare has become the largest source of American jobs, it’s crucial that women do not lose out on opportunities to pave the future of the industry. The Bureau of Labor Statistics projects that the entire healthcare sector will account for a third of all new employment in the decade preceding 2026.
Furthermore, the role of the healthcare administrator has soared since the 1970s—by more than 3,000 percent—leaving many opportunities for young female professionals looking to become healthcare leaders. Shock’s tips for them?
“Get a coach, find a mentor, and for the love of God, negotiate.”
About Lisa Shock
Lisa P. Shock is a member of the clinical leadership team at Evolent Health. As vice president of clinical strategy and operations of value-based services, she is responsible for working with Evolent’s accountable care organization partners to realize clinical and economic outcomes.
As a certified physician assistant with subspecialties in geriatrics and rural health, Shock currently practices outpatient medicine in a skilled nursing facility in rural North Carolina. She also serves as part-time medical director for WakeMed Key Community Care (WKCC) where she works directly with health system leaders and an interdisciplinary team and oversees the delivery of tailored programs that improve quality and outcomes while simultaneously lowering costs. She serves on several boards and committees, including the North Carolina Institute of Medicine Board of Directors and the North Carolina Medical Society Foundation, and is a guest lecturer at Campbell University’s physician assistant program.
Shock is currently an executive doctoral student in public health at the University of North Carolina, Chapel Hill. She has a bachelor’s degree in neuroscience from Colgate University and a master’s and physician assistant certificate from Duke University.