Karen J. Nichols, DO, former AOA president, addresses her colleagues as then-AOA President John W. Becher, DO, looks on in this 2015 photo.
lessons from a leader

How this DO says the osteopathic medical profession can encourage female leadership

“We must have diversity, but that alone is not enough. Diversity is like opening up a jigsaw puzzle and throwing all the pieces on the table. Inclusion is when you put the pieces together,” says Karen J. Nichols, DO.

AOA Past President Karen J. Nichols, DO, is no stranger to blazing a trail.

She was the first DO elected to chair the Accreditation Council for Graduate Medical Education (ACGME) board of directors, and the first female president of the AOA in 2010-11. She also played a key role in the transition to a single GME accreditation system.

But her path to success has not been without the obstacles that many women in medicine still face, especially when it comes to implicit biases.

On March 25, she spoke to AOA staff during a virtual forum on the state of female leadership in medicine. The event was held in recognition of Women’s History Month. Drawing upon her own career experiences and insights from studies on how women and men lead, Dr. Nichols provided unique insights on how the osteopathic medical profession can continue to encourage the development of women leaders.

Below are highlights from Dr. Nichols’s remarks.

Dr. Nichols’ background

In 1981, Dr. Nichols became the first female resident in her internal medicine program at Oklahoma Osteopathic Hospital (now Oklahoma State University Medical Center in Tulsa). While she was there, she interacted frequently with a cardiologist who spoke openly about his skepticism of women physicians. She eventually won his approval, but his comments were indicative of the bias she continued to face in her career.

When she started practicing, only 15% of all licensed physicians in the U.S. were women. Her first job was in Arizona, where there were just two other women on a staff of 180 physicians.

“I would get a question from patients who had probably never seen a woman doctor before: ‘So what is it like being a woman doctor?’” Dr. Nichols said. “I soon figured out what they really meant was, ‘… in comparison to men.’ My comment was ‘I’m not going to take care of you like a woman doctor, I’m a woman, who is a doctor, who’s going to take excellent care of you.’”

How men and women approach leadership

The differences between male and female brains are well-documented, Dr. Nichols said. Studies have suggested that women are generally better at managing people and are more communal, while men are generally better at managing tasks and are more competitive. One published conclusion from those findings is that women leaders may start being trained to emulate men leaders, which is less than ideal, she said.

And while these findings are gross generalizations, Dr. Nichols said, they help provide a perspective on how women can use their skills to become leaders in their own right rather than trying to fit themselves into stereotypically male leader molds.

They are also useful findings when considering the presence of implicit biases, and how men and women leaders are perceived differently. For example, she said, men are often given credit if they are warm and kind because it is unexpected, whereas women are often given less credit for the same traits because they are expected to be that way.

Because of these differences in approaches to leadership, women are also more likely than men to qualify or diminish their own achievements, which Dr. Nichols said she has felt herself do before, and strongly discourages.

Challenges women leaders in medicine face

Dr. Nichols discussed the prevalence of implicit and explicit biases that women in medicine often face. Everyone should look within to identify their own biases, she said, because anyone, whether or not you like and respect them, is capable of bias.

“If you take an implicit association test, it’s pretty sobering,” she said. “I wasn’t overwhelmingly impressed by my score, even when it came to bias against women. At first I thought, ‘there must be something wrong with this test. I’m a woman leader.’ But I still have some bias.”

Another challenge Dr. Nichols said women can face is the weight of being the first to do something or being one of few in a large group.

“If you are the only woman, you are seen as speaking as a woman, or seen as representing all women,” Dr. Nichols said. “This applies for every minority. There should be enough of everyone in any group, so that everyone can bring forth their opinions without feeling like they represent everyone who looks like them.”

Keeping all of the above in mind, Dr. Nichols lives by this motto: “Respect: Ask nothing more, accept nothing less.”

Addressing the challenges

Though the distribution of men and women in medicine is becoming more equitable, many of the same issues Dr. Nichols faced in training and during her career persist, she said. She provided these six concrete actions people can take to address these challenges:

  1. Take your own “bias pulse.”
  2. Refer to all men and women in a group the same way, if applicable, to avoid implying differences in status.
    • (i.e. John, Stephanie, and Elizabeth, or Dr. Smith, Dr. Jones, and Dr. Wilson, not Dr. Smith, Stephanie, and Elizabeth).
  3. Be aware of your underlying assumptions.
    • Dr. Nichols’s example: assuming a woman isn’t interested in a job opportunity because she has just given birth.
  4.  Build diverse teams …
  5. … but don’t lose sight of inclusion.
    • “We must have diversity, but that alone is not enough. Diversity is like opening up a jigsaw puzzle and throwing all the pieces on the table. Inclusion is when you put the pieces together,” Dr. Nichols said.
  6. If you have a speaking panel, make sure women are represented equally with men.

Related reading:

On National Women Physicians Day, female DOs reflect on women in medicine

Karen J. Nichols, DO, receives AOA’s highest honor

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