GENDER MEDICINE/VOL. 9, NO.

4, 2012

Challenges of Work–Life Balance for Women

Physicians/Mothers Working in Leadership Positions
Claudia Schueller-Weidekamm, MD, MBA1; and Alexandra Kautzky-Willer, MD2
1
Department of Radiology, Medical University of Vienna, Austria; and 2Unit of Gender-Medicine, Division
of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna,
Austria

ABSTRACT
Background: Female leadership in medicine is still disproportionately small, which might be due to the
barriers of combining work and family.
Objectives: The aim of this study was, first, to perform a strengths, weakness, opportunities, and threats
(SWOT) analysis and, second, to create a strategic concept for career development.
Methods: In this study, all women in leadership positions in the health care system in Vienna, Austria,
with at least 1 child (n ⫽ 8), were interviewed about the advantages and disadvantages of gender with
regard to career development, the strengths and weaknesses of female leadership, and their work–life
balance. Different factors that influenced the work–life balance were specified, and career strategies to
realize adequate solutions were developed.
Results: The sporadic focus on career advancement, time-consuming child care, responsibility for family
life, and a woman’s tendency toward understatement were barriers to career development. Work–family
enrichment has a positive spillover effect that spreads positive energy and helps to balance the work–life
relationship. For each individual, the allocation and interaction of different resources such as time, money,
scope of decision making, and physical, emotional, and social resources, were essential to maintain the
individual work–life balance.
Conclusions: In addition to the existing “glass ceiling,” the predominant responsibility for child care is
still borne by the woman. However, mentoring programs, coaching, networking, and support of the
partner or of other people help to strengthen female “soft” skills and achieve a work–life balance. (Gend
Med. 2012;9:244 –250) © 2012 Elsevier HS Journals, Inc. All rights reserved.
Key words: career ladder, gender, leadership, motherhood, sex, woman’s role, work–life balance.

Accepted for publication April 30, 2012. http://dx.doi.org/10.1016/j.genm.2012.04.002

© 2012 Elsevier HS Journals, Inc. All rights reserved. 1550-8579/$ - see front matter

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 C. Schueller-Weidekamm and A. Kautzky-Willer

INTRODUCTION factors that explain the gender disparity in leader-

In 1849, when the first college for women was ship positions.1 Definitive answers remain unclear,
founded in London, a new standard was set for in- but, based on our own experience in public and
creased, unrestricted entry of women to universities academic medicine, we believe that both institu-
to study medicine in Europe. Compared with the tional barriers to success and gender differences in
early 1950s, today the number of women and men career, life goals, and balance of work life are impor-
who successfully finish medical school is approxi- tant. To elucidate these invisible barriers, we con-
mately equal. However, women who enter academic ducted questionnaire-related interviews with
medicine have been less likely than men to be pro- women in leadership positions and developed an
moted or to serve in leadership positions.1 What analysis to evaluate the strengths, weaknesses, op-
accounts for the apparent paradox of dramatic portunities, and threats (SWOT) concerning work–
growth in the rate of women who enter the field of life balance and career development. In addition, a
medicine but their lesser success in leadership roles strategic concept was created for career development
in academic medicine by women compared with for women in medicine.
men? Despite the fact that the conditions that would
allow equal opportunities for women to assume lead-
ership roles have supposedly been fulfilled, the dis-
METHODS
parity still exists. This begs the question of whether In this study, all women in leadership positions in
female physicians have the same opportunities as the health care system in Vienna, Austria, with at
their male colleagues or whether they are exposed to least 1 child (n ⫽ 8), agreed to participate in this
barriers that are the reason that they are more likely study and were interviewed. A leadership position
to play a secondary role. Many women still feel sig- was defined as the head of a department or head of
nificant conflict about the choice between career and a university or public hospital. The women had at
family life and have concerns about their work–life least 1 child but not more than 2 children. At the
balance. In addition to the individual constraints, time when women achieved their leadership posi-
such as focus on family life or lack of leadership tions, 6 of 8 had children ⬍10 years old. Three of
ambitions, there must be more invisible barriers that the included women were part of dual-career cou-
influence a female physician’s career. Some studies ples. Four women got divorced within the first 4
found that women were less likely to be promoted years after they achieved their leadership position.
within a specified period of time than men.2 Some For these women, child care was mainly supported
stated that lower productivity as measured by num- by grandparents, a nanny, and/or kindergarten.
bers of publications or external grants, fewer hours The interviews were based on a questionnaire that
devoted to their work, and fewer resources might be included 11 open and closed questions (Table I).

Table I. Questionnaire designed for the interviews.

1. Why did you decide on a career?

2. Did you plan a path of career development at the beginning of your medical education?
3. Which barriers confronted you on your way to the top?
4. What are your personal strengths that you could use for your career?
5. Were there any obstacles to your career development due to your sex?
6. Which skills do you lack compared with your male colleagues?
7. What was the reaction of your environment as you achieved a leadership position?
8. What would you ameliorate to obtain a well-balanced work life?
9. What are your sources of energy?
10. What is your advice for women with families about how to be successful in a leadership position?
11. Are you are satisfied with your work-life balance or would you like to put more time and energy in your job or
your family?

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Gender Medicine

The advantages and disadvantages of gender with able to take advantage of new opportunities; (3)
regard to career development, the strengths and strengths should be used to avoid threats; (4) defen-
weaknesses of female leadership, and the physicians’ sive strategies should be developed to prevent exist-
work–life balance were analyzed. Thoughts, assump- ing weaknesses from becoming the target of threats.
tions, dreams, wishes, and fears of the women were
clustered and analyzed. RESULTS
The evaluation was performed semiquantita- An analysis of the questionnaire showed that the
tively, descriptively, and anonymously. main motivator for establishing a career was im-
Different factors that influenced work–life-balance mense scientific interest and the resulting success-
were specified, and career strategies to realize ade- ful scientific career. Two women reported that the
quate solutions were developed. A SWOT analysis, advice of their mentor or partner encouraged them
developed by Albert S. Humphrey, was performed to apply for a leadership position. The desire to
based on the answers of the 8 women.3 SWOT anal- achieve excellent job performance and the chance
ysis is a strategic planning method that can be used to be a serious competitor with male colleagues
to evaluate the SWOT in a business model. In this encouraged 2 of the women.
study, SWOT analysis was used to analyze different All of the interviewed women stated that the de-
parameters that influence career development for sire to achieve a leadership position did not exist at
women with families. Strengths are internal charac- the beginning of their career. The desire to establish
teristics that give an individual an edge over others a career grew during their education and was
for career development (Table II). Weaknesses are strengthened by success or overall positive feedback.
internal characteristics that are disadvantageous for The most important thing for all women was to
career development. Opportunities are external acquire as much professional expertise as possible.
chances to improve the position. Threats are exter- Children were cited as the most important obsta-
nal elements in the environment that could be prob- cle on the way to the top (n ⫽ 6). Family life, child
lematic for the position. This method helps to iden- care, and child education were time-consuming and
tify the internal and external factors that are required power and energy that would also be required
favorable and unfavorable when trying to achieve a for the work. Harassment at work (n ⫽ 3) and the lack
leadership position. Four different strategies can be of a women’s network (n ⫽ 4) were additional factors
drawn from the SWOT analysis: (1) new opportuni- that counted against prolonged career development.4
ties should be pursued based on the identified new The lack of female mentors and role models and low
strengths; (2) weaknesses should be eliminated to be self-confidence prevented a smooth career.

Table II. SWOT analysis for strategic career concept.

Strengths* Weaknesses*

Translate into tasks for the strategic Management of family affairs Poor network
career concept Knowledge of leading Poor self-confidence
Opportunities†
Female soft skills How do I use these strengths to take How do I overcome the weaknesses that
advantage of these opportunities? prevent me from taking advantage of
these opportunities?
Threats†
Poor self-representation How do I use my strengths to reduce How do I address the weaknesses that
Poor self-confidence the likelihood and impact of these might make these threats a reality?
Burnout threats?
Boreout

*Internal analysis.
†
External analysis.

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 C. Schueller-Weidekamm and A. Kautzky-Willer

Favorable skills for career development covered a which were strongly influenced by patient feedback.
wide range. The broad spectrum included social Three women regarded their family as the main source
skills, authenticity, commitment to the profession, of energy. The others mentioned that their spare time,
persistence and power of endurance, will power, as- their hobbies (sports activities), and friends were help-
sertiveness, complexity of interests and thinking, in- ful for enjoying life and drawing energy.
novation in organizing ability, and positive energy Advice for women about how to enable a good
and power. Organizing ability was a primary issue work–life balance included the following. Courage
because time management was a daily challenge to and self-confidence would guide entry into a career
manage both work and life tasks. Flexibility was a and help negotiate the negative comments of peo-
strength that helped to solve difficult situations and ple. Persistence and consequent pursuing personal am-
conflicts between work and family life, which also in- bitions should be in the forefront. Time management,
cluded the ability to set priorities and delegate tasks. strategic planning, networking, authenticity, and an
Motivation to become the head of a department awareness of being a woman are important factors that
resulted from the desire to perform outstanding and aid in achieving a top position while maintaining a
interesting work that had a strong and positive in- good work–life balance. To avoid an imbalance and too
fluence on the environment. Assertiveness, strength much work stress, priorities and limits should be set.
of purpose, and strategic and communicative skills Positive visions have a strong influence on the han-
were ranked as the most important leadership skills. dling of positive and negative experiences.
Six of the 8 women felt that their sex was an obstacle Six women were content or extremely content
in their career. One of the reasons was the burden of with their work–life balance, whereas 1 woman
child care and child education. During the application had the feeling that the time was too short for
procedure for the leadership position, 1 woman was at work and family life, in particular. One woman
a disadvantage because of her sex, and another woman stated that her strong emphasis on work would
stated that retrospectively she realized that she had always result in an imbalance. For 4 of the women,
experienced sexual harassment. Helpful networks were the time devoted to family life was too limited,
created by men and were mainly restricted to men. whereas work was always highly ranked in the life
Four women believed that they did not lack real concept. Five women noted that each woman is
skills and had no weaknesses compared with men. responsible for her own work–life balance and
Four women stated that men were unscrupulous, should search for her individual energy sources.
more focused, egotistical, authoritarian, and more One important issue is to delegate time-consum-
self-confident compared with women. The reaction ing and unimportant tasks. Several women stated
of the environment to a successful career was posi- that the secret to establishing a career is the sup-
tive for all women. None of the women felt any port of a partner or of friends or family members.
negativity or resistance from the private or profes- The SWOT analysis showed that women with
sional environment. families have the strength to organize family and
To improve the work–life balance, 4 women pro- home life and achieve leadership skills. With regard
posed establishing reliable, accessible, and super- to the weaknesses, women have a poor presentation
vised child care, including checking of the kinder- of their own skills, personality, and success. Women
garten teacher’s competence. The start and the have a tendency toward understatement and poor
length of kindergarten day should be flexible and self-assessment.
made longer, so that child care could be ensured, In addition, women lack confidence compared with
even for night shifts and attending conferences. In their male colleagues. An important weakness is the
addition, financial support for child care should be expenditure of time for family life, which includes the
offered by the government, which might ease the responsibility for children’s education, child care, and
dual burden of work and family for single mothers. organizing family life and structure.5 There is much
Three women derived energy for their daily life more stress for women due to the dual burden of fam-
from their personal success and working satisfaction, ily and work; actually, this is a triple burden of family,

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work, and home life. These stress factors might lead to The lack of an initial strong intention to start a career
a burnout syndrome that occurs in ⬎30% of people could be a reason for prolonged career development.
who work in the health care system.6 The term glass ceiling is a metaphor for the condi-
The strategic concept for career development is tion that, despite increased entry of women into
based on the answers to the questionnaire based on traditionally male-dominated fields, their advance-
the SWOT analysis. At the beginning of a career, ment to leadership positions is still limited.8 Lack of
women should definitely be aware of the first step in career advice and counseling from department heads
climbing the career ladder and facing all the obsta- and colleagues may contribute to the glass ceiling
cles. The presence of role models, especially women effect on women’s upward mobility.9 The barriers are
who have achieved a work–life balance, influence invisible, and obvious obstacles to impede women
the decision to establish a career. The best strategy is from climbing the career ladder seem to be nonexis-
to have confidence in female strengths. The so-called tent.5 In other words, the glass ceiling effect can be
soft skills, such as the capacity for teamwork and described as “an invisible barrier that keeps women
empathy, gain more and more importance for lead- from rising above a certain level in corporations.”10
ership qualities. Skills and qualities should be en- The glass ceiling phenomenon is built by traditional
couraged, developed, and supported to achieve un- gender roles, manifestations of sexism in the medical
questionable qualification for top positions. The environment, and lack of effective mentors. These
time-consuming courses, studies, and coaching hours different factors lead to weak leadership ambitions.
demand organization of family life and sharing of child As stated by Carnes et al,11 women bear the primary
care. Coaching and mentoring programs are helpful in responsibility for child care and housework and deal
breaking with the traditional concept and expecta- with competing time pressures of professional produc-
tions that a woman should stay at home and care for tivity and family care, both of which negatively affect
children. Networking is a factor that has a tremen- women.11 The scarcity of women in senior positions
dous influence on success in achieving a top posi- inevitably means that their individual and collective
opinions are less likely to be voiced in policy- and
tion. However, men’s networks are much more effi-
decision-making processes, and, consequently, youn-
cient compared with those of women.4 An efficient
ger women will not be encouraged or motivated to
network requires a significant time investment to
achieve top careers in medicine because there is a lack
maintain and network with colleagues, which, for a
of same-sex mentors. Kvaerner et al12 reported that the
woman, would take time away from her family life.
percentage of female leaders in medical subspecialties
Family is not only time-consuming; it also has pos-
substantially correlated with the increased employ-
itive effects that should be discovered and used.
ment of women in the respective fields.
Work–family enrichment has a positive spillover ef-
Women still face a trade-off between career positions
fect that spreads positive energy and helps to balance
that are associated with power and influence and emo-
the work–life relationship. Women should recognize
tional responsibilities and family life. Long-term career
and appreciate this spillover effect phenomenon and
planning is partly hindered by family planning, which
integrate it into their career strategy concept.
affects successful career development. In dual-career
couples, men are usually not willing to share equally in
DISCUSSION child care. In these families, women are also tradition-
Women are still disproportionately underrepre- ally in charge of child care.13
sented in leadership positions. The “sticky floor” The initial expectations for career advancement
phenomenon, which refers to factors that keep were lower for women than for men at baseline, but
women in low-wage, nonleadership positions, is one significantly higher after institutional intervention
of the primary explanations for the lack of women in and associated with higher rates of promotion, as
such leadership positions.7 Often, young childless shown in a study by Fried et al.14 These results were
women still maintain the idea of having a family, confirmed in our study, in which all of the inter-
which prevents them from focusing on their career. viewed women stated that they were uncertain

248
 C. Schueller-Weidekamm and A. Kautzky-Willer

about their career path upon entry into their medical partnership, especially in dual-career couples, to
education. However, during their medical education, avoid misunderstandings and disappointments and
especially during their fellowship experiences, 7 of to strengthen the support of the partner.
them felt that the “fire in the belly” that was the A perfect work–life balance is a very important
most important predictor of career advancement. issue for women in leadership positions. Power and
Faculty mentoring and fellowship activities posi- energy can be drawn from a well-balanced lifestyle
tively influence colleague relationships by lively com- with career fulfillment and family life that includes
munication with faculty members about projects and happiness, well-being, harmony, and health. The
grants.15 This might lead to successful promotion be- early recognition of personal overload, conflicts be-
cause a network of academically productive colleagues tween family and work, and overstress should avoid
can be established.15,16 Again, these activities are time- the burnout or boreout syndrome. Burnout or bore-
consuming, which thus might be a problem for out syndrome negatively affects family and work life,
women who try to spend their spare time with their which results in individual additional problems and
families. sickness and lack of work. In the case of very small
In contrast to the United States, in Austria, none children who demand a lot of time and special at-
of the women in a leadership position stated that tention, the mental burden and the time demands
sexual discrimination was an important issue that might be felt as stressor. Therefore, for these women,
prevented and/or slowed career development. In the additional energy required for management
the United States, sexual discrimination was the tasks is lower compared with childless colleagues.
number 1 factor that hindered an academic career Diversity in management levels is advantageous be-
for 40% of women in medical professions.17 cause male and female leaders have different ways of
SWOT analysis is a tool for strategic planning that problem solving and assessing certain situations. Even
was developed for business analysis. The main ad- the method of making decisions varies. Therefore,
vantage of conducting a SWOT analysis is that it companies should strive to create a diversity in their
simplifies complex situations for a better under- management levels. This study should encourage
standing of the internal and external environments. women to apply for leadership positions and to be
The personal situation of a working woman physi- aware of the conflict between work and family life.
cian in a leadership position with children is com- Women should be encouraged to break through the
parable to that of a company. Combining work and glass ceiling and apply for top positions. Courage and
family and achieving an adequate work–life balance power are the most important attributes in the climb
are challenges that demand a careful SWOT analysis. up the career ladder, even with the burden of family.
Identification of SWOT is essential because subse-
quent steps in the process of planning a career derive CONCLUSIONS
from a SWOT analysis. Based on the results of an One of the main factors for the disproportionately
individual SWOT analysis, the most balanced work– low number of female physicians in medical leader-
life balance can be achieved. Because women typi- ship might be the incompatibility of career and fam-
cally place themselves under great pressure to be ily. In addition to the existing glass ceiling, the pre-
more efficient compared with their male colleagues, dominant responsibility for child care is still borne
they have a desire for perfectionism and are often by the woman. For each individual, the allocation
too reticent to apply for top positions in their field. and interaction of different resources, such as time,
Therefore, the bar is raised for starting a career. If a money, scope of decision making, and physical,
leadership position is achieved, the work becomes a emotional, and social resources, are essential to
stress factor and prevents a good balance of work and maintain the individual work–life-balance.
life. As stated previously, housekeeping, child educa- Mentoring programs, coaching, networking,
tion, and child care are important time-consuming and support of a partner or of other persons help
issues and should be shared with the partner. In our to strengthen female soft skills and achieve a
opinion, it is critical to come to an agreement in a work–life balance.

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Gender Medicine

ACKNOWLEDGMENTS 7. Shambaugh R. It’s Not a Glass Ceiling, It’s a Sticky

We thank Karin Gutierrez-Lobos, MD, and her team Floor: Free Yourself from the Hidden Behaviours
from the Department of Psychiatry and Psychotherapy Sabotaging Your Career Success. New York, NY:
of the Medical University of Vienna for their support McGraw-Hill, 2008.
and advice for the design of the questionnaire. We 8. European Commission. Gender pay gaps in Euro-
thank Mary McAllister for her thorough reading and pean labour markets—measurement, analysis and
editing of the manuscript. Dr. Kautzky-Willer contrib- policy implications. Commission Staff Working Pa-
uted to preparing the paper and adding corrections to per, SEC, Brussels, September 2003. http://www.
the manuscript. Dr. Schueller-Weidekamm is responsi- ispesl.it/dsl/dsl_repository/Sch39PDF08Marzo06/
ble for literature search, study design, development of Sch39PayDiffGensec_03_937_en.pdf. Accessed May
the questionnaire and interviews of the participants, 14, 2012.
evaluation of the questionnaire, data interpretation, 9. Lyness KS, Thompson DE. Above the glass ceiling?
table creation, writing, and editing of the manuscript. A comparison of matched samples of female and
male executives. J Appl Psychol. 1997;82:359 –375.
CONFLICTS OF INTEREST 10. Morrison AM, White RP, Van Velsor E. Breaking the
The authors have indicated that they have no con- Glass Ceiling: Can Women Reach the Top of Amer-
flicts of interest regarding the content of this article. ica’s Largest Corporations? Reading, Mass, 2000.
11. Carnes M, Morrissey C, Geller SE. Women’s health
and women’s leadership in academic medicine:
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Address correspondence to: Claudia Schueller-Weidekamm, MD, Department of Radiology, Medical University
of Vienna/Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: claudia.
schueller-weidekamm@meduniwien.ac.at

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