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The ‘lean in’ approach to general practice: lessons from Sheryl Sandberg

I recently finished reading Sheryl Sandberg’s Lean In: Women, Work, and the Will to Lead. I’ve been a fan of the Facebook COO and ex-Google VP since watching her electrifying TED talk, ‘Why we have too few women leaders?’

Her message - that women sabotage themselves at work in ways that men don’t - has been controversial and heavily criticised but, through her book and non-profit organisation Lean In, she has put the spotlight on issues facing women worldwide in the workplace and balancing work with family life.

She encourages the formation of ‘lean in’ circles, groups of  eight to 10 people who meet regularly to share and learn together. Whilst her ideas, thoughts and concepts are directed towards women, men can learn just as much from them.

Reading Lean In has made me wonder - how are Sheryl’s messages relevant to general practice, especially at a time where recruitment to our speciality is low?

Because of the way medical training is structured, many men and women who enter general practice training schemes are at a time in their lives where their priorities are changing. I completed  my registrar year in a six-partner training practice that had four female partners who worked part-time and job shared. One went on maternity leave whilst I was there and she was met with excitement and joy upon announcing her news. She took six months’ maternity leave, and when she returned it was as though she had never been away. I found this inspiring and felt assured that I had chosen the right career path - I could still achieve professional goals whilst having a family.

But I was shocked at the end of my training, when one of my programme directors explained to a (predominantly female) group of ST3s that the ‘problem’ of taking on newly-qualified female GPs was the financial risk they posed to the practice if they became pregnant and took maternity leave.

Due to comments like this, and others, I couldn’t help but feel slightly guilty when I took on a partnership and its many responsibilities the year before I got married.

When I shared this with a colleague I was reassured; and was told they’d rather work with the right person and acknowledge that they may take 12-18 months out over a 20- to 30-year career than have the wrong person within their team. After all, a male colleague who decides to have a sabbatical or has time off due to ill health could well pose the same risk.

But from speaking to female friends who are, like me,in their early thirties, I worry this sort of understanding isn’t widespread. I know many male colleagues who have entered GP partnerships after finishing their VTS, but hardly any female colleagues who have done the same.

It has also been widely reported that women are under-represented in CCGs. How much of this is because the women aren’t putting themselves forward? In Lean In Sheryl Sandberg cites many reasons for this including ‘internal obstacles’, a lack of mentoring, institutional obstructions, parenting/housework overload, and personal choice. And how much of this under-representation is related to gender bias? Sandberg notes that a 2011 McKinsey study showed that, while men are promoted based on potential, women tend to get a ‘leg up’ based on past accomplishments.

Sandberg seems to understand that many women don’t want to have both a career and a family, and that many don’t aspire to leadership positions. This is pertinent to general practice: many women are happy to be locums and part-time salaried GPs without taking on other responsibilities or engaging in activities such as becoming a trainer or attending peer support/young practitioner groups (in some cases, not dissimilar to Sheryl’s ‘lean in’ circles).  

She also acknowledges that there are occasions when one must ‘lean back’ such as the birth of a child, sickness of a parent, or simply when you need to recharge.

Maybe as GPs we need to be more in tune with when to ‘lean in’ and when to ‘lean back’, that won’t be of detriment to our future careers. One of Sandberg’s key messages is ‘don’t leave before you leave’ when she describes how women stop reaching for opportunities long before they really need to.

For example, when I entered medical school the thought of having children was at the back of my mind. Gradually this thought become more pertinent, especially when I met my husband. At this point many women reason that, to make room for their future child, they should scale back straight away, even if that possibility in real terms is five years away.

There are aspects of ‘lean in’ that aren’t relevant to general practice. For instance, most of us chose our profession because we wanted anything but the corporate path that Sheryl Sandberg has followed.

However, having more inspiring female leaders such as Professor Clare Gerada will help the status and opportunities of all women in general practice and will (I hope) cause a gradual shift in attitudes, making it easier to lean in when we want or need to.

Now, does anyone want to join in my ‘lean in’ circle?

Dr Sara Khan is a GP in Hertfordshire and edits the MWF’s magazine, Medical Woman. She is also involved in her local CCG and LMC. You can tweet her @DrSaraK