By Matt Skoufalos
Diversity in leadership remains a persistent and widespread challenge in the medical imaging space. In a June 2024 study in the Journal of Breast Imaging, researcher Jean M. Seely spoke about the disparity in representation among women in radiology. Despite comparable graduation rates, men account for some 70 percent of applications to diagnostic radiology residency programs. Women comprise less than a quarter of all practicing radiologists in Canada and the United States, although men and women are almost equally represented in radiology in other countries.
“In leadership roles in radiology, the percentage of women is even lower,” Seely continued, noting that women radiologists from racial or ethnic groups that are underrepresented in medicine face additional hurdles.
“Underrepresented in medicine medical students shoulder burdens of microaggressions or overt racism, which can precipitate stress responses that may interfere with their ability to function in a work environment,” Seely wrote. “The intersectionality of being female and a UIM physician compounds the challenges.”
Part of those challenges includes better establishment of benchmarks to achieve in diversifying leadership, from entry-level positions to those in the C-suite, and better opportunities for advancement.
Seely’s report summarizes what many women working in the medical imaging space have observed for years, which is largely that “gender diversity … is good for the bottom line,” having been shown to increase employee satisfaction, challenge status-quo thinking, and improve patient outcomes. However, the process of developing opportunities for women to hold leadership roles, contribute to shaping policy, and mentor their colleagues, feels farther off from being fully implemented.
In 25 years as a medical imaging professional, Tricia Trammell, imaging operations manager at UT Southwestern Medical Center at Moncrief Cancer Institute in Fort Worth, Texas, said she has seen many changes in the landscape of imaging leadership.
For a start, there are far more women working as imaging leaders today than there were when Trammell began her career, and they are more than willing to lean on one another for support in the workplace. She said the latter point feels as important as the former when health care organizations aspire to high-reliability goals, and employees are encouraged to self-disclose mistakes to mitigate their recurrence.
“I think the whole landscape of leadership is changing, and I think that’s a good thing because diversity brings strength to our teams,” Trammell said. “In health care, we have been conditioned to think that errors are bad. Everyone has a fear of being perceived as if they do not know what they are doing. But as many health care organizations transition to become high-reliability organizations, transparency and psychological safety become increasingly more important.”
“My whole team happens to be women,” she said. “I feel strongly that the women on my team feel empowered and are incredibly supportive of each other, and that is evident by the high employee engagement of the team.”
“I have a remarkably diverse group of women with diverse cultures and backgrounds. Everyone appreciates that about each other,” Trammell said. “We celebrate each other. I meet with the people on my team and find out what their goals are; my goal is to help them reach their goals. We win together!”
When leadership is diversified and focused on psychological safety, Trammell said, it facilitates an environment focused on correcting mistakes rather than punishing the people who have made them; on connecting with employees to create a workplace in which people can thrive and develop self-confidence and trust in their colleagues. Trammell said that her own participation in a mutual mentorship program facilitated between her employer and the Association for Medical Imaging Management (AHRA) helped demonstrate the value of non-hierarchical professional coaching while simultaneously underscoring the challenges that other women similarly face in the workplace.
“I took part in a mentorship program where I was both a mentor and mentee, and that gave me an opportunity to help someone else, and also to be helped,” Trammell said. “I mentored a young woman who is not in imaging, but in health care. Ironically, the struggles that she was going through were related to how she was being treated by her boss. The reason she signed up for the mentorship program was she really wanted someone to talk to about how to navigate incivility in the workplace.”
“This is a very big and ongoing problem, and people are getting mentors and executive coaches just trying to figure out how to navigate incivility in the workplace or an uncivil boss,” she said.
The phenomenon of workplace incivility is becoming better documented in recent years, specifically in health care – and, according to Trammell, women are getting the worst of it, often from other women. She described feelings of insecurity driving behaviors of jealousy and intimidation that can result in withholding information and other forms of subtle sabotage or microaggressions.
“More women experience incivility than their male-counterparts, and they are often experiencing it at the hand of their female colleagues. Women can have problems with jealousy and insecurity that drives negative work behavior such as intimidation and withholding information,” she explains.
Trammell believes that such behaviors are rooted in insecurities that can be compounded within the organizational structure of a business, and that addressing those insecurities requires “a straight-up culture of civility” that overcomes any other entrenched routines. She talks about creating a workplace where a diversity of employees can thrive within an atmosphere of psychological safety. To facilitate that environment, Trammell said, she turns her attention to her own behavior first.
“You have to walk the walk and talk the talk,” she said. “Even though we have an overall vision and mission that is set forth by our organization, there are still individual cultures within the organization based on how the individual leaders lead. That is why two clinics within the same organization can have a different culture.”
“I teach civility and how important it is in our workplace,” Trammell said. “I teach psychological safety, and about how important it is to bring your authentic self to work every day. I want my diverse team of women to feel safe enough with me and each other to bring their authentic selves to work every day. This kind of culture takes work and a transparent leadership style.”
After more than 20 years in medical imaging, radiology administrator Nicole Dhanraj, who owns the professional education group South Texas Associates of Radiology and the veterans transitional coaching program Service to Success, established 424 Business Group Inc., a consultancy that leverages her doctorate in organizational management and decades of industry expertise.
Dhanraj’s resume comprises a dozen academic degrees and professional certifications. She operates multiple businesses. And yet her experience in medical imaging – as well as in other health care settings – has been that even highly qualified women still face various obstacles that are couched in heteronormative gender differences and social power dynamics.
“From a very high level, it’s the same things – pay, promotion, biases – that happen everywhere else,” Dhanraj said. “Culture, socioeconomic status, education: all of that influences anyone’s interactions with you. People formulate their interpretations based on culture, and we have additional layers that add to the whole problem.”
In her experience, Dhanraj said that women in radiology may tend to take on “the worst jobs” for want of opportunities and may be more likely to hang in with a difficult assignment to demonstrate their capabilities to their colleagues, or simply to keep a title that might be the only one available to them. She said that women seem to bear the brunt of organizational dysfunction in distinct ways that mirror their experiences in a broader social context.
“Women are more likely than the men to stay and put up with the nonsense to keep the title and the salary because they’re not getting selected elsewhere,” Dhanraj said, “whereas a man would either leave the job or put boundaries in place.”
“I also think women who come into an environment that’s chaotic want to fix everything,” she continued. “They’re doing so much, and they feel like if they don’t juggle it all, then they’re going to be looked at as incompetent. There’s less forgiveness and less room to breathe in a very chaotic operation.”
Dhanraj was also quick to point out that whether men or women hold leadership roles, gender disparities in the workplace can persist if they are institutionally reinforced within the overall structure of the organization. She spoke about participating in a hiring panel that landed on familiar conversations about whether a woman would be a suitable candidate for a particular job role based on her status as a parent.
“The real stereotypes of pregnancy, children, ‘What is she doing outside of work?’ – that haunts women still,” Dhanraj said. “To be successful as leaders, we need people to be open to improving their workplaces and their understanding of individual cultures, and to support their staff.”
When women do attain leadership roles, Dhanraj said again that she has observed them falling victim to gender biases. The resultant stereotyping may result in women leaders hardening their exterior outlook because they feel it’s necessary to get their work done, or to command respect, especially if such strategies helped them attain the positions they hold.
Women’s job performance may be judged more harshly than that of their male counterparts, and their mistakes chalked up to their gender, simply because of the strength of these entrenched social hierarchies. All of that weight adds to the challenges of effective leadership, to say nothing of the effort that’s already necessary to create psychologically safe workplaces in which to facilitate staff professional development.
“I think there’s less forgiveness when it comes to women,” Dhanraj said. “The only way to confront these negative behaviors toward women is to drag them into the open – women sharing as well as others calling out the behaviors – and to shed light on their impact on the workforce. Identifying problematic behaviors is a start; supporting others who are willing to speak up about them reinforces the practice.”
“We’ve got to speak up,” Dhanraj said. “Women need to have the courage to address the behaviors. Pull someone aside, and say, for example, ‘When you’re talking to me in meetings, I notice that you continuously cut me off, and to me, it means that you have no respect for me.’ ”
“Women need to speak up, and I think they may need coaching to do so,” she said. “When I talk to others experiencing this, they are thinking it’s all in their head. What they’re feeling and experiencing, they’re thinking this is all on them; that it’s their fault.”
“The main solution is having that psychological safety,” Dhanraj said, “but the ‘Mean Girls’ club, we perpetuate it. We should not tolerate this anymore because we need staff. We need to break all of these negative behaviors. It’s unfortunately a nasty, perpetuating cycle in health care.”
“Who’s going to do this?” she said. “I think it is us women leading this change.”
Karen Anderson leveraged her 19-year background as a radiographer and breast center manager at Parkland Health and Hospital Systems in Dallas, one of the biggest public health systems in the country, to champion women’s health causes in the medical imaging space.
Today, Anderson works as a key opinion leader, engagement leader, and scientific marketing manager for Women’s Health at Siemens Healthineers North America, and for the past two years, has volunteered to perform mobile mammography studies with the nationwide Siemens Healthineers breast cancer screening van initiative.
As a discipline, mammography is an imaging space with a majority of women in key roles because the modality caters nearly exclusively to women’s health needs. Yet Anderson came up in a health care industry almost entirely run by men. When she arrived at Parkland in 1987, Anderson said she was “shocked at the amount of patients, policies – everything in upper leadership was run by men.”
“How does that help me grow and get into leadership roles?” she asked. “I went back and got my master’s degree. I dug in and learned all aspects of Parkland Hospital and what it meant for the community. I found mentors who showed me how to grow and lead, including Eloise Shelley, Parkland’s first female African-American associate director of radiology. I then landed as an X-ray QC manager on the 11-7 shift.”
“Male doctors thought they were it: ‘You do what I say,’ ” Anderson remembered. “As I grew into my role, this was about how we serve patients. I started to really focus on the goal of Parkland Hospital, which was to serve the people of that community. I started doing mammography as a technologist, and I left the management role.”
When she was given the opportunity to lead her department, Anderson said she felt the stress of working in leadership, from parlaying with advocacy groups, to fundraising, to forming strategic partnerships. She said the work compelled her to proceed with the national breast cancer program to grow it into what it is today, and that it was personally taxing to pursue. The unspoken danger of failing to address gender disparities in the workforce creates the false choice that so many in health care must someday confront – put up with an unsustainable professional culture to pursue a moral or personal passion, or prioritize self-protection and leave the work in the hands of others who may be less dedicated or capable.”
“Burnout is a real thing,” Anderson said. “When women start to experience that burnout, they have so much knowledge, so much expertise, that they don’t want to leave that knowledge on the table.”
Rather than working against her in the mammography space, Anderson said that that her gender and cultural identity as a Black woman have enabled her to connect more deeply and more frequently with women in the demographics that are most critically underserved by breast cancer screenings. When she walks them through the procedures, she is also answering questions about her career pathway, and what of her efforts could be reproducible for their children. The generosity of Anderson’s accumulated skill and wisdom enables her not only to coach patients through the intimate sensitivities of mammography with compassion and grace, but also to reveal underlying concerns that a less thoughtful approach would overlook.
“Some of the things you need to be able to do for this particular career is be passionate; be empathetic,” she said. “You have to have concern for that patient, and you have to speak their language. I gained that skill over time of speaking to people where they are over time.”
Anderson takes a similar approach to her work as an imaging leader, placing emphasis on what she can do to help advance the careers of the people working alongside and under her.
“If you’re in a center together, everyone has to grow,” she said. “You can’t leave one person behind. That’s how I approach my group when I’m in leadership. You can overcome working with a group if you’re able to relate one-on-one.”
She advised women in medical imaging to consider their options, clinical environments, instructional opportunities, work with federal agencies or non-governmental organizations, or joining a private-sector business as a skilled technical liaison.
“You don’t have to be stuck,” Anderson said. “You don’t have to feel like you’re in a career that has no pathway. I stay in this industry because I’m a patient-centered person. The only way I can keep that focus is to perform mammography part-time at a local hospital, which I’ve done for the past five years.”
“I have an overwhelming passion to support women, I have a technical expertise of 37 years total in this industry, and I don’t want to let that go, because I’m so focused and passionate about this industry,” she said. “Learn the fundamentals and become an expert. There are applications for growth. Although I’m working for a Fortune 500 company today, where I can continue to support women, I still enjoy the clinical side, and this is the primary reason why I continue doing mammography on the weekends.” •
