Skip to Main Content

At least on paper, businesses and institutions have achieved equality through thoughtful diversity, equity, and inclusion (DEI) policies that examine bias and end discrimination against women and people from underrepresented groups.

In reality, though, little has changed to truly integrate women and people from underrepresented groups into the workplace.


The DEI policies that most institutions have developed offer excellent roadmaps for hiring diverse candidates. But when real people bring their judgments into the discussion, stereotypes win out. The conscious desire to be fair is often overwhelmed by persistent unconscious bias that drives talented people out of their professions.

Well-intentioned people can hold consciously rational opinions in one part of their mind yet simultaneously be influenced by unconscious cultural stereotypes. They can decide they wish to be fair and equitable, yet still choose to hire only people who fit their image of what a leader is. Some researchers argue that implicit bias “is like a habit.” Habits can be broken, but not by written policies.

Patricia Devine, a longtime researcher, describes unconscious bias as the difference between conscious, actively chosen beliefs and unconscious associations that are absorbed from one’s cultural surroundings. Those associations — like the assumption that boys are better at math than girls — are dictated by the cultural milieu.


As Jessica Nordell explores in her 2021 book “The End of Bias,” once a specific situation triggers unconscious assumptions, a person may make decisions that are radically at odds with the fairness they believe they espouse.

The solution to bias starts with conversation

Without ongoing discussions, DEI policies alone don’t work — in fact, they can even make things worse: A recent New York Times opinion piece points out how one-size-fits-all trainings can actually create a backlash.

My recent qualitative research on gender in academic medicine suggests how some powerful gender stereotypes are at work, and helps explain why women’s advancement to leadership positions remains stuck. For this work, I interviewed more than 100 physicians, physician-scientists, and Ph.D. scientists, half women and half men, at 16 institutions across the U.S.

Although my research focused on barriers to women’s advancement in leadership positions, the findings also can inform how to understand — and break down — barriers that prevent people from underrepresented groups from rising to leadership roles.

As I’ve gone around the country presenting this work, the most common response has been, “I’ve never heard anyone say this out loud before.” Until the issues are articulated, DEI policies will obscure the work that’s necessary to achieve equity.

My research analyzes the language institutional leaders use, which pinpoints areas where stereotypes about women are most strongly expressed: motherhood, invisibility, anger, and unwillingness to be led by women.

Motherhood seems to trigger an intractable cultural stereotype about women’s ability to perform in the workplace, in which they are deemed to be less serious about their careers. Alyssa (the names used here are pseudonyms for people I interviewed) shared with me this conversation with a colleague: “He said to me, ‘Science is a hierarchy, and you shouldn’t aim for the top.’ I asked him why and he said, ‘You’re a woman, and you have kids.’ I pointed out a successful male scientist who had children, and his response was: ‘His wife stays home with them.'” That colleague had preemptively closed off any leadership path for Alyssa because she had children.

The outmoded idea that only women are responsible for child care still rules: Fathers remain invested in their work, while mothers are distracted by mixed loyalties.

Invisibility refers to the stereotypes that make it difficult to recognize accomplished women as experts, and it was the first thing many women brought up. Elaine told me, “If I don’t wear my white coat and identify myself quickly, I could be the nurse or the cleaning lady. There’s a sense of being invisible.”

Male colleagues sometimes noticed this. Arthur told me about a Black female colleague: “When she’d walk into a room even as an attending [physician] with her white coat on, the patient would assume she was a nurse. Another of my African American colleagues told me that patients assumed she was there to clean the room.” His observations echo what women told me: Patients expect to see women cleaning and nurturing, not being experts. Jon recounted a conference speaker asking the question, “How many of you were asked to do something because patients assumed you weren’t a doctor, like change a bedpan or start an IV?” Many women raised their hands, while no men did.

Patients struggle to accept women as experts, but so do their colleagues. Almost every woman I spoke with described this scenario: They’d say something in a meeting and be ignored, then a man would say the same thing and be praised. Some women devised strategies to overcome this universal deafness by amplifying each other’s voices, but it remains a struggle for women to be seen or heard.

Anger is an enduring stereotype: Ideas about “appropriate” femininity are hard to dislodge. Researchers of unconscious bias argue that humans have a deep attachment to their unexamined assumptions: We’re happy when someone behaves as we expect them to, and uncomfortable — or even angry — when they don’t. Any professional woman could surely give examples of getting pushback for not fitting the stereotype of “niceness.” Tough, assertive women are often seen as bitches, while aggressive, overbearing men are often promoted.

Unwillingness to be led by women is a fourth barrier to women’s advancement in academic medicine. Josiah unconsciously showed this bias when he told me how he advised a female division chief in his department to soften her edges because she “clashes” with strong men. “We tell her she can’t say, ‘That was a stupid idea,’ even if it was a stupid idea. Instead she could say, ‘I would think about it differently.’ We’ve tried to rein in some of that, so others don’t feel like she’s exerting too much authority over them.”

He acknowledges that men are uncomfortable with this woman exerting authority over them which is, after all, her job as a division chief. The “we” who really run things have had to “rein her in” and get her under control. Many women who spoke to me described this impossible position: be an assertive decision-maker but still be nice.

The mental energy required to maintain one’s professional sense of self while being misrecognized by patients, talked over by colleagues, and dismissed for having children is exhausting.

Conversations about unconscious assumptions

Many men I spoke with saw themselves as champions of women in their field and emphasized their advocacy. Yet their actions and language reveal the powerful pull of unconscious assumptions. Perhaps no one has ever asked them to consider why they think women must do all the child care, why they frequently interrupt and talk over women, or why they find assertive women disturbing.

Until conversations about those problems begin, DEI policies will never produce a gender-diverse workforce. Even worse, the constant pressure of discriminatory attitudes stops women from being rewarded for their work or advancing. Today’s emphasis on DEI without the hard work of changing professional cultures is pernicious. It’s no wonder that women leave their fields or give up their research. And that is a brain drain nobody can afford.

Jennifer Rubin Grandis is a surgeon, scientist, and distinguished professor of otolaryngology‑head and neck surgery at the University of California, San Francisco.

First Opinion newsletter: If you enjoy reading opinion and perspective essays, get a roundup of each week’s First Opinions delivered to your inbox every Sunday. Sign up here.

Create a display name to comment

This name will appear with your comment

There was an error saving your display name. Please check and try again.