We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:

“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession anywhere in the world.

The fault line is in the family and life balancing act women must do to survive in the workplace.  To be clear this is true for men too. Women are more likely to face challenges when long work hours, travel and the business of professional networking keep them away from families.

Furthermore, the profession of medicine requires a commitment to patient care, education and research, but the climb to the top has additional milestones. While many put in extra time and sweat their persistence still places them outside the closed doors of  hospital board rooms, department chair offers, academic medicine positions or physician-leader roles.  Data and research are scant on measures for progress.  I always look at the pictures on the walls in medical center hallways and conference rooms, it’s rare to see anyone who resembles me in those pictures. I do see women moving through up the ranks who are awesome role models.

For the last 10 years medical school classes have held equal portions of men and women, but those who teach medical students and lead institutions are predominately men.  Recent research published by Dr. Borges and others indicate that “women physicians choose their careers because of the perceived quality of life, earnings potential, and organizational reward. They are less likely than men to identify role models for professional–personal balance.”

Women do need to seek out role models early in their careers, but it’s not enough. More significant is the understanding that if there’s no institutional, top-down approach to addressing the complexity of these issues, meritocracy alone will not break down barriers nor will change occur.

Dr. Karen Sibert’s recent op-ed in the New York Times inspires my blog post along with other offline discussions, including the talk with Michele Martin on NPR’s Tell Me More, which aimed to further the conversation about part-time career choices women are making in the face of doctor shortages, decreasing health care budgets and a moral obligation. Dr. Sibert and others make it clear about the sacrifices for both men and women when it comes with a commitment to patient care, but Dr. Au and others make the case for our right to choose, wisely and carefully.

I follow the career paths by reading the literature as well as over the years some of the books written by women in medicine, here are just a few from my bookshelf:

Treatment Kind and Fair: Letters to a Young Doctor by Perri Klass

Zenzele: A Letter for My Daughter by J. Nozipo Maraire

Final Exam: A Surgeon’s  Reflections on Mortality by Pauline Chen

Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside by Katrina S. Firlik

Medicine in Translation: Journeys with My Patients by Danielle Ofri

Almost Home: Stories of Hope and the Human Spirit in the Neonatal ICU by Christine Gleason

The Country Doctor Revisited: A Twenty-First Century Reader edited by Therese Zink

Stories of Illness and Healing: Women Write Their Bodies edited by Marsha Hurst and Sayantani DasGupta

On a historical note Dr. Virginia Apgar’s story is endearing as she was set on becoming a surgeon, but gender discrimination led her to a career in anesthesiology after training she went on to head a new division of anesthesiology where she developed the Apgar score. As the medical school’s first female division head, she built a residency program and, in 1949, became the first woman appointed to a full professorship at the Columbia University College of Physician & Surgeons.  No, I’m not interested in a career anesthesiology, I am looking for opportunities where innovative ideas are supported regardless of gender, race or ethnicity.

A few pointers, I’ve heard from those listed above and elsewhere:

• Relationships and family matter, try to avoid undermining your anchors to move ahead, you may find short-term success and long-term misery with the loss of your family and friends and a more demanding job.
• Don’t turn your head or look way when you see real harm done to women especially if it’s you in the hot seat, choose battles worth fighting.
• Read and review the policy handbook at your institution. Knowledge is power.
• Honor and respect women physician-leaders in their roles and get to know their stories.
• Tell your own stories so that others might know of your success and/or be warned of your pitfalls.
• “Lift as you climb” so that you enable collective success in the profession.
• The road is long so make good friends for the distance.

U.S. Surgeon General Regina Benjamin, Secretary of Health and Human Services, Gov. Kathleen Sebelius and First Lady Michelle Obama are at the helm efforts to improve health and health care in America and these women are all phenomenal. We should continue our look up stream and push for policies and practices that allow for a more balanced profession for men and women, which in my view enables better patient care and improves quality of life for both patient and physician. There should debate, divergent points of view as well as common ground to stay focused on more progress.

Katherine Ellington is a medical student who blogs at World House Medicine.

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