Lean In“We still have a problem” Sheryl Sandberg alarms us in her influential 2010 TED Talk, Why we have too few women leaders. “Women are not making it to the top of any profession anywhere in the world.” While women are getting more college degrees and graduate degrees, and more women are entering the workforce than ever before, when it comes to leadership positions, women do not come close to matching their male counterparts. “The blunt truth is that men still run the world.”

Sandberg believes that the key to fixing this problem is to keep women in the workforce. In her book, Lean In: Women, Work, and The Will to Lead, she points out that the way to prevent women from dropping out of the workforce is by focusing on change at the individual level. She asks that we all do our part to change the messages we tell ourselves, the women we work with, and what we share with our daughters.

Lean In offers 3 valuable pieces of advice for all women who want to stay in the workforce and pursue leadership:

  1. Sit at the table.
  2. Don’t leave before you leave.
  3. Make your partner a real partner.


While Lean In is a book about advice for women and the workplace, it also serves as a pseudo-memoir where Sandberg outlines her pathway to a successful professional life starting with her childhood, descriptions of her mentors, highlights of critical moments in her college and post college years, and the variety of jobs she held before COO of Facebook. Each chapter focuses upon an important lesson illustrated with personal examples, critical references, and hard numbers. Through the book’s dialogue the reader learns that Sandberg’s decisions along her career path were not merely intuitive, but based upon considerable deliberation and weighing of priorities. Sandberg skillfully balances her own experience with  numerous examples from other colleagues, mentors and friends – both men and women – in attempt to provide a more widespread discussion of her conclusions about the United States current work culture. The book, of course is published before the widely known tragic death of her husband Dave Goldberg in May of 2015. However, because the book is written as a means to start a conversation, the reader is encouraged to Lean In and go further. The reader walks away from the book, not necessarily an expert, or with the tools to exactly obtain success, but rather with considerable evidence to ponder upon as they determine what “Lean In” means to them, their life partner, and their personal and professional goals.

Message #1: Sit at the table

No one gets to the corner office by sitting at the side, not at the table, and no one gets the promotion if they don’t think they deserve the success or understand their success.

Sandberg observes that men are reaching for opportunities and putting themselves forward far more often than women. She admits that even she has failed to correct for this gap on many occasions. Sandberg asks that “If we want a world with greater equality, we need to acknowledge that women are less likely to keep their hands up. We need institutions and individuals to notice and correct for this behavior by encouraging, promoting and championing more women. And women have to learn to keep their hands up, because when they lower them, even managers with the best intentions might not notice.”

Women very often underestimate their own abilities and attribute their success to external forces such as luck and help from others, whereas males contribute their success to their own doing. Sandberg points out “it’s cliché but opportunities are rarely offered; they’re seized.”  Given how fast the world is moving today, It’s more important than ever for women to reach for these opportunities.  Sandberg shares that women often don’t believe they are deserving of their success, and often think they do not have the skills for a reach job. Sandberg discusses how taking initiative pays off. She gives several examples from her own experience in business of women not reaching, not leaning in, and how this has hurt their individual progress. She compares this to stories of both men and women who have taken initiative. “It is hard to visualize someone as a leader if she is always waiting to be told what to do.”

In the chapter Success and Likability, Sandberg highlights that while success and likability are positively correlated for men, they are negatively correlated for women. In terms of negotiation men are expected to ask for advances, however women must justify their requests. For women to negotiate effectively requires a strategic process of smiling, emphasizing common goals, and appreciation. It often is not a single discussion, but a drawn out process. “No wonder women don’t negotiate as much as men. It’s like trying to cross a minefield backward with high heels.”  However, the only way to make progress Sandberg argues it to believe in yourself, negotiate for yourself, and own your own success.

Message # 2: Don’t leave before you leave

Of all the ways women hold themselves back, perhaps the most pervasive is that they leave before they leave.

Sandberg acknowledges that women often face harder choices between professional success and personal fulfillment than their male colleagues. Yet, too often women are leaving the workforce prematurely. She warns women that planning too far in advance to accommodate for a family will often close doors rather than open them. “What often happens is that women will make small decisions along the way, making accommodations and sacrifices that they believe will be required to have a family.” Sandberg advises that the time before having a family is the critical time to lean in, pursue opportunities, and prepare for the career that she most desires. By scaling back too early, women inevitably end up in less fulfilling and less engaging jobs which ultimately makes it even harder for them to stay in the work force. “When they finally have a child, the choice- for those who have one- is between becoming a stay-at-home mother or returning to a less-than-appealing professional situation.

Message #3: Make your partner a real partner

I believe that the single most important career decision that a woman makes is whether she will have a life partner and who that partner is. I don’t know of one woman in a leadership position whose life partner is not fully-and I mean fully- supportive of her career. No exceptions.

Sandberg points out that women have made more progress in the work setting than we have in our homes. If a man and woman both work full time jobs, it is likely that that the women will do twice as much house work and three times the amount of child care than the man does.

Sandberg believes societal pressures have a lot to do with this. Common stereotypes of a working mom and a crying baby, and expectations that a man should be the bread winner, make it difficult for women not to feel guilt-ridden about working, and similarly challenging for men to take more of a role at home. In an attempt for a fifty-fifty partnership with her own husband, Sandberg reveals that it was not easy, but is essential if a woman desires to be a leader. “It takes continual communication, honesty, and a lot of forgiveness to maintain a rickety balance. We are never at fifty-fifty at any given moment- perfect equality is hard to define or sustain- but we allow the pendulum to swing back and forth between us.” If we are to see women in leadership, we need more women to lean in, negotiate for higher positions, acknowledge their success, and “we need more men to sit at the the table – the kitchen table.” As it turns out – couples who share in domestic responsibility have more sex. Not a bad trade-off for doing a few dishes!

In the chapter, The Myth of Doing It All, Sandberg reminds women that “trying to do it all and expecting that it all can be done exactly right is a recipe for disappointment.” Sandberg recommends setting obtainable goals, embrace that done may be better than perfect, and decide what matters and what doesn’t matter. “If I had to embrace a definition of success, it would be that success is making the best choices we can, and accepting them.”

Gender Disparity in Medicine

The medical profession is no exception to the gender gap highlighted by Sandberg. Within academic medicine female faculty are less likely to be advanced to higher leaderships positions in their institution. We see less females as associate and full professors. In addition, accounting for other variables, females earn less as attending physicians in their private practices. Emergency Medicine may provide addition unique biases. These are some of the issues that drove the founding of the blog www.feminem.org in 2015 by Dr. Dara Kass.

 Book Club Questions:

  1. Sandberg begins the book with an eye opening experience she had during her first pregnancy while in a leadership position at Google. She tells of a difficult pregnancy, of morning sickness that lasted into the third trimester, significant weight gain, and discomfort. During this period, she was running to meet a client and the only parking spot was extremely far away. She later discussed the situation with her husband who pointed out that in his company there are designated parking spots for expecting women. “to this day, I’m embarrassed that I didn’t realize that pregnant women needed reserved parking until I experienced my own aching feet. As one of Google’s most senior women, didn’t I have a special responsibility to think of this?” Is there inadvertent discrimination against pregnant women in the workplace?  How can work places better accommodate pregnant women, and make allowances for family in general?
  2. In the chapter, Success and Likeability, Sandberg points out that women succeed by showing a commitment to the group. This is a strength which ultimately benefits any team, because a well-functioning group is always stronger than its members. Do we value and reward equally traits that are classically considered female to those that are male, especially in a group setting?
  3. Lean In is a call to action. Sandberg’s message for women in leadership has continued to evolve since her publication of Lean In. In a recent Facebook post Sandberg acknowledges the many struggles faced by single mothers, and admits she did not recognize how hard it is until the passing of her husband, Dave. In what ways does Lean In fall short of advocating for women in the work force? In what ways can we work towards a more effective work place?

Google Hangout Discussion – Featuring writers and editors from feminem.org


Go Further

For more information on Sheryl Sandberg’s Lean In, we recommend visiting her website: http://leanin.org

Jordana Haber, MD

Jordana Haber, MD

Director of Clinical Education
Dept. of Emergency Medicine
Assistant Professor UNLV School of Medicine
Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions