McGuire, Lindsay K.; Bergen, Merlynn R. PhD; Polan, Mary Lake MD, PhD, MPH
Between 1975 and 2000, the percentage of women medical students in the United States increased from 38.9% to 46.4%. A similar increase occurred in the number of women residents; women comprised 28% of total residents in 1989 and 38% in 2000. In contrast, the proportion of women faculty at the level of professor has remained static at approximately 11%, although there has been an increase in women faculty at the assistant professor level from 21% to 24% from 1995–2001.1–3 Given the increasing number of young women faculty in academic medicine and the perceived difficulties of such a career, it is important for the medical community to understand the needs and desires of women faculty at academic institutions so the community can best support their career advancement, and retain them in the academy.
Although women in academic medicine have many of the same career requirements as do men, they also have some issues and needs specific to their gender and family responsibilities including gender discrimination, gender stereotypes, and their desire to bear children. Thus, it is necessary to assess women's needs separately from men's. However, as women physicians have the same drive, intelligence, and capability as men physicians, it is important to afford them similar academic opportunities while taking into consideration these unique needs.
Past research has shown that women in academic medicine still face gender discrimination, disadvantaging them in relation to their men colleagues. Compared to men, women have slower career progress and are less likely to be promoted or tenured.1,2 Women are also much less likely to hold leadership roles such as division head, department head, or dean, in part because they are overlooked for promotions, and because the process takes place more slowly for women.1,4 Clinical department chairs report part of the problem lies in the constraints of traditional gender roles, sexism, and lack of women mentors.5 Additionally, at one academic health center, women physicians at all levels reported less interest in academic fields because of a concern about balancing their career and family responsibilities.6 Women may be hesitant to enter academic medicine because they are aware of the obstacles and perceive a gender climate that will impede their academic career.7 Gender climate issues include sexual harassment, discrimination, and lack of mentoring. To overcome these disincentives for women, universities must take a multifaceted approach and deal with several problem areas.8 A study from The Johns Hopkins University School of Medicine suggested that a multifaceted intervention can be successful by increasing promotions and salary equity for women faculty and decreasing gender bias.9
A previous study at Stanford University examined perceptions of school climate to assess the effectiveness of a required, universal training program designed to reduce gender insensitivity and sexual harassment. After participation in the training program, there were significant improvements in women faculty's ratings of the school climate, as well as significant decreases in sexual harassment, gender discrimination (the degree to which women in medicine feel that their gender is an important part of the way they are treated), and gender insensitivity (the degree to which women in medicine feel attitudes toward men and women are different).10
We undertook this study of women faculty at Stanford University School of Medicine to assess the current perception of gender climate seven years after the previous evaluation and to prioritize women faculty's needs for both career advancement and environmental comfort. Women physicians are an integral part of academic medicine and it is imperative to examine this group to better understand their perceptions of gender discrimination and their requirements for academic success.
In October 2001, the dean of the School of Medicine convened a Committee on Women in Medicine and Science and charged it to “consider how the School of Medicine can enhance its ongoing efforts to increase the representation of women in the professorate and to address the professional well-being and success of women faculty.”11 The committee included full-time women faculty on the tenure (research), Medical Center (clinical research and patient care), and staff physician (clinical care and teaching) lines from ten different departments of the medical school.
Ten women faculty members, who were also committee members, developed a set of nine “resources and supports” based on knowledge of what women in the Medical Center may desire that they derived from multiple conversations with a broad spectrum of women faculty. In the needs assessment section of the instrument, participants were asked to “rate the set of resources and supports for their importance to you” (1 = not at all important; 5 = very important). They were then asked to “review the nine items and indicate the two that are most important to you.” In addition, participants were encouraged to indicate other need(s) not addressed in the nine items and provide other general comments.
In the climate section of the instrument were the 50 items from the Faculty Climate Scale used in the earlier Stanford study.10 There were two positive scales (Positive Climate and Cohesion) and three negative scales (Sexual Harassment, Gender Discrimination, and Gender Insensitivity). Participants were asked to respond to each of the items on the basis of their perceptions of the School of Medicine during the academic year using a four-point scale (1 = strongly disagree; 4 = strongly agree).
On November 15, 2001, we sent the instrument to 309 women faculty in the School of Medicine including all tenure-line faculty, Medical Center line (MCL) faculty, staff physicians, and research-line faculty. Because responses to the instrument were anonymous and to maximize yield, a repeat instrument was sent to the same set of women faculty on January 17, 2002.
The mean ratings provided a ranking of the nine items. We obtained the number of women who indicated an item was “most important” and broke down the ratings data by item with respect to participants’ faculty rank and track, and whether they had children. We analyzed these data using one-way analysis of variance (ANOVA) with Tukey follow-up tests. We calculated the means and standard deviations of the five scales of the climate data and determined comparisons with scale means from the earlier Stanford study using independent t tests. We broke down the climate scale data by groups (track, rank, and children) and analyzed them using one-way ANOVA with Tukey follow-up tests.
One hundred sixty-three (53%) participants completed instruments. Table 1 lists the respondents’ characteristics. Seventy-five percent of the respondents were married. Of particular importance, 67% reported that they had children (mean = 2.1 children). Over 60% of the children were younger than 12 years. The majority of the respondents were in the MCL promotional track and either associate or assistant professors (see Table 1).
The mean ratings for and number of resource and support items indicated as “most important” from the women faculty needs assessment are listed in Table 2. Item 4, a “flexible work environment without negative consequences for women with young children,” not only had the highest mean ranking in terms of importance, but also received the highest number of “most important” mentions. Closely following were three resources and supports (Items 1, 2, and 3): “a three-month sabbatical from clinical work at the end of the third year of appointment,” “school/departmental administrative support for grant and manuscript writing,” and “departmental mentoring for grant preparation and academic career development.” Item 5, “part-time MCL and University tenure line (UTL) faculty positions for family reasons and with a corresponding delay of promotion timelines,” was fifth highest in mean rating, but received the second highest number of “most important” mentions.
We conducted analyses of the mean ratings by respondents’ rank and track, and whether they had children (see Table 3). Item 4 (“flexible work environment without negative consequences for women with young children …”), Item 5 (“part-time MCL and UTL faculty positions …”) and Item 9 (“create a third line as clinician–scientist or clinician–educator …”) showed significant differences among groups in these analyses (see Table 3).
Three items showed significant differences among the professorial ranks. For Item 4, the staff physicians’ mean rating was significantly higher than the mean for associate professors. For Item 5, the staff physicians’ mean rating was significantly higher than the mean for professors, associate professors, or assistant professors. For Item 9, the staff physicians’ mean rating was significantly higher than the mean for professors, associate professors, or assistant professors.
Two items showed significant differences among the tracks. For Item 5, the mean rating of UTL physicians was significantly lower than the mean for either the MCL or the nontenure line, research (NTLR) physicians. For Item 9, the UTL mean rating was significantly lower than the rating for MCL.
Two items showed significant differences between respondents who had children and those who did not. For both Items 4 and 5, mean ratings of needs by women with children were significantly higher than mean ratings of those without children. Two issues were apparent in the written comments returned with the survey instrument. First, flexibility to allow women to maintain family and personal lives while succeeding academically was of paramount importance to respondents. Second, parity both in salary and benefits, particularly between the University faculty at Stanford Medical Center and at the VA Palo Alto Healthcare System, was also of significant importance (e.g., housing benefit, institutional matching for retirement funds).
The analysis of the climate data from the women respondents in 2002 is shown in Table 4. Responses for each scale ranged from 1 = strongly disagree to 4 = strongly agree. Items were scored so that higher means indicated a higher degree of the scale construct (e.g., more Cohesion, more Sexual Harassment). We conducted analyses of the mean ratings of each scale by track, rank, and whether the respondent had children.
Two scales showed significant differences among the women in the various ranks (see Table 5). Professors perceived significantly less gender discrimination and gender insensitivity than did associate professors. We found no significant differences among tracks for any scale.
Two scales showed significant differences between respondents who had children and those who did not. For Positive Climate, women with children perceived the climate to be significantly less positive than did those without children. For Cohesion, women with children perceived there to be significantly less cohesion than did those without children.
We compared our 2002 data for women faculty with the women faculty's responses in 1994 and 1995 (see Figure 1). Between 1994 and 1995, when gender sensitivity training occurred as a mandatory process in the School of Medicine, mean ratings for positive climate and cohesion increased and mean ratings for sexual harassment, gender discrimination, and gender insensitivity decreased significantly, indicating an improvement in the medical school environment.10 In contrast, mean ratings for positive climate and cohesion remained stable in the seven years from 1995–2002 (p > .2). Although there was no significant regression in the specific areas of sexual harassment (p > .1), gender discrimination (p > .2), and gender insensitivity (p > .2) from 1995–2002, mean ratings decreased.
The dual goals of our study were to understand the career needs of women faculty members in a research intensive medical school and to assess specific measures of institutional environment by comparing the climate data from 2002 with information generated by women faculty responding to the same set of items in 1994 and 1995. As might be expected, the primary need expressed by the 2002 group of women faculty was the creation of a flexible work environment enabling them to accommodate the demands of both young children and/or aging parents in the household. Their desire for flexibility included part-time faculty appointments and sensitivity with regard to when meetings are scheduled within departments in the School of Medicine, as well as access to on-site drop-in and/or emergency child care for work days when a child is sick yet clinical obligations remain.
Although over 50% of the respondents to the needs assessment in 2002 were Medical Center line faculty who had significant clinical responsibilities, their primary needs were related to protected time and mentoring to advance their academic careers through research grant applications and manuscript submissions. Thus, the second most desired need was providing a three-month sabbatical from clinical and administrative work allowing women faculty to write grants and papers. Such sabbaticals would best be combined with a mentorship program assisting the faculty member in grant and manuscript preparation. This need is consistent with the next three highest ranked needs for additional resources for department-based mentoring for grant preparation and academic career development with specific review of grants and career plans by senior faculty.
Because we had accumulated climate data from a validated survey used with women faculty at Stanford University School of Medicine in 1994 and 1995, we included the same survey items in 2002 to determine whether any changes in climate had occurred in the intervening seven years in the absence of additional gender sensitivity training. As shown in Figure 1, mean ratings for sexual harassment, gender discrimination, and gender insensitivity continued to decrease, although not significantly, between 1995 and 2002. No further gender sensitivity training was either required or available from 1995–2002. Perhaps because the issue has been highlighted both legally and ethically on the Stanford University campus and externally in the press, situations of gender discrimination and sexual harassment are now less frequent.
It is of some concern that the ratings for positive climate and cohesion have not improved since 1995. This may have been the result of the difficulties between 1995 and 2002 with the merger and de-merger activity between Stanford University Medical Center and University of California, San Francisco Medical Center, as well as the significant external stresses on academic health centers both in California and throughout the United States. The lack of improvement in positive climate and cohesion ratings may reflect the external stress currently affecting academic health centers including decreased financial reimbursement for services as well as an increasingly onerous regulatory environment. The additional family and childcare responsibilities described by women faculty at Stanford may amplify such negative effects of the external environment.
We presented the results of this study to the faculty and staff of Stanford University School of Medicine on December 20, 2002. Medical School administration, including the deans, and women faculty were present. The dean's office is committed to implementing these recommendations to provide support for academic advancement of women faculty members. Several of the recommendations are already in place such as the possibility of part-time MCL positions and availability of sabbatical time for both tenure-line and MCL faculty.
It is clear from the needs assessment results that women faculty members at Stanford University School of Medicine would like to see specific interventions to facilitate their careers and accommodate their family responsibilities. Previous work has shown that interventions to enhance the climate for women do not require enormous, additional resources to encourage their career advancement.9 Medical school administration and women faculty members must work together to initiate and maintain changes in the structure of the programs in order to best accommodate their needs. This study and report are promising first steps in further improving the environment at Stanford University School of Medicine for women faculty, thus advancing women's careers in academic medicine.
We would like to thank Dean Philip Pizzo and Associate Dean David Stevenson for their support and encouragement in this study. In addition, we are very grateful to the women who participated in the Stanford University Committee on Women in Medicine and Science who included Robyn L. Birdwell, MD, Department of Radiology; Michael L. Cowan, Postdoctoral Affairs; Teri A. Longacre, MD, Department of Pathology; Yvonne A. Maldonado, MD, Department of Pediatrics; Suzanne R. Pfeffer, PhD, Department of Biochemistry; Martha K. Terris, MD, Department of Urology; Lucy S. Tompkins, MD, PhD, Department of Medicine; Hannah A. Valantine, MD, Department of Medicine; and Eva E. Weinlander, MD, Department of Family and Community Medicine.