The Future of Academic Medicine Has Begun

Whitcomb, Michael E. MD

From the Editor


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Last year, for the first time ever, the number of women applying to medical school exceeded the number of men. And as Cooper pointed out in a recent article in this journal, that is only the beginning of a trend that will continue well into the future.1 According to his analysis, women will account for 57% of medical school applicants in the year 2020. This trend has major implications for the future of medicine. Of particular importance, it presents a major challenge to the current leaders of academic medicine: How should they respond to the special needs of women physicians who wish to pursue an academic career?

In the past few years, a great deal of work has been done to document how the daily lives and career experiences of women in academic medicine differ from those of men. Three of the articles in this issue of the journal contribute important information about those concerns. McGuire and her coauthors describe the results of a survey designed to identify interventions that might improve the career success and sense of well-being of women members of the Stanford faculty. Schroen and her coauthors report the experiences of women in academic departments of surgery. And Draznin contributes a personal note by recounting the challenges she faces as an aspiring academician. These articles, and others published in the journal in the past few years, provide insight into the challenge the leaders of academic medicine face.2,3

One aspect of this challenge is of particular concern to many—the relatively small number of women who hold leadership positions in academic medicine. Various committees have studied this issue, and each has proposed similar recommendations for how the issue might be addressed.4 In general, they call for the adoption of institutional policies governing promotion and tenure that will require committees and institutional leaders to more explicitly take into consideration the special circumstances women face in pursuing an academic career. And they emphasize the need for programs that will help faculty women acquire the skills they need to hold leadership positions. McDade and her coauthors report the results of one such program—the Executive Leadership in Academic Medicine (ELAM) program—in this month's journal.

But will focusing on the development of leadership skills lead to an increase in the number of women being appointed to department chair positions or deanships? While this approach seems perfectly reasonable in one sense, it fails to deal with the reality of academic medicine's culture. All concerned about the representation of women in leadership positions in academic medicine must be honest in acknowledging that at present, neither the men nor the women who are selected for leadership positions within academic medicine's institutions are chosen primarily because of their perceived leadership skills. In virtually all cases, individuals are selected because of the weight of their scholarly contributions in their disciplines. This is simply the way of academic medicine's culture.

Given that, some suggest that the culture needs to be changed. They would argue that leadership skills should be valued more highly than academic accomplishments when selecting individuals, whether men or women, to serve as department chairs or deans. Indeed, this view is implicit in some of the recommendations that have emanated from various committees charged to study the problem. But I, for one, don't believe that the culture is likely to change in the foreseeable future. If I am correct, then the leaders of academic medicine must develop strategies for ensuring that women have the opportunity to achieve at a level of scholarship that will make them competitive candidates for department chair positions or deanships. The challenge for the current leaders of medical schools and teaching hospitals is to design and implement those programs, recognizing that women face demands that disadvantage them when competing with men who are at similar stages in their careers.

Those involved in such an effort must recognize also that achievement in the domain of research is weighted far more heavily within the culture of academic medicine than is achievement in the domains of education or patient care. This means that advancement to leadership positions in academic medicine is disproportionately based on achievement in research. Thus, the focus of the effort to increase the number of women in leadership positions must be to help women achieve in the research domain. This makes the challenge at hand greater than it may seem at first, because the special demands that disadvantage women affect primarily those interested in a research career. The reason for this relates to how modern biomedical research is conducted. A successful research program requires a team of investigators to work together in a highly efficient, collaborative mode over a period of years. The development of a successful research career requires an individual to be an effective member of such a team. Obviously, women who wish to take time off to have and to raise children are going to have a difficult time contributing as much as are men working in the same environment under the same conditions. Dr. Draznin says it clearly in her article: “The reality is such that I am unlikely to succeed in academia by being a part-time basic science researcher or clinical scientist. A part-timer cannot be competitive in the world of science, where others work 80–100 hours a week.”

Some readers may wish to challenge the logic of my reasoning. In defense of my position, let me point out that women are already highly successful in the medical education domain. At present, one third of the individuals directly responsible for the management and oversight of the medical education programs conducted by medical schools—individuals holding the title of vice dean or associate dean—are women. (In contrast, only 10% of the individuals having similar responsibilities for the institutions’ research programs are women.) And many women now hold positions as course directors, clerkship directors, or residency directors. I don't think that the success women are having in achieving positions of leadership in medical education indicates that they necessarily possess superior leadership skills. Instead, it shows that achievement in the medical education domain is determined largely by an individual's interest, commitment, and ability—personal attributes that women possess and can apply as well as men—despite the special demands on their time. But if women are being appointed to leadership positions in medical education, why then are not more women being appointed as department chairs or deans? Because success in the medical education domain generally does not result in appointment to those positions, regardless of whether one is a woman or a man. Once again, we see the culture of academic medicine at work.

Recognizing the difficulty of changing the culture of the academic medicine environment, my plea is that the leaders of academic medicine focus on developing and implementing innovative programs that will allow women physicians to be effective members of successful research teams during the early stages of their careers when they are most disadvantaged, career-wise, by the demands of motherhood. While some may view this as a strategy simply for ensuring that more women become department chairs and deans, I think there is an even more important issue at stake. Given the changing demographics of medicine, what will happen to the quality of the biomedical research conducted in this country if women physicians are unable to participate fully in the research enterprise? After all, if women physicians don't succeed in the research domain, who will carry out the important basic and translational research that will need to be done by physician scientists in the future?

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1. Cooper RA. Impact of trends in primary, secondary, and postsecondary education on applications to medical school. 1: Gender considerations. Acad Med. 2003;78:855–863.
2. Wright AL, Schwindt LA, Bassford TL, et al. Gender differences in academic advancement: patterns, causes, and potential solutions in one U. S. college of medicine. Acad Med. 2003;78:500–508.
3. Morahan PS, Voytko ML, Abbuhl S, et al. Ensuring the success of women faculty at AMCs: lessons learned from the National Centers of Excellence in Women’ Health. Acad Med. 2001;76:19–31.
4. Bickel J, Wara D, Atkinson BF, et al. Increasing women's leadership in academic medicine: Report of the Association of American Medical Colleges (AAMC) Project Implementation Committee. Acad Med 2002;77:1043–1061.

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