Many from varied professional environments recognize that the advancement of women to leadership positions lags well behind that of their male counterparts. Numerous prestigious organizations have recently published reports documenting this phenomenon in government laboratories, higher education, business corporations, and academic health centers (AHCs) in the United States and Europe.1–9 Each has concluded that, even though women have reached parity at the beginning career stages, they have yet to reach parity at the senior and leadership levels.
The reasons for the persistent underrepresentation of women as professors and leaders in AHCs and other organizations are complex. Attrition is greater among women as compared with men, particularly during the early stages of a career because of a wide array of factors including traditional gender roles that impact how women are perceived and influence the choices available (and taken) when they confront work/life issues, a lack of a critical mass of female role models and mentors at all career levels, the undervaluing of women’s traditional communication and leadership styles, and more overt discrimination such as divergent pay scales for men and women. Several metaphors may describe the attrition issues: “leaky pipeline,” “blocked pipeline,” “many off-ramps and few on-ramps,” and a “labyrinthine” maze for women.10–14 Within academe, cohort studies have demonstrated that women faculty advance more slowly than men faculty, even when factors such as research productivity are equal.15–17 An alternative explanation for the slow rise of women into leadership is that women leave institutions and organizations because they have less interest in leadership; however, the evidence in support of this theory is mixed.18,19
Within AHCs it is clear that the lack of women in leadership positions is not simply a pipeline problem.1,20,21 For more than two decades women have made up an increasing percentage of graduating physicians, with women representing 49% of those graduating in 2005–20061; yet, that same year, women represented only 32% of medical school faculty and were predominantly at the assistant and associate professor ranks.1 The change in leadership continues to be glacially slow. Currently, women represent only 12% (17/144) of deans at accredited medical schools in the United States and Canada.22
The evidenced scarcity of women in leadership in academic medicine is more dramatic in view of the mounting evidence of the business case for gender diversity in science and technology organizations, especially related to well-educated women at senior levels and on governance boards. Several investigators have observed that companies that are diverse in their ethnic and gender composition also tend to be more financially successful. Factors that contribute to this link are the better tap on the employee market for companies willing to hire from a diverse pool, the input of individuals similar to purchasers on product development and marketing, and the increased innovative potential of diverse groups.8,9,23 Recent evidence also supports the ethical imperative that increased diversity in gender and race, together with cultural competence, leads to better teaching, research, and clinical care environments. This yields a more diverse set of role models for students, a more representative health care workforce for patients, and more effective health care because of the better understanding of disease in the cultural context.24–32
The recognized paucity of women in formal leadership positions, coupled with the documented benefits of a diversified workforce, underscore the importance of examining the often unquestioned assumptions behind the policies and procedures in effect in AHCs, and the embedded “implicit cultural and gender biases” associated with them.4,33–36 Nelson and Rogers37 summarize this need when they conclude that “in order to diversify successfully and open wide the doors for women, universities have to examine culture, attitudes, and policies they have long followed assuredly. This is a long-overdue and realistic response to a changing world.”
In response to concerns regarding the advancement of women and the need for increased diversity, there has been an increasing number of assessments of the organizational climate within U.S. higher education and academic medicine.38–41 However, most studies have documented the perceptions of faculty rather than those in leadership roles (i.e., chairs or deans), and most resulted from a single-institution study rather than a broad regional sample.12,38,42–49 This current study provides a picture of the organizational culture as perceived by the dean, the highest academic officer of a medical school. It also goes beyond a single institution to provide a broad snapshot of the organizational climate, as perceived by institutional leaders at multiple U.S. and Canadian medical schools. Finally, it provides a unique, third-party perspective on the impact of the Executive Leadership in Academic Medicine program (ELAM) on both the institutions where the ELAM fellows practice and on the fellows themselves. To our knowledge, this is the first quantitative study of its kind.
ELAM, officially the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women, is a yearlong, part-time program designed to advance senior women faculty into leadership roles at AHCs. ELAM, now in its 14th year of operation, has demonstrated success in addressing the scarcity of women in leadership in academic medicine.50,51 Each cohort consists of 48 participants who meet for three 1-week residential sessions (in September, in November in conjunction with the annual Association of American Medical Colleges [AAMC] meeting, and in April), and complete individual and group assignments via virtual sessions throughout the program year. The curriculum has three themes: (1) mini-MBA, (2) emerging issues and new approaches for leadership, and (3) personal professional development. (Additional program details may be found at [www.drexelmed.edu/elam].) As of September 2008, the number of current ELAM fellows and alumnae exceeds 570, and 116 (of 144) accredited U.S. and Canadian medical schools (80%) have sponsored at least one faculty member.52 Many U.S. schools have sponsored multiple women, with 35 (of 127; 28%) sending six or more, and 39 (31%) sending between three and five. As of April 2008, 5/17 (29%) of the women deans in accredited U.S. and Canadian medical schools were alumnae of the program.22 The results of this study not only extend other program evaluation research we have conducted but also document the benefits of the ELAM intervention to both alumnae and their schools.50,53
Materials and Method
In May 2006, we obtained a comprehensive list of the entire population of 206 U.S. and Canadian medical and dental school deans from the AAMC and the American Dental Education Association (ADEA). The list included the name of each dean as well as his or her mailing and e-mail address. We sent the survey to the deans of 125 U.S. and 17 Canadian medical schools with both AAMC affiliation and Liaison Committee on Medical Education accreditation and to the deans of the 56 U.S. and Canadian dental schools affiliated with the ADEA. For this study, we report only the data from the medical school deans (N = 142); we will report the data from the dental school deans elsewhere.
We created a questionnaire to solicit the perceptions of the deans with regard to the climate, policies, and leadership opportunities for women faculty at their institutions. With permission, we used seven items measuring the organizational climate from a questionnaire developed by the University of Michigan, the National Science Foundation (NSF) ADVANCE 2005 Survey of the Climate for Women Scientists and Engineers.54 Thematic analysis of data generated from pilot interviews with 16 deans, as well as a review of the relevant literature, led to the development of additional items. In response to pretest feedback, we made minor revisions of wording. Five leaders in AHCs reviewed the questionnaire for content.
The final questionnaire comprises six sections, each with 6 to 16 items, and a section with four open-ended questions about leadership. A minority of respondents answered these four questions, and we will analyze their responses with other data for later reporting. A seven-point Likert scale (1 = strongly disagree, 2 = moderately disagree, 3 = slightly disagree, 4 = neither agree nor disagree, 5 = slightly agree, 6 = moderately agree, 7 = strongly agree) is the response format for three of the sections; a seven-point verbal frequency (1 = never, 2 = rarely, 3 = occasionally, 4 = half the time, 5 = frequently, 6 = usually, 7 = always) is used for one section; and items of the fifth section ask the respondent to indicate whether or not the institution has already implemented, or is considering adding, specific employee policies. The questionnaire is available from the ELAM program upon request (e-mail: email@example.com).
Administration of the questionnaire
The AAMC and ADEA alerted deans that the survey would be coming. In May 2006, we e-mailed a cover letter to the 206 medical and dental school deans explaining the purposes and rationale for the study and our plan to publish the data, along with a link to the consent form, a preaddressed, stamped return envelope for return of one copy, and a link to an electronic version (Survey Monkey) of the questionnaire. The cover letter indicated that a hard copy of the survey was available on request. We sent a total of four reminders, the first two by e-mail and the final two by mail with a $5 Starbucks gift certificate.
Data storage and preliminary data handling
We downloaded data from Survey Monkey into a Microsoft Excel spreadsheet and manually entered and verified hard copy data. To minimize response bias, we used a combination of positively and negatively worded statements, the latter of which we reverse scored to use within the composite. We reverse scored six items. The use of seven-point response scales supported treating the ordinal data as interval for the computation of five composite scores.55 We handled missing values in the following manner: for any composite with more than 33% of the items missing, we did not include the questionnaire in that analysis. We replaced missing values for any item (with fewer than 33% missing for a composite) with the modal response for that item from the entire sample, and we did include the item in the analysis. We calculated Cronbach alphas to assess internal consistency reliability (Table 1).
Our response rate of 58% (n = 83/142) is exceptional given our cohort of busy physician leaders56,57; however, 42% (n = 59/142) of the population did not respond to the survey despite multiple attempts to solicit their input. Given these multiple efforts, it seemed unlikely that a sufficient number of nonrespondents could be obtained to complete a formal analysis of nonresponse. Therefore, we considered respondents as a sample, and we completed analyses to assess the degree to which they represented the larger population on a number of relevant variables: rate of response by gender, NIH ranking,58 and number of ELAM fellows at the institution. Chi-square tests of proportion were nonsignificant for all three variables, allowing the interpretation that the respondents likely reflected the total population.
We constructed the questionnaire to gather information about five constructs: (1) the organizational climate, (2) practices to support leadership development, (3) family-friendly policies, (4) the impact of ELAM fellows on the school, and (5) the impact of ELAM on the ELAM fellows themselves. To further probe the responses, we disaggregated the data and conducted comparative tests to assess the potential for different responses by (1) men and women deans, (2) deans of schools in the top, middle, and lowest NIH ranks, and (3) deans with no ELAM fellows, one to two ELAM fellows, three to five ELAM fellows, and six or more fellows. One of five 2-independent-samples t tests of gender was significant. All four 1-way fixed-effects ANOVAs testing differences among NIH ranking were nonsignificant, and one ANOVA measure, testing the mean differences among deans with different numbers of ELAM fellows, was significant. For all tests, the research design met the assumptions of normality and independence. When the homogeneity of variances assumption was violated, as indicated by a significant Levene, we used the Aspin, Welch, Satterwaite correction to adjust the t test and employed the Brown Forsythe exact test instead of the ANOVA. We used Microsoft Excel to manage the data and then imported the data into SPSS 14.0 for analysis. We used a 0.05 level of significance for all tests, and we have presented only those tests which were significant.
Institutional review board approval
The institutional review boards of both Drexel University College of Medicine (Protocol #42, initial approval September 24, 2002) and The George Washington University (IRB#U020325ER, initial approval March 14, 2003) approved this study as a part of a larger study of medical and dental school deans. Study participants signed and returned a consent form explaining the purpose of the study and authorizing the use of data collected by the survey.
The total response rate of both medical and dental school deans between May and November was 65% (N = 134/206); however, the usable response rate was 57% (n = 117/206) because 17 surveys arrived without consent forms, and we could not count them as valid. In this paper, we report the results from the medical school deans. The usable response rate for the medical school deans was 58% (n = 83/142).
The deans responding to the survey were representative of the total population (Table 2). The chi-square analyses revealed no significant differences on several parameters, including frequency of response by (1) gender (χ2 [df = 1, N = 142] = 0.788, P = .375), (2) NIH ranking of medical schools (χ2 [df = 2, N = 122] = 1.76, P = .414), and (3) number of ELAM fellows at a school (χ2 [df = 3, N = 142] = 2.39, P = .495). The data confirm the paucity of women medical school deans, who numbered only 16 of 142 deans (11%) during the summer of 2006. We found the average tenure of a dean to be 5.0 ± 3.8 years overall and 4.7 ± 4.9 years at the current medical school (n = 75).
Deans’ perceptions of organizational climate for women
Using a seven-point Likert scale, the deans responded to 15 items about the organizational climate for women at their schools (Table 3). Deans perceived that gender equity, as indicated by median scores of 6 and above (items adjusted for reverse scoring noted with brackets), was present for the following nine items:
- My school has a more positive work environment for faculty now than 10 years ago.
- My school has a more positive work environment for women now than 10 years ago.
- Compared with other medical schools, our school has a more positive work environment for women.
- My school enforces gender equity with regard to salary.
- Regular reports on the status of women are important ways to improve the work environment for women.
- My school’s environment promotes adequate collegial opportunities for women.
- There is equal access for both men and women in lab/research space and resources.
- Men [do not] receive preferential treatment in promotion.
- Men are [not] more likely than women to have the authority that is necessary for a leadership responsibility.
Both women and men deans perceived gender inequity in regard to four items:
- Women are appropriately represented in senior positions.
- Some faculty [have] a condescending attitude toward women.
- [More than] time is needed to improve the institutional work environment for women.
- [More than] time is needed for women to move into leadership positions within my school.
The data suggested few differences between the responses of men and women deans. To test this, we produced a composite score of the seven items used in the University of Michigan NSF ADVANCE 2005 organizational climate survey.54 There was no significant difference on this composite (t 81 = 1.019, P = .311) between the men (M = 32.89, SD = 7.41, n = 72) and women (M = 30.45, SD = 7.17, n = 11) dean respondents. On only two items—“In meetings people pay just as much attention when women speak as when men do” and “Men are [not] more likely than women to receive helpful career advice from colleagues” (which was reverse scored)—did the responding men and women deans differ by one to two points, with women deans more likely to perceive inequity.
Flexibility policies and benefits within medical schools
Deans indicated whether their schools had implemented any of 15 policies that are generally considered to be gender equitable or family friendly (Table 4). Only three policies were reported available in more than two thirds of the medical schools according to the 83 deans who answered this question: 73 deans (88%) reported that their medical school provides benefits for part-time faculty, 72 (87%) offer paid maternity leave, and 57 (69%) offer paid paternity leave. Of these 83, between 30 and 47 medical school deans (36%–57%) reported that another seven benefits or policies are available, including regular salary equity analysis, optional delayed tenure clock for childbirth/adoption, a child care facility at or near the institution, mandated representation of women on search committees, recruitment of dual-career couples, optional delayed tenure clock with special family needs, and tenure for salaried part-time faculty.
Five benefits and policies specifically designed to increase recruitment, retention, and advancement of women are, according to our survey respondents, available in fewer than 14% (n = 3–11) of the medical schools: automatic delayed tenure clock for birth or adoption, incentives to chairs to hire women faculty, incentives to departments for reaching gender work environment goals, automatic delayed tenure clock for faculty with special family needs, and a mandate for at least one woman finalist for each search. When the deans were then asked whether these policies were under consideration, more than 60% (n = 49–68; spread = 59–83%) reported they were either not applicable (e.g., tenure) or not under consideration.
There were no significant differences between the policies and benefits available at the medical schools led by men and women deans, by medical schools in the highest and lowest NIH rankings, or by schools with the highest and lowest numbers of ELAM fellows and alumnae.
Practices to develop faculty leadership
The deans used a seven-point verbal frequency scale to indicate the frequency with which they personally used nine practices to support the leadership development of their faculty (Figure 1A). The men and women deans in our sample indicated that they used the combined nine practices more than “half the time” (M = 4.47, SD = 1.02). For the combined practices, the t test indicated that there were significant differences between the men and women deans (t 77 = −2.182, P = .032), with women deans (M = 5.01, SD = 0.717, n = 11) reporting more frequent use of practices than did men (M = 4.35, SD = 0.968, n = 72). Women deans more frequently than men deans used four practices “usually” or “always”: publicly supporting the person when he or she makes a difficult decision (women deans 82% [9/11] versus men deans 65% [47/72]), appointing a faculty member to high-level committees or task forces (73% [8/11] versus 57% [41/72]), nominating faculty to leadership training outside the institution (45% [5/11] versus 28% [20/72]), and nominating faculty to leadership training within the institution (45% [5/11] versus 26% [19/72]).
Men and women deans identified three practices which they used infrequently (fewer than 13% used them usually or always): providing faculty with the opportunity for shadowing (n = 10) and providing coaching by either an external (n = 6) or internal (n = 6) coach.
In addition to indicating the frequency of use, we also asked the deans to indicate whether they perceived each practice to be particularly useful for supporting women (Figure 1B). Men (38/72) as well as women (6/11) deans indicated that appointing women to high-level committees or task forces supported the women’s leadership development (more than 53% combined). Men (33/72) and women (5/11) deans also thought nominating women to leadership training within the institution was helpful (46% combined). However, the responding men and women deans differed substantially in their views of the helpfulness to women of five practices: nominating women to leadership training outside the institution (women deans 73% [8/11] versus men deans 50% [36/72]), mentoring women (women 64% [7/11] versus men 36% [26/72]), publicly supporting a woman when she makes a difficult decision (women 45% [5/11] versus men 29% [21/72]), providing an internal coach for a woman (women 45% [5/11] versus men 15% [11/72]), and providing an external coach for a woman (women 36% [4/11] versus men 17% [12/72]).
Deans’ perceptions of impact of ELAM on their schools and on ELAM fellows
We used a seven-point Likert scale to record the responses to six items about the deans’ perceptions of ELAM fellows on the school (Table 5). The overall impression was positive (M = 5.62, SD = 0.961). The highest mean was for “ELAM fellows have become a valuable resource within my school” (6.15 out of 7.0), and the lowest mean, for “I am confident that our ELAM alumnae are more likely to stay at our institution than other women faculty here,” did not drop below 5.11. The other four survey questions in this section—“ELAM has had a positive impact on my views on the advancement of women”; “ELAM has had a positive impact on the work environment of my school”; “The individual Action Projects completed by ELAM fellows are beneficial to my school”; and “More so than other women, ELAM alumnae provide a critical advisory function about women’s issues for my school”—received positive responses within this spread.
Supporting the concept that ELAM fellows have a perceived positive impact on their schools, significant differences occurred among schools with different numbers of ELAM fellows (F 3, 59 = 4.145, P = .01). The post hoc comparison tests indicated that the deans with three or more fellows (M 3–5 = 5.94, n = 26; M 6+ = 5.89, n = 13) gave significantly more positive responses than those with fewer ELAM fellows (M 0 = 5.00, n = 3; M 1–2 = 5.123, n = 21).
The deans had an even greater perception of the benefit of ELAM to ELAM fellows (M = 6.27 out of 7, SD = 0.789) (Table 5). Seven items using a seven-point Likert scale assessed the general impact of the program on individual fellows, with five additional items querying the likelihood of appointing an ELAM fellow to a new or open position. The deans perceived that the ELAM experience broadens a fellow’s perspectives about academic medical issues; increases her self-confidence; develops her leadership, business, and management skills; has a positive impact on her career development; and increases her local and national visibility. The deans also viewed ELAM alumnae as eligible for leadership positions (M = 5.7, SD = 0.971) (Table 5). Individual means were greater than 5.5 out of 7.0 for perceived advancement for both informal leadership positions (committee or task force chairs) and formal positions in the dean’s office or as department or center heads.
This first survey of perceptions of medical school deans in the United States and Canada found that they perceived gender inequity in four important areas: (1) there is a lack of appropriate representation of women in senior positions, (2) a condescending attitude toward women on the part of some faculty continues to exist, (3) time alone is insufficient for women to move into leadership positions, and (4) time alone is insufficient to improve the institutional work environment for women (Table 3). These findings support previous reports that time alone is not sufficient to ensure the advancement of women to senior positions and that explicit interventions are needed to reach gender equity.4,5 When the deans considered the impact of the ELAM program, they reported that it seems to be a useful intervention, having a positive impact on their schools and benefiting the fellows themselves in regard to knowledge, skills, and eligibility for advancement (Table 5).
A major theory about the advancement of women is that a critical mass of women, especially at leadership levels, is necessary to achieve gender equity and to effect organizational change.23,59–61 A recent study of Australian universities demonstrated that a critical mass of more than 30% women in senior management is associated with increased networks, encouragement, and support from organizational leaders, friendly and collegial environments, and strong organizational commitment to values.60 Another study found that having three women on corporate boards (about 25% of the usual 12 members) provided broader perspective, more consideration of difficult or controversial issues, introduction of new product lines, more attention to women employees and succession planning, and more collaborative group dynamics.23 Further studies have correlated increased organizational results with an increased proportion of women leaders.6,62
Our study supports this theory of a critical mass of women. Deans at schools with three or more ELAM fellows were statistically more likely to perceive that fellows had a positive impact on their school (Table 5). Further study is needed to determine whether the deans’ positive perceptions of ELAM fellows will translate into a positive effect for all women faculty and an increase in the number of successful senior women faculty. Further, there seemed to be a more consistent perception of the positive impact of ELAM fellows as evidenced by less variance of response at schools with greater numbers of ELAM fellows. Although some could argue that these findings are simply an indication that deans who like the ELAM program continue to send women faculty, we have reason to believe that this is not the case. The mean tenure for responding medical school deans was 5.0 years overall and 4.7 years at the current medical school, making it unlikely that only the responding dean sent all of any given medical school’s ELAM fellows and alumnae to the program.
Several studies have suggested that there is often a marked difference between the perceptions of leaders and those in positions of reduced authority on organizational climate issues. These studies have found that the majority (usually white men in leadership roles) perceives life for the minority (usually women and/or people of color) as better than how the minority itself perceives its lot.12,40,42,44,49,62,63 Within AHCs, Souba et al64 found that deans consistently rated the leadership climate more positively than did surgery chairs. Our study seems to confirm this difference in perception; the responding deans reported that the organizational climate for women was improving at their institutions and that, overall, there were no major differences in climate for men and women (Table 3), even though recent studies of AHC faculty have documented a less positive perception of organizational climate.47
We found few statistically significant gender-related differences among the deans. This may indeed reflect a true absence of gender-based differences. However, a more compelling possibility is the insufficient power of the statistical tests to detect existing differences due to the small number of women deans in the population. Even with a 69% response rate of the women deans, this was a sample of only 11, which, coupled with the inequality of sample sizes, seriously limited the power of the tests.
It is interesting that for this sample, on two items the women deans perceived a poorer organizational climate than did the men deans. Women deans had a two-point-lower median score on “In meetings people pay just as much attention when women speak as when men do.” This phenomenon of women’s contributions becoming “disappearing acts” is well documented,65,66 and many prestigious senior women leaders often mentioned it as a common occurrence in their professional lives.67 Also, women deans had a one-point-lower median score on “Men are no more likely than women to receive helpful career advice from colleagues”; this general perception, that men are more likely to receive helpful career advice and mentoring, has been recorded in other studies as well.68,69
Responding women and men deans did differ significantly on one important leadership role: practices used to promote leadership development. Women deans used all nine identified practices to develop leadership in their faculty more frequently than men (Figure 1A). Additionally, more of the women than men dean respondents identified specific strategies as being of particular use in the development of women (Figure 1B). These data support meta-analytic findings that women leaders differ from men most on considering individuals—including developing, supporting, and rewarding their direct reports.70–72
Many recent studies on faculty development and satisfaction have emphasized that organizational issues are central in the decisions faculty make about career choices including whether or not to stay at a given institution or within academia.39,73,74 A recent study of five medical schools highlighted key components in faculty recruitment and retention: processes and structures that (1) are fair, (2) are transparent and facilitate open communication between faculty and administrators, and (3) lead to collegial interpersonal relationships.75 Given the financial cost of faculty turnover coupled with the decreasing resources of many AHCs, retaining highly productive faculty, including women and minority faculty members, is critical to the economic well-being and general health of AHCs.76
Numerous recent studies considering organizational culture as it pertains to balancing faculty careers and family report the adverse effects on women faculty of having children, the bias against care giving, and the need for greater flexibility in academic careers.77–83 Unfortunately, there seems to be little movement to change the situation. Women physicians and their physician daughters both report entrenched gender discrimination and sexual harassment.84 Of the 15 policies we identified as family friendly and gender equitable, none are offered by 100% of medical schools, and only three are offered at more than two thirds: benefits for part time faculty (88%), paid maternity leave (86.7%), and paid paternity leave (68.7%). For the other 12 policies there is limited use, and often little or no expressed interest in implementing them. These seemingly “dead in the water” policies include an automatic delayed tenure clock for childbirth, adoption, or special family needs; tenure for part-time faculty; and recruitment practices for dual careers (Table 4). This study cannot tell us why none of these family-friendly benefits are offered on a consistent basis across institutions, but it does suggest that schools are either not fully committed to implementing the changes to traditional academic structure and culture that are implicit in creating a family-friendly, gender-neutral environment, or that schools are not confident about which benefits and policies will most effectively promote a family-friendly agenda—or a combination of the two. Moreover, this study focused on the issues of early and midcareer faculty, and it did not address policies and procedures for senior-level faculty, such as phased retirement or availability for part-time work at senior levels; the gender impact of such policies has not been sufficiently investigated.
Numerous internal organizational interventions have been proposed or implemented to address the deficits in organizational culture and women’s leadership development. The “simple solution” of Daniel Cheever,85 president of Simmons College, is that “more men should be doing their fair share of the work at home.” He asserts that the academic community needs to view helping women succeed, child care, single motherhood, women’s health, and domestic abuse as not “women’s issues” but as issues that belong to all. Mirroring this sentiment, Gloria Steinem,86 in a recent commencement address, stated,
Your generation (of women) … often still says: How can I combine career and family? … First of all there can be no answer until men are asking the same question. Second, every other modern democracy in the world is way, way ahead of this country in providing a national system of child care, and job patterns adapted to the needs of parents, both men and women.
In many respects, corporate America is ahead of academia in addressing these issues, requiring bosses to identify and mentor women and minorities in their pool of possible successors, and keeping women connected while they are home raising children.87 Within academia, perhaps the most far-reaching organizational changes have come as the result of the NSF ADVANCE Institutional Transformational Awards to advance women in science, technology, engineering, and math.88,89 Unfortunately, these awards were available primarily for science, technology, engineering, and math disciplines—not for medical and other clinically oriented schools. It is encouraging that NIH has recently announced a request for applications in this area; this could certainly be a catalyst for change within the medical and clinical settings, and it could help the Clinical Transformational Science Awards to reach their full potential for interdisciplinary teamwork that values the contributions of all.90
A few institutions have provided financial awards with the explicit purpose of enabling junior women scientists to balance family life, such as awards for child care while away at scientific meetings or hiring an assistant when on maternity leave.91–93 Others have used workshops with a focus on dialogues or drama to facilitate faculty discussion and understanding about the need for organizational family-friendly cultural change.94,95 Related initiatives have focused on educating faculty about unconscious gender schemas that impede equitable hiring and promotion practices.96,97 Especially notable are the NSF Georgia Tech initiative ADEPT (Awareness of Decisions in Evaluating Promotion and Tenure) and the University of Wisconsin’s climate workshops for department chairs and special training for hiring committees.98–100 In addition, broadening the view of scholarship to recognize interdisciplinary and team science is likely to promote gender equity.75,101,102 The ELAM program is one external intervention that this study and previous studies show to be effective in increasing senior women faculty’s leadership knowledge and skills, as well as helping them achieve their leadership aspirations in AHCs.50,51 Importantly, this is one of few studies103 that document a leadership program’s effectiveness from the view of stakeholders beyond the women scientist/physician participants themselves. The study adds to the body of knowledge about programs, policies, and attitudes that facilitate real gender equity at all organizational levels, by providing the unique perspective of deans of U.S. and Canadian medical schools regarding their organizational climate and culture, as well as the impact of a national leadership program on individual participants and the institutions they serve. The study also elucidates the specific practices that these institutional leaders use to develop up-and-coming leaders and the prevalence of family-friendly policies at the schools of responding deans. This study, taken in concert with previous research, suggests that a variety of approaches are essential to ensure that women achieve the critical mass needed to guarantee the linked goals of increased organizational effectiveness and gender equity.
This research was supported in part by grants from the Robert Wood Johnson Foundation and the Jessie Ball duPont Fund. The Mayo Medical School, University of Michigan Medical School, Vanderbilt University School of Medicine, and Wright State University School of Medicine also supported this research. None of the sponsors had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.
The authors would like to acknowledge Victoria C. Odhner for her contributions to research administration as well as several graduate students, especially Yu-Chuan Chuang and Brian Sponsler, both in the Center of Educational Leadership and Transformation at The George Washington University, for their assistance in data survey development and data verification.
3 Bystydzienski JM, Bird SR. Removing Barriers: Women in Academic Science, Technology, Engineering, and Mathematics. Bloomington, Ind: Indiana University Press; 2006.
4 Committee on Maximizing the Potential of Women in Academic Science and Engineering, Committee on Science Engineering and Public Policy. Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering. Washington, DC: National Academies Press; 2007.
5 Committee on the Guide to Recruiting and Advancing Women Scientists and Engineers in Academia, Committee on Women in Science and Engineering, Policy and Global Affairs, National Research Council of the National Academies. To Recruit and Advance: Women, Students and Faculty in U.S. Science and Engineering. Washington, DC: National Academies Press; 2006.
6 Helfat CE, Harris D, Wolfson PJ. The pipeline to the top: Women and men in the top executive ranks of U.S. corporations. Acad Manage Perspect. November 2006;20:42–64.
8 European Commission. Women in Science and Technology: The Business Perspective. Brussels, Belgium: European Commission; 2006.
9 Catalyst. The Bottom Line: Connecting Corporate Performance and Gender Diversity. New York, NY: Catalyst, Inc.; 2004.
10 Hewlett SA, Luce CB. Off-ramps and on-ramps: Keeping talented women on the road to success. Harv Bus Rev. March 2005;83:43–53.
11 Goodman JS, Fields DL, Blum TC. Cracks in the glass ceiling: In what kinds of organizations do women make it to the top? Group Organ Manage. 2003;28:475–501.
13 White JS. Pipeline to pathways: New directions for improving the status of women on campus. Lib Educ. Winter 2005;91:22–27.
14 Eagly AH, Carli LL. Women and the labyrinth of leadership. Harv Bus Rev. September 2007;85:62–71.
15 Valian V. Why So Slow? The Advancement of Women. Cambridge, Mass: MIT Press; 1998.
16 Ash AS, Carr PL, Goldstein R, Friedman RH. Compensation and advancement of women in academic medicine: Is there equity? Ann Intern Med. 2004;141:205–212.
17 Nonnemaker L. Women physicians in academic medicine: New insights from cohort studies. N Engl J Med. 2000;342:399–405.
19 Buckley LM, Sanders K, Shih M, Kallar S, Hampton C. Obstacles to promotion? Values of women faculty about career success and recognition. Committee on the Status of Women and Minorities, Virginia Commonwealth University, Medical College of Virginia Campus. Acad Med. 2000;75:283–288.
20 Bickel J, Wara DW, Atkinson BF, et al. Increasing women’s leadership in academic medicine: Report of the AAMC Project Implementation Committee. Acad Med. 2002;77:1043–1061.
21 Nora LM. Academic medicine gets a poor report card—What are we going to do? Acad Med. 2002;77:1062–1066.
22 Richman R. Internal Executive Leadership in Academic Medicine (ELAM) Program Documentation. Women medical, dental, and public health deans in the U.S. and Canada [unpublished]. August 2008.
24 Ely RJ, Thomas DA. Cultural Diversity at Work: The Moderating Effects of Work Group Perspectives on Diversity. Boston, Mass: Center for Gender in Organization. October 2000. Working paper no. 10.
25 Nunez-Smith M, Curry LA, Bigby J, Berg D, Krumholz HM, Bradley EH. Impact of race on the professional lives of physicians of African descent. Ann Intern Med. 2007;146:45–51.
26 Betancourt JR, Reid AE. Black physicians’ experience with race: Should we be surprised? Ann Intern Med. 2007;146:68–69.
27 Tedesco LA. Post-affirmative action Supreme Court decision: New challenges for academic institutions. J Dent Educ. 2005;69:1212–1220.
28 Van Ummersen CA. No talent left behind: Attracting and retaining a diverse faculty. Change. 2005;37:26–31.
30 Mundell EJ. For better science, just add color: Bold ideas are needed to boost sagging minority participation in the life sciences. The Scientist. November 7, 2005. Available at: (http://www.the-scientist.com/2005/11/07/s8/1
). Accessed September 30, 2008.
32 Bickel J, Brown AJ. Generation X: Implications for faculty recruitment and development in academic health centers. Acad Med. 2005;80:205–210.
33 Ely RJ, Meyerson DE. Theories of Gender in Organizations: A New Approach to Organizational Analysis and Change. Boston, Mass: Center for Gender in Organizations, Simmons School of Management; May 2000. Report no. 8.
34 Morahan P, Bickel J. Capitalizing on women’s intellectual capital in the professions. Acad Med. 2002;77:110–112.
35 Ely R, Meyerson D. Advancing gender equity in organizations: The challenge and importance of maintaining a gender narrative. Organization. 2000;7:589–608.
36 Gordon C, Keyfitz BL. Women in academia: Are we asking the right questions? Notices Am Math Soc. 2004;51:784–786.
38 Kirch DG, Grigsby RK, Zolko W, et al. Reinventing the academic health center. Acad Med. 2005;80:980–989.
39 Bland CJ, Seaquist E, Pacala JT, Center B, Finstad D. One school’s strategy to assess and improve the vitality of its faculty. Acad Med. 2002;77:368–376.
40 Corley EA. How do career strategies, gender, and work environment affect faculty productivity levels in university-based science centers? Rev Policy Res. 2005;22:637–645.
41 McGuire LK, Bergen MR, Polan ML. Career advancement for women faculty in a U.S. school of medicine: Perceived needs. Acad Med. 2004;79:319–325.
42 Carr P, Ash AS, Friedman RH, et al. Faculty perceptions of gender discrimination and sexual harassment in academic medicine. Ann Intern Med. 2000;132:889–896.
43 Yedidia MJ, Bickel J. Why aren’t there more women leaders in academic medicine? The views of clinical department chairs. Acad Med. 2001;76:453–465.
44 Hostler S, Gressard R. Perceptions of the gender fairness of the medical education environment. J Am Med Womens Assoc. 1993;48:51–54.
45 Kalet AL, Fletcher KE, Ferdman DJ, Bickell NA. Defining, navigating, and negotiating success: The experiences of mid-career Robert Wood Johnson Clinical Scholar Women. J Gen Intern Med. 2006;21:920–925.
47 The Collaborative on Academic Careers in Higher Education. Tenure-Track Faculty Job Satisfaction Survey: Highlights Report. Cambridge, Mass: Harvard University; August 1, 2007.
48 Bilimoria D, Perry SR, Liang X, Higgins P, Stoller EP, Taylor C. How do female and male faculty members construct job satisfaction? The roles of percieved institutional leadership and mentoring and their mediating processes. J Technol Transf. 2006;31:355–365.
49 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.
50 McDade SA, Richman RC, Jackson GB, Morahan PS. Effects of participation in the Executive Leadership in Academic Medicine (ELAM) program on women faculty’s perceived leadership capabilities. Acad Med. 2004;79:302–309.
51 Dannels SA, Yamagata H, McDade SA, et al. Evaluating a leadership program: A comparative, longitudinal study to assess the impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women. Acad Med. 2008;83:488–495.
52 Richman R. Personal communication. February, 2008.
53 Sloma-Williams L, McDade SA, Richman RC, Morahan PS. The role of self-efficacy in developing women leaders: A case of women leaders in academic medicine and dentistry. In: Dean DR, Bracken SJ, Allen JK, eds. Women in Academic Leadership: Professional Strategies, Personal Choices. Sterling, Va: Stylus Publishing; 2007.
54 Malley JE, Rainwater K, Stewart A. Summary of analysis of the climate for women scientists and engineers in 2001 and 2005. Network of Women Scientists and Engineers Climate Survey. Available at: (http://www.umich.edu/∼advproj/climate2005.pdf
). Accessed September 30, 2008.
55 Jaccard J, Wan CK. LISREL Approaches to Interaction Effects in Multiple Regression. Thousand Oaks, Calif: Sage; 1996.
56 Veitch C, Hollins J, Worley P, Mitchell G. General practice research: Problems and solutions in participant recruitment and retention. Aust Fam Physician. 2001;30:399–406.
57 Garimella RN, Plichta SB, Houseman C, Garzon L. How physicians feel about assisting female vicitims of intimate-partner violence. Acad Med. 2002;77:1262–1265.
59 Kanter RM. Men and Women of the Corporation. New York, NY: Basic Books; 1993.
60 Chesterman C, Ross-Smith A. Not tokens: Reaching a “critical mass” of senior women managers. Employee Relat. 2006;28:540–552.
61 Ely RJ. The power of demography: Women’s social constructions of gender identitiy at work. Acad Manage J. 1995;38:589–634.
63 Witte FM, Stratton TD, Nora LM. Stories from the field: Students’ descriptions of gender discrimination and sexual harrassment during medical school. Acad Med. 2006;81:648–654.
64 Souba WW, Mauger D, Day DV. Does agreement on institutional values and leadership issues between deans and surgery chairs predict their institutions’ performance? Acad Med. 2007;82:272–280.
65 Fletcher JK. Disappearing Acts: Gender, Power, and Relational Practice at Work. Cambridge, Mass: The MIT Press; 2001.
66 Valian V. Sex, schemas, and success: What’s keeping women back? Academe. September–October 1998;84:50–55.
67 Morahan P. Personal communication. January, 2008.
68 Gersick CJG, Bartunek JM, Dutton JE. Learning from academia: The importance of relationships in professional life. Acad Manage J. 2000;43:1026–1044.
69 Haapanen KJ, Ellsbury KE, Schaad DC. Gender differences in the perceptions of mentorship among first and second year medical students. Acad Med. 1996;71:794.
71 Eagly AH, Johannsen-Schmidt MC, van Engen ML. Transformational, transactional and laissez-faire leadership styles: A meta-analysis comparing women and men. Psychol Bull. 2003;129:569–591.
72 Arnold KA, Loughlin C. Promoting Transformational Leaders: Gender and Time Spent “Doing” Individualized Consideration. Philadelphia, Pa: National Meeting of Academy of Management; 2007.
73 Nyquist JG, Hitchcock MA, Teharani A. Faculty satisfaction in academic medicine. New Dir Inst Res. 2000;27:33–43.
74 Pathman DE, Konrad TR, Williams ES, Scheckler WE, Linzer M, Douglas J. Physician job satisfaction, job dissatisfaction, and physician turnover. J Fam Pract. 2002;5:593–597.
75 Bunton SA, Mallon WT. The continued evolution of faculty appointment and tenure policies at U.S. medical schools. Acad Med. 2007;82:281–289.
76 Waldman JD, Kelly F, Arora S, Smith HL. The shocking costs of turnover in health care. Health Care Manage Rev. 2004;29:2–7.
77 Mason MA, Goulden M. Do babies matter? The effects of family formation on the lifelong careers of academic men and women. Academe. 2002;88:21–27.
78 Drago R, Colbeck C, Stauffer KD, Pirretti A. Bias against caregiving. Academe. 2005;91:22–25.
79 Miller JE, Hollenshead C. Gender, family, and flexibility—Why they’re important in the academic workplace. Change. November/December 2005;37:58–62.
80 Marcus J. Helping academics have families and tenure too. Change. March/April 2007;39:27–32.
81 Gatta ML, Roos PA. Balancing without a net in academia: Integrating family and work lives. Equal Oppor Int. 2004;23:122–142.
83 Mason MA, Goulden M. Marriage and the baby blues: Redefining gender equity in the Academy. Ann Am Acad Pol Soc Sci. 2004;596:86–103.
84 Shrier DK, Zucker AN, Mercurio AE, Landry LJ, Rich M, Shrier LA. Generation to generation: Discrimination and harassment experiences of physician mothers and their physician daughters. J Womens Health. 2007;16:883–894.
85 Cheever DS. Women’s progress: A simple solution. Chron High Educ. October 7, 2005:B16.
87 Catalyst. Flexible Work Arrangements III: A Ten-Year Retrospective of Part-Time Arrangements for Managers and Professionals. New York, NY: Catalyst, Inc.; 2000.
89 Rosser SV, Chameau JL. Institutionalization, sustainability, and repeatability of ADVANCE for institutional transformation. J Technol Transf. 2006;31:335–344.
90 Carnes M, Bland C. Viewpoint: A challenge to academic health centers and the National Institutes of Health to prevent unintended gender bias in the selection of clinical and translational science award leaders. Acad Med. 2007;82:202–206.
91 Stephenson J. Relief for women scientists—Christiane Nusslein-Volhard Foundation. JAMA. 2005;294:297.
93 Wilson R. Family science. Chron High Educ. July 22, 2005:A6.
94 Quinn K, Yen JW, Riskin EA, Lange SE. Enabling family-friendly cultural change. Change. July/August 2007;39:42–47.
96 Moody J. Rising Above Cognitive Errors: Guidelines for Search, Tenure Review, and Other Evaluation Committees. San Diego, Calif: Joann Moody; 2005.
97 Biernat M, Fuegan K. Shifting standards and the evaluation of competence: Complexity in gender-based judgment and decision making. J Soc Issues. 2001;57:707–724.
98 Georgia Institute of Technology. ADEPT. Promotion and Tenure: Awareness of Decisions in Evaluating Promotion and Tenure. Available at: (http://www.adept.gatech.edu
). Accessed September 30, 2008.
101 Austin LS. What’s Holding You Back? Eight Critical Choices for Women’s Success. New York, NY: Basic Books; 2000.
102 Morahan PS, Fleetwood J. The double helix of activity and scholarship: Building a medical education career with limited resources. Med Educ. 2008;42:34–44.
103 von Vultée P, Axelsson R, Arnetz B. Individual and organizational well-being of female physicians: An assessment of three different management programs. MedGenMed. January 2004;6:4.