American higher education is committed to diversity. Advocates say that diversity improves the learning environment1–15; that, for example, enrolling college students with widely different demographic characteristics and experiences encourages a more free-wheeling and wide-ranging interpretation of academic topics.
Medical schools have become especially strong diversity advocates. According to Joseph B. Martin, faculty dean of medicine at Harvard University, a “diverse and culturally sensitive medical profession, without a doubt, delivers higher quality health care.”10 Increasingly, universities herald their diversity, not just within the student body but also in the faculty and administration. In 2007, National Public Radio carried a story about Nancy Andrews becoming Duke University's first female medical school dean.1 In commenting on this notable accomplishment, Andrews said she “believe[s] strongly that diversifying all levels of academic medicine is not only politically correct, it also … make[s] our institutions better.”1 She went on to say it was “puzzling that there are not more women in leadership positions in academic medicine.”1 (Others have discussed increasing the percentage of female medical school deans.11,16,17)
Medical schools have expressed equal pride when a member of a racial minority is appointed dean. In 2000, an AAMC Bulletin stated that Donald Wilson had become the country's “first African-American dean of a predominantly nonminority accredited medical school [Maryland].”18 Wilson has been recognized for his commitment to diversity and equity in health care and for fostering an environment that values and celebrates cultural and gender diversity.19
To measure diversity, medical schools gather data about particular underrepresented groups. The Association of American Medical Colleges lists this information on its Web site.20 Of the categories measured, underrepresented socioeconomic background has received markedly less attention than the others, and it has been applied only to students,6,21,22 not administrators. Anyone interested in the socioeconomic diversity of medical school deans quickly learns that none of the field's formal organizations gather and publicize data about the social class origins of these officials.
Given the control deans exercise over medical school operations4,23 and the influence they yield beyond the academy, reformers understandably want greater demographic diversity among these administrators. So, it is “puzzling,” to use Dean Andrews'1 word, that diversity advocates have not demanded the hiring of more deans of humble origins. If diversity at every level of academic medicine improves educational institutions, as Andrews1 insists, why are medical schools not bragging about having appointed a dean whose parents never finished high school and worked as janitors all their adult lives?
The first step toward expanding the definition of diversity is to show that this expansion is necessary. I address that challenge by exploring the socioeconomic origins of today's medical school deans. My findings demonstrate that medical schools have good reason to include social class origins in their affirmative action efforts for selecting deans.
In this study, I gauged the social class backgrounds of deans at America's elite medical schools, by which I mean the 50 medical programs ranked highest in the 2009 issue of U.S. News & World Report's America's Best Graduate Schools.24 I chose these institutions because if these leading programs, having been shown the evidence that more socioeconomic integration is needed, begin weighing class considerations for diversity purposes, other schools may follow their precedent.25 Nonetheless, the study's logic, rationale, and methodology are easily transferable to any accredited American medical school.
I gathered data using a four-item questionnaire, distributed in three waves during spring 2009, that asked 50 deans to indicate their parents' highest levels of education and principal occupations during the respondents' youth. The questionnaire guaranteed that all answers would only be used for statistical purposes and that no individuals would be identified in any materials drawn from the data. The University of Illinois–Springfield human subjects review committee approved this research project.
I measured socioeconomic background according to parental education and occupation. This is consistent with how the American Medical College Application Service26 applies the concept to students. I wanted to compare the socioeconomic backgrounds of current deans with those of the U.S. population. Yet, socioeconomic measures change over time, as education becomes more affordable, for instance, or as economic conditions improve. So, I had to find the correct cohort in the general population with which I could appropriately compare the deans. More accurately, I had to find the correct cohort with which to compare the deans' parents, as it is the parents' education and occupation that define the socioeconomic background of the deans.
In their 2008 study of burnout among medical school deans, Gabbe et al23 reported that the median and mean age of their respondents was 60 years, suggesting that most of the 34 respondents were born sometime in the late 1940s to early 1950s. I assumed that most of these deans were born to parents between the ages of 25 and 34 years, the main childbearing time for most couples. Because the number of years of formal schooling completed has been rising among Americans over the last several decades, I decided it best to compare the deans' parents with other Americans of the same age. Using U.S. Census figures for the year 1950,27 I compared the educational levels of the deans' parents with those of other Americans who were 25 to 34 years old, many of whom were young couples raising children of their own.
In 1950, the U.S. Census Bureau listed highest education attainment as “four years or more” of college. It did not separately list graduate and professional schooling, nor did it distinguish between individuals who had received a college degree and those who had attended four years or more of higher education without actually graduating; all were categorized as having “four years or more” of higher education. Although the number of Americans who completed four years of college without graduating was probably miniscule, it is important to note this technicality. In contrast, to gain a more precise understanding of the deans' backgrounds, I asked them to indicate whether their parents had received a diploma and whether they had completed schooling beyond undergraduate college. The categories of postundergraduate education offered on the questionnaire were (1) attended graduate school, (2) completed graduate school (master's degree), (3) PhD, or equivalent (e.g., EdD), (4) attended law school, (5) completed law school, (6) attended medical school, (7) completed medical school, and (8) other (specify).
I scored the respondents' parental occupations using the 1950 Nam–Powers career ranking system.28 Nam–Powers assigns a value from 0% to 100% to each U.S. Census job category using a formula that weighs the median education and income levels of all individuals employed in that category. The values are updated after each census. In 1950, dentists (99%), accountants (92%), and veterinarians (95%) were among the highest-rated careers, shipping and receiving clerks (58%) and upholsterers (53%) ranked in the middle ranges, and babysitters (7%) and shoe shiners (2%) were two of the lowest categories.
The 1950 Nam–Powers study only evaluated and listed information relating to men in the workforce; there was no separate scale and analysis for women. Because this was before the women's movement and laws requiring pay equity between the sexes, women working outside the home in 1950 likely earned lower wages than their male counterparts doing the same jobs. Thus, the 1950 Nam–Powers scale is less exact in measuring the socioeconomic status of women in the workforce. Still, because a high percentage of the deans' mothers worked in white collar occupations and because it was the best alternative available, I assumed that the Nam–Powers male occupational scores reasonably reflected the class status of these women. Moreover, because I grouped the survey results in deciles, I had some leeway in interpreting the scores. If a respondent marked “lawyer” for both parents' occupations, I assigned each a Nam–Powers score of 98%, putting both in the 90–100 range (see Table 1). Even if it were more accurate to assign female lawyers in 1950 a Nam–Powers score of 90%, they would still fall within the 90–100 range. In sum, I deemed the 1950 Nam–Powers scores fair, if imperfect, approximations of both parents' socioeconomic circumstances and, therefore, of the socioeconomic backgrounds of the responding deans.
Parenthetically, just over one-third of the responding deans indicated that their mothers had not worked outside the home. Because the 1950 Nam–Powers scale did not include a category for domestic work responsibilities, I omitted such responses from the analysis.
I matched the survey results with U.S. population figures using four controls. First, I compared the survey responses on parental education with national statistics by gender. That is, I matched the deans' fathers' education levels against those of all U.S. males aged 25–34 years as reported in the 1950 census; I compared the deans' mothers' education levels the same way.
Second, I sorted the deans' parental schooling answers after controlling for highest education by household. Although the 1950 census did not separate data this way, I considered this procedure another useful measure of the deans' socioeconomic circumstances growing up and, it follows, of the social, financial, and cultural capital29 available to them during their youth. (Others have offered similar comments about access to such assets.8,22,30)
Third, I sorted the survey results to show the percentage of deans' mothers and fathers who held advanced degrees, putting those who had completed a master's in one category and those who had finished a PhD, MD, etc., into another. These results offer further evidence for how different in their origins these medical school deans are from the U.S. population.
Finally, I classified the deans' parents' professions using the Nam–Powers occupational ranking scale.
Thirty-four of the 50 deans replied, a 68% participation rate. There was no obvious pattern in the return distribution, meaning, for instance, that deans from the top 25 programs were no more or less likely to respond than those from schools ranked 26 to 50.
Figure 1 compares the deans' fathers' education levels with those of the U.S. population of men aged 25–34 years in 1950. The figures above each pair of bars are the ratios (rounded to the nearest tenth) between the two percentages. The results show that the deans' fathers were more than five times as likely to have earned a college degree or more than were men in the general population. At the other end of the distribution, U.S. men were 3.5 times more likely to have not completed high school than were the respondents' fathers. Finally, the deans' fathers were about twice as likely as other men to have attended college without finishing a four-year degree.
Figure 2 shows the same comparison between the deans' mothers and U.S. women aged 25 to 34 years in 1950. Deans' mothers were almost 11 times more likely to have completed at least an undergraduate degree than were women in the general population. At the other end of the spectrum, women in the general population were approximately four times more likely to have failed to complete high school than were the respondents' mothers. In sum, the educational disparities between the deans' mothers and other U.S. women were pronounced. These findings suggest that mothers played an important role in motivating and fostering the aspirations of their sons (most of the deans are men).
When asked about their parents and advanced degrees, roughly one-third of the deans said their parents had taken course work beyond the undergraduate level, with all but two of these mothers and fathers having completed a graduate or professional degree. Of the deans' mothers, 17.6% completed a master's degree and 5.9% went on to attain a doctorate or professional degree. Of their fathers, 14.7% finished a master's degree and 17.6% earned a doctorate or professional degree. The ratio of deans' parents with advanced degrees compared with the U.S. population having “four years or more” of college is roughly 4:1, further demonstrating the wide gap between the respondents' origins and those of the U.S. population.
Various researchers30–32 have shown how parental education profoundly affects children. Even if only one parent holds a college degree, children raised in these circumstances acquire many of the attitudes and intellectual skills associated with academic success, starting with the simple notion that one can complete four or more years of advanced education.33 Although it was impossible to compare my survey data with the U.S. population (because the 1950 U.S. Census did not report highest education level by household), I nonetheless decided that measuring the deans' home environments by highest parental education would help me understand the early socioeconomic conditions that propelled them toward careers as administrators at America's top medical schools. After controlling for highest parental education by household, the analysis showed that 71% of these deans were raised in families where at least one parent had completed an undergraduate degree or more. A further breakdown revealed that 41% of these households were headed by a parent who had taken course work beyond the undergraduate level, with 35% having finished a master's, doctorate, or professional degree. This further demonstrates the high proportion of respondents who grew up in environments especially conducive to success in formal education.
Table 1 presents the findings for parental socioeconomic status using the Nam–Powers scale. The analysis shows that roughly three-quarters of the deans' mothers and fathers worked in occupations ranked in the top 20% of the Nam–Powers categories. Nearly two-thirds of the fathers held jobs ranked in the top 10%. Conversely, fewer than 6% of the fathers and 5% of the mothers worked in jobs rated in the bottom half of the scale.
Prior to the 1990s, little attempt was made to diversify the student body of medical schools according to socioeconomic background. Most medical students came from the privileged classes, and thus the current pool for deans is not diverse. My findings simply support this already-apparent conclusion. But should we stop there? Following Dean Andrews'1 advice that “diversifying all levels of academic medicine is not only politically correct, it is also the way to make our institutions better,” perhaps we should now apply the efforts we've made to achieve socioeconomic diversity among students with equal force to those who administer and lead our medical schools.
Deans at the nation's top 50 medical schools are disproportionately drawn from highly educated and privileged socioeconomic origins, as measured by parental education and occupation. These findings support the argument for expanding current diversity efforts to include hiring more medical school deans of working and poverty class origins.
Madolyn Kimberly and Elsie Bilderback assisted with this project.
The University of Illinois–Springfield human subjects review committee approved this research project.
The author received no outside grants or awards to conduct this research. Madolyn Kimberly and Elsie Bilderback bear no responsibility for the ideas expressed in this report.
1Andrews NC. Climbing through medicine's glass ceiling. N Engl J Med. 2007;357:1887–1891.
2Bromberg MS. Harvard Law School's war over faculty diversity. J Blacks High Educ. 1993;1:75–82.
4Cohen JJ, Gabriel BA, Terrell C. The case for diversity in the health care workforce. Health Aff (Millwood). 2002;21:90–102.
5Francis CK, Alpert JS, Clark LT, Clark LT, Ofili EO, Wong RC. Working group 3: How to encourage more minorities to choose a career in cardiology. J Am Coll Cardiol. 2004;44:241–245.
6Jolly P. Diversity of U.S. medical students by parental income. AAMC Analysis in Brief. January 2008;8:1–2.
7Kingston R, Tisnado D, Carlisle DM. Increasing racial and ethnic diversity among physicians: An intervention to address health disparities? In: Smedley BD, Colburn L, Evans CH, eds. The Right Thing to Do, the Smart Thing to Do: Enhancing Diversity and Health Professions. Washington, DC: National Academies Press; 2001.
8Lakhan S. Diversification of U.S. medical schools via affirmative action implementation. BMC Med Educ. 2003;3:6.
11Richman RC, Morahan PS, Cohen DW, McDade SA. Advancing women and closing the leadership gap: The executive leadership in academic medicine (ELAM) program experience. J Womens Health Gend Based Med. 2001;10:271–277.
13Statement of John Yuasa, Health Policy Director, The Greenlining Institute. University of California medical school admissions and shortages in the California health care workforce. Joint Informational Hearing Senate Health Committee. February 23, 2005. Available at: http://strategy.ucsf.edu/stories/changing-the-face-of-medical-education/
. Accessed August 14, 2010.
14Steinecke A, Terrell C. After affirmative action: Diversity at California medical schools. AAMC Analysis in Brief. September 2008;8:1–2.
15University of Maryland Medical Center. University of Maryland School of Medicine dean becomes chair of the Association of American Medical Colleges. Available at: http://www.umm.edu/news/releases/wilson_aamc.htm
. Accessed August 14, 2010.
16Dannels SA, McLaughlin JM, Gleason KA, McDade SA, Richman RC, Morahan PS. Medical school deans' perceptions of organizational climate: Useful indicators for advancement of women faculty and evaluation of a leadership program's impact. Acad Med. 2009;84:67–79.
19Association of American Medical Colleges. AAMC names University of Maryland dean first recipient of Nickens award for diversity [press release]. October 28, 2000.
20Association of American Medical Colleges Web site. Available at: http://www.aamc.org
. Accessed May 11, 2010.
21Magnus SA, Mick SS. Medical schools, affirmative action, and the neglected role of social class. Am J Public Health. 2000;90:1197–1201.
22Whitney WT. Becoming a physician: Class counts. Nat Soc Thought. 2002;15:261–274.
23Gabbe SG, Webb LE, Moore DE, Harrell FE Jr, Spickard WA Jr, Powell R Jr. Burnout in medical school deans: An uncommon problem. Acad Med. 2008;83:476–482.
24U.S. News & World Report. America's Best Graduate Schools. 2009 ed. Washington, DC: U.S. News Publication Corporation; 2008.
25Chused RH. The hiring and retention of minorities and women on American law school faculties. Univ Penn Law Rev. 1988;137:537–569.
27U.S. Bureau of the Census. Census of population: 1950, vol. II, pt. 1, characteristics of the population, Table 154. Years of school completed by persons 25 years old an over, by color and sex, for regions, urban and rural, and by age for regions, 1950. Washington, DC: Bureau of the Census.
28Nam C, Powers M. Changes in the relative status level of workers in the United States, 1950–1960. Soc Forces. 1968;47:158–170.
29Bourdieu P. The forms of capital. In: Richardson J, ed. Handbook of Theory and Research for the Sociology of Education. New York, NY: Greenwood; 1986.
30Sacks P. Tearing Down the Gates: Confronting the Class Divide in American Education. Los Angeles, Calif: University of California Press; 2007.
31Hart B, Risley TR. Meaningful Differences in the Everyday Experiences of Young American Children. Baltimore, Md: Paul Brookes Publishing Company; 1995.
32Lareau A, ed. Unequal Childhoods: Class, Race, and Family Life. Berkeley, Calif: University of California Press; 2003.
33Oldfield K. Humble and hopeful: Welcoming first-generation poor and working-class students to college. About Campus. 2007;11 (Jan–Feb):2–12.