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Academic Medicine:
doi: 10.1097/ACM.0b013e31825d3495
Institutional Issues

Gender-Related Differences in the Pathway to and Characteristics of U.S. Medical School Deanships

White, F. Scott EdD; McDade, Sharon EdD; Yamagata, Hisashi PhD; Morahan, Page S. PhD

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Author Information

Dr. White is project manager, SRA (Systems Research and Applications) International, Inc., Durham, North Carolina.

Dr. McDade is director, Fellows Program, American Council on Education, Washington, DC.

Dr. Yamagata is senior court researcher, Circuit Court for Montgomery County, Rockville, Maryland.

Dr. Morahan is founding director, Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Correspondence should be addressed to Dr. White, 2605 Meridian Parkway, Suite 200, Durham, NC 27713; telephone: (919) 313-7590; e-mail: scott_white@sra.com.

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Abstract

Purpose: To explore factors that may be involved in the persistent paucity of women leaders in U.S. academic medicine and to provide baseline gender-related data for developing strategies to promote gender equity in academic medicine leadership.

Method: Using data sets from the Association of American Medical Colleges, the authors examined the relationship of gender to career progression and to deanship characteristics by conducting descriptive and correlation statistical analyses for 534 full and interim deans (38 women; 496 men) appointed between 1980 and November 2006 (inclusive) to serve U.S. Liaison Committee on Medical Education (LCME)-accredited medical schools.

Results: Although the number of women deans increased during the 27-year study period, the representation of women remains low (they constitute only 15% of deans appointed from 2000 to 2006) and has failed to keep pace with the percentages of women medical school faculty and students. On average, women deans—most with deanships at less research-intensive medical schools—obtained their initial doctorates from similarly less research-intensive schools, held more business-related advanced degrees beyond the original doctorate, took longer to be promoted to full professor, and had shorter tenures than did their men counterparts.

Conclusions: Women leaders of U.S. LCME-accredited medical schools have taken longer to advance through the academic ranks, serve at less research-intensive institutions, and had shorter tenures than did men deans. These results underscore the challenges women leaders face in traditionally male-dominated organizations, and they provide baseline data to inform medical schools building inclusive senior leadership teams.

Despite the increased representation of women in academic medicine, the percentage of women who ascend to the medical school deanship is still very low. In the 2009–2010 academic year, 47.8% (37,129/77,722) of the enrolled students, 48.3% (8,127/16,818) of the graduates, 34.8% (44,741/128,650) of the full-time faculty, 35.8% (378/1,055) of the associate deans, and 27.9% (117/420) of the senior associate/vice deans in U.S.

Liaison Committee on Medical Education (LCME)-accredited medical schools were women; in contrast, only 13.0% (17/131) of medical school deans were women.1,2 This percentage is far lower than the proportion of women presidents of colleges and universities (23%)3 or law school deans (20%),4 although it is comparable to the representation of women CEOs in the health care industry (12%).5 A typical medical school dean still tends to be a white male who assumes the deanship in his early 50s and whose primary specialty is internal medicine.6,7

The corporate world is increasingly recognizing the association between the growing number of women leaders and both improved financial performance and the presence of women in more key decision-making positions.8–11 In academia, the presence of women leaders is positively associated with the advancement of women faculty,12 and in academic medicine in particular, the long-term survival of academic health centers depends on capitalizing on the leadership abilities of all faculty, including women.13–15 As medical schools have recently expanded, the need for developing and deploying such leadership capabilities is even greater.14,16

To our knowledge, this study is the first to identify gender-related differences in career trajectories and characteristics in the medical school deanship. We used data on 534 deans appointed to their first deanship at a U.S. LCME-accredited medical school between 1980 and 2006 (inclusive) in an effort to examine the relationship of gender to ascendance to the position of dean and to characteristics of deanships.

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Method

Data

We merged the Association of American Medical Colleges (AAMC) Faculty Roster17 and Council of Deans18 databases to create a data set that provided information on the education, training, faculty promotion, and deanship appointment of 534 deans (38 women and 496 men) of U.S. LCME-accredited medical schools who were appointed to their first full or interim dean positions between 1980 and November 2006 (inclusive). Specifically, we examined the following characteristics of women and men deans:

* their ages at specific milestones in their academic careers (e.g., achievement of full professor) and the duration between milestones,

* the 2005 National Institutes of Health (NIH) ranking of their MD-granting institution,

* their specialty (scientific or clinical discipline),

* the number and types of advanced degrees they earned beyond their initial MD,

* the NIH ranking and special mission(s) (i.e., historically black or Hispanic or traditionally community focused) of the institution for which they served as dean,

* the type of initial appointment (i.e., interim or full) and duration of their first deanship, and

* the likelihood that they would serve a second deanship.

The lead author (F.S.W.) arranged a data use agreement with the AAMC, and the George Washington University’s human subjects review board approved the project (#070645, 08/31/2006).

Because the study focused on women and men who began their first deanships during the study period, deans who had begun their tenure before 1980, even if they were still serving as deans in or after 1980, were excluded. The 1980 starting point and the 2006 end point reflected the fact that the study was part of the dissertation research for the lead author.

Because most deans become deans only after passing a set of specific academic career milestones (e.g., promotion to assistant professor, promotion to full professor), we examined how quickly men and women deans reached these milestones. We used their ages to determine the number of years between promotion from assistant to full professor and the number of years between promotion to full professor and appointment as dean. We calculated the average age at academic appointments based on the deans whose age information was available. Because department chair is also considered to be a major step before deanship,7,19 we compared the percentage of men and of women deans who held the position of department chair before becoming dean.

We used the 2005 NIH awards list20 because it corresponded to the 2006 end point. Further, we used the 2005 list to extract the medical school research ranking of the institution that awarded each dean’s initial MD because rankings remain stable, especially within quartiles, over a decade. We included the rankings of deans’ MD-granting institutions because we felt that the women deans captured in our study, who were among the first to become medical school deans, might have achieved exceptional successes, including graduating from highly NIH-ranked medical schools. This analysis of the rankings of the deans’ MD-granting institutions, as well as the analysis of the rank of the institution each dean served, was based on the available records of 525 deans (37 women and 488 men) who were appointed to 1 of the 123 NIH-ranked medical schools existing in 2005. We excluded the remaining 9 deans from this analysis.

For the analyses based on decade, we used the year of deanship appointment to identify the decade to which the appointment belongs; for example, the 1980s decade included all deans who were appointed at any point between January 1, 1980, and December 31, 1989, regardless of whether the appointment ended within that decade or not. We excluded deanships that were still ongoing at the end of the study period from the analysis of deanship duration.

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Statistical analysis

Our descriptive statistics included the frequency, mean, and standard deviation of the number of men and of women deans and selected study variables. We used the two-independent-sample t test to determine the statistical significance (P < .05) of gender differentials in means. (Because the data encompassed the entire population of medical school deans during the study period, a test of statistical significance would not be necessary; nonetheless, we included the results of tests of significance that are commonly used in similar studies.) When we detected statistically significant differences, we calculated Omega22) and Eta22) to determine how much of the variability might be explained by the independent variable (gender). To determine the statistical significance of gender differences in percentages for categorical variables, we used a chi-square (χ2) cross-tabulation; when we found a statistically significant difference, we calculated the Cramer V statistic to determine the strength of the association between the two variables.

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Results

Men and women U.S. medical school deans, 1980–2006

Overall, only 7.1% of medical school deans in the entire 27-year period (38/534) were women (Table 1). In the 1980s, only 2 women (1.1% of 186 deans) were appointed to deanships; in the 1990s, 12 women were appointed, representing 7.5% of 160 newly appointed deans. In contrast, during the first years of the 2000s, 24 women became deans, increasing the representation of women among the 188 newly appointed deans to 12.8% (during this 7-year period). These 24 women deans appointed during just these 7 years account for 63.2% of the women medical school deans appointed during the entire 27-year study period.

Table 1
Table 1
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Gender differences in pathways to U.S. medical school deanship

The average age of deans at appointment to assistant professor (an entry point for academic progression) was 31.9 years for women and 32.5 years for men (Table 2). The difference was not statistically significant. Appointment to full professor, however, showed a clear gender differential: Men deans achieved the rank of professor at a mean age of 40.9 years compared with women deans, who achieved that rank at the average age of 45.5 years (P = .005, ω2 = 25.9%, η2 = 28.4%). Interestingly, we detected no such age difference at appointment to deanship: Women achieved that position at a mean age of 54.2 years and men at a mean age of 54.9 years.

Table 2
Table 2
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Our analysis of the duration of time between academic ranks confirmed gender differences in academic progression (Table 2). Whereas men took, on average, 9.5 years to progress from assistant to full professor, women deans took 12.1 years (P = .047, ω2 = 10.0%, η2 = 13.4%). However, we found no differences in the duration of time from appointment to assistant professor to appointment as interim or full dean between women deans (20.6 years) and men (21.6 years). Thus, women deans had a significantly shorter duration of time (9.8 years) than did men (14.6 years) from full professor appointment to initial interim or full deanship (P = .005, ω2 = 18.6%, η2 = 21.4%).

Overall, 86 of 534 deans (16.1%) held chair positions before assuming the deanship. A greater percentage of women deans (28.9%; 11/38) than men deans (15.1%; 75/496) held a chair appointment (χ2 = 4.99; df = 1; P = .025; v = .009; data not shown).

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Gender differences in U.S. medical school deans’ education and training

Our analysis of factors related to deans’ education and training revealed statistically significant differences. Our findings showed that a significantly smaller percentage of women deans received their MDs (36.4%; 12/33) from the top 50 NIH-ranked research-award schools than did men (56.8%; 258/454), and a greater percentage of women (63.6%; 21/33) than men (32.4%; 147/454) received degrees from lower-tier (51st–123rd) research-award institutions (P = .005, ω2 = 23.3%, η2 = 25.4%; see Table 3).

Table 3
Table 3
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Internal medicine (39.3%; 184/468) and pediatrics (11.5%; 54/468) were the most common specialties among all deans (Table 3). Internal medicine was less common among women (23.5%; 8/34) than men (40.6%; 176/434). Instead, a greater proportion of women deans, compared with their men counterparts, specialized in pediatrics (20.6% [7/34] versus 10.8% [47/434]), family medicine (17.6% [6/34] versus 3.5% [15/434]), and pathology (14.7% [5/34] versus 6.0% [26/434]). No women deans, but more than 13% of men (57/434) deans, specialized in surgery or a surgery subspecialty.

A slightly higher percentage of women deans (28.9%; 11/38) than men deans (22.8%; 113/496) held graduate degrees beyond their original MD (Table 3). The difference was not statistically significant. However, we found gender-related differences in the type of additional graduate degrees (P = .019). Compared with 23.9% (27/113) of men deans, 63.6% (7/11) of women had a business-related degree (MBA, MHA, MPH, or JD); in contrast, 18.2% (2/11) of women deans and 43.3% (49/113) of men had PhDs or other doctorates.

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Gender differences in U.S. medical school deanships

We also found gender-based differences in the institutions men and women deans served, in the likelihood of their holding subsequent positions as deans, and in the duration of their first deanships.

Only 5.4% of women deans (2/37) served at top-25 NIH-ranked institutions for their first deanship, compared with 16.8% (82/488) of men (Table 4). Only 16.2% of women deans (6/37) served at top-50 institutions—about half the proportion of men deans (33.0%; 161/488). The average NIH-research-award ranking of medical schools for women deans was 84.2 ± 30.1, significantly lower than the average ranking of institutions served by men deans (64.3 ± 34.1; P = .005, ω2 = 23.3%, η2 = 25.4%; see Table 5).

Table 5
Table 5
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Table 4
Table 4
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In 2006, half (19/38) of the women deans had completed deanships, or were currently serving, at medical schools with special missions, including historically black institutions (n = 5), historically Hispanic institutions (n = 5), and institutions that traditionally focus especially on primary or community-based care (n = 9; data not shown). This finding is notable because, in 2006, the AAMC listed only 4 historically black medical schools, 4 medical schools in Puerto Rico, and approximately 20 medical schools with a primary care or community-based education focus.

Of the 534 deans, 194 (36.3%) were appointed as interim deans for their first deanship between 1980 and 2006: 11 (28.9%) of 38 women and 183 (36.9%) of 496 men. Of these, 183 (176 men, 7 women) completed their interim positions, and 100 served subsequent deanships: 93 (88 men, 5 women) served as full deans, and 7 (7 men, 0 women) served again as interim deans. A similar proportion of women deans (45.4%; 5/11) and men deans (48.1%; 88/183) who initially served on an interim basis later served as full deans—almost all at the institution where they initially served as interim deans.

Only 5% of both women (5.2%; 2/38) and men (5.0%; 25/498) deans were appointed to a subsequent full deanship at another institution after completing their first deanship. The mean institutional research-award ranking of first deanship was 93.5 for women and 61.5 for men deans (Table 5). Among the 25 men deans who served second full deanships, their second appointments showed an average increase in institutional research-award ranking of eight points. Of the two women who served two full deanships, one subsequently served at an institution with a higher ranking, and the other subsequently served at a school with a lower NIH ranking.

We analyzed the duration of first deanships of the 321 deans appointed as full deans during 1980–2006 by gender and decade (Table 6). Overall, women’s appointments as dean were of shorter durations than those of men: a mean of 3.0 ± 1.8 years versus 5.4 ± 4.1 years (P = .000, ω2 = 38.5%, η2 = 38.8%). During the 27-year period, the average tenure of all medical school deans decreased from 6.6 years in 1980–1989 to 5.1 years in 1990–1999 and to 2.4 years in 2000–2006. The average duration for 2000–2006 is likely to be underestimated because the average (2.4 years) includes only those deans (n = 59) who were appointed and had completed their tenures during the 7-year period; we excluded from this analysis data on 90 full deans (11 women, 79 men) appointed during 2000–2006 and still in the position as of November 2006.

Table 6
Table 6
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Our analyses of the distribution of 321 completed deanship tenures by gender and decade (Table 7) revealed that the most frequent first deanship duration across the 27-year study period was fewer than 3 years, accounting for 40.5% (130/321) of all initial appointments; however, a much greater proportion of women (70.0%; 14/20), as compared with men (38.5%; 116/301), had such short tenures. Although about an equal percentage of women (20.0%; 4/20) and men deans (19.9%; 60/301) served for 3 to 5 years, only 2 women deans (10.0%; 2/20) served for 6 or more years compared with 41.5% of men deans (125/301). The distribution of deanship tenures of men deans over time suggests that their tenures may have been trending toward those of women: Among deans appointed between 2000 and 2006, over 75% of both men and women deans had tenures of fewer than 3 years, and all women deans and close to 95% of men had tenures under 5 years.

Table 7
Table 7
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Discussion

This research is, to our knowledge, the first to characterize and compare women and men medical school deans using longitudinal data.

Our findings showed that a significantly greater percentage of women deans received doctorate degrees from institutions with lower NIH-research-award rankings than did men (63.6 versus 32.4), perhaps because these women obtained degrees at a time when opportunities at top schools for women were limited. Also, over 80% of women in our study served as deans at schools with lower NIH-research-award rankings (51–123). These findings (regarding institution of service) resemble those from higher education that indicate that a greater proportion of women are presidents of lower-tier institutions rather than of research-intensive universities.3 Women deans may have recognized greater opportunities—or felt more comfortable or competent—at institutions similar to those where they had started their careers. It is also possible that these lower-tier institutions are more open to accepting women leaders than their higher-tier counterparts. Furthermore, some women may have chosen to serve institutions that are not awarded a large amount of research awards but whose missions and values fit with their values21–24—as evidenced by our finding that half of the 38 women deans served at historically black, Hispanic, or community-based medical schools.

Perhaps our most important finding is that the 20 women who were appointed as first-time full deans and completed their deanships during 1980–2006 served, on average, for a significantly shorter duration than did men deans (3.0 years versus 5.4 years). Moreover, the likelihood of women deans having tenures of fewer than 3 years is nearly twice as large (70%) as that of men (38.5%). Clearly, women deans seem to be at greater risk of having shorter tenures than men. These results are similar to those for college and university presidents3 and corporate CEOs8 who serve their institutions for shorter periods of time than men. Previous researchers have suggested many reasons: Compared with men, women leaders are more visible and thus more vulnerable to entrenched and unconscious gender schemas about how a leader should act; women may not negotiate as hard for sufficient resources to be successful; more women may be offered “glass cliff” jobs (i.e., jobs that have a high chance of leading to failure); women are more isolated and thus not as able to garner sufficient feedback or support; and women have less robust networks to facilitate smooth transitions when they traverse a leadership change.25–35 Of course, the shorter tenures for women may also reflect the fact that women accomplished what they wished in the position and then moved on. Additional explanations will require researchers to conduct qualitative studies, including interviews of women and men deans, in order to capture their reasons for, especially regarding the timing of, their departure. The only good news is that during the 2000–2006 period, the average tenure of men deans became more comparable to that of women deans. An investigation with additional data that covers the entire 2000–2009 period is needed to verify this observation.

Our findings on medical school deanship tenure are similar to previous studies of Banaszak-Holl and Greer6,19 in that they show a trend toward shorter deanship durations. However, our findings indicate shorter tenures than those reported in a recent study: 6.0 median years for deanship duration with few differences across five decades.36 We have speculated on a few possible reasons for the difference. First, we used a conservative definition of duration of full deanship—appointment to full deanships exclusive of duration of preceding interim appointment (rather than calculating duration from the start date of the interim deanship held prior to full deanship at the same institution). A dean serving on an interim basis may not have as full a range of strategic and operational options as a full dean. Interim deans, particularly women and minorities, are on trial because proven competence is more important than potential performance when being considered for a leadership position.37

Second, we calculated mean durations of completed deanships, rather than median durations for five-year cohorts in which at least half the members had left office.36 When observations with extreme values exist or when the distribution is skewed, the two metrics will differ because means will be affected by the presence of such outliers. Given that more than 40% of all the completed deanships in our data set were less than three years in duration, the means may be smaller than medians because the calculation of the latter does not take such trends into consideration. Third, although calculating the median solves the problem associated with using data that contained observations with incomplete tenures, the median suffers from not being able to precisely examine the most recent cohort because half of the cohort members have not completed their tenures. Although our use of the mean duration of completed deanships may underestimate actual durations because of the exclusion of those deanships begun, but not yet expired, during the 2000s (37.5% [12/32] women and 23.7% [94/395] men), we did find gender equity in the average duration of deans whose tenures were begun and completed between 2000 and November 2006.

The data-sharing agreement covered only the 1980–2006 time period, which prevented us from analyzing data post 2006. Further study is needed to confirm whether deanships in the 2000s are shorter and more gender equitable (at least in terms of length). In addition, further investigation will help the academic medicine community understand how to sustain leaders, particularly women leaders, in these complex roles so that they can optimally advance their schools’ missions.6,19,36,38

We explored various career elements for gender-related differences among deans. We detected no significant differences in medical specialty; both women and men deans most commonly specialized in internal medicine and pediatrics, although the next most common specialties among women deans were family medicine and pathology, in contrast with surgery and psychiatry for men. These findings are similar to those of previous reports that indicate that internal medicine and pediatrics are the two most common specialties,7,19 and they are commensurate with specialty distribution generally (the largest departments are internal medicine, pediatrics, and surgery).39

We found gender differences in the advanced degrees beyond the initial MD that medical school deans hold. Whereas about one-quarter of both women and men deans held at least one additional degree beyond the MD (a finding that reflects previous research7), business-related degrees (63.6%) predominated among women, whereas PhDs or other doctorates (43.3%) predominated among men. This finding may reflect a trend toward more leaders who are business-savvy.

We speculate that the gender differences in postgraduate degrees beyond the MD may exist because women believe that business-related degrees provide them with additional credibility or because they perceive a need to be prepared for and self-confident in their business knowledge and skills. Another possibility is that employers may believe that women need to prove their proficiencies in management and finance.40–42 Future research is needed to explore these possibilities.

We also identified gender differences in academic rank progression—as have other researchers.43 The women in our study were highly qualified and subsequently became deans but, when compared with men, took three to five additional years to reach the rank of full professor. Possible reasons include the following: Women may be held to different standards, women tend to prefer interdisciplinary research that requires more time and adds obstacles to traditional promotion within a discipline, and women face the challenge of balancing the demands of family and career44–47—particularly women deans who started their careers before family-friendly work policies became available.48

Given previous research,7,19 our finding—that the duration from full professorship to deanship was shorter for women than for men—is surprising. The women deans in our study may have taken extra time to acquire one or more additional degrees and/or assumed senior administrative positions that helped others recognize them as legitimate candidates for deanship. These additional preparations49 slow the pace of academic progression, but they may help women both to demonstrate the breadth and depth of their administrative capacity and compensate for unconscious gender bias in searches.40,50,51 Further research could clarify the relationship between rank and the additional time required for women to be promoted—that is, whether the delay was at the assistant or associate professor level. Such research could also clarify the relationship of academic rank to assuming administrative roles and/or to enrolling in degree programs.

Previous research shows that the department chair may be a stepping stone to deanship.52 Almost double the proportion of women (28.9%), compared with men (15.1%), held chair positions before becoming deans, suggesting that work as a chair is a useful proving ground. However, this position is not a common one on the path to deanship for women; few women chairs exist across all departments.53–56 This may, in turn, suggest that widening career paths toward the department chairmanship for women faculty may be a viable way to increase the representation of women among medical school deans. In terms of interim deanships, fewer women than men were appointed to such positions, although both had about a 50% chance of later becoming full deans. More research is needed to evaluate the effectiveness of each of the following pathways to deanship: senior administrative appointments, department chair appointments, and appointments as interim deans.57,58

This study has established a baseline of career progression variables for the small number of women who have ascended to deanships. According to AAMC data, since the early 1990s the representation of women medical school deans has gradually increased, reaching 13% in 2010 (personal communication with Hershel Alexander in November 2011). At this rate of increase, it would take at least another 50 years to reach gender parity in medical school deanship; however, according to the theory of a critical mass of women leaders,59–63 achieving a certain proportion of women leaders may yield qualitative cultural improvements, accelerating the change in the distribution. We speculate that this point will occur when 15% to 20% of women deans have tenures greater than three years and are then likely to be viewed as successful and influential leaders.25 The baseline information that our data provide constitutes the necessary first step for developing strategies to meet today’s leadership needs,14,16 and these data highlight the fact that greater efforts are needed to sustain women in deanships, especially in terms of the length of their tenures.

Acknowledgments: The authors thank the Association of American Medical Colleges for providing access to the data.

Funding/Support: None.

Other disclosures: None.

Ethical approval: A data use agreement was arranged between the Association of American Medical Colleges and the lead author (F.S.W.), and the project was approved by the George Washington University’s human subjects review board (#070645, 08/31/2006).

Disclaimer: The opinions expressed in this article are those of the authors and do not reflect the views of the Association of American Medical Colleges.

Previous presentation: A paper related to this topic entitled “The relationship between gender and career progression variables and service factors for deans of U.S. medical schools from 1980–2006” was submitted to the American Educational Research Association in April 2009.

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