The recent US Presidential election brought issues of gender equity into sharp focus. On the one hand, we saw the historic candidacy of the first female major party nominee; on the other, we also witnessed sobering reminders of the distance we as a society still have to go before we achieve the ideals of true gender equity. Given the transformation of epidemiology, with increasing numbers of women entering the field, many in this discipline naturally wonder how gender influences career trajectories, and what this may mean for the future. In this issue, Schisterman and colleagues1 present an illuminating analysis of the status of women in the field of epidemiology that provides important data to ground speculations in this regard.
Even after adjusting for the selection bias that led to female-heavy departments being more likely to respond to their surveys, Schisterman et al.1 provide convincing evidence that women constitute the majority of epidemiology early career faculty, constituting an estimated 61% of assistant professors in the field. Similarly, women were more likely than men to serve in the more junior position of first authorship, but women were less likely to serve in the traditionally more senior position of last authorship, and women constituted only 32% of full professors. Moreover, although 73% of epidemiology doctoral students from 2013 to 2015 were female, none of the editors-in-chief of the major epidemiology journals were women, and the editorial boards were also predominantly male. These results mirror those of many academic disciplines.2–5 Thanks to the enactment of Title IX of the Education Act Amendments in 1972, which forbade institutions of higher education from discriminating against women in admissions and promotions, women have gradually increased their representation among the students of almost every academic discipline. Yet these advances at junior levels have failed to result, in many fields, in the transformation of the more senior ranks and leaders.
Some hypothesize that these findings simply reflect a “slow pipeline.” The slow pipeline hypothesis focuses on the fact that it takes many years for the all-male classes to retire and wash out of the pool of senior members of any given field, especially in academics, where careers are long. Therefore, the impact of greater representation of women among students of a discipline cannot reasonably be expected to result in meaningful changes at senior ranks for many years. However, the pipeline hypothesis suggests that with time, women will eventually reach senior positions.
Others worry that the pipeline is not simply slow but dysfunctional. Studies that have followed cohorts of graduates into their faculty positions have revealed that women do not achieve promotions at the same rate as their male peers.6,7 Some have argued that this may reflect differences in the aptitude or aspirations of the men and women who enter faculty positions, but even studies of the highly apt and unquestionably motivated recipients of career development awards from the National Institutes of Health are less likely to succeed in attaining subsequent independent grants, publications, and leadership positions if they are female.8,9
Why do similarly apt and motivated young women who enter academics fail to succeed at the same rates as their male colleagues? Numerous mechanisms are likely. A powerful one relates to unconscious bias. As the National Academy of Sciences concluded in a landmark report, “An impressive body of controlled experimental studies and examination of decision-making processes in real life show that, on the average, people are less likely to hire a woman than a man with identical qualifications, are less likely to ascribe credit to a woman than to a man for identical accomplishments, and, when information is scarce, will far more often give the benefit of the doubt to a man than a woman.” Indeed, from randomized studies that have shown how powerful a simple change in name at the top of an identical CV can be:10 Karen Miller is less likely to be hired than Brian Miller, and she is objectively rated as having had inferior service, teaching, and scholarship—despite an identical CV.11 Vivid qualitative evidence suggests that women are truly invisible (such as a dramatic story from a woman who stood waiting her turn to ask a question at a conference microphone as the moderator first called on every other microphone and then ultimately took questions from the audience rather than acknowledging her). Leaders in the field recount how they were later told that many were surprised at their willingness to uproot their families, suggesting that other women may never even be offered leadership positions for this reason.12
Another challenge is the prevalence of norms, practices, and policies that either force the collision of biological and professional clocks or magnify the inequities of the traditional gendered division of labor in our society, in which many women continue to bear the greater burden of domestic responsibilities. In our own work, we have documented that promising NIH career development awardees spend 8.5 hours more per week on parenting and domestic tasks than their male colleagues, even after adjustment for spousal employment status and numerous other factors.13
Appalling stories of overt discrimination and sexual harassment also continue to make media headlines, reminding us that women may face these hurdles as well. In a survey of former career development awardees, we found that 30% of women (compared with 4% of men) had experienced sexual harassment from a superior or colleague in their careers; 40% of these were more severe (involving sexual advances or worse) and 47% reported perceptions that these experiences negatively affected their career advancement.14
Together, these disadvantages accumulate to challenge even the brightest and most promising young women joining academic faculties.15 Moreover, evidence suggests that the differences are not simply additive but supraadditive.16,17 Fortunately, the work of groups like Schisterman and colleagues1 serves to shine light on the need for targeted interventions to ensure that the slow pipeline is not also leaky for women. And considerable work has been done to identify ways that institutions, professional societies, and others can work together to promote gender equity and academic success.
Chief among these approaches is the development of mentoring programs.18–23 Mentoring programs are effective in providing women with opportunities that might otherwise be allocated by an informal old-boy’s network. By training mentors to engage in the critical activity of sponsorship, mentorship programs can help to ensure that all promising young faculty have the chance to demonstrate their abilities.24 Mentoring programs can also teach mentors to encourage resilience in the face of failure, a common experience in academics,25 and to teach women to play games they may not necessarily have learned in childhood. Mentoring programs can promote the discussion of negotiation between mentors and mentees, which may help to reduce the gender gap not only in compensation26,27 but also in access to resources necessary for academic success.28,29 Mentoring programs can be structured to promote networking and collaborations—something that Schisterman and colleagues’1 study suggests may be particularly lacking for women. And, finally, it is heartening to note that although women may benefit from having at least one female mentor, gender concordance in mentor–mentee pairings is not critical for success, and men can serve as wonderful and valuable mentors to women.30
Other innovative programs can also be leveraged to promote gender equity in epidemiology. In academic medicine more generally, there has recently been growing attention to the promise of bridge funding programs that may help to support the work efforts of promising faculty who face substantial demands of caregiving.31,32 Numerous institutions have initiated interventions to transform culture and promote bias literacy.33–36 Such programs have been shown to have enduring impact.33–36
Ultimately, gender equity is, of course, important for its own sake—as a demonstration of the respect we accord all human beings, given the inherent dignity that stems from our capacity for rational thought and freely willed action. Gender equity is also essential to achieve the ends we pursue as scholars. Only with gender equity and diversity throughout its ranks can epidemiology hope to maintain a robust influx of aspiring leaders into the field. The diversity of experience that results from the inclusion of increasing numbers of women at all ranks will benefit scholarship and the society served by the field, by encouraging more innovative questions and approaches to their solution.37 Schisterman and colleagues1 have laid down the gauntlet: it is now up to all of us to ensure that future analyses show that we will not squander the promise of the newest generation of scholars entering the field.
ABOUT THE AUTHOR
RESHMA JAGSI is a Professor and Deputy Chair in the Department of Radiation Oncology and the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. She has received grants from the National Institutes of Health and numerous philanthropic foundations to study gender in academic medicine and has published extensively on this subject.
1. Schisterman EF, Swanson CW, Lu Y, Mumford SL. The changing face of epidemiology: gender disparities in citations? Epidemiology. 2016.
4. Jagsi R, Guancial EA, Worobey CC, et al. The “gender gap” in authorship of academic medical literature–a 35-year perspective. N Engl J Med. 2006;355:281–287.
5. Jagsi R, Tarbell NJ, Henault LE, Chang Y, Hylek EM. The representation of women on the editorial boards of major medical journals: a 35-year perspective. Arch Intern Med. 2008;168:544–548.
6. Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex differences in academic rank in US medical schools in 2014. JAMA. 2015;314:1149–1158.
7. Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med. 2000;342:399–405.
8. Jagsi R, Motomura AR, Griffith KA, Rangarajan S, Ubel PA. Sex differences in attainment of independent funding by career development awardees. Ann Intern Med. 2009;151:804–811.
9. Jagsi R, DeCastro R, Griffith KA, et al. Similarities and differences in the career trajectories of male and female career development award recipients. Acad Med. 2011;86:1415–1421.
10. Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proc Natl Acad Sci U S A. 2012;109:16474–16479.
11. Steinpreis RE, Anders KA, Ritzke D. The impact of gender on the review of the curricula vitae of job applicants and tenure candidates: a national empirical study. Sex Roles. 1999;41:509–528.
12. Andrews NC. Climbing through medicine’s glass ceiling. N Engl J Med. 2007;357:1887–1889.
13. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160:344–353.
14. Jagsi R, Griffith KA, Jones R, Perumalswami CR, Ubel P, Stewart A. Sexual harassment and discrimination experiences of academic medical faculty. JAMA. 2016;315:2120–2121.
15. Valian V. Why So Slow? The Advancement of Women.1998.Cambridge, MA: MIT Press.
16. Martell RF, Lane DM, Emrich C. Male–female differences: a computer simulation. American Psychologist. 1996;51:157–158.
17. Valian V. Ceci SJ, Williams W. Women at the top in science–and elsewhere. In Why Aren’t More Women in Science? Top Gender Researchers Debate the Evidence. 2007:Washington, DC: American Psychological Association; 27–37.
18. Bussey-Jones J, Bernstein L, Higgins S, et al. Repaving the road to academic success: the IMeRGE approach to peer mentoring. Acad Med. 2006;81:674–679.
19. Mayer AP, Files JA, Ko MG, Blair JE. The academic quilting bee. J Gen Intern Med. 2009;24:427–429.
20. Moss J, Teshima J, Leszcz M. Peer group mentoring of junior faculty. Acad Psychiatry. 2008;32:230–235.
21. Lewellen-Williams C, Johnson VA, Deloney LA, Thomas BR, Goyol A, Henry-Tillman R. The POD: a new model for mentoring underrepresented minority faculty. Acad Med. 2006;81:275–279.
22. Files JA, Blair JE, Mayer AP, Ko MG. Facilitated peer mentorship: a pilot program for academic advancement of female medical faculty. J Womens Health (Larchmt). 2008;17:1009–1015.
23. Pololi LH, Knight SM, Dennis K, Frankel RM. Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program. Acad Med. 2002;77:377–384.
24. Travis EL, Doty L, Helitzer DL. Sponsorship: a path to the academic medicine C-suite for women faculty? Acad Med. 2013;88:1414–1417.
25. DeCastro R, Sambuco D, Ubel PA, Stewart A, Jagsi R. Batting 300 is good: perspectives of faculty researchers and their mentors on rejection, resilience, and persistence in academic medical careers. Acad Med. 2013;88:497–504.
26. Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in the salaries of physician researchers. JAMA. 2012;307:2410–2417.
27. Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in salary in a recent cohort of early-career physician-researchers. Acad Med. 2013;88:1689–1699.
28. Holliday E, Griffith KA, De Castro R, Stewart A, Ubel P, Jagsi R. Gender differences in resources and negotiation among highly motivated physician-scientists. J Gen Intern Med. 2015;30:401–407.
29. Sege R, Nykiel-Bub L, Selk S. Sex differences in institutional support for junior biomedical researchers. JAMA. 2015;314:1175–1177.
30. DeCastro R, Griffith KA, Ubel PA, Stewart A, Jagsi R. Mentoring and the career satisfaction of male and female academic medical faculty. Acad Med. 2014;89:301–311.
31. Jagsi R, Butterton JR, Starr R, Tarbell NJ. A targeted intervention for the career development of women in academic medicine. Arch Intern Med. 2007;167:343–345.
33. Carnes M, Devine PG, Isaac C, et al. Promoting institutional change through bias literacy. J Divers High Educ. 2012;5:63–77.
34. Carnes M, Devine PG, Baier Manwell L, et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Acad Med. 2015;90:221–230.
35. Richman 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.
36. 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.
37. Page S. The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies. 2007.Princeton, NJ: Princeton University Press.