Rank, Track, and Time to Promotion
The distributions of male and female faculty members differed significantly according to rank (p < .00005) and track (p < .0005, see Figure 2). Women were predominantly in non–tenure-track positions at the assistant professor level (49%). In contrast, more than half of the men (55%) were promoted (associate or full professors) and tenured.
Based on questionnaire responses, women at the College of Medicine were significantly more likely to have considered changing academic tracks (58% versus 29%, p < .0001). This was particularly true on the tenure track, where almost half the women had considered changing tracks (46% versus 9% of men, p < .00001). However, women were no more likely than men to have actually changed tracks (19% versus 14% for men) or to have delayed the tenure clock (16% versus 10% for men).
Attaining the rank of associate professor took longer for women than for men. For the 97 associate or full professors who indicated on the questionnaire the numbers of years they had been assistant professors, the average time to promotion had been 6.5 years for women, versus 5.2 years for men (p < .05). There was no significant gender difference in lengths of time as associate professor.
A common explanation for the differences in rank between male and female faculty members is that women may be less serious about their careers than men and thus less productive. However, questionnaire responses indicated no significant gender difference in the reported importance of career advancement (p = .79) or the extent to which work and personal life conflicted (p = .78). Women who worked full-time were no more likely than men to want to work part-time (38% versus 27% for full-time men, p < .13). However, a higher proportion of men were willing to move to take a better job (71% versus 51% of women, p < .05).
Initial comparisons of the numbers of peer-reviewed publications for faculty suggested that men were more productive than women (see Table 3), regardless of whether the estimates came from faculty members' CVs or from self-reporting on the questionnaire. However, this was an artifact of gender differences in rank, track, and time in rank. When stratified by rank and track, gender differences disappeared, except among full professors on the tenure track. In this category, men published more, but they had been at that rank twice as long as the women had been (11.7 versus 6.4 years, p < .05). When adjusted for years in rank, the difference in mean numbers of publications for female and male full professors became insignificant (63.1 versus 78.0, p < .49). Also, equal proportions of women and men had received teaching awards (30.2% and 33.3%, respectively).
Clinical revenues by gender, adjusted for specialty and rank, are shown in Table 4. The difference in clinical revenues was significant for only two of the comparisons: full professors who were generalists (in which case the sole woman in this category made twice the average revenues for the men) and surgical specialists at the level of assistant professor, where men generated significantly more clinical revenues than women (p < .05).
Respondents' leadership experiences are presented in Table 5. Contrary to our hypothesis, there was no significant gender difference in self-assessed leadership ability or aspirations to hold leadership positions. Nevertheless, women were significantly less likely than men to have been asked to serve in leadership roles. They were also less likely to report ever having served as committee, section/division, or department chairs. When analyses were limited to associate or full professors, women were still significantly less likely to have been asked to serve or to have served as section heads or department chairs. More than one fourth of the men who responded to the questionnaire had been invited to serve as department heads, as compared with only 6% of women.
Given the differences in leadership opportunities, it was not surprising that the women felt they had significantly less power and influence in their departments. Half as many women as men reported having decision-making authority over promotion of colleagues (27% versus 48%, p < .005) or over non–grant-related resources (22% versus 47%, p < .001). Also, the women were significantly less likely to offer advice to department chairs (2.7 versus 3.2 on a 1-to-5 scale from never to always, p < .001) and to feel that they effectively influenced departmental decisions (2.5 versus 2.8 on a 1-to-6 scale from never effective to always effective, p < .01).
Institutional Support and Access to Resources
There was no significant gender difference in access to or difficulty obtaining resources, office space, or staff support. However, differences did exist with regard to research space. Of those who responded to the questionnaire, 60.8% of the women and 43.4% of the men reported sharing their research space with other faculty members. Among full professors, 72.7% of the women reported sharing research space with other faculty, as compared with only 40.0% of the men. After adjusting for rank, women reported exerting significantly more effort to obtain non–grant-supported research space (4.42 versus 3.87 for men, on a 1–5 scale, 5 = “a great deal of effort,” p < .01).
Treatment and Climate Issues
Women were significantly more likely than men to cite safety concerns, with regard to working at certain times or in certain places (see Table 6). They were also much more likely to feel that their departments treated men and women differently. Almost one third of the women reported being discriminated against, as compared with only 5% of the men (p < .00001). Only two of the 22 women who reported being discriminated against had sought recourse for the discrimination. A majority (68%) of these 22 women but only 15% of the men who reported being discriminated against felt the College did not respond appropriately to such charges. Finally, women were significantly less likely to feel that they “fit in” at the College of Medicine (72% versus 85%, p < .03).
Our investigation into the status of male and female faculty members in a College of Medicine indicated substantial gender differences in the rewards and opportunities of academic medicine. There were significant gender disparities in salary, with women earning 89% of what men earned. A plurality of women were non–tenure-eligible assistant professors, while the majority of men were tenured associate or full professors. In general, women were as productive as men, indicated by both publications and clinical revenues, despite having less research space and less influence in their departments. Although the women aspired to leadership positions and felt they had leadership skills, few had been asked to lead. Almost one third of the women reported experiencing discrimination. These differences support the widespread perception that academic medicine is not gender-blind and that the road to success is more challenging for women than for men.
Similar studies have been conducted at other medical institutions.16,17,18,19,20 Our study provides a more comprehensive picture of gender differences in academic medicine by examining a wide range of aspects of academic life beyond salary,16 promotion rates,17 or faculty perceptions of the academic environment,18,19,20 which have often been studied in isolation. Further, we incorporated a number of measurement techniques into our study, including institutional databases, questionnaires, and interviews, to present a fuller picture of gender disparities at the University of Arizona College of Medicine.
Our findings of gender differences in rank are similar to those of other analyses. These differences are often attributed to a pipeline effect,1,3,4,5,6 the notion that an insufficient number of women have been in academia long enough to have reached the rank of full professor. Yet, analyses of gender differences in rank attainment have not supported this hypothesis.1,3,5 An alternate explanation for the paucity of women at higher ranks is that they are less committed to their careers because of family and other personal responsibilities. In our study, the women were no more likely than the men to report conflicts between family responsibilities and work. However, other studies have shown that women are differentially affected by and concerned with family responsibilities.11,12,21 It is possible that there were gender differences in interpreting our questionnaire, with more men than women taking for granted the full support of their spouses in caring for children. Finally, gender differences in productivity have been postulated as another factor leading to women's slow progression through academic ranks. Our study found substantial unadjusted gender differences in numbers of peer-reviewed publications and clinical revenues, but once adjustments were made for rank, track, and years in rank, these differences disappeared. Although some widely cited studies showed that male faculty members publish more papers than female faculty members,1,5,8,10 these studies did not adjust for differences in track, rank, and years in each rank. The only other study that adjusted for confounding influences on productivity found no gender difference in numbers of publications or grants.4
The rewards of the system also appeared to differ by gender. Substantial gender differences were evident in salary, after adjusting for other predictors of compensation. Salary disparities have been documented in many specialties and both academic and practice environments.4,7,8,9 Our observation that significant gender differences in salary also existed for assistant professors suggests that the problem has not been solved.
Our study also showed gender differences in leadership opportunities. At the time this research was conducted, there was no female department head of any of the 19 departments in the College of Medicine, and only 10% of section or division chairs (four) were women. National data have revealed a similar absence of women in leadership positions.1,2 The paucity of women at higher ranks may contribute to the underrepresentation of women in high-level leadership positions, since the candidate pool of potential leaders remains small. Our study showed that a very high proportion of women in academic medicine believe they have leadership aspirations and skills. This suggests that leadership that is overwhelmingly male may not recognize leadership abilities in women or that women may abandon their aspirations without female role models.
Given these findings, it is not surprising that women were more likely to report differential treatment on the basis of gender at the University of Arizona College of Medicine. The literature on gender discrimination in academic medicine has indicated that subtle forms of gender discrimination are prevalent across the United States.13,14,15 Besides being illegal, gender discrimination and harassment can have detrimental effects on career advancement and satisfaction. Carr et al. reported that women who experienced gender discrimination reported lower levels of career satisfaction than did women who had not experienced discrimination.15
Our study had limitations. First, the respondents were not entirely representative of the larger faculty, and longitudinal data were not available to track changes over time. Further, the College of Medicine database did not contain accurate information about research grants, making it impossible to adjust for potential differences in research funding, which might account for some of the observed salary and rank disparities. Nevertheless, the fact that similar disparities have been observed at the national level suggests that these findings are not likely to be limited by the data.
Numerous solutions have been proposed to address gender disparities among academic medicine faculty.2,11,22,23 Regular monitoring of salaries, track assignments, start-up packages, and promotions would help to identify disparities and assess progress.22,24,25 A system for mentoring and advising junior faculty members early in their careers about promotion requirements will facilitate advancement.2,22,24,26 Institutional changes should be made to allow greater flexibility in tenure-track positions and in the definition of scholarly contributions, while maintaining a commitment to academic excellence. Promotion and search committees as well as influential individuals such as department heads and deans should be educated about subtle forms of discrimination. Perhaps the most critical element for ensuring change is assigning accountability.27 Progress in the recruitment, promotion, retention, and advancement of female faculty members to leadership positions should be rewarded. Departments with exemplary performances could be rewarded with additional research funds for faculty or additional faculty lines, while administrators who consistently impede the diversification of faculty must be penalized.25,26
In conclusion, our analysis suggests that male and female faculty members have substantially different experiences in academic medicine. In general, women's contributions are less likely to be recognized (either financially or through promotion) and their leadership abilities are more likely to be ignored. Changing these discriminatory patterns and behaviors will require persistent effort, open communication, continuous monitoring of progress, and a commitment to diversifying faculty and leadership. The alternative, in the words of Dr. Catherine DeAngelis, is to “waste half our genetic pool of intelligence, creativity and critical insights and experience. Medicine simply can't afford that loss.”24
1. Bickel J. Women in medical education: A status report. N Engl J Med. 1988;319:1579–84.
2. Bickel J. Women in academic medicine. J Am Med Wom Assoc. 2000;55:10–2.
3. Dial TH, Bickel J, Lewicki AM. Sex differences in rank attainment among radiology and internal medicine faculty. Acad Med. 1989;64:198–202.
4. Carr PL, Friedman RH, Moskowitz MA, Kazis LE. Comparing the status of women and men in academic medicine. Ann Intern Med. 1993;119:908–13.
5. Tesch BJ, Wood HM, Helwig AL, Nattinger AB. Promotion of women physicians in academic medicine: glass ceiling or sticky floor? JAMA. 1995;273:1022–5.
6. Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med. 2000;342:399–405.
7. Baker LC. Differences in earnings between male and female physicians. N Engl J Med. 1996;334:960–4.
8. Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement: results of a national study of pediatricians. N Engl J Med. 1996;335:1282–9.
9. Ness RB, Ukoli F, Hunt S, et al. Salary equity among male and female internists in Pennsylvania. Ann Intern Med. 2000;33:104–10.
10. Levey BA, Gentile NO, Jolly HP, Beaty HN, Levey GS. Comparing research activities of women and men faculty in departments of internal medicine. Acad Med. 1990;65:102–6.
11. Fried LP, Francomano CA, MacDonald SM, et al. Career development for women in academic medicine. JAMA. 1996;276:898–905.
12. Carr PL, Ash AS, Friedman RH, et al. Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty. Ann Intern Med. 1998;129:532–8.
13. Lenhart S, Klein F, Falcao P, Phelan E, Smith K. Gender bias against and sexual harassment of AMWA members in Massachusetts. J Am Med Wom Assoc. 1991;46:121–5.
14. Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of U.S. women physicians. Arch Intern Med. 1999;159:1417–26.
15. Carr PL, Ash AS, Friedman RH, et al. Faculty perceptions of gender discrimination and sexual harassment in academic medicine. Ann Intern Med. 2000;132:889–96.
16. Holmes-Rovner M, Alexander E, O'Kelley B, et al. Compensation equity between men and women in academic medicine: methods and implications. Acad Med. 1994;69:131–7.
17. Nickerson KG, Bennett NM, Estes D, et al. The status of women at one academic medical center: breaking through the glass ceiling. JAMA. 1990;264:1813–7.
18. Hostler SL, Gressard RP. Perceptions of the gender fairness of the medical education environment. J Am Med Wom Assoc. 1993;48:51–4.
19. Foster SW, McMurray JE, Linzer M, et al. Results of a gender-climate and work-environment survey at a midwestern academic health center. Acad Med. 2000;75:653–60.
20. Buckley L, Sanders K, Shih M, et al. Obstacles to promotion? Values of women faculty about career success and recognition. Acad Med. 2000;75:283–8.
21. Levinson W, Tolle SW, Lewis C. Women in academic medicine: combining career and family. N Engl J Med. 1989;321:1511–7.
22. American College of Physicians. Promotion and tenure of women and minorities on medical school faculties. Acad Med. 1991;114:63–8.
23. Association of American Medical Colleges. Increasing women's leadership in academic medicine. Acad Med. 1996;71:800–11.
24. DeAngelis CD. Women in academic medicine: new insights, same sad news. N Engl J Med. 2000;342:426–7.
25. Massachusetts Institute of Technology. Special edition: a study on the status of women faculty in science at MIT. The MIT Faculty Newsletter 1999;XI.
26. Yedidia MJ, Bickel J. Why aren't there more women leaders in academic medicine? The views of clinical department chairs. Acad Med. 2001;76:453–65.
© 2003 Association of American Medical Colleges
27. Morahan P, Voytko M, Abbuhl S, et al. Ensuring the success of women faculty at AMCs: lessons learned from the national centers of excellence in women's health. Acad Med. 2001;76:19–31.