Related to the notion of fit were aspects particular to AHCs; certain qualities of the academic medicine setting drew some women to practice in this environment. The nine subthemes under AHC environment constitute the qualities that attracted some women: mobility, intellectual stimulation, teaching, variety, training opportunities, remaining current, subspecialty practice, lifestyle / flexibility, and patient acuity (see Table 3). Our study participants perceived these qualities as congruent with their own values or with their perceptions of what is important in the practice of medicine.
The influence of individuals in these women's lives also emerged as a key factor in their decisions to practice academic medicine. This theme's four subthemes—mentors, role models, colleagues, and parents/family members—delineate the various roles played by the people who encouraged the women in our study to consider and ultimately choose an academic medicine career path. One woman noted,
[A]s I was doing my fellowship, I came into contact with academic [specialists] who I sort of found [to be] mentors and people I looked up to, and I thought “I want to be just like them.”
And another woman stated,
I was feeling a push away from private practice and feeling a pull toward academic medicine ... because of the people I was working with.
The women also discussed various types of exposure to academic medicine, including both positive and negative events, as key factors in their career decisions. One interviewee commented,
I had a lot of exposure to research and mentors who were very involved in that arena and [who] gave me a very positive experience.
Although they did not elaborate on it in great depth, many women alluded to patient care, taking care of patients, and the more clinical aspects of medicine when describing why they chose academic medicine.
How did women choose academic medicine?
Five themes capture how our participants made the decision to enter academic medicine: (1) change in specialty, (2) dissatisfaction with former career, (3) emotionality, which includes the two subthemes of affinity and fear, (4) parental influence, and (5) decision-making styles, which includes four subthemes: serendipitous/passive, reflective/intuitive, active/planned, and foreclosure (see also Table 4).
Change in specialty.
Career changes prompted some participants to consider academic medicine. These women initially entered one specialty and later decided to work in another specialty or to further subspecialize, and these new choices prompted them to think about and ultimately to choose academic medicine. To illustrate, one interviewee said:
I was a community [specialist], sort of a private practice [specialist].... I realized this was not the career I wanted to pursue for the rest of my life ... made calls back to the academic center to see if there was an academic position.
This respondent went on to subspecialize and received additional training in a specialty that is more common to academic medicine than to private practice. In other, similar cases, academic medicine was the only environment in which some of the women could practice because theirs is not a subspecialty frequently found in private practice.
Dissatisfaction with former career.
Dissatisfaction with their initial specialty choices prompted some women to enter academic medicine. One woman explained,
I did private practice for a year ... it wasn't a learning environment ... it wasn't how I had seen myself living the whole rest of my life.
Such women pursued a position in academic medicine but maintained their specialty.
Many participants mentioned emotional aspects, using words such as “like,” “love,” and “fear,” to describe elements of their decisions. Participants expressed sentiments of affinity most often in relation to teaching (“I've loved teaching”), and they expressed fear in describing managing a practice (“I wasn't so sure about the business aspects of medicine”). Both fondness for teaching and concerns regarding practice management pushed them toward academic medicine (see also Table 4).
Parental influence emerged as a theme in how—as well as in why—women chose careers in academic medicine. Our participants usually described the influence of their parents in an indirect but positive manner:
I come from a family of teachers ... not physicians ... but teachers ... and always loved to teach.
In our analysis of our participants' explanations of how they made their decisions, we noted various decision-making styles, which we labeled serendipitous/passive, reflective/intuitive, active/planned, and foreclosure (see Table 4).
When did women choose academic medicine?
Thematic analysis revealed four themes that offer explanations of when our participants decided to enter academic medicine: (1) as a practicing physician, (2) as a fellow, (3) as a resident, and (4) as a medical student (Table 5). None of our participants indicated that they had decided on academic medicine prior to medical school. Overwhelmingly, participants indicated that as medical students they did not know enough about academic medicine to choose it as a career. Three women we interviewed made the decision to practice academic medicine while attending medical school, but, among our study participants, their experiences seem to be the exception rather than the rule. Among the women we interviewed, fellowship or residency seemed to be critical points in considering academic medicine; some women indicated that they became more aware of academic medicine as a career path during residency but did not solidify their decision to work as an academic physician until during a fellowship. Finally, some participants chose academic medicine while in practice, sometimes after trying private practice first. These respondents each had their individual reasons for entering academic medicine.
Knowledge of academic medicine during education and training years
Although our main objective was to answer the question “Why, how, and when do women choose careers in academic medicine?” we also asked the women we interviewed what they knew about the field of academic medicine during their education and training. Participants indicated that during medical school they knew very little—they described themselves as “naïve” regarding careers in academic medicine. For example, one interviewee said, “In medical school … nothing…. I really didn't know anything [about academic medicine].” Participants indicated that as residents they knew a little bit more than they did as students. Several themes related to why, how, and when women chose academic medicine careers reemerged in participants' responses to this final query: the influence of others including parents; aspects of the AHC environment, particularly variety; and fit, especially salary as a nonissue (see Table 6). The theme of exposure reemerged the most often among respondents.
Discussion and Conclusions
This qualitative study of women academic physicians and their reflections provides insight into the process of selecting academic medicine as a career. The current study helps to fill a void in the literature, contributes to an area of inquiry that greatly needs further investigation, and begins to answer questions raised by the extensive literature review conducted in 2010.3 The environment in which one trains seems to be a substantial influence. For example, those participants who received training in teaching hospitals expressed formative experiences resulting from simply being in an environment where teaching and research were a daily presence. In addition to the environments where the physicians trained, the people around them, including faculty, mentors, role models, and family, serve as influential factors. Some women are fortunate to cross the path of someone or multiple “someones” who suggest, introduce or expose them to, and shape their interest in academic medicine. The serendipitous nature of these chance encounters may indicate that physician educators miss opportunities to cultivate the talents of trainees who have not necessarily been identified as having interests in academic medicine but who, nonetheless, may be—or could become—interested.
Medical schools and residency programs can take steps to purposefully and thoughtfully introduce careers in academic medicine to medical students and residents. Just as a school works with individual medical students as they investigate various specialty choices, so, too, a school could provide early exposure to practice options through formal or informal experiences, such as specialty interest groups, panel discussions, career interviews, and shadowing experiences.
The women physicians in academic medicine whom we interviewed frequently mentioned an interest in teaching as a reason for pursuing a career in academia. Some of our respondents were aware of their affinity for teaching prior to entering medical school, whereas others' interest in teaching surfaced during residency or fellowship when they actually had the opportunity to teach medical students and other trainees. Programs and initiatives, including teaching electives for medical students, aimed at developing medical students' and residents' teaching competencies are becoming more common.13,14 These increased opportunities for medical trainees to understand and learn teaching skills may lead more students and residents to consider academic careers.
As with all research studies, our study has limitations. We developed a codebook through consensus, and one of us reviewed the assessments of our other team members; nonetheless, others may have identified different themes and subthemes. Because qualitative work focuses on the particulars of a phenomenon, the results of this study may not be generalizable to all women in academic medicine. We attempted to gather a representative sample of women physicians based on rank, specialty, and ethnicity, but we did not necessarily capture all perspectives. Further, our study sample included only women physicians in the southern and central regions of the United States. In addition, women in this study self-selected to participate. Other women physicians in academic medicine had the opportunity to participate but chose not to for unknown reasons. Finally, we did not interview men who work as physicians in academic medicine. A study of male physicians in academic medicine could provide further insights into and understanding of how men and women differ from and parallel one another in coming to their decisions to enter academic medicine careers. Given that the number of women in medical school has only recently equaled the number of men and that male faculty continue to far exceed the number of women faculty,1,2 we felt that focusing this study on women physicians was important.
Although not surprising, it was unsettling to learn that entering a career in academic medicine was not necessarily an active, planned decision; rather, it was serendipitous or circumstantial. Physician career development—specifically, engaging medical students in the decision-making process early—is important if the medical education community wants to have physicians who are satisfied with their specialty and practice-setting decisions. Educators have an obligation to medical students and residents to develop their knowledge and skills, including those related to career development, for effectively practicing medicine. Our study shows that faculty can play a key role in helping students and residents with their career planning. On the basis of the findings of this study, we suggest that medical educators and administrators seriously consider providing programming and opportunities at their schools and residency programs to expose not only women, but all medical trainees, to careers in academic medicine. Assisting these trainees as they determine whether the AHC environment is a good fit for them is vital for the future of academic medicine.
The authors wish to thank Jeremy Reese, MD, who helped conduct phone interviews as part of his fourth-year elective in medical education research, and Laura Johnson, MEd, who transcribed the interviews. They would also thank Lionel Howard, EdD, at the George Washington University Graduate School of Education and Human Development (Washington, DC) for his consultation on this study.
This project was funded by the American Medical Association Foundation Joan F. Giambalvo Memorial Scholarship program, presented in association with the American Medical Association Women Physicians Congress. Dr. Borges is the 2009 recipient of the Joan F. Giambalvo Memorial Scholarship. Dr. Grover received support from the National Institutes of Health Building Interdisciplinary Careers in Women's Health grant.
Ethical approval was granted by institutional review boards at Wright State University (Dayton, Ohio) and Virginia Commonwealth University (Richmond, Virginia) and through an internal exemption at the Association of American Medical Colleges (Washington, DC).
The authors have previously presented some of this research as the following: Borges NJ, Navarro AM, Grover A. Women physicians' reflections on choosing an academic medicine career. Research paper presented at the annual meeting of the Association for Medical Education in Europe, Vienna, Austria, September 2011; and as Borges, NJ, Navarro AM, Grover A. A qualitative study of women physicians and their choice of a career in academic medicine. Oral abstract presented at the Research in Medical Education (RIME) conference at the annual meeting of the Association of American Medical Colleges, Denver, Colorado, November 2011.
1Nonnemaker L. Women physicians in academic medicine: New insights from cohort studies. N Engl J Med. 2000;342:399–405.
3Borges NJ, Navarro AM, Grover AC, Hoban D. How, when, and why do physicians choose careers in academic medicine? A literature review. Acad Med. 2010;85:680–686.
4Brown AJ, Swinyard W, Ogle J. Women in academic medicine: A report of focus groups and questionnaires with conjoint analysis. J Womens Health (Larchmt). 2003;12:999–1008.
5Leonard JC, Ellsbury KE. Gender and interest in academic careers by first- and third-year residents. Acad Med. 1996;71:502–504.
6Levine RB, Lin F, Kern D, Wright SM, Carrese J. Stories from early-career women physicians who have left academic medicine: A qualitative study at a single institution. Acad Med. 2011;86:752–758.
7Reed DA, Enders F, Lindor R, McClees M, Lindor KD. Gender differences in academic productivity and leadership appointments of physicians throughout academic careers. Acad Med. 2011;86:43–47.
9Navarro AM, Taylor A, Pokorny A. Three innovative curricula for addressing medical students' career development. Acad Med. 2011;86:72–76.
10Merriam SB. Qualitative Research: A Guide to Design and Implementation. San Francisco, Calif: Jossey-Bass; 2009.
11Savickas ML. Career style assessment and counseling. In: Sweeney T, ed. Adlerian Counseling: A Practical Approach for a New Decade. 3rd ed. Muncie, Ind: Accelerated Development Press; 1989:289–320.
12Hartung PJ, Niles SG. Established career theories. In: Luzzo D, ed. Career Counseling of College Students: An Empirical Guide to Strategies That Work. Washington, DC: American Psychological Association; 2000:3–21.
13Soriano RP, Blatt B, Coplit L, et al. Teaching medical students how to teach: A national survey of students-as-teachers programs in U.S. medical schools. Acad Med. 2010;85:1725–1731.
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14Post RE, Quattlebaum RG, Benich JJ 3rd. Residents-as-teachers curricula: A critical review. Acad Med. 2009;84:374–380.