Even though women have represented nearly half of medical school students for more than a decade, they remain disproportionately underrepresented in the higher-ranking positions in medical schools such as full professor, chair, and dean.1–5 This leadership paucity persists, although the “pipeline” has now had a reasonable period to produce senior women* academic and administrative leaders, given the usual career advancement trajectories.3,6–8 Women faculty in academic medicine holding the full professor rank, a position that is generally a predecessor to administrative leadership ranks, increased only slightly in nearly 35 years, from 7% (518/7,153) in 19769 to 13% (5,753/45,722) in 2010.10 Similarly, women in leadership positions represented only 21% of division and section chiefs and 11% of deans in 2010.10 This historic trend of underusing women in top administrative positions exacerbates a potential leadership deficit occurring during a growth period in a number of medical schools and campuses that is expected to continue throughout this decade (2010–2020), in part because a physician shortage exists in the United States.11,12
The small number of women leaders may decrease further if women interested in and prepared for leadership are not geographically mobile. The few previous studies in higher education have concluded that geographic mobility is advantageous to career advancement,13–25 particularly because candidates compete for occupational opportunities in a national labor market.17,22 However, these studies in this area were conducted over four decades, with only 2 of the 13 being reported since 2000; thus, we need to reexamine the relationship of geographic mobility and career advancement in light of the major career and lifestyle changes over the past two decades as women have entered professions in greater numbers. Moreover, none of the previous research studied academic medicine. Understanding how geographic mobility and related factors might affect women who aspire to administrative promotions could enhance the ability of medical schools to attract and hire qualified women candidates for top administrative positions. The findings might also be useful to women navigating their careers.
The major research question we asked was whether there are associational relationships for women among geographic mobility, institutional prestige, and career advancement, which we defined as administrative advancement to mid-, senior-, or executive-level positions at U.S. medical schools (See Supplemental Digital Figure 1, http://links.lww.com/ACADMED/A160, which illustrates the conceptual framework and research model for the associational variables in this study). We also asked whether mobility is associated with age (women are less likely to move in later career stages)22,24 or with city size (women prefer larger cities).18,22–24 Our intent in this quantitative exploratory study was to provide insight into this phenomenon and determine whether the findings might warrant further investigation for causality. Given that few recent studies existed, this research has extended the literature on geographic mobility and career advancement to a new demographic, women in academic medicine, and to the current time.
We sampled women in their mid- to senior career stages who were interested in leadership positions in academic medicine by selecting participants in the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women at Drexel University College of Medicine in Philadelphia, Pennsylvania, between 1996 and 2005. ELAM is a one-year, part-time leadership development program for women faculty who have been nominated by their employer. The program requires both the participant and the supervisor to develop a pathway to leadership on completion of the program.26,27 The program began with a class of 25 in 1995; since 2009, the annual classes have included 54 women faculty from medical, dental, and public health schools primarily from the United States and Canada.
We purposefully selected this group and this period so that for data analysis in 2009, the alumnae would have had four or more years to make career changes; in our experience, it takes several years for ELAM alumnae to move to new internal or external positions after completing the program. The original sample included all 380 ELAM alumnae in medical, dental, or public health schools or in positions outside academia (see Supplemental Digital Table 1, http://links.lww.com/ACADMED/A160, which shows full sample and subsample per cohort). A limitation of the sample we used is that it was not a random sample from the larger population of women in academic medicine in the United States.
ELAM provided a deidentified dataset with random ID numbers with primary data extracted on the academic ranks, administrative positions, and institutions of the study participants. The ELAM directors developed the administrative promotion categories through an iterative process over the first 10 years of the program as they accumulated data on the various administrative positions that ELAM alumnae assumed (see Table 1). We defined leadership responsibility and scope by administrative title; although there are general definitions, the exact meaning of administrative titles differs from school to school. The primary purpose of the database was to collect information on the ELAM participants when they applied to and attended the program. We obtained information such as later job changes through voluntary self-reporting and staff data collection on an ongoing basis. Consequently, the dataset had limitations because of inconsistent self-reporting by study participants, resulting in incomplete data that affected some analyses. The lead author (M.R.M.) obtained permission to use ELAM data, and the George Washington University’s human subjects review board approved the project.
We used the U.S. Office of Management and Budget Metropolitan Statistical Areas28 (http://www.census.gov/population/metro/) and the U.S. Census Bureau Population Finder (http://www.census.gov/popfinder/) to classify city size into small (fewer than 499,999 population), medium (500,000 to 999,999), large (1 to 2 million), and metropolitan/urban (2 million or more) categories. We defined geographic mobility (movers) as a distance-based measure of migration between medical school employers of 50 or more miles apart, based on the “theoretical notion of changing labor markets.”29 (p1) We calculated the distance of moves between school addresses using MapQuest (http://platform.mapquest.com/). We classified institutional research levels using as an estimate the U.S. Department of Health and Human Services National Institutes of Health (NIH) Awards to Medical Schools by Rank30; this provided an award-ranking number for each institution ranging from 1 (high) to 125 (low), representing schools that received the greatest amount of NIH funding to those that received the least. To address variation in rankings of institutions from year to year, we used an average of NIH award annual rankings for each institution that had received funding more than once between 1996 and 2005 to establish an equitable, single ranking for each institution. Also, the institutional prestige measure (NIH research levels) is weighted toward research revenue and can only be a proxy for institutional prestige.31–34
We performed descriptive analyses (frequency, proportion, mean [M], median, and standard deviation [SD]) for cohort, year, degree type, age, faculty and administrative rank (position level), job change, geographic mobility, and city size. These descriptive statistics established the profile of the study participants and provided context for the inferential statistics findings.
We used the Mann–Whitney U test to analyze whether movers and stayers differed with regard to 10 administrative position levels of interest. We used binary logistic regression to test the relationship of the dichotomous (dependent) variable representing career advancement (promotion or no promotion; see Supplemental Digital Table 1, http://links.lww.com/ACADMED/A160 for categories) to the independent variables for geographic mobility (move or stay) and institutional research level (NIH averaged ranking number). We used the χ2 test to explore mobility (frequency) among participants who attended the ELAM program and the possible association between movers and stayers based on expected frequency (a statistical calculation of the product of row and column frequencies for a given cell divided by the total frequency; see Table 2). We used the t test to explore how geographic mobility differed for movers and stayers with regard to age (in years) at the start of the most recent job. We used the McNemar test to analyze the before-and-after relationship of movers who had relocated from smaller cities (combined small–medium) to larger cities (combined large–urban), or the reverse (larger city to smaller city), after attending the ELAM program (before) to the most recent job (after). We used inferential statistical procedures to analyze for significance at the 95% probability level (α = .05).
We established the following subgroups for analysis (see Supplemental Digital Table 1, http://links.lww.com/ACADMED/A160): women who were working in academic medicine at both the time they participated in ELAM and at their most recent job (subsample n1 = 351; adjusted to 345 participants in some analyses because of missing data); women who had changed jobs in the period under analysis, whether or not the change involved a move (subsample n2 = 278); and women in subsample n2 who had moved from their previous institution (subsample n3 = 83 = movers).
Increase in administrative positions between the time of attending ELAM and at the last job on record
When attending ELAM, almost all participants (98.3%, 345/351) held faculty positions; the vast majority held the rank of associate (47.9%, 168/351) or full professor (46.4%, 163/351). Their median age was 48 years when they attended the ELAM program and 52 years when at the most recent job of record.
When attending ELAM, 88.0% (309/351) of the participants held one of nine categories of administrative positions (see Table 1). The majority (41.6%, 146/351) held positions at the division chief/director level (level 4), followed by the associate or vice chair level (16.8%, 59/351) (level 5), and the chair or center director level (16.2%, 57/351) (level 6) (see Table 1). The administrative position level increased substantially at the last job of record; 40.7% (143/351) held the position of chair or higher (levels 6–12), in contrast to the 29.7% who held such a position (104/351) during the period they attended ELAM.
Geographic mobility of ELAM participants
In aggregate, only 24.1% of participants (83/345) of the ELAM classes (1996–2005) were movers (see Table 2). The last three classes in the study showed the least movement, possibly because they had had less time to traverse the necessary steps for job change.3 ELAM graduates who did move were an average of two years older at the time of their move (M = 53.58, SD = 4.841) than women in the study who did not move (M = 51.7, SD = 5.122, P = .007).
Positive relationship of geographic mobility with advancement in administrative position
Geographic mobility was positively associated with career advancement (administrative position category level), evidenced by a multipredictor binary logistic regression model that included three independent variables: geographic mobility, prestige of the institution from which the subject received her doctorate, and prestige of the institution at which the participant was employed during the time she was at ELAM. These were combined in one model, using all participants working in academic medicine (n1 = 351) (see Table 3). Geographic mobility was the only independent variable that we found to be positively related to career advancement (promotion) (P = .001). Odds for promotion were 168% greater for geographic movers than for stayers [odds ratio Exp(β) = 2.684].
Movers attained higher administrative position levels than stayers (Mann–Whitney U = 4463, P = .003) (see Table 4). Using the study participants in academic medicine who changed jobs, subsample1 (n1 = 351), the 70 movers who had administrative positions at the last job on record attained significantly higher administrative position levels (Mann–Whitney mean rank = 141.32) than stayers (Mann–Whitney mean rank = 112.1).
Moreover, the majority of study participants who were administratively promoted had moved (see Table 5). Slightly more than one-third (38.6%) of the combined movers-and-stayers group had been promoted (increase in administrative job rank). However, for those who were movers, the majority, 60.2%, advanced their administrative positions. For those who did not move (stayers), the opposite occurred; 31.7% had administrative advancement (χ2 [1, n1 = 345] = 21.706, P = .0001). The movers-and-administratively advanced group had the highest standardized residual value (3.2), indicating that there were more women who moved and received administrative advancement than would be expected by chance (an absolute residual value of 2.0 or greater indicates a major influence on a significant χ2 test statistic).
We explored changing city size in conjunction with career progression to determine whether ELAM alumnae who moved and received administrative advancement (60%, 50/83) chose to relocate to similar-size or larger markets as hypothesized18,22,23 or to smaller cities. The majority of ELAM alumnae resided in large and urban cities with populations of one million or more at both career points in time—71% (235/331) when attending ELAM and 69% (208/300) at the most recent job. Most of the 125 medical schools in the study (62%, 77/125) are also located in large and urban cities combined. Consequently, although moving was associated with career advancement, we found no significant relationship in changing city size (smaller-to-larger or larger-to-smaller) between the employer at the time of attending ELAM to the employer at the most recent job (P = .458). For those ELAM alumnae who advanced in administrative position, approximately 20% (19.6%, 9/46) had lived in small–medium cities while at ELAM and relocated later to large–urban cities, and only 8% (7/89) had lived in large–urban cities while at ELAM and moved to small–medium cities for their most recent jobs.
Investigation of relationship between institutional prestige (NIH research level) and administrative advancement after ELAM
Although we found a positive association between mobility and administrative position in subjects who had attended ELAM, we found no significant association between institutional research level and administrative position level for the combined movers-and-stayers group (see Table 3). Because the large number of stayers might have skewed the results, we tested the movers-only subgroup in subsample1 using the two independent variables: NIH research level of the doctorate-granting institution, and NIH research level of the participant’s employer during the time she was at ELAM, combined in one model. For these movers only (n3 = 83), the NIH research level of the doctorate-granting institution showed an odds ratio of Exp(β) = .998 (P = .795), and the NIH research level of the institution while at ELAM showed an odds ratio of Exp(β) = 1.004 (P = .603). These results indicated no significant relationship between institutional research level and administrative position, even among those who moved.
Further analysis revealed that, among the 50 women academics who moved for a higher administrative position, on average this group moved from lower-prestige institutions when attending ELAM (M = 52.04, SD = 34.68) to higher-prestige institutions at the most recent job (M = 47.24, SD = 31.26). However, the difference was not significant [t(30) = −0.978, P = .17, d = 0.15].
Investigation of relationship between institutional prestige (NIH research level) at earlier career stage
Approximately two-thirds (67%; 221/331) of the ELAM women employed at NIH institutions when at ELAM were employed at the higher-ranked 125 schools of medicine (NIH rankings above the midpoint of 62). They were employed by institutions with an average NIH ranking of 49.83 (SD = 31.92) and median ranking of 47. We found a significant relationship between the prestige of doctorate-granting institutions and prestige of employers when at ELAM for the combined movers and stayers (n1 = 351; P = .0001) and for movers only (n3 = 83; P = .034).
Our findings establish that geographic mobility had a positive association with administrative career advancement for ELAM alumnae. From the individual perspective, this should be encouraging to women who have the flexibility to move for career growth opportunities at any of the 141 academic medicine institutions in the United States,35 given that this labor market is highly competitive36,37 and national in scope.17,22 However, women who have obstacles to moving, such as dual-career relationships and child care or elder care responsibilities, need strategies for leveraging, timing, and negotiating career growth at their current institution or at another in the same geographic market, or identifying medical schools that can ease the transition of moving with specifically targeted work–life balance benefits and adequate compensation. Unfortunately, few universities currently have policies and procedures to address such issues, and those that do often have policies that are not clearly defined, difficult to access, or experiencing implementation challenges.36
The small group of movers among midcareer women faculty in medical schools (24%) attained career advantages as evidenced by three analytical approaches. This is commensurate with previous research that, collectively, suggests that mobility appeared to remain central with regard to career advancement in higher education in the first decade of the 21st century. Between 1971 and 2006, similar findings were reported for academics in psychology and in the social and life sciences, as well as for college presidents and government and industry professionals.13–25 Our results extend similar findings in other areas of higher education and in other professions to a new demographic, women in academic medicine, and to the current time.
The fact that only a quarter of the women moved at the later career point in our study supports the premise that women professionals tend to move less than men as they get older or are in later career stages.19,22,38 Further study is needed to investigate this, given the well-known obstacles and barriers that women may face,39 such as difficulty in attaining tenure during the childbearing years,40,41 the challenges faced by women in dual-career couples,42–46 and the disproportionate burden of child care or elder care responsibilities on women.47–49
One of the most consistent themes in the literature is that women academics in higher education fields, including psychology, science, and engineering, tend to reside in large, metropolitan labor markets.18,22–24 Our study demonstrated this for women in academic medicine also. Further investigation into the relocation decisions of professional women is needed regarding choices for relocation, including changing city size, with or without the added incentive of being promoted. Complex factors beyond a woman academic’s own career include socioeconomic and lifestyle choices, children’s educational opportunities, partner’s career opportunities, and parental responsibilities.50
In contrast to geographic mobility, at senior post-ELAM career levels institutional prestige (as defined by research grant level) appears to be a secondary or nonfactor in career advancement. This finding contradicts previous reports that the prestige of the degree-granting institution or department is important to candidate selection and is advantageous for individuals seeking to attain leadership positions at future employers.13,15,25 On the basis of the logistic regression analysis we conducted using the doctorate-granting institution (P = .27) and employer when at ELAM (P = .67) as independent variables (see Table 2), institutional prestige at the most recent job was not related to career advancement.
At the earlier career level, however, we did find a significant relationship between the prestige of doctorate-granting institutions and prestige of employers when at ELAM for the combined movers, as has been found in other studies.13–15,25 This finding suggests that earlier in their careers, ELAM alumnae chose or were chosen by employers of similar prestige as their doctorate-granting institution. One possible explanation is that employers evaluating candidates at earlier career stages rely on credentials and accomplishments at the institution where the candidate earned her doctorate, because these women have fewer professional experiences and accomplishments for employers to assess. The limited literature on later career periods indicates that candidates tend to be evaluated on their actual experiences and accomplishments (e.g., leadership experience and training, including advanced degrees and leadership development programs such as ELAM) and not merely on potential.5,51,52
Our study has limitations for generalizability to all faculty in academic medicine. Women who attended ELAM might not be representative of women in academic medicine. In a previous study, we reported that more ELAM alumnae had leadership aspirations than did applicants who were not accepted, or women faculty matched from the Association of American Medical Colleges faculty database.53 Other studies have shown that professional women have similar leadership aspirations as men.54
As one of several factors in career decisions, these findings on geographic mobility can be useful for both women faculty and organizations in academic medicine to strategically plan and implement policies and practices relating to the employee–employer relationship, achieving gender equity, and career advancement.55 An individual faculty member needs strategies for leveraging, timing, and negotiating career growth at her current institution or another in the same geographic market. An institution needs specifically targeted strategies to become known as an employer that can ease the transition of geographic mobility for faculty, such as having dual-career or moving assistance. Eliminating obstacles to hiring practices inherent in geographic mobility that have disproportionately disadvantaged women in professional ranks50 is a goal that benefits not only women but also the academic medicine enterprise, particularly the new generation of academics.43,56
Establishing a positive relationship between geographic mobility and administrative career advancement, and the fact that only a quarter of women undertake such moves, sets the stage for future qualitative studies. Topics for future study include the psychosocial and socioeconomic factors that underlie an academic’s decision to move for career advancement; the impact of those choices on faculty careers and institutional effectiveness; and whether gender-related differences affect relocation choices.55 Myriad possible questions include the following: Do women (or men) who move differ from those who do not move in their degree of leadership ambition? Are movers more satisfied than stayers in job or lifestyle? Do movers and stayers receive different opportunities? Do stayers not accept different opportunities because they differ in family or community ties?
Acknowledgments: The authors wish to thank the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women, who granted us permission to use the ELAM dataset, and Victoria “Tori” Odhner on the ELAM staff, who diligently ensured that the dataset met the needs for this study.
* Consistent with terminology in sex and gender research, because this study investigates societal influences on women rather than biological differences, the term “women” is used rather than “female” as an appositive noun (noun acting as an adjective), which is accepted practice in the journal Biology of Sex Differences of the Organization for the Study of Sex Differences; http://www.bsd-journal.com/content/1/1/1 (accessed July 14, 2013).
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