The Josiah Macy Jr. Foundation has held three conferences in the past 50 years on the theme of women in medicine: Women for Medicine in 1966,1 Women in Medicine in 1976,2 and Women and Medicine in 2006.3 Reading the reports of these conferences confirms that a lot has changed for the better regarding the participation, role, and status of women in medicine over these decades. By the time of the 2006 conference report,3 women had achieved parity in the number of matriculants to medical school (from less than 10% at the time of the previous reports), nearly one-third of the faculty of medical schools were women, and there were some women deans and department chairs. All of this was encouraging, but the findings and recommendations from that conference clearly indicated that all was not right with the world of academic medicine in terms of true gender equity. Barriers were identified to professional advancement and financial equity, and a work environment was described that was at best indifferent, and at worst hostile, to the needs and values of women faculty members. Recommendations were made to achieve specific numeric goals for women in leadership positions (e.g., 50% of department chairs by 2025 and 50% of deans by 2030), for an improved work environment with specific leadership training opportunities for women, and for greater flexibility for training and career trajectories.
The articles from the Research Partnership on Women in Biomedical Careers in this issue of Academic Medicine4–11—along with other data and observations in this issue and elsewhere—support the case that much work still needs to be done to achieve parity for women in medicine. As one example, a 17-year follow-up of a 1995 faculty survey demonstrates that a 10% lower salary for women versus men faculty persists across faculty careers.4 This discrepancy appears to be predominately determined by a lower starting salary for women that never “catches up.” Those who take time off or work part-time for a period of time (whether men or women, but disproportionately this affects women) also have a salary “penalty” which persists.
Regarding academic rank and leadership positions for women, we are far from achieving the goals recommended in the 2006 Macy report.3 According to the 2013–2014 Association of American Medical Colleges (AAMC) report “The State of Women in Academic Medicine,”12 women make up 38% of the full-time faculty, but only 13% of women faculty are full professors (compared with 30% of men faculty). Only 15% of department chairs and 16% of deans are women. These numbers have increased only marginally over a decade, and the pace of change is not on track to meet the recommended targets.
The reasons for the slow progress toward parity are many and complex. By some quantitative measures of productivity (such as number of articles published and grants submitted), women are less productive than men. These quantitative differences are at least partially explained by the greater number of hours women spend than men on housekeeping and child care activities. But there are no qualitative measures of performance that would explain the lack of parity. It has been speculated that women do not negotiate as well on their own behalf or that they may be less likely to seek out leadership positions for personal or psychological reasons. Although there may be some truth in both of these assertions, it is hard to believe that these could fully explain the persistence and magnitude of the lack of parity, particularly in the percentage of women in professorial and leadership positions. Women are more likely to take time off from their career or to work part-time for a period of time. There is little doubt that there is some fiscal and/or professional cost for this, and the cost may be persistent and out of proportion to the time lost. This calls for further study and for policies to promote flexibility and the customization of career pathways for both women and men.
It could still be that the most important explanation for the lack of parity is the culture of academic medicine, which in turn determines the work environment. That work environment may dispropor tionately affect the likelihood of women achieving their full potential in academic medicine. Multiple surveys and recent publications13–15 indicate that many of the findings in the 2006 Macy report3 about the working environment are sadly still valid today. Issues of work–life balance, the availability of adequate mentoring, the need to feel appreciated and recognized for one’s work, and the desire to work in an organization with values synchronous with one’s own are important for the success of all faculty. But because of the unique role of women as mothers and caregivers, because of a body of data showing that women prioritize certain values differently from men, and because of traditions and hierarchy that have favored men, these issues are much more important for women and have greater impact on the likelihood of their success.
Taking the long view, we can legitimately say that the state of women in medicine has improved. But more than a decade after parity in matriculation to medical school has been achieved, we still have not achieved parity in many other dimensions. It is important to address this, not just as an issue of social justice (as important as that is), but as an issue of optimal resource management to achieve excellence. If half our workforce is at risk for failing to reach its full potential, then we are not as likely collectively (as an organization or as a profession) to achieve our full potential. And if the experiences, points of view, and voices of our leaders are not sufficiently diverse, the best decisions will not be made.
The work of the Research Partnership on Women in Biomedical Careers represented in this issue of Academic Medicine is very important to highlight. It provides an evidence base for the ongoing discussion on gender equity in academic medicine. It is incumbent on all of us to work within our own institutions to address these policy and cultural issues and to work with national organizations such as the National Institutes of Health and the AAMC in their programmatic efforts for gender equity. Continued progress in this area is important for the success of all faculty and for the overall success of academic medicine.
1. Josiah Macy, Jr. Foundation. 1966 Annual Report. 1966.New York, NY: Josiah Macy, Jr. Foundation.
2. Spieler C. Women in Medicine, 1976: Report of a Macy Conference. 1977.New York, NY: Josiah Macy, Jr. Foundation.
3. DeAngelis CD, Hager M. Women and Medicine: Proceedings of a Conference Sponsored by the Josiah Macy, Jr. Foundation. 2007.Bermuda, NY: Josiah Macy, Jr. Foundation.
4. Freund KM, Raj A, Kaplan SE, et al. Inequities in academic compensation by gender: A follow-up to the National Faculty Survey cohort study. Acad Med. 2016;91:1068–1073.
5. Ginther DK, Kahn S, Schaffer WT. Gender, race/ethnicity, and National Institutes of Health R01 research awards: Is there evidence of a double bind for women of color? Acad Med. 2016;91:1098–1107.
6. Carapinha R, Ortiz-Walters R, McCracken CM, Hill EV, Reede JY. Variability in women faculty’s preferences regarding mentor similarity: A multi-institution study in academic medicine. Acad Med. 2016;91:1108–1118.
7. Remich R, Jones R, Wood CV, Campbell PB, McGee R. How women in biomedical PhD programs manage gender consciousness as they persist toward academic research careers. Acad Med. 2016;91:1119–1127.
8. Kaatz A, Lee YG, Potvien A, et al. Analysis of National Institutes of Health R01 application critiques, impact, and criteria scores: Does the sex of the principal investigator make a difference? Acad Med. 2016;91:1080–1088.
9. DeCastro Jones R, Griffith KA, Ubel PA, Stewart A, Jagsi R. A mixed-methods investigation of the motivations, goals, and aspirations of male and female academic medical faculty. Acad Med. 2016;91:1089–1097.
10. Raj A, Carr PL, Kaplan SE, Terrin N, Breeze JL, Freund KM. Longitudinal analysis of gender differences in academic productivity among medical faculty across 24 medical schools in the United States. Acad Med. 2016;91:1074–1079.
11. Plank-Bazinet JL, Bunker Whittington K, Cassidy SKB, et al. Programmatic efforts at the National Institutes of Health to promote and support the careers of women in biomedical science. Acad Med. 2016;91:1057–1064.
12. Association of American Medical Colleges. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership 2013–14. 2014.Washington, DC: Association of American Medical Colleges.
13. Pololi LH, Civian JT, Brennan RT, Dottolo AL, Krupat E. Experiencing the culture of academic medicine: Gender matters, a national study. J Gen Intern Med. 2013;28:201–207.
14. Krupat E, Pololi L, Schnell ER, Kern DE. Changing the culture of academic medicine: The C-Change learning action network and its impact at participating medical schools. Acad Med. 2013;88:1252–1258.
15. Carr PL, Gunn CM, Kaplan SA, Raj A, Freund KM. Inadequate progress for women in academic medicine: Findings from the National Faculty Study. J Womens Health (Larchmt). 2015;24:190–199.