The gender distribution among applicants to and students matriculated at U.S. medical schools has changed rapidly over the past two decades.1–3 Since the early 2000s, the male-to-female ratio among U.S. medical students has approached 50:50.1 Many recent studies document the relative paucity of women in academic medical faculty and leadership positions and the gradient in the prevalence of women as one ascends the academic hierarchy.4–8 There is evidence of a “pipeline effect,” with some progress to which mentoring programs contribute. But women still start their careers with lower average salaries than men of the same rank and do not catch up to their male counterparts in this regard as time progresses. Women are more likely to take time off for childbearing, child rearing, or parent care than men. They are also more likely to work part-time, a fact that affects both time course and programmatic types of careers pursued by women.8
This study is aimed at providing a current picture of the quantitative and qualitative aspects of women at the decanal level (i.e., dean, vice dean, senior associate dean, associate dean, assistant dean) in U.S. medical schools. In so doing, it serves as a baseline for charting the evolution of such representation of women in roles at the academic medical school dean’s level.
Data were collected on September 10–18, 2016, from the Web sites of each of the 136 allopathic U.S. medical schools accredited by the Liaison Committee on Medical Education and represented on the roster of accredited MD programs in the United States that had full accreditation as of June 22, 2016.9 Schools with provisional accreditation were not included because most did not have a full administrative roster displayed on their Web sites.
In each case, the data collected consisted of the list of administrative appointees whose titles included the word “dean.” Apparent gender was inferred for each appointee in accordance with given name and, in most cases, accompanying or Web-sought and found photograph. The term “gender,” as opposed to the term “sex,” is used in this work, because it would be impossible to discern biological sex without direct interaction, and it is assumed that facial appearance and name generally reflect whether a person identifies and wishes to be recognized as male or female, respectively. Rank was assigned directly from the list, with cohorting of senior associate and vice dean positions as a single rank. Interim deans were counted as deans. Deans were also divided into cohorts according to the primary emphasis of their administrative duties (i.e., general, clinical, research, education, corporate decision making, and image making) and further subdivided by the specific topic or population (e.g., students, faculty, finance, communications) to which their administrative activities applied. Programmatic foci such as education, mentoring, public relations, fundraising, and human resources are perceived to have been more accepting of women in professional roles than other more strategic or political areas.10,11 Medical and graduate student educational program leaders, overseers of curricula, clinical rotation and house staff (residents and fellows) directors, and student affairs officers were cohorted under “education and student affairs.” Clinical, basic, and translational research deans were cohorted under “research.” Deans with responsibilities related primarily to the delivery of clinical service, regardless of venue or mechanism of provision, were cohorted under “clinical.” Statistical significance of the correlation between gender and rank was determined by Spearman rank correlation test, with P ≤ .05 considered statistically significant.
Data collected for this study were all from publicly available Web sites and were recorded in aggregate quantitative, anonymized fashion. This study is therefore exempt from institutional review board review. Data recorded included number of individuals of each gender for each decanal rank, programmatic job title, and public versus private institution. Comparisons were made by gender for programmatic job area and decanal rank, and within female gender, for public versus private institutions.
Prevalence of women in decanal roles
The prevalence of women in all decanal roles of any rank or programmatic focus at U.S. medical schools at the time of data collection was 44% (825/1,875). Men outnumbered women in such roles by a factor of 1.5 (1,239/825). Although one study hypothesis was that state regulations and requirements vis-à-vis diversity and equal opportunity would drive a difference in the prevalence of women in decanal roles between public and private medical schools, this was not the case (40% and 44%, respectively). In contrast, the prevalence of women in the role of the dean or the interim dean was 15% (22/149), and men outnumbered women in these roles by a factor of 6 (127/22). Similarly, the prevalence of women in the role of vice dean was 18% (7/40), and men outnumbered women in this role by a factor of 5 (33/7).
Figure 1 shows the prevalence of women in positions of various decanal ranks, from dean to vice dean or senior associate dean to associate dean to assistant dean. While half (206/420) of assistant deans were women, the prevalence of women decreased with increasing decanal rank (R2 = 0.93, P < .05; Spearman rank correlation test).
Women constituted 54% ± 6% (SEM) of decanal-level administrators below the rank of dean in institutions led by a female dean and 44% ± 2% of such administrators in those led by a male dean.
Prevalence of women in decanal roles with specific programmatic foci
Table 1 shows the percentage of women and the ratio of women to men in decanal roles of any rank that address specific programmatic areas of focus. The prevalence of women in general, clinical, research, and corporate decision-making areas of decanal leadership is considerably lower than that in education and mentoring and image-making areas. Figure 2 demonstrates the relationship of these data to the percentage of women among U.S. medical school graduates in 2015.3
Women constituted between 12% and 18% of medical school deans.5,6 Although they constituted as much as 44% of the decanal administration of U.S. medical schools, their prevalence among associate, senior associate, and vice deans was lower than that among assistant deans. It is interesting that, although the prevalence of women increased with decreasing decanal rank, among women in decanal roles, the most prevalent rank was associate (45%), not assistant (27%) dean (Schor NF, preliminary data). This raises the question of whether, some years ago, the peak might have been at the assistant dean level. If, as we suspect, this is a success of the pipeline, we would predict that, in the next decade, the peak prevalence of women in decanal roles will be at the level of vice dean or dean.
Decanal administrators serve all of the missions, functions, and infrastructural requirements of each academic medical center. Women have constituted half of the graduates of U.S. medical schools for almost two decades, and they now constitute approximately 44% of all decanal administrators. However, their distribution is uneven among those missions, functions, and infrastructural requirements. Women are disproportionately represented among decanal administrators serving the educational and image-making functions of medical schools. They tend to be more sparsely represented among decanal administrators who serve the general (i.e., top) leadership, clinical, research, and corporate strategy and policy functions. In addition, women in decanal positions studied in 2012 had master’s-level degrees related to population health and business, in contrast to the PhDs held by men, often in the basic sciences, in addition to their MDs, and trained and worked in less research-intensive institutions than the men.5 It is not clear whether this reflects the innate preferences of women in field of study and/or the degree to which women are encouraged, welcomed, and mentored in particular fields relative to men.
The loss of women from the faculty workforce in general as they progress up the academic ladder may relate more to choice of family needs over career4,11 or a more frequent choice of women chairs not to pursue decanal positions. The latter may also relate to women’s greater emphasis on work–life balance and the contributions of their work to individuals at the local level (i.e., to direct, individual mentoring of junior faculty and trainees) than on career title advancement and national or international recognition of their work.12
According to a study by Leslie et al,13 the prevalence of women in a particular field is inversely proportional to women’s perception that success in that field requires innate “brilliance” and endogenous aptitude. It is interesting that psychology and education were perceived by those studied as having a low requirement for innate brilliance, while the more quantitative sciences (e.g., computer science, mathematics, physics) were perceived as having a higher requirement for innate brilliance; the latter fields have a lower prevalence of women. This has led to the notion that women often choose fields of endeavor like education and psychology over more quantitative, research-intense fields. Even in pediatrics, a field with a high prevalence of women, women are less well represented in research careers than are men.11
The current study and its predecessors4–8 suggest that women have made little progress in their quest to gain entrée into the leadership suite in academic medical institutions. We have far to go before long-held programmatic stereotypes14 are abandoned and women are represented among all ranks and all roles in the dean’s office. The present data suggest that, as more women assume decanal roles, increasingly more women will be encouraged and recruited by and because of them to assume such roles. The effects of engagement of leadership around the need for women in academic medical leadership roles15 and of women leaders as role models for future generations of women will doubtless serve to fuel such growth.
Strategies have been suggested and are just beginning implementation to address the discrepancy between pipeline enhancement and the persistent leadership gender skew in academic medicine. Educational interventions, supportive infrastructure for women-predominant life course circumstances, and enhanced mentoring opportunities have been piloted and have shown encouraging signs of efficacy.16,17 Mentoring programs should leverage the affinity and talent women have for deep, longitudinal, individual mentoring relationships while providing venues for networking with other women at varied academic levels and in programmatically varied career tracks.18 Emphasized metrics and rewards for achievement should align with those things that women faculty value (e.g., achievement of mentees, building of consensus among those one leads, and attainment of academic goals in a culture of shared governance), rather than such things as level of national recognition or accrual of awards. Follow-on studies are critically important to chart the progress of closure of the “decanal divide” and to design and implement programs that ensure the continued fueling and ascension of a diverse career pipeline.
Limitations of the present study include the potential for out-of-date information appearing on the Web sites from which data were gathered, the small possibility that first name and/or photograph do not accurately reflect the gender of a given decanal-level administrator, and the fact that this study represents a snapshot in time of an evolving landscape.
Future studies will examine the evolution of these findings over time. In addition, the relationship between changes in the prevalence of women in specific types and ranks of decanal positions and the perceptions of medical students of either gender vis-à-vis women in leadership roles in academic medicine should be explored. Finally, the relationship between the prevalence of women in decanal roles and institutional policies, priorities, and collective governance style would be of interest, as well.
The author is indebted to Elizabeth R. McAnarney, MD, for many helpful discussions.
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