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Invited Commentaries

Where Are We in Bridging the Gender Leadership Gap in Academic Medicine?

Valantine, Hannah A. MD

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doi: 10.1097/ACM.0000000000003574
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Abstract

In 2013, I proposed an audacious goal—“50:50 by 2020”—to bridge the gender leadership gap in academic medicine.1 At the time I realized that achieving gender parity among U.S. medical school department chairs was aspirational but I hoped that enhanced representation of women among the highest academic ranks would be a transformative step toward necessary culture change. Many organizational climates in academia, however, inhibit our efforts to achieve this goal by perpetuating messages that women do not belong—keeping them in the periphery and limiting their advancement to leadership. These negative experiences are even more severe for women of color.2,3 It is now 2020, and we still have work to do, but I truly believe that success is near if we keep a sharp focus on creating and sustaining cultures of inclusive excellence. This means establishing academic medicine environments in which individuals from all backgrounds, including those from underrepresented groups, thrive in their pursuit of new knowledge to benefit human health.

Recognizing diversity as an institutional core value is an important first step to linking faculty diversity and research excellence. In 2005, the Stanford University School of Medicine responded to a faculty needs assessment by establishing the Office of Diversity and Leadership and appointed me to lead the effort as its inaugural senior associate dean. The landmark National Academies of Science Engineering and Medicine report “Beyond Bias and Barriers”4 served as my guiding star, and I drew from evidence-based strategies then emerging from the National Science Foundation’s ADVANCE program to implement programs and policies geared to the advancement of women in the professoriate. Now, as chief officer for scientific workforce diversity at the National Institutes of Health (NIH), a post I have held since 2014, I have promulgated an integrated approach to drive systems-level change toward achieving inclusive excellence in the NIH intramural research program (IRP), as well as at a national level. Herein, I report the current status of gender representation among U.S. medical school department chairs as a pivotal benchmark of academic leadership, and I describe NIH’s framework and tools for creating cultures of inclusive excellence.

Representation of Women at the Top Ranks of U.S. Medical Schools

Only 5 of the 154 Liaison Committee on Medical Education–accredited U.S. medical schools have achieved the goal of 50:50 by 2020, according to 2019 data from the Association of American Medical Colleges faculty roster—but notably, only 2 of these 5 schools have more than 2 or 3 chairs in total.5 On the whole, women comprise only 19% (637) of 3,297 department chairs, and more than half (80) of the schools have fewer than 20% female department chairs. Moreover, the representation of women among department chairs exceeds 30% at only 22 institutions: a concerning statistic because we know that the tipping point for institutional change is 30%.6 Equally disconcerting is that among the top 10 research-intensive institutions in the United States,7 the proportion of female department chairs hovers around 20% (or less), with only one institution over 30%5 (Figure 1). Understanding and sharing those approaches being used by institutions where women are well represented among department chairs will help guide a national strategy to eliminate the gender leadership gap in academic medicine.

Figure 1
Figure 1:
Percentage of female department chairs at top research-intensive institutions, 20195 (arranged by U.S. News and World Report 2020 medical school rankings7). Among the top 10 research-intensive institutions in the United States, the national average representation of female department chairs is 19%, with only one institution over 30%. Abbreviations: Stanford, Stanford University School of Medicine; Harvard, Harvard Medical School; Penn, Perelman School of Medicine–University of Pennsylvania; Wash U, Washington University School of Medicine in St. Louis; UCSF, University of California, San Francisco, School of Medicine; Hopkins, Johns Hopkins University School of Medicine; UCLA, University of California, Los Angeles, School of Medicine; Mayo-Alix, Mayo Clinic Alix School of Medicine; NYU, NYU Grossman School of Medicine; Columbia, Columbia University Vagelos College of Physicians and Surgeons; NIH, National Institutes of Health.

NIH Strategy for Inclusive Excellence: An Integrated, Systems Approach to Culture Change

Because the scientific workforce composition of the NIH IRP mirrors that of research-intensive institutions, this population is a useful testbed for an integrated approach to achieve inclusive excellence.* We anchored an NIH plan for creating cultures of inclusive excellence in 2 guiding principles, which are implemented through 4 integrated strategies (Table 1). The first, most compelling guiding principle is that strategies focused on an individual are necessary but not sufficient for institutional culture change, an idea supported by a substantial body of research.8 Second, evidence from effective programs such as ADVANCE9,10 tell us that the advancement of women and individuals from other underrepresented groups requires accountability and transparency; clear metrics of inclusion, diversity, and equity; tracking and evaluation of such metrics; as well as tying these metrics to institutional reward systems.

Table 1 - National Institutes of Health (NIH) Integrated Strategies for Inclusive Excellencea
Strategy Goal
NIH Equity Committee Provide coordinated, centralized oversight, tracking, and reporting of Institute/Center-level diversity and inclusion metrics
Trans-NIH searches, enhanced bibliographic search tools Broaden and diversify candidate pool beyond “who-you-know” networks
Bias education for all searches and promotion committees Mitigate implicit bias in recruitment, hiring, and promotion
Distinguished Scholars Program Drive institutional culture change through cohort program of ~15 tenure-track investigators committed to inclusive excellence
aNIH’s integrative strategies for inclusive excellence include NIH leadership involvement in tracking and reporting diversity and other metrics through the NIH Equity Committee; new protocols for diversifying talent pools; and mitigating bias through evidence-based implicit bias education for intramural research program (IRP) search committees, staff, leadership, and Boards of Scientific Counselors (external reviewers of IRP investigators). The NIH Distinguished Scholars Program embodies all these components toward transforming IRP culture.

What does this look like in practice? A key element is engaging senior leadership (at NIH, this means Institute, Center, and scientific directors; and in academia, deans and department chairs) in a coordinated institution-wide process for tracking and evaluating department-level metrics of inclusion and diversity with centralized reporting and oversight. Beyond demographic data, metrics should include salary, personnel and other support, space, conference speaking invitations, and departmental efforts to support work–life integration. Disaggregation of data by department is essential to reveal unit-level gender and race/ethnicity gaps that can be remedied by targeted solutions to close those gaps. A committee of senior faculty members—each with a track record of commitment to diversity, inclusion, mentoring, and equity—should oversee this process as well as be responsible for reviewing the data presented to the committee by each department chair. Equally important is transparency of the committee’s analyses, which must be disseminated institution-wide as soon as possible. Rather than “shaming” units and their leaders for existing gaps, rapid and full transparency offer opportunities to highlight promising practices and solutions for others to adopt. NIH is using this approach to monitor metrics in the NIH IRP, using an online sharing platform (Figure 2). Research also tells us that effective approaches to achieve inclusive excellence must be integrative (Table 1), as outlined in the NIH Scientific Workforce Diversity Toolkit.11

Figure 2
Figure 2:
Percentage of female tenure-track investigators in the NIH IRP by year, 2010–2019. The online NIH SWD Network Platform monitors and reports diversity metrics in the NIH IRP. Source: Office of Intramural Research. Intramural Research Program Personnel Demographics (End FY19). National Institutes of Health. https://oir.nih.gov/sourcebook/personnel/irp-demographics/intramural-research-program-personnel-demographics-end-fy19. Accessed June 8, 2020. Abbreviations: NIH, National Institutes of Health; IRP, intramural research program; SWD, scientific workforce diversity.

At NIH, we are forging ahead with these approaches, which are themselves encapsulated within the NIH Distinguished Scholars Program (DSP), a highly integrated and innovative 3-year pilot to recruit IRP tenure-track investigators. DSP investigators are selected first on the basis of outstanding scientific accomplishments and also have a strong track record of committing to the principles of inclusion, diversity, mentoring, and equity. To ensure inclusion and foster a sense of belonging among the DSP cohort, we provide research resources, high-quality mentors vetted for their mentoring skills, networking activities with senior institutional leaders, and a robust curriculum for leadership and professional development. After only 2 rounds of the DSP pilot, we are seeing an impact on the overall IRP demographic metrics, with marked enhancement of diversity (Figure 2), and we are currently measuring data on institutional climate compared with baseline (pre-program) conditions. Based upon early results of the DSP and published literature on the impact of cohort hiring on faculty diversity,12–14 NIH has approved $421 million to support a similar national cohort-model program at NIH-supported institutions.15

The Role of Workplace Climate

The overarching goal of our 4 integrated strategies for achieving inclusive excellence in scientific work environments is organizational culture change. We know that specific elements of workplace climate not only perpetuate barriers for advancement of women and individuals from other underrepresented groups but are also the harbingers of gender harassment, the most common form of sexual harassment.16 In 2019, NIH developed and administered the NIH Workplace Climate and Harassment Survey that has uncovered modifiable elements of our organizational climate that are guiding current harassment-prevention strategies. Based on our survey data, we have designed interventions to eliminate incivility and create respectful environments; we are holding supervisors accountable for fair, equitable, and inclusive behaviors (and providing training to do so); and we are offering NIH-wide bystander training aimed to encourage and reward a culture where speaking up about inappropriate behaviors becomes the norm rather than the exception.

Accelerating Progress for the Future

While the representation of women and individuals from underrepresented racial and ethnic groups in biomedicine still falls short of that in the U.S. population, women now comprise 45% of NIH IRP tenure-track investigators (compared with 36% in 2013, and now exceeding the national average), and individuals from underrepresented racial and ethnic groups now comprise 13% of IRP tenure-track investigators (up from 6% in 2013). Up the career ladder, the NIH IRP has seen an 18% increase of female tenured investigators: from 169 in 2013 to 199 in 2019. Notably, the addition of 30 more women over a relatively short period signals an acceleration in the rate of change toward bridging the gender leadership gap, which is improving dramatically at the top. Compared with 2013, women now comprise 37% of NIH Institute/Center directors17 and 25% of NIH scientific directors. Both were under 10% just 6 years ago.

In 2020, success is in sight both for the NIH IRP and for NIH-funded institutions. Although we have not yet reached gender parity in academic leadership, we know what to do to get there, and we can do so rapidly by adhering to the guiding principles and integrated strategies I have articulated herein. My experience over the past 6 years underscores the importance of strong partnerships between NIH and the academic community to embrace the shared responsibility for transforming institutional cultures to those that promote the principles of inclusive excellence. While NIH’s integrated strategy provides a model that institutions can readily adopt, sustained organizational culture change will require additional actions to address gender gaps that persist throughout the culture of science, including in research funding and bibliographic data. As I wrote in 2013, the culture of academic medicine must also change to one in which work–life integration is a core value—reflected by substantial support, including affordable childcare.1 In 2014, I calculated that it would take 40 years to achieve gender parity nationally among academic faculty, based on the rate of change over the preceding 5 years.18 As I have described in this Invited Commentary, in 2020, we can do this faster, but we must work together and keep our eyes on the prize. Fully realizing a national standard for inclusive excellence is our greatest hope for harnessing the full intellectual capital required to maintain the nation’s preeminent status in biomedical research.

Acknowledgments:

The author recognizes leadership support for organizational culture change from National Institutes of Health (NIH) director Francis Collins, MD, PhD, and NIH principal deputy director Lawrence Tabak, DDS, PhD; ongoing collaborations to implement system-wide strategies for organizational culture change from the associate director for NIH Intramural Research Program Michael Gottesman, MD, PhD, and distinguished investigator and chair of the NIH Equity Committee Gisela Storz, PhD; editorial contributions from Alison F. Davis, PhD; data analyses and editorial review from Lyl Tomlinson, PhD; data acquisition on the NIH intramural research program from Roland Owens, PhD; and the collaborative efforts of Charlene Le Fauve, PhD, William Riley, PhD, and Katherine Morris, MS, for developing, administering, and analyzing the NIH Workplace Climate and Harassment Survey.

FOOTNOTE

*The NIH IRP scientific workforce includes 700 tenured principal investigators (PIs), 400 tenure-track PIs, 3,000 postdoctoral fellows, 2,000 predoctoral fellows, and 500 graduate students.

References

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