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How Women Neurologists Broke Through the Glass Ceiling

Defino, Theresa

doi: 10.1097/01.NT.0000388433.47216.3d
DEPARTMENTS: Career Tracks

Asked what skills women neurologists need to excel in academia, “pioneer” Lois Nora, MD, answers, “time management, goal setting, being your own harshest critic and your own best friend.” In 2002, Dr. Nora, who has a MBA and law degree in addition to her medical degree, became the first female neurologist chosen dean and president of an American medical school.

Other factors are important, such having a good mentor, said Dr. Nora, and a handful of other female neurologists who have ascended the academic ladder concur.

But like Dr. Nora's friend/critic description, the advice that she and others give — such as “be tough, but not too tough” — typifies the almost acrobatic maneuvers they say are still demanded of women who want to move beyond being an assistant or associate professor in an academic institution.

Women who began their careers as practicing neurologists are under-represented in the higher levels of academic medicine nationwide. Although they number nearly half the total in medical schools and residency programs, their presence fades out over time, so much so that there are currently fewer than a dozen female heads of neurology departments in the US.

According to 2009 statistics from the Association of American Medical Colleges (AAMC), women total 40 percent of assistant neurology professors; 30 percent of associate professors, and 14 percent of full professors.

Even more rare are women like Dr. Nora, who achieve the rank of dean or presidents of institutions. While 14 women currently serve as deans at the 133 US medical schools, none are neurologists. Yet, hope is not lost, and there are specific strategies women can take to overcome these odds and better prepare — and position — themselves for advancement and leadership positions in academia.



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Allison Brashear, MD, named in 2005 to lead the Neurology Department at Wake Forest University Baptist Medical Center, credits her success to help from others but also to being “proactive and seeking opportunities.”

“We really haven't seen that many women neurology professors or vice chairs, or chairs,” said Dr. Brashear. “For women to advance, it really takes someone looking out for them.” But, women themselves “must be very purposeful about thinking, ‘how will I grow?’”

Anne Young, MD, PhD, agrees. For a time, she was the only woman department head at her institution, Massachusetts General Hospital, but also the only female department head at any academic medical center in America. Recognized for her research and expertise in Huntington and Parkinson diseases, Dr. Young said “learning how to ask for what you need” is key.

On the one hand, she doesn't take kindly to women who make demands, particularly if the request is “impossible.” What works with Dr. Young is when the person can argue how the request will benefit patient care, or the department — offer some reason beyond personal desire for why Dr. Young should say yes. “What are we going to get back? What is the return on investment? That's what I want to know,” she said.

She is surprised that some women neurologists will go to the mat for patients, yet have a difficult time advocating for themselves. One member of her staff becomes uncomfortable and routinely cries when she meets with Dr. Young to make a request for something. While Dr. Young said she is trying to “teach her that it is OK to ask for things” without such an emotional display, she is nonetheless promoting her within the department because she is progressing in her academic work. The woman recently received a research grant from the NIH, and that is one of the criteria for promotion, Dr. Young says.

Dr. Young said sometimes women are held back because they don't know what it takes to be promoted. So, an important strategy is to learn as much as possible about the opportunities for advancement, including pay increases, and the culture for women — even before joining an institution.

Find out the rate of promotion for women and the percentage of female faculty who have achieved full professorship, said Jessica Lee, MD, who also advises not being afraid to ask such questions during a job interview.

Dr. Lee, chair of the AAN Women In Neurology Section, was recently named medical director for neurology and neurosurgical services for University Hospital-Zale Lipshy, part of the University of Texas Southwester School of Medicine, where she is also an assistant professor at the University of Texas-Southwestern School of Medicine.

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The importance of a facile mentor is one constant that runs through all the careers of the high achieving women neurologists. If a mentor doesn't emerge naturally, a woman will need to find one, and should seek someone who can meet her specific goals, said Dr. Nora, who stepped down as dean of Northeastern Ohio Universities Colleges of Medicine and Pharmacy in January and is now a professor of internal medicine/neurology and behavioral and community health at the institution.

Dr. Nora declines invitations to mentor women she doesn't know — “a recipe for disaster”— and recommends individuals choose someone they already know, or start slowly to build a relationship with someone before labeling them a “mentor.” It's a good idea have more than one mentor, Dr. Nora said, and to broaden the definition of mentor.

She counts among her “mentors” the authors of books that she has found extremely useful. Her two favorites are the 1989 self-help book, The Seven Habits of Highly Effective People by Stephen Covey and Good To Great, by Jim Collins, published in 2001.

Women in academia are “less likely to have received strong mentoring,” said Janet Bickel, a career coach who specializes in women and academic medicine. As a result, they “can end up in blind alleys and taken advantage of, such as not getting credit for their work.”



She and others recommend women investigate what's available at their institutions as increasing numbers offer career advancement seminars or programs for faculty. Attending outside classes and workshops can also be invaluable and may be considered mandatory to be promoted.

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Attendance at Drexel University College of Medicine's Executive Leadership in Academic Medicine (ELAM) program, exclusively for women, is often touted as providing an unparalleled foundation for career advancement and promotion. ELAM bills itself as “the nation's only in-depth program focused on preparing senior women faculty at schools of medicine, dentistry, and public health for institutional leadership positions where they can effect positive change.” (See

Subjects covered include leadership style, finance, strategic planning, human resource issues, and creating a personal development plan. The year-long program can be done from one's home university but does require 20 days of on-site participation and class size is capped at 54, chosen through a competitive process that requires written statements of support from the individual's employer.

Drs. Nora and Brashear are ELAM graduates; Bickel is a member of the faculty.

Because it is for “senior” women faculty (defined as associate or full professors) a choice for younger women might be the “Early Career Women Faculty Professional Development Seminar,” offered by the Association of American Medical Colleges (AAMC) for women at the instructor or assistant faculty level. Topics include grant-writing, negotiating contracts, and understanding how a woman's personality can influence her leadership style and work environment. (see

Dr. Nora was among the speakers at this year's conference in July, where she discussed the concept of having “one life.”

“Where I have seen people fall off the track or get very disappointed is when they have been overly dualistic…‘this is my professional life, this is my family life.’ That doesn't help them blend the two…we really have one life that we want to be fulfilling,” Dr. Nora said.

The AAMC annually offers a similar program for “mid-career women.”

In the near future, Dr. Lee anticipates taking what she learns from conferences she attends and sharing that knowledge with members of the AAN Section through various means, including its Web site and offering “short courses,” as well as meetings at the AAN annual and regional conferences.

Bickel offers one final thought: Get men into the room where these complex issued are discussed. Help them understand that the playing field is not level and that “gender stereotypes” can prevent women from reaching their full potential. “We need men to be active participants here. Talent development is everyone's issue,” she said.

©2010 American Academy of Neurology