References from this Issue

Selected Reference on Negotiation

• Shell, Richard. Bargaining for Advantage, Penguin Books 1999

Selected References on Compensation and Resource Equity

• Ash A, Carr P, Goldstein R, Friedman R. Compensation and advancement of women in academic medicine: is there equity? Ann Intern Med 2004; 141:205-212
• Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA 2000;284: 1085-1092
• Wright A, Schwindt L, Bassford T, Reyna V, Shisslak C, St. Germain P, Reed K. Gender differences in academic advancement: patterns, causes, and potential solutions in one U.S. college of medicine. Acad Med 2003;78:500-508
• Fister E, Gordon MA, Hoersch M, McAlpine L, Morrissey C editors, Beyond Parity Workbook for Action, The University of Illinois at Chicago Center for Research on Women and Gender 2004

Ash A, Carr P, Goldstein R, Friedman R. Compensation and advancement of women in academic medicine: is there equity? Ann Intern Med 2004; 141:205-212

Do women receive similar rewards for similar achievement in the current environment of academic medicine? The authors address the question by analyzing 1814 (60% response rate) responses to a mailed survey of full time faculty from 24 randomly selected medical schools in the United States in 1995. Outcomes were salary, pretax academic year compensation including clinical payments, and promotion to full professor.

The authors constructed models to compare male and female faculty data for deviations from expected rates of promotion based upon equal career seniority (number of years from first appointment), comparable numbers of publications and academic responsibilities (teaching, administrative, research, clinical); in addition to the factors already listed, they analyzed expected ranges of salary based upon type of department (primary care, medical specialty, surgical specialty, and basic science.

Results of their analysis showed that for all levels of productivity measured, women are less likely to be full professors and to be less well compensated than their male peers. For each year of seniority, women were less likely than men to be promoted to full professor. Women were more likely to be full professor if they were in a basic science department, had more career publications, were chair or chief of an academic division, and worked more hours. For both men and women, salaries were higher for faculty with more seniority, more than 40 publications, physicians in a medical or surgical specialty, chairs and chiefs of divisions, and working more hours per week. Time spent in research or teaching was associated with a reduction in compensation. Independent of profession, female physicians received almost $12000 less than male physicians, and almost $5000 less additional salary than men for each 10 years of seniority.

The accompanying editorial by Laine and Turner, Unequal pay for equal work: the gender gap in academic medicine, lays out strong challenges to men and women in academic medicine to address the profession in which the gap between male and female wages reported in 2000 by the U.S. Census Bureau is greater than any other profession listed. The Census Bureau clearly states that it has not considered differences of work load or reimbursement patterns within the profession. While this difference may be due more to the wide variation in practice patterns and specialties than to discriminatory behavior on the part of employers, it is still an important difference. The challenge requires women to learn to negotiate effectively and to advocate for themselves and for each other and for leaders of good conscience to increase transparency in the promotion and compensation practices of academic medical institutions.

Fister E, Gordon MA, Hoersch M, McAlpine L, Morrissey C editors, Beyond Parity Workbook for Action, The University of Illinois at Chicago Center for Research on Women and Gender 2004.

The Beyond Parity Workbook for Action was developed to assist with activism to promote positive gender climates at academic medical institutions, to increase diversity within leadership positions and to reframe academic excellence to reflect the contributions of women faculty. The Workbook includes 1)a summary of the Beyond Parity conference held in 2002; 2) a summary of 20 models of medical academic women's leadership programs; and 3) an outline of implementations steps for transforming the academic work environment to increase the diversity of leadership. Background points highlight the challenges in this proposed transformation:

1. The norm that assumes unlimited time for professional endeavors differentially disadvantages women, since they are more likely to have their career interrupted or decelerated by family obligations. As dual career families increase, this obstacle will have more of an impact upon men as well.
2. System norms facilitate ongoing discrimination against women and minorities, however inadvertent or subtle.
3. Given that leadership in academic medicine continues to be largely represented by majority males, women and minorities are often underrepresented on high-level committees, and other decision-making bodies, rendering them voiceless on important procedural issues and policy decisions.

Wright A, Schwindt L, Bassford T, Reyna V, Shisslak C, St. Germain P, Reed K. Gender differences in academic advancement: patterns, causes, and potential solutions in one U.S. college of medicine. Acad Med 2003;78:500-508.

The author's report the results of information from the personnel database and 198 responses to an on-line survey of 418 faculty at the University of Arizona College of Medicine. The results of this analysis of faculty salaries, ranks, tracks, leadership positions, resources and perceptions of academic climate showed significant gender differences, even after adjusting for rank, track, degree, specialty, clinical revenues, years in rank and administrative positions. Men and women gave similar importance to career advancement, leadership ability and aspirations, work-personal life conflict. However, women were less likely to have been asked to serve as section or department heads, to have decision-making authority over promotion of colleagues or non-grant related resources, and to feel that they effectively influenced departmental decisions. They were more likely than men to share research space.

The results of this study describe an academic environment that is significantly more challenging for female than for male faculty in their institution. Solutions proposed to improve the academic climate for all faculty include: regular monitoring of salary and resource distribution, mentoring and advising junior faculty, increased flexibility in tenure track positions and definition of scholarly contributions, and education about subtle forms of discrimination.

Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA 2000;284: 1085-1092.

Analysis of data from the AAMC Faculty Roster system compared promotion rates of 50,145 full time U.S. faculty who became assistant or associate professors between 1980 and 1989. Racial/ethnic disparities in promotion were evident for all underrepresented minorities, even after adjusting for cohort, sex, tenure status, degree, department, medical school type (public or private) and receipt of NIH awards. After 17 years of follow-up, only half of the minority faculty who had become assistant or associate professors in 1980-81 had been promoted. Receipt of NIH awards is one of the strongest predictors of promotion. However, minority faculty members are less likely to receive NIH awards or be on tenure tracks. They are more likely to be affiliated with departments and medical schools with lower promotion rates and more likely to be women.

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