Back to Front PageVOLUME 6, NUMBER 4

Breaking Out of the 'Male Mold': Increasing Female Leadership in Academic Medicine

By Barbara A. Gabriel

This year marks the 25th anniversary of the AAMC's Women in Medicine program. To commemorate the group's work over the past quarter century, the AAMC Reporter will run a series of stories in 2001 examining the changing role of women in academic medicine.

Caption: Judith Lea Swain, M.D., chair of the Department of Medicine at the Stanford University Medical Center, says that Stanford's broad-based faculty searches have led to more women being considered for leadership positions.

The past 25 years have brought tremendous change to the gender makeup of the world of academic medicine. Once dominated by male professors teaching male students, medical schools and teaching hospitals were on the brink of change in 1976 when the AAMC's Women in Medicine program was established. Women were applying to and being accepted by medical schools at unprecedented rates. Nearly 25 percent of the students entering U.S. medical schools in 1976 were women, up from approximately 14 percent just five years earlier. Today, women compose more than 45 percent of the national freshman medical school class.

Yet female professors at academic medical centers remain far outnumbered by their male counterparts. On average, there are 21 women full professors per medical school, compared with 161 men at that rank. In 2000, only 11 percent of female faculty at U.S. medical schools held the rank of full professor, compared with 31 percent of male faculty - these percentages have remained remarkably stable for the last two decades, according to an AAMC report.

The paucity of women full professors means a relatively small pool of women ready for recruitment into the senior-most management level of medical schools. Nationally, women department chairs number only 180, or approximately 7.5 percent of all chairs. At least 23 schools have no women department chairs. And there are only seven female medical school deans, a figure that includes three interim deans.

With so many female faces on the receiving end of medical education, many have begun to question why the number of women faculty in positions of leadership in our nation's medical schools has not grown accordingly.

Several medical schools notable for their promotion of women to senior faculty and administrative positions point out that until more women occupy these highly visible positions, little will change. "If women see other women who are successful, I think it goes without saying that they will be able to imagine success for themselves," says Layton McCurdy, M.D., dean of the Medical University of South Carolina (MUSC). "If we say we want women in positions of leadership but don't put them there, we have no credibility."

Fostering Women's Professional Growth Under Dr. McCurdy's leadership, MUSC has earned a reputation for its active promotion of women faculty members. Three of the school's 10 associate deans are women, there is one woman assistant dean, and MUSC boasts three women department chairs. Dr. McCurdy, who says his own medical school graduating class had only one female member, demands that chairmanship search committees at MUSC produce at least one woman on their "short lists" of potential candidates. "They aren't always the ones who get chosen," Dr. McCurdy says, "but being on that short list ensures that qualified female faculty members are considered."

When Dr. McCurdy assumed the deanship of MUSC 10 years ago, he made the examination of gender inequities on campus one of his top priorities. "It came to my attention that there might be a salary discrepancy between women and men with similar rank and job duration," Dr. McCurdy explains. He ordered a salary audit to explore the issue and found sex-based discrepancies in several departments. The new dean became active in his campaign for salary equity, and he says the experience not only raised consciousness about equal pay for equal work but also raised larger questions about the particular concerns women faculty face.

In response to those concerns, the new dean helped found the Women in Medicine and Science group, which since its inception in 1993 has been a "powerful force" on campus, Dr. McCurdy says. Open to medical students, residents, and faculty members, the group meets once a month to offer various programs, talks, and opportunities for discussion about issues that affect women faculty. One outgrowth of the group has been the Office of Gender Equity, which deals with sexual harassment and gender inequity on a university-wide level.

Although not specifically targeted at women, other policies instituted at MUSC in the interest of faculty development have enabled women faculty members to more easily manage career and family responsibilities. Part-time faculty tracks and policies that permit faculty to stop the "tenure clock" help both men and women pace their careers at their own rates.

Finally, Dr. McCurdy credits the Hedwig van Amerigen Executive Leadership in Academic Medicine (ELAM) Program for Women, sponsored by MCP Hahnemann University, with shaping a cadre of female leaders on the MUSC campus. Each year, MUSC supports one or two female applicants to the ELAM program, which helps prepare women faculty at academic medical centers for senior leadership positions. The ELAM program brings together senior women faculty for skills training, mentoring, networking, and professional development.

Over its six years of existence, ELAM has graduated about 200 women, says the program's co-director, Page Morahan, Ph.D. Dr. Morahan, who won the AAMC's 1997 Women in Medicine Leadership Development Award, says that ELAM helps give women the tools and confidence that they need to advance. But citing the work of Stanford Business School's Debra Meyerson, Ph.D., she says that three other elements are critical in women's quest for equality.

First is celebrating the accomplishments of women, says Dr. Morahan, urging medical schools to recognize and publicize women's promotions. The next element is increasing access for women, for example, by changing the tenure track and establishing programs for dual recruitment. Finally and most difficult to achieve, Dr. Morahan says, is raising awareness of and working to change "gender schemas," subconscious expectations about the roles of the sexes, including the professional competence of women. "It takes a great deal of commitment from the very top to change gender schemas," she stresses.

Redefining Professional Achievement Linda S. Austin, M.D., MUSC's associate dean for continuing medical and public education and a professor of psychiatry, is a product of ELAM. Her promotion to associate dean followed her completion of the rigorous program. "MUSC has been one of the strongest supporters of the ELAM program," Dr. Austin says. "Many women who complete the fellowship receive significant administrative promotions within a year."

"Even in this day and age, for a woman to be a doctor feels like a big deal in and of itself," Dr. Austin stresses. "ELAM provides support for women to crystallize their ideas about what they might be able to achieve."

Dr. Austin, who calls herself an "atypical academician" because her primary work involves public education rather than research, is a well-known figure on the radio waves. She has hosted a public radio mental health call-in show called "What's On Your Mind?" for the past 10 years. The nationally syndicated program has allowed Dr. Austin to share her expertise as a psychiatrist with individuals in about a dozen states.

In her latest project, a book called "What's Holding You Back? Eight Critical Choices for Women's Success," Dr. Austin examines the self-imposed psychological glass ceiling as well as the continuing characterization of barriers in academia. She maintains that one reason women still experience difficulty achieving top positions in academic medicine is that promotions criteria have been written from "a distinctly male point of view."

"Achieving the rank of full professor has typically required national prominence in a very focused area of expertise," Dr. Austin says. "I suspect that if women had written promotions criteria, they would look very different." She cites studies that suggest that women develop a broad-based, multifaceted intelligence, whereas men tend to focus on a particular area of expertise. She says that since promotions criteria generally reward such academic concentration, men have done very well. Dr. Austin believes the steps taken by MUSC and other medical schools to institute several different promotion tracks will help promote women at a greater rate.

"Women need to be able to take risks and try activities that suit them and their particular talents, as opposed to feeling like they have to fit into a male mold," Dr. Austin explains. "And academic medical centers need to appreciate a different array of contributions."

Addressing the Pipeline Problem The Stanford University School of Medicine is notable for having six female chairs, more than any other U.S. medical school. Eugene Bauer, M.D., dean of the Stanford University School of Medicine, credits the school's successful promotion of women faculty to its policy of casting the widest possible net in searches for senior and administrative staff. "My belief is that you should probe the talent pool as deeply as possible, finding the best person for the job, irrespective of gender," Dr. Bauer says.

A fund explicitly set aside for the retention of highly valued female faculty at Stanford is another measure Dr. Bauer points to as helping the school maintain its high number of talented women faculty members. He also cites Stanford's formal mentoring program. The program focuses on assistant professors in their first five years, and Dr. Bauer says it has been effective in helping both male and female junior faculty build professional networks and get the help they need in honing the skills essential to promotion.

Dr. Bauer attributes the nationwide lack of women leaders in academic medicine to a "pipeline problem." "This is not about malice of intent," he emphasizes. "It's about coming to grips with the reality that there is a delay between the time one enters medical school and when one becomes a fully mature person capable of directing a division or department."

Judith Lea Swain, M.D., is a cardiologist whose position as chair of Stanford's Department of Medicine makes her only one of three female chairs of medicine departments in the U.S. "Stanford is more direct and interested in broad-based searches for faculty than any other institution I've seen," Dr. Swain says. "There is a very clear message from the top that searches should cover all available candidates, especially women and minorities. If you can get more women in the pipeline, they will rise up."

Dr. Swain adds that an essential element to the professional success of women faculty is institutional recognition of a woman's familial responsibilities. "No matter what anyone says, taking care of a family tends to fall more on women than men," she emphasizes. "It is in an institution's best interest to recognize that a faculty member's first responsibility is to his or her family, because if things are not working out at home, they won't work out on the job." Dr. Swain applauds Stanford for investing in an on-site day-care center that makes it easier for women faculty members to attend to their multiple responsibilities.

"A female Nobel Prize winner once said, 'For a woman to be successful, she has to be twice as smart and work twice as hard as a man - fortunately, that's not very difficult,' " quotes Dr. Swain with a laugh. "Of course, that's meant to be a joke. But I do think the bar is still a little higher for women; they have to be a little better and work a little harder to achieve professional recognition."

Dr. Morahan adds that despite women's progress in attaining assistant professor and lower-level faculty jobs, academic medicine "still has a long way to go" before women achieve equality in leadership positions. "We need to change the culture of medicine - that will take a sustained effort for at least 20 years."

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08 February 2005