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Viewpoint: Women in Medicine: The Work that Remains

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Viewpoint: Women in Medicine: The Work That Remains

Janet Bickel

By Janet Bickel, AAMC Associate Vice President for Medical School Affairs and Director, Women in Medicine program.

Since its beginnings in 1976, the AAMC's Women in Medicine (WIM) program has evolved from its original concentration on women students to the development of women faculty and leaders. At this point, ironically, the good news - the high numbers of women entering medical schools - actually obscures the bad news: that academic medicine still greatly favors the development of men.

This "tilt" in men's direction is deeply rooted in our culture, beginning with our "mental models" of gender. Since everyone believes they are fair, labeling these filters "sexist" has not helped to dispel them. Some instances are laughable; e.g., a patient trying to compliment a senior attending says, "Do you have, like, a Ph.D. in nursing or something, because you're really good!"

But it's not amusing when the search committee chair doesn't take you seriously because you remind him of his mother. Or when your mentor tells you that because you have children, you'll never make full professor. Such inaccurate evaluations of women's credentials and competence are incredibly persistent, in part because powerful individuals tend to ignore information discrepant to their stereotypes.

Too few of our leaders challenge their colleagues' beliefs and behaviors. When a choice opportunity opens up, most still contact their "Old Boys' Club." Since diverse teams deliver more than homogeneous ones, the smarter course of action is to make the extra effort to bring in a woman or an ethnic minority.

The 'human capital' era

I read the incorporation of women into the health professions as an unfolding drama. Act 1 might have been titled "we're here!" or "add women and stir." Act 2 was the "pipeline dream" - we fantasized that increasing numbers of women would create equity. Act 3 is just beginning. I hope it will become known as the "human capital" era, with leaders placing greater value on the development of both women and men. Many practices still inhibit this orientation; for instance, penalizing residents and junior faculty for taking time for self-care and family responsibilities.

Given the "24/7" nature of patient care, adding flexibility is indeed a complex challenge, but dualistic thinking has robbed us of our creativity; i.e., either you're fully available during your 20s and 30s to work or you're uncommitted and will never be worthy to lead. Generations 'X' and 'Y' are intent on "working to live," not "living to work," as most faculty appear to. Such restrictions are discouraging many promising young physicians from entering or staying in academic medicine.

In addition to more flexible options for faculty, academic medical centers also need to create stratified, multi-dimensional faculty development programs - a much smarter use of resources than continual retraining and re-recruiting. The AAMC's Increasing Women's Leadership in Academic Medicine report [published in Academic Medicine in October 2002] provides a template for accomplishing the culture changes necessary to develop a human resources focus to better leverage both women's and men's intellectual capital.

New challenges

Among the greatest immediate challenges facing WIM programs is building bridges to the next generation of young women who have not yet experienced limitations on their choices. Preparing young women for the career disadvantages they will face once they leave the protective walls of medical school without discouraging them entails walking a fine line between pessimism and optimism. Would programs that bring students together with high-achieving women who also have rich family lives inspire fortitude in the younger generation? Or does the very paucity of such role models send a more powerful message?

I believe a more promising avenue is for every department head to initiate a conversation with every woman and minority faculty in his/her department to learn what they need for their career progress and to encourage their development. That would send a powerful message of attention and engagement that might make all the difference in whether those underrepresented faculty leave academic medicine or become role models for the next generation.

It's impossible to predict how many years it will take for our academic medical centers to create a more level playing field, which would put AAMC's WIM program out of business. In the meantime, the AAMC Women Liaison Officers require the support of dean's offices to assist their institutions in this work. The liaison officers' connection to each other and to AAMC resources continues to be essential.

Editor's Note: After 25 years of service, Janet Bickel is leaving the AAMC to dedicate herself to partnering with individual faculty as a career coach and with institutional leaders as a faculty career development consultant. As of March 1, she may be reached at (703) 876-0111; janetbickel@cox.net or www.janetbickel.com.