AAMC Reporter: February 2005

Women Deans Optimistic About Increasing their Numbers

Barbara Atkinson, M.D., (far left) executive vice chancellor of the University of Kansas Medical Center and executive dean of the medical school, instructs pathology residents

By Donna Coffman
Special to the Reporter

The number of women attending medical school has increased steadily since the 1960s, reaching 49.5 percent in 2004. Yet at the same time, only 14 percent of the senior faculty and 10 percent of medical schools deans are women.

There is reason for optimism, however, as more women are becoming deans at the nation's medical schools. In 1990 there was only one female dean. As of early 2005 there are 13. Most of the women serving as dean were appointed in 2001 or thereafter.

"Huge progress has been made over the last 10 years," said Barbara Atkinson, M.D., dean of the Kansas University School of Medicine.

There needs to be a push to promote qualified women into positions of seniority. As current female deans point out, it is not enough to have more women medical students.

The pool of talented candidates for senior faculty and administration will shrink if women cannot fully participate. Women are still not entering the pipeline to top positions. It is not enough to simply wait for promotions to occur with the passage of time, according to several deans.

"There is a lot of turnover, and you need as many good candidates as you can get," said Betty Drees, M.D., dean of the University of Missouri at Kansas City School of Medicine.

Cause for Delay

A 2002 AAMC study looked at why the number of women candidates for higher positions was so small. The committee, which Dr. Atkinson served on, found that women were not advancing as quickly from assistant to associate to full professorship as quickly as men, resulting in a delay in advancing women to department chair and eventually to dean.

"You have to have half the junior faculty and half the senior faculty represented by women," Dr. Atkinson said.

Such observations are not new, and there have been efforts to determine what can be done to promote parity. In a 2004 study conducted by the Stanford University School of Medicine, women faculty members were asked about their perceived career needs. Of a series of potential changes that could be made, the two options mentioned as most important were "a flexible work environment" and "part-time faculty positions for family reasons."

Tenure Track

Laura Schweitzer, M.D., Interim Dean of the University of Louisville School of Medicine

Laura Schweitzer, M.D., dean of the University of Louisville School of Medicine, agrees that the traditional tenure track impairs women from advancing their careers.

"Physicians go through a long training period and at some point want to have a family," she said. "The rigidity of the tenure clock undermines women's ability to attain tenure."

Dr. Schweitzer suggests eliminating or modifying the tenure track so that going part-time or taking time off does not disrupt the process. It would help women if schools allowed more flexibility in the rules that restrict the tenure track to seven years.

At some schools, changes allowing more flexibility in the tenure track have already been made. Deborah Powell, M.D., dean of the University of Minnesota Medical School, points out that "for young women who want a career and a family it's hard because the time table is all wrong."

Deborah Powell, M.D., Dean of the University of Minnesota Medical School and Chair, AAMC Council of Deans

School officials at Minnesota are experimenting with different ways to add flexibility to the tenure track including using a clinician-educator model as an alternative and allowing the tenure track to be extended for up to 10 years for faculty in the clinical departments of the medical school.

"The idea of extending the tenure clock is a good one, but sometimes you need the opportunity to step off the clock," Dr. Powell said. "We've made it a one-size-fits-all and that's not going to work. We need some flexibility."

Taking time off is not the only impediment to earning tenure. In the past, there has been a great deal of emphasis placed on being the first author of a publication. Dr. Drees points out that first authorship discourages the collaborative work styles that women prefer.

"We have to realize the value of clinical research," Dr. Powell said. "The problem is that large clinical studies take a lot of time and lots of people and tenure committees look at who's the first author. We need to be more inventive at looking at the roles of people in large projects."

Another potential obstacle to the promotion of women is the issue of moving. There are clearly more opportunities to advance a career if a candidate is able and willing to move, according to Dr. Drees. However, the prospect of uprooting a family for a career opportunity can be disruptive to many women.

Promoting Internally

Betty Drees, M.D., Dean of the University of Missouri at Kansas City School of Medicine

A potential solution is to put more emphasis on reviewing candidates from within the institution. Dr. Drees was able to stay in Kansas City as she advanced to her current position, but it was difficult. Dr. Schweitzer provides another example. Prior to becoming medical school dean at Louisville, she was the faculty dean at the University of Louisville.

Effective mentoring can also produce dramatic results. Dr. Schweitzer noted that women at Louisville were rising from assistant to associate professor level and then not progressing further. She developed a mentoring program specifically to address this lack of advancement.

"At the University of Louisville, the promotion from assistant to associate professor is a triggered event, meaning there's a process that triggers a promotional consideration," she said.

The next step up, to full professor, is not automatic, but requires a nomination. Dr. Schweitzer discovered that women who were eligible waited until they had more funding and more published papers than the men before nominating themselves for consideration. In addition, there seemed to be greater scrutiny of women candidates once they were nominated. Despite these obstacles, the mentoring program was very successful. In the first year of the program, the percentage of females promoted to full professor out of the entire faculty jumped from zero percent to 20 percent.

In addition to finding a mentor within an academic institution, the Executive Leadership in Academic Medicine (ELAM) program is available for eligible women. Based at Drexel University College of Medicine in Philadelphia, the program works to increase the number of women in leadership posts. In its 10-year existence, two-thirds of the program's 350 graduates were promoted within three years after completing the curriculum.

Patricia Monteleone, M.D., Dean, St. Louis University School of Medicine

Each year 45 women, at the associate professor level or above, participate. There are three intensive sessions over the year covering a range of topics including finance, management training and building diversity, according to Page Morahan, co-director of ELAM. Participants complete a project that benefits their own institution.

"Many of the current women deans have been involved in the ELAM program," said Dr. Atkinson, who also recommends consulting women's groups within medical specialty organizations and the AAMC's Women in Medicine (WIM) program.

The AAMC's professional development seminar for mid-career faculty women in medicine is designed for associate professors with clear potential for advancement to a major administrative position such as section or department head. The seminar, held in the summer, provides participants with insights into the realities of gaining a senior administrative position in academic medicine.

Patricia Monteleone, M.D., dean of the St. Louis University School of Medicine, said that formal degrees are not the only way to learn these skills. Another source of training can be obtained on-the-job. Serving on an institution's finance committee affords an opportunity to prove your ability to manage.

"If you do a good job as chairman, you not only learn a lot, but it sends the message that you have administrative skills," Dr. Monteleone said.

Future Prospects

Although more changes are needed, current efforts to promote women are paying off. More women are in positions of department chairs and deans than ever before.

"It has to stay a high priority for schools to recognize that they need to have diversity of all kinds," Dr. Atkinson said.

Dr. Powell has found her work enjoyable and rewarding and she wants to encourage more women to consider academic and administrative positions for their own fulfillment.

"Clearly, the future of academic medicine is going to depend on our getting more women into senior leadership positions," Dr. Powell said. "So we have to do everything we can to help women understand how much they can accomplish in these positions and that they are worth what seems to be the hassle of moving or getting education in different areas to prepare for these jobs."

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