Back to Front PageVOLUME 6, NUMBER 4

‘Below the Surface’
Academic Medical Centers Identify and Address Gender Inequity

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 is running a series of stories in 2001 examining the changing role of women in academic medicine.

Carol C. Nadelson, M.D. (center), director of the Partners Office for Women’s Careers at Brigham and Women’s Hospital, works with women faculty in the Department of Medicine to promote their professional development.

Scenario 1

A male and a female resident are walking down the hallway of a hospital. They encounter another male member of the hospital’s housestaff, who, after briefly greeting the female resident, engages the other male resident in a conversation about a potential opportunity for working in a clinician’s lab. He makes eye contact with his male colleague, again briefly acknowledges his female colleague, and walks away.

Scenario 2

A male senior faculty member attending rounds is informed of the admittance of a 45-year-old female colleague who is complaining of fatigue. He immediately makes the assumption that his colleague is suffering from menopause-related symptoms, when in fact tests later show her hematocrit level is dangerously low.

These two scenarios can — and do — occur frequently in academic medical centers across the country. The gender-based assumptions they reveal are subtle and often overlooked by men and women alike. However, it is precisely these types of situations that Sharon Foster, M.D., associate professor of pediatrics at the University of Wisconsin (UW) Medical School, believes caused women faculty to rate her school’s environment as unsupportive in a 1997 faculty questionnaire. That’s why she included the above scenarios in an educational video she and her colleagues produced about how gender-based assumptions can lead to missed professional opportunities for women and even gross medical errors.

Dr. Foster’s survey, completed by 507 faculty members four years ago, is still making its mark at UW. "One of the most interesting things about the study was the notable differences between men and women respondents in regard to their perceptions of our academic environment," she says. Perceptions about receiving departmental support, being sought for collaborative research efforts, and obtaining promotion opportunities at UW Medical School differed sharply among men and women faculty.

The survey started having an impact before the ink was dry. Prior to its publication, Judith Leavitt, Ph.D., then the associate dean for faculty at UW, instituted "First Fridays." This event provided a space for networking among women faculty members and included presentations on professional challenges specific to them. A professor in UW’s Department of the History of Medicine, Dr. Leavitt is credited by Dr. Foster as the driving force behind campus initiatives now in place that specifically address gender inequities. When Dr. Leavitt left her position as associate dean, the dean appointed Gloria Sarto, M.D., Ph.D., as his special assistant on gender to build on Dr. Leavitt’s work.

Under Dr. Sarto, who is also co-director of the UW National Center of Excellence in Women’s Health and a professor of obstetrics/gynecology, the First Fridays event has grown, professional development seminars have been instituted, a policy has been developed in which faculty who have children automatically have a year added to their tenure clock, a part-time tenure track has been instituted, and search committees are encouraged to include women faculty in their ranks.

Dr. Sarto points out that these measures accommodate both female and male faculty. "What we are striving to accomplish for women will likewise benefit men and the university as a whole," she says.

Structural vs. Cultural Barriers

Emma Stokes, Ph.D., senior organizational development specialist with Johns Hopkins University, calls these changes organizational responses to structural barriers, an important response to gender inequities but by no means the only one. Dr. Stokes explains that while changing an organization’s structure and policies is important, it does not address a far more difficult problem — how an organization’s underlying culture works to inhibit women’s progress.

"Few medical schools have done much work on culture," Dr. Stokes says. "The active and involved partnership of informed leaders is missing from many gender initiatives. They have not provided a legitimate place for men and women to talk about what it is in their professional culture that may be inhibiting their effectiveness or satisfaction."

According to Dr. Stokes, the most recent focus of Hopkins’ Department of Medicine Task Force on the Academic Careers of Women in Medicine is on culture, and its building blocks are surveys taken of female and male faculty about perceived obstacles to their professional growth. "Women express feeling isolated in their departments; they say they are not included in important networks, which adds to their perception of not fitting in," Dr. Stokes says.

These gender-based perceptions are the focus of a new intervention called the "Goal Five Group on Colleagueship." Dr. Stokes explains that colleagueship is the last of five goals developed to maintain and solidify the Department of Medicine’s preeminent standing in research, teaching, and patient care. "The group’s purpose is to foster a collegial and nurturing work environment that promotes the success and well-being of faculty, staff, students, and patients," she says.

Formed last spring, the group consists of two dozen men and women chosen by the department director to examine aspects of their work culture that may be interfering with the way faculty, particularly women, experience their jobs. "They participate in workshops that allow them to discuss the consequences of behaviors that result from gender schemas — the way one thinks about what’s appropriate for men and women," Dr. Stokes says.

Although addressing and remedying the subtle yet corrosive effects of a climate that is hostile to women’s progress is the ultimate challenge, Dr. Stokes believes that the organizational changes she has helped foster have also leveled the playing field considerably at Hopkins’ medical school. She describes her job as that of an internal consultant who works on an organizational level to assess problems in sectional units, such as clinical departments, and offer solutions to the leaders of those units. When she started her job at Hopkins in 1992, half of her time was allocated to work on gender equity issues that were arising in the Department of Medicine.

Dr. Stokes says she has spent the majority of her time on structural interventions to address gender inequities. For example, she makes sure promotions committees regularly review the CVs of women faculty to prevent them from being inadvertently passed over for promotion. A periodic salary review helps women maintain pay equity with men. "But if you don’t address culture a lot of the structural areas don’t stay fixed," Dr. Stokes warns. "Three or four years later, you again find salary inequity or the number of women leaders has stagnated or shrunk."

"Until there’s a link established between the disadvantages women experience and the problems that keep leaders awake at night, those disadvantages are not going to be addressed," she emphasizes. "The connection has to be made between gender bias and expensive turnover, poor productivity, and even litigation. The real challenge is to get men and women together to talk about these difficult issues."

The Triumph of Small Wins

The Partners Office for Women’s Careers at Brigham and Women’s Hospital was established to address women faculty’s promotion and career advancement. Charged with the task of focusing on both structural and cultural barriers to women faculty’s professional development, Carol C. Nadelson, M.D., clinical professor of psychiatry at Harvard Medical School, was appointed the office’s director. "My office is a major morale boost," Dr. Nadelson says. "Simply the fact that someone thought this issue was important enough to establish an office and appoint a senior person to run it sends a strong message."

Dr. Nadelson says that her office uses numerous strategies to promote the careers of women faculty. She meets regularly with division chiefs, chairs, and search committees to identify women with the greatest potential for leadership positions. "We’ve had innumerable women promoted," she says. "One of our biggest success stories has been getting a woman division chief in medicine, which has never happened before. We identify women’s successes and celebrate them."

On the institutional side, Dr. Nadelson counts among her successes an eight-week paid maternity leave policy, a mentorship program, and the establishment of a senior women’s network. Dr. Nadelson emphasizes that these structural changes contribute to establishing an academic environment in which women can operate on more even ground with their male counterparts.

"If you don’t have resources that meet the needs of people at different stages in their life cycle, you aren’t paying attention to reality," she says. "People need to perceive childbearing as the norm instead of the aberrant, so it becomes part of the fabric of the institution, and you work around it."

Dr. Nadelson adds that having women in leadership positions is a sure way to draw attention to changes that need to take place in a workplace seeking gender equity. "Women have to be on policy-making committees," she emphasizes. "That’s why things like maternity leave hadn’t happened before. Growing numbers of women in fields such as pediatrics and obstetrics/gynecology are exerting real pressure for change."

Taking a Cue from the Business World

Geraldine Ferraro knows a lot about the cost of ignoring women’s concerns in the workplace. The woman who made history as the first female candidate of a major political party for the vice presidency of the United States, she is now the founding president of G&L Strategies, a company that assists both federal and commercial clients in strategizing their positions within the global community. One of the services her firm offers is addressing workforce diversity. She says that business, like academia, suffers from a lack of female leadership in spite of having a significant number of women in the pipeline.

"What is it that keeps Fortune 500 corporations from having no more than a handful of CEOs?" she asks. "In business schools, 30 to 40 percent of entering classes are now female. The top-notch schools are graduating women in large numbers. If they’re not prevented from getting into schools, and they are as equally qualified as their male counterparts when they graduate, there has to be something else that is holding women back."

Ferraro dismisses the typical answer: "children." "Women today are putting off having children until later, or they have children and continue to work. It goes back to the hesitancy of those who hold power — white males — to give it up. Perhaps it’s subtle; perhaps it’s below the surface, but women are being held back."

The business world is starting to pay attention. For example, in 1992, Michael Cook, then the CEO of Deloitte & Touche, chaired a task force that created Deloitte’s Initiative for the Retention and Advancement of Women. Since then, the global company’s proportion of women partners has increased nearly threefold. Deloitte’s top brass says the company has increased employee awareness of gender-based assumptions that can prevent women from obtaining top assignments. The result, says the company’s CEO, is "increased creativity from our employees and better performance for our clients."

Dr. Nadelson says the same holds true for medical school faculty when the barriers created by gender inequities are addressed. "Our programs make for a better environment that increases people’s creativity and productivity by helping them feel good about where they work and who they’re working with." Pulled quote: "The connection has to be made between gender bias and expensive turnover, poor productivity, and even litigation. The real challenge is to get men and women together to talk about these difficult issues."

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18 May 2001