While women have made up almost half of graduating medical students since 2004, they represent just 35% of active physicians. Female physicians make 76 cents and female scientists make 90 cents for every dollar earned by men, even after adjusting for age, years of experience, and specialty. Fewer than 20% of medical school deans and department chairs are women.
These and other systemic disparities have prompted the AAMC to launch a bold new initiative on gender equity, calling on medical schools, teaching hospitals, and academic societies to step up their efforts to identify and address the discriminatory practices that have led to stark gender differences in pay, promotion, and representation among specialties, among other areas.
“For too long, gender inequities have persisted in our communities, limiting the contributions and the promise of many of our colleagues and learners.”
David Skorton, MD, AAMC president and CEO
This week, the AAMC issued a statement and call to action on gender equity, the first in a series of efforts designed to encourage academic medical institutions to take meaningful and effective actions to correct the inequities that have led to many women leaving or being forced to abandon medical and scientific careers.
“For too long, gender inequities have persisted in our communities, limiting the contributions and the promise of many of our colleagues and learners,” David Skorton, MD, AAMC president and CEO, wrote in a letter to the nation’s medical school deans, teaching hospital CEOs, and academic society leaders. “As leaders, you play a critical role in setting the tone and creating accountability for achieving [gender equity] within your institutions and organizations, as well as across your learning environments.”
Led by David A. Acosta, MD, AAMC chief diversity and inclusion officer, and endorsed by the AAMC Board of Directors, the initiative calls on institutions to address seven types of inequities in four primary areas: the physician and scientific workforce, leadership and compensation, research, and recognition.
Women continue to be underrepresented in the physician and scientific research workforce despite near parity in entering and graduating students. Indeed, women have comprised almost 50% of medical school graduates since 2004, but they make up just 35% of the physician workforce. Likewise, women represent half the graduates of STEM programs but represent less than 25% of STEM faculty.
Within medical specialties, women represent far higher numbers of physicians entering primary care specialties than nonprimary care specialties. For instance, 63% of pediatricians are women, compared to just 18% of cardiologists and 5% of orthopedic surgeons.
“We know that many women are pushed out of medical and scientific careers because of gender bias, harassment, and abusive cultures that actively exclude them,” says Diana Lautenberger, a research director at the AAMC who is co-leading the gender equity project under Acosta’s leadership. “It’s time for our profession to change the narrative so that we can address these issues head-on.”
Leadership and compensation
Women are not promoted as quickly or to the same levels of leadership as men. While women are the majority of faculty at the instructor level, their numbers decline at each subsequent rank of assistant professor, associate professor, full professor, department chair, and dean. About 18% of department chairs and deans are women.
Women are offered less in starting salary, negotiated pay, and other forms of compensation (e.g., resources and bonuses) than men despite equal effort, rank, training, and experience. A recent AAMC report found that women in clinical departments make 76 cents on the dollar compared to men. That same report found that women in basic science departments earn 90 cents on the dollar compared to men.
The exclusion of women from, and the concentration of men in, leadership positions creates extreme power differentials in academic medicine. “These power differentials have an impact on the culture and climate of an institution and make it that much more difficult for women to reach parity in pay and promotion,” Acosta says.
There is a gender gap in authorship of peer-reviewed publications, especially in high-impact journals. Indeed, women are much less likely to be first or second authors on the papers they publish, and their work appears less often in prestigious journals. This could be partly because editorial boards are overpopulated by men, and partly because most submitted papers are reviewed exclusively by men.
Male researchers receive more research funding than their female peers. While men and women receive grants at about the same rate, the amount awarded to women is consistently less than that given to men. Again, this could be partly because grant review panels consist mostly of men.
“Women and racial and ethnic minorities also receive less mentorship and guidance when applying for grants,” says Laura Castillo-Page, PhD, senior director of diversity policies and programs at the AAMC and co-lead of the gender equity project with Lautenberger. “We need to do a better job of ensuring all women, including women from racial and ethnic minority backgrounds, are given the time to pursue research and the guidance to publish that research in the most prestigious journals.”
Women receive less recognition through honors, speaking invitations, and awards than their male counterparts. Female faculty are less likely than men to receive awards from professional societies, be invited to speak about their research, or be introduced with their professional titles.
“Leaders need to be intentional in recognizing the contributions of all and think critically about who they mentor and sponsor,” says Lautenberger. “Often, minoritized groups are not just ignored, but penalized, because they’re not ‘in the club.’”
In his letter, Skorton called on leaders in academic medicine to accept leadership accountability for achieving gender equity. He also emphasized that the AAMC’s commitment to improving gender equity is one piece of the association’s long-term commitment to advancing diversity, equity, and inclusion in academic medicine overall.
“If we want the best and brightest minds to enter the scientific and medical fields, we need to take a hard look at why so many are being sidelined,” says Acosta. “This is not just about women. Gender equity affects everyone.”