In 1973, the year I started medical school, women constituted only a small percentage of all medical students. My own class at the University of Colorado reflected this trend. I realize, in hindsight, how unaware my male classmates and I were of the many barriers our female colleagues had overcome to be there—from unconscious bias to outright sexism—and how they continued to experience more of the same in medical school and residency training. While I could look to male scientists and physicians as examples and mentors through childhood, my undergraduate degree, and medical school, the same cannot be said for most of the women of my generation who made their way to medical school and became physicians, often without female role models.
My memory of my own trailblazing classmates is one reason I am so encouraged by a landmark that we passed in 2017: For the first time, the majority of entering medical school matriculants are women.
This moment has been a long time coming. For years, women have outnumbered men in bachelor and graduate degree programs, and women have been closing the gap in matriculation to medical school over the last few decades. Closing that gap has depended on improved STEM mentorship as early as elementary school—mentorship that has been key to helping girls realize that they have a talent for medicine and science and that there is a place for them in the scientific and medical fields. For too many years, through childhood and young adulthood, girls and women were counseled out of careers in medicine and science because of unconscious bias and a culture that did not encourage them to see themselves as physicians and scientists.
I have been so pleased to see improvements in our pipeline that have been bringing more women to medical school and scientific research over the last few decades. However, achieving medical school classes that represent women equitably is only the first step. The culture and climate of medical training and practice too often persist in being excessively hierarchical, competitive, and individualistic, rather than collaborative, mutually accountable, and team-based. Where this culture continues to exist in medicine, it allows biased behaviors to thrive, from sexual harassment to microaggressions that chip away at self-confidence and self-worth. Recent research shows that women in medicine have significantly higher odds of burnout and are more likely to experience symptoms of depression than male physicians. Women of color face an added level of bias. It is no surprise, then, that for years we saw a drop off after undergraduate education in women pursuing careers in medicine.
At a time of heightened consciousness about the pervasiveness of sexism and harassment in American culture, we must examine how we can create more inclusive cultures within medical education, training, and practice. One important way to promote inclusivity is to focus on our efforts to remove glass ceilings at every level of academic medicine and in the medical profession more broadly. Unfortunately, this is another area where we are falling short. Only 25 of 149 deans (17%) at AAMC member schools in the United States are women, along with only 17% of all department chairs. We must solve systemic issues in our promotion and advancement paths so that women as well as men have a clear way to rise into the leadership ranks in academic medicine. We can do this by ensuring diversity on our search and promotion committees, providing training in unconscious bias, implementing rigorous search and promotion policies, and making the criteria for hiring and promotion crystal clear. When institutions are rigorous about fair and objective recruitment, retention, and promotion policies, women advance. Programs that support women in entering a leadership track early on in their careers, like the Early Career and Mid-Career Women Faculty Leadership Development Seminars provided by the AAMC, have proved successful at helping women achieve their own goals and growing our ranks of women leaders.
I have seen the benefits of improved representation of women in leadership firsthand. As our own AAMC Leadership Team has become more diverse over the last decade—with a stronger representation of women, underrepresented minorities, and nonphysicians—our team has grown more successful at finding creative solutions to solving the challenges we face and has made the AAMC a more successful and innovative association. My experience is borne out by the research, which shows that diverse teams do a better job of solving complex problems and lead to better organizational performance.
With the largest proportion of women entering medical school in history, we now have both an opportunity and an obligation to create safe, supportive, and inclusive learning and practice environments that will encourage women to stay in medicine and help them thrive when they do. Our organizations must take an intersectional approach to fostering conversations about diversity and inclusion and creating forums where all can feel free to openly discuss their experiences and challenges. We need to ensure that we have objective, anonymous, and responsive reporting systems in place for those who experience harassment in the work or learning environment. And we need to ensure salary equity between men and women at all levels. If we are to succeed as a community of academic medicine, it is incumbent on all of us to make improvements in our policies and culture so that we are fostering organizations and teams that are diverse, inclusive, and equitable.