As COVID-19 continues to pummel communities across the country, the need to attract, retain, and promote talented health and science professionals — including women and members of underrepresented communities — has never been greater. On May 28, the AAMC released the State of Women in Academic Medicine 2018-2019, which highlights some progress in gender equity, as well as areas that continue to lag behind.
The report, which is based on pre-pandemic data, notes that while women make up nearly half of medical school graduates, they represent just 25% of full professors and 18% of department chairs. In addition, the ranks of women faculty from underrepresented backgrounds has grown approximately 1 percentage point in the past decade.
“While we celebrate the high percentages of women entering medicine and science, we must diligently and intentionally address the extremely slow rate of change in the proportions of women in leadership positions.”
Linda Chaudron, MD
Chair, AAMC Group on Women in Medicine and Science Steering Committee
Last updated in 2014, the report provides a snapshot of the status of women at key junctures in their careers as learners, faculty, and leaders. Based on extensive AAMC and external data, it is intended to help individual institutions and national leaders identify ways to foster greater equity and inclusion.
Certainly, work remains. For example, only 65% of women faculty agreed that their medical school offers equal opportunities regardless of gender — compared to 85% of men. Meanwhile, schools are working to address concerns, with nearly half dedicating a formal administrative role solely to gender equity issues.
“While we celebrate the high percentages of women entering medicine and science, we must diligently and intentionally address the extremely slow rate of change in the proportions of women in leadership positions,” says Linda Chaudron, MD, who chairs the AAMC Group on Women in Medicine and Science Steering Committee.
AAMC Chief Academic Officer John Prescott, MD, noted that the need for providers is great given a predicted shortfall of nearly 122,000 physicians by 2032. “One fundamental way we can recruit and retain health care workers is to ensure equitable, inclusive environments that allow women and underrepresented groups to flourish,” he says.
Below are some of the report’s main findings, looking at key populations.
In 2018-2019, women represented more than 50% of medical school applicants and matriculants but less than 48% of graduates. The report notes that previous editions showed similar declines during the school years, highlighting a need to better understand what causes medical school attrition among women.
Women are disproportionately represented in certain residencies: obstetrics and gynecology, pediatrics, and dermatology (83%, 71%, and 60%, respectively) — and they remain largely underrepresented in traditionally male-dominated fields, such as surgical specialties. To help achieve equal representation across all fields, the report’s authors suggest that institutions need to explore possible structural biases that may influence women’s specialty choices.
Women comprise 46% of postdoctoral students in biological and medical science, well below the proportion of women doctoral students in those fields, which is 61%. Given the importance of postdoc experiences for anyone aspiring to a faculty position, the report notes, institutions must make sure to mentor women graduate students.
The proportion of women faculty has continued to rise at all levels over the past decade. Still, women are the majority — 58% — only at the instructor level. What's more, the percentage of full-time women faculty is rising slowly, from 36% to 41% since 2009.
Data show that, after a seven-year period, a greater proportion of men than women faculty members receive promotions. The report notes that although the gap between the proportion of promoted men and women narrows after 10 years, it still persists.
Women have constituted 50% or more of graduate students in biological, clinical, and health science doctoral programs (excluding MDs) since 1994, but in 2018 they made up just 40% of full-time faculty members in such fields.
Significantly, the report notes that there has not been a substantial change in the percentage of women department chairs and senior associate deans since 2014. The proportion of women department chairs has increased at a rate of only half a percentage point each year since 2009, for example.
In positive news, women are increasingly appointed to assistant and associate dean positions (up 6 and 8 percentage points, respectively, over the past few years), making up 52% of assistant deans and 47% of associate deans. Still, while growth in these areas is critical to filling pipelines to more senior roles, these positions don’t hold the decision-making power of senior associate dean roles. Those positions have seen only a very small rise in women since 2013 (from 33% to 34%).
“We urge institutions to take a hard look at systemic inequities and intentionally search for ways to remove obstacles that can prevent all women from achieving their fullest potential and contributing to the health of the nation.”
AAMC director of faculty and staff research
Women are less likely to be found in leadership roles within areas deemed to require “hard skills” — such as clinical affairs and research — than they are in roles thought to use “soft skills” — including diversity and student affairs.
The ranks of medical school deans remain overwhelmingly male, with the percentage of women reaching just 18% in 2018. The authors note that even with the launching of several new medical schools over the past decade, the number of deans has increased on average by only one woman per year.
Women’s representation among division chiefs and center directors continues to grow, but it still amounts to slightly less than a third of these positions. Increasing the share of women in these roles — which frequently precede higher-level positions — could swell the ranks of women deemed qualified for senior positions, the report authors suggest. They also recommend such steps as integrating women’s leadership courses into educational programs.
Women from diverse backgrounds
Women medical school graduates came from diverse backgrounds at slightly greater rates than their male peers in 2018-2019, continuing a trend over the past five years.
However, once they were past their training, women from underrepresented backgrounds have made smaller gains in faculty representation than other women. For example, the proportion of Asian women has increased by 3 percentage points whereas other women of color have seen only a 1 percentage point increase in full-time faculty numbers over the past decade. Additionally, the report shows that women from underrepresented backgrounds are mostly holding the ranks of assistant professors and instructors.
The way forward
“This report helps identify some of the unique challenges women from various backgrounds face and provides actionable data leaders can use to address equity issues in their institutions,” says Diana Lautenberger, AAMC director of faculty and staff research and co-lead of the new AAMC Gender Equity Lab, an internal working group created to assist member institutions in their efforts to address gender equity.
“We urge institutions to take a hard look at systemic inequities and intentionally search for ways to remove obstacles that can prevent all women from achieving their fullest potential and contributing to the health of the nation," Lautenberger says.