When the Office of Women Faculty Programs at MD Anderson Cancer Center opened in 2006, Associate Vice President Elizabeth Travis, PhD, started crunching numbers. A data-driven bench scientist, Travis knew there was a shortage of women in leadership positions, but seeing it on paper was eye-opening. Just 14% of the department chairs and other senior leaders were women, despite women making up 34% of the faculty.
Her first thought: “These numbers have to change.” And that became her top priority.
Unfortunately, MD Anderson’s inequitable workforce was not an anomaly. At academic medical institutions across the country, the number of women at the highest levels of leadership — chief medical officer, chief financial officer, department chair, and dean — remains low. According to 2018 AAMC data, women account for 16% of medical school deans, 18% of department chairs, and 25% of full professors. Those numbers are only slightly higher than a decade ago, when 12% of deans, 12% of department chairs, and 19% of full professors were women.
Yet women are graduating from medical school and attaining faculty positions in record numbers. Since 2017, women have made up a majority of those enrolling in medical school.
“This isn’t a pipeline issue,” says Sasha Shillcutt, MD, MS, associate professor and vice chair of strategy and innovation in the department of anesthesiology at University of Nebraska Medical Center. “It’s a lack of intentional effort to recruit and hire women for leadership positions and then support them and ensure they will be successful in a realm that has many proven barriers.”
“Inequities can affect a school’s ability to recruit, retain, and keep engaged, talented faculty. Ultimately, that has a negative impact on our students and our patients.”
John Prescott, MD
As issues of gender equity gain national attention, professional societies, medical journals, and academic medical institutions are committing to level the playing field. But change is slow, in part because of a longstanding culture in medicine that has not actively recruited women into leadership positions.
“There are clear benefits to addressing equity issues and costs to ignoring them,” says John Prescott, MD, AAMC chief academic officer. “Inequities can affect a school’s ability to recruit, retain, and keep engaged, talented faculty. Ultimately, that has a negative impact on our students and our patients.”
Obstacles to equity
Walk along any academic medical institution’s “wall of fame,” and you’ll probably notice few, if any, women. Read a medical journal and you’ll see more research from men than women. Listen to a Grand Rounds recording and you’ll not only hear from more men, you’re also likely to hear women introduced without the “doctor” attached to their name, according to a 2017 study published in the Journal of Women’s Health.
“When committees consider women for opportunities, you hear things like, ‘She just had a baby,’ or ‘We could consider her, but she has three kids.’ These are things that never come up with men who are in the same rank,” says Shillcutt.
“Promotion in academic medicine is formulaic,” explains Julie Silver, MD, associate professor and associate chair in the department of physical medicine and rehabilitation at Harvard Medical School. “Men and women have to fill up their CVs with publications, awards, and speaking engagements.”
“When committees consider women for opportunities, you hear things like, ‘She just had a baby,’ or ‘We could consider her, but she has three kids.’ These are things that never come up with men who are in the same rank.”
Sasha Shillcutt, MD, MS
University of Nebraska Medical Center
That’s just not happening, though. In fact, a new study in Academic Medicine suggests that women and people of color are disproportionately tapped to serve on committees and participate in focus groups for representation purposes at the expense of pursuing more scholarly activities required for career advancement. This so-called “minority tax” not only contributes to burnout, but it also affects their ability to progress at the same clip as their white male counterparts.
On the research front, a 2018 study published in JAMA Surgery reported that across five of the most prominent surgical journals, nearly 80% of first authors were male. The four top-rated pediatric journals also underrepresented women in perspective articles and opinion pieces.
And a research letter published in JAMA Internal Medicine reported no female presidents among 10 separate medical societies — not because there aren’t highly qualified women to take these positions, but because women are not being elected to them. A follow up survey of more than 1,200 female physicians found that half reported being interested in future elected positions and need support from supervisors and colleagues.
“I don’t know a football coach in this country who is willing to leave 50% of their talent on the bench,” says Travis. “But that’s what we do in medicine.”
The message women get: “We just don’t think you’re as valuable.”
Cultivating institutional change
At the institutional level, many schools have formed task forces to assess practices that affect gender equity, examine best practices that lead to improved equity, and determine how to measure accountability.
“I’m a firm believer that ‘if you can’t see it, you can’t be it,’” says Travis, who is part of a leadership team focused on increasing the number of women in leadership positions at MD Anderson. The first thing she did in her role as vice president of the Office of Women Faculty Programs: restructure the leadership search policy. The office convened a diverse search committee, trained them in unconscious bias and behavioral interviewing skills, and charged them with creating a short list of three candidates for each open position, including one woman and/or one minority.
“Instead of asking about items listed on CVs, search team members asked candidates questions about how they reacted in a particular situation and resolved conflicts,” says Travis. That line of questioning, coupled with an intentional effort to recruit more female leaders, has doubled the percentage of women leaders at MD Anderson from 14% in 2008 to nearly 30% in 2018.
Georgetown University School of Medicine’s Women in Medicine (GWIM) program, too, has been enhancing the visibility of women, starting with the physicians and female leaders who appear on the institution’s walls. “We have been conducting a sort of ‘image audit’ to see who is in our portraits,” says Kristi Graves, PhD, immediate past-president of GWIM and associate professor of oncology and director of the Survivorship Research Initiative at Georgetown University’s Cancer Prevention and Control Program. “The goal is to ensure an inclusive and diverse representation of the type of people who contribute to the value of medicine at our institution.”
In 2015, the school also launched a campaign to reach 100 female professors — and they noticed a dramatic uptick in full professor application packets coming in from women. The medical school achieved that goal and has since announced a new one: at least 25% women department chairs by 2025.
“The institutions that are performing the best in terms of gender equity are intentional about inviting more women to the table and shining a light on their successes.”
Elizabeth Travis, PhD
MD Anderson Cancer Center
These interventions work best when leaders recognize their own implicit biases. At the University of Michigan Medical School, administrators have developed strategies to get more women into high-level positions, including mandatory implicit bias training workshops for leadership, search committee members, and residency program directors who are interviewing students. “An important part of the efforts to improve equity in faculty recruitment come from our Committee on Strategies and Tactics for Recruiting to Improve Diversity and Excellence (STRIDE), which offers workshops that teach leaders to avoid terminology or requirements that might introduce bias and how best to evaluate candidates fairly,” says Reshma Jagsi, MD, DPhil, a professor and director of the school’s Center for Bioethics and Social Sciences in Medicine.
Jagsi serves on the committee for the medical school’s “ADVANCE” leadership program, which addresses institutional, systemic, and structural barriers to gender equity while also helping women navigate the labyrinth of achievements and responsibilities that are required to climb up the ladder in academic medicine. They host their own women’s leadership courses and also encourage women to participate in groups such as the AAMC Group on Women in Medicine and Science, the AAMC Midcareer Seminar for Women, and Executive Leadership in Academic Medicine (ELAM).
“The institutions that are performing the best in terms of gender equity are intentional about inviting more women to the table and shining a light on their successes,” says Travis. “Women bring a different voice and a different perspective that can help solve many of the problems facing academic medicine today.”
Indeed, the data consistently show that diverse leadership promotes higher quality care, enhances scientific discovery, and provides a critical cohort of role models for young women who are embarking on medical careers. “There’s no space between diversity and excellence,” says Travis. “We need to shift the culture of medicine to embrace that.”