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    Advancing women in academic medicine


    As I wind down my remaining weeks as AAMC president and CEO, the last affinity group meeting I will attend is devoted to faculty affairs and the advancement of women in academic medicine. I am proud that the Group on Women in Medicine and Science (GWIMS) was formed during my tenure and will celebrate its 10th year at a joint meeting with the Group on Faculty Affairs (GFA) in July.

    The AAMC is committed to helping women enter and advance in academic medicine. The future looks bright. Our applicant data from 2018 showed that for the first time, more women than men entered medical school.

    Yet women in academic medicine are still outnumbered by men in faculty positions today, and they are not promoted or advanced to leadership positions at the same rate as men. Further, a recent analysis of the AAMC Faculty Salary Survey revealed that compensation for men is higher than for women at almost every rank across most specialties and departments. Of even greater concern is the 2018 report from the National Academies of Sciences, Engineering, and Medicine (NASEM) documenting that sexual harassment and gender discrimination are appallingly common on our campuses.

    Academic medicine boasts a wealth of accomplished female physicians, scientists, and educators, but they are hitting the glass ceiling when they try to advance to full professors, department chairs, deans, and hospital chiefs.

    The reasons for gender inequities are nuanced and complicated. Overt or unconscious bias can influence hiring and promotion decisions. Mistreatment may be underreported due to fear of retribution or the lack of mechanisms in place to safely report and respond to complaints. And in a culture with few female leaders, sexual harassment is more likely to occur.

    To solve these problems, we have to debunk overly simplistic, cultural narratives about the causes. Over the last decade, GWIMS and its local medical school chapters have shifted from an emphasis on helping women develop skills to removing larger systemic barriers within academic medicine. To ensure gender equity progress, institutional solutions need to be developed that support inclusive and supportive environments along with opportunities for women to build their skills.

    Institutional climate is a key factor in understanding the root of inequities, and this is where we need to start if we want change.

    Moving toward gender equity

    Following are the four areas we must act on to achieve gender equity in the academic medicine community.

    Close the pay differential. Last month, the AAMC published the results of the first-ever study of faculty compensation by gender across our institutions, Promising Practices for Understanding and Addressing Salary Equity at U.S. Medical Schools. The study documents gender discrepancies in salaries across the majority of clinical science disciplines, with compensation gaps widest at higher levels of leadership.

    Clearly, this is not where we want to be. But understanding the national picture is an important first step in the process of closing these gaps. The AAMC report includes benchmark data on starting salaries and provides examples of policies and procedures that have been effective at lessening the gap at some institutions.

    For real change to happen, institutions need to conduct their own transparent self-assessments. Identifying the barriers that are preventing compensation equity is hard, but important and necessary work.

    Promote female leaders. We also need to ensure that more women rise to leadership positions in academic medicine. When I became a medical school dean in 1994, my colleagues included only three female deans. Today, there are 26 female deans at our institutions, but we still are falling short given our 154 member medical schools in the United States.

    Academic medicine boasts a wealth of accomplished female physicians, scientists, and educators, but they are hitting the glass ceiling when they try to advance to full professors, department chairs, deans, and hospital chiefs. Highly qualified women are not receiving grants, awards, or publication acceptances at the same rate as men. Some women encounter obstacles finding mentors and sponsors. Only 18% of our department chairs are women.

    We must redouble our efforts to tackle the biases that are keeping women from achieving these higher-level positions. This must include unconscious bias training for recruiters and hiring committees.

    Eliminate sexual and gender harassment. More than 50% of female faculty and staff in academia and between 20% and 50% of female students in science, engineering, and medicine said in the NASEM report that they experienced sexual harassment. The data also indicates that the prevalence of sexual harassment in academic medicine is nearly double that of other science and engineering specialties. The fallout is job dissatisfaction, burnout, increased stress, and poor performance, the authors report.

    Because of the urgency and pervasiveness of this issue, the AAMC Board of Directors chose sexual and gender harassment as the subject of the annual June Leadership Forum. This meeting is an opportunity for AAMC governance, councils, organizations, and affinity groups to highlight and expand the national conversation on sexual and gender harassment and develop action steps to address it. Leaders will share best practices and collect resources to help institutions have their own serious conversations about this issue.

    Given our role as respected professionals and leaders, it is incumbent on academic medicine to model diverse, inclusive, and respectful environments.

    In addition, the AAMC has helped establish the Societies Consortium on Sexual Harassment in STEMM (science, technology, engineering, mathematics, and medicine) to advance ethics, equity, and inclusion. And this spring, the StandPoint Faculty Engagement Survey conducted by the AAMC began to collect data on experiences of gender harassment within the academic medicine workplace.

    Together, these initiatives will promote a common understanding of the problem and identify steps toward eliminating gender and sexual harassment in academic medicine. Institutions must act quickly and decisively to end harassment with policies, effective practices, and disciplinary consequences for violators.

    Improve institutional climate. Historically, the culture of academic medicine has been a rigid hierarchy with sharp power differentials. Any approach to resolve gender inequities must involve a fundamental cultural shift, rather than blaming women for the problem. The NASEM report found that perceived organizational tolerance is the single most important predictor of sexual harassment.

    Measures to address harassment, salary inequity, and the glass ceiling in academic medicine are pieces of a broader strategy focused on improving the institutional climate. These efforts must include family-friendly policies, mentoring programs for women, and dedicated resources to support women’s equity. Importantly, the impact of all these actions must be reviewed and evaluated over time.

    The AAMC offers data, tools, and resources to help medical schools assess their climate and implement changes to support women faculty, as well as faculty leadership development seminars both for early- and mid-level career women. To assist, GWIMS developed a toolkit in collaboration with more than 20 medical school chapters on professional development topics related to women’s advancement.

    Gender inequities and sexual harassment have no place in medical schools, teaching hospitals, and biomedical research. All the research tells us that diverse organizations where people feel respected, validated, and valued perform better, too. Given our role as respected professionals and leaders, it is incumbent on academic medicine to model diverse, inclusive, and respectful environments. This is not just a “women’s issue.” All of us are accountable, and it is essential for the well-being of everyone in academic medicine to address these problems.

    I hope to see some of you in Chicago, Illinois, at the upcoming GWIMS-GFA meeting, “Leading and Advocating Through the Winds of Change,” where we will discuss these issues in greater depth.