Throughout her 25-year career, Carrie Byington, MD, has heard people identify her by titles that signal her achievements: physician, professor, researcher, associate vice president, vice chancellor, and dean. Before each title, people routinely insert “female.”
“I’m always identified as a female leader, as a female physician-scientist,” says the executive vice president of University of California Health (UCH). “Why? Why am I not just referred to as a leader or as a physician-scientist?”
Byington knows why: The vast majority of people holding high-profile positions in academic medicine are men. “That is the expectation,” she explains. “The male perspective is the de facto position” for leaders in medical science.
The primacy of men in academic medicine — reflected in everything from their salaries and leadership posts to research grants and publications — has spurred leaders like Byington to initiate myriad strategies aimed at pushing the field toward gender balance. Those strategies seek to change both individuals and institutions by building the skills of women to advance their careers and by creating policies and procedures to remove barriers. Women scientists credit these efforts with accelerating progress toward equity.
“I've seen things improve, there's just no question about it,” says Marie A. Bernard, MD, chief officer for scientific workforce diversity at the National Institutes of Health (NIH).
But there’s a long way to go: Gender inequities have been documented through countless studies that examined salaries, staff rank, publication in journals, grants, and recognitions like awards and speaking engagements. This month alone, studies were published showing that women in internal medicine specialties earn lower salaries and occupy disproportionately fewer leadership positions than do their male colleagues and that academic journal articles in which women are the primary or senior authors get about half as many citations as articles in which men are the primary or senior authors.
Now come concerns that the COVID-19 pandemic has set women scientists back. The pandemic forced many of them to take on more child care responsibilities due to the closures of schools and other youth activities, leading them to work fewer hours and do less research and writing for publication. It increased their sense of burnout by blurring the lines between work and home and reduced the in-person engagement with colleagues that is critical to building careers, according to a recent report by the National Academies of Sciences, Engineering, and Medicine.
“The disruptions caused by the COVID-19 pandemic endangered the engagement, experience, and retention of women in academic STEMM [science, technology, engineering, mathematics, and medicine], and may roll back some of the achievement gains made by women,” the report noted.
Against that challenge, below are some of the strategies that have shown promise in helping to elevate the careers of women in medical science.
Diversify committees that hire and promote
Traditionally, committees that search for people to fill staff positions or consider promotions at academic medical centers have been overwhelmingly composed of White men, reflecting the leadership makeup of the institutions, says Elizabeth Travis, PhD, associate vice president for faculty diversity, equity and inclusion at the University of Texas MD Anderson Cancer Center in Houston. As a result, the committees tend to give more weight to the candidacies of White men, even in the absence of conscious bias.
When thinking of who to work with or elevate, “people think of people who look like them,” Travis explains.
Countering that inclination requires examining the makeup of committees to see not only which demographic groups are represented but also which ones are not, she says. “When you talk about who’s at the table, you have to see who’s not at the table” and invite them to join.
For example: In 2012, MD Anderson adopted a policy that at least 35% of the people serving on search committees had to be women or members of a minority, Travis explains. It subsequently added a requirement that the shortlist of job candidates that committees submit for consideration — typically three people — must include at least one woman or member of a minority.
Since then, the percentage of leadership positions at MD Anderson held by women has grown from 14% to 36%, according to Travis.
The strategy is spreading. Several years ago, the University of California, San Francisco (UCSF), School of Medicine began requiring at least half the members of every committee making personnel decisions to be women or members of minorities, says Elena Fuentes-Afflick, MD, MPH, vice dean for academic affairs. She notes that the school has since seen a 50% increase in the share of endowed chairs that are held by women.
“The hope was that by requiring that level of diverse representation, we would promote diversity, equity, and inclusion on the outcome side,” Fuentes-Afflick says.
Train for self-advocacy and leadership
Teaching negotiation, based in part on research showing that women tend to be less assertive than men in negotiating for themselves, is one of many strategies employed to help women in academic medicine develop the skills, knowledge, and mindset needed to advance their careers.
For example, each year, a trainer from Rice University comes to MD Anderson to train women faculty about how to negotiate for themselves for things like salaries, promotions, or being cited as the primary author on a research paper.
“That is still an issue: Women don’t like to negotiate,” according to Travis.
Leadership training for women also teaches communicating effectively, developing relationships with mentors and sponsors, gaining and using influence, and managing institutional finances. The initiatives include Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) fellowships, a program of Drexel University College of Medicine in Philadelphia; the AAMC’s (Association of American Medical Colleges’) Mid-Career Women Faculty Leadership Development Seminar; and Women in Medicine and Health Sciences fellowships at UC Davis Health.
“It set me on the path to leadership,” says ELAM alumnus Archana Chatterjee, MD, PhD. After her 2007-08 fellowship, she moved up from a faculty member at Creighton University School of Medicine in Omaha, Nebraska, to an associate dean there, moved on to chair the Department of Pediatrics at the University of South Dakota Sanford School of Medicine, then rose to where she sits now: dean of the Chicago Medical School at Rosalind Franklin University of Medicine and Science.
Chatterjee explains that the fellowship showed her how people become leaders — “I understand now that leaders are not born, they’re made” — and connected her to a network of women physicians, scientists, and academicians who continue sharing insights and connections to help build each other’s careers.
The ELAM program reports that more than 1,200 women have completed its one-year program. Among the leadership positions they hold (as of this month) are 56 chief executives or academic officers, 21 deans or interim deans of U.S. medical schools, and 187 department chairs at medical schools.
Connect with mentors and sponsors
When Byington served as associate vice president for faculty and academic affairs at University of Utah Health in Salt Lake City, she launched a mentoring program for investigators who conduct clinical and translational research. The program was not limited by gender, but it drew many women.
“For our female early-career faculty, this was a lifeline,” Byington says. “Many of them weren’t getting the usual one-on-one mentoring” that develops naturally through relationships.
Why not? Studies cite such factors as the need for some women to devote time to child care at the expense of cultivating professional relationships, a greater comfort among many men to initiate personal connections to help build careers, and the fact that the upper ranks of faculties are dominated by men. While many women credit male mentors for boosting their careers, they would also like to have women mentors — and the shortage of women leaders makes that difficult.
“The natural human tendency is to gravitate to those who are like you and have a similar background,” explains Bernard at the NIH, which studies and advocates for mentoring efforts targeted toward women and other underrepresented groups. “You have to intentionally build and facilitate those sorts of things [mentor relationships], particularly if you're looking at scientists who come from groups that are traditionally underrepresented in medicine and science.”
Travis urges women to go a step further by cultivating sponsors. While mentors advise, she says, “sponsors are action-oriented.” Sponsors are usually senior leaders who not only offer guidance but actively advocate for a young colleague and help them build their career. That advocacy can include guiding them to get on high-profile committees, coaching them through applying for positions and research grants, and suggesting them to colleagues for positions and assignments that will help build their careers.
Expand child and family support
Women who enter medical science get the message early that having children might impede their careers because the demands of parenting will detract from the time and focus they devote to work.
“There were many times I was told that my willingness to have a child meant I wasn’t fully committed to research,” Byington explains.
Researcher Ashley Ritter, PhD, ARNP, notes a painful dilemma for young women scientists: Their prime years for having babies and caring for their young children coincide with their early career-building years, when success requires working especially long hours, attending events to build professional networks, and getting research papers published. Those demands keep many women from entering medical research and drive some women researchers to retreat, says Ritter, CEO of Dear Pandemic, a website developed by women scientists to educate the public about COVID-19.
“You can’t put your reproductive years on hold until you’re a tenured professor,” she explains.
Institutions are increasingly trying to make it easier for young parents to continue their medical science careers. The supports include on-site child care — such as the centers at Johns Hopkins Medicine and Yale School of Medicine — and extended family leave after the birth or adoption of a child, such as a University of California policy that took effect this month giving new parents as much as 70% of their salaries for up to eight weeks.
There is also an expanding array of financial supports for new parents. The NIH’s Family Friendly Initiatives for biomedical researchers include funding to cover extended leave and research deadline extensions; extra personnel, services, and supplies during a researcher’s reduced hours on a project; child care; and education and training to help them reenter the research workforce.
The Doris Duke Charitable Foundation, based in New York City, spearheads the Fund to Retain Clinical Scientists, a collaborative effort with medical schools to provide supplemental funds to early-career physician-scientists across the country who shoulder family caregiving responsibilities. An evaluation of the program, which started in 2015, found that it helped to retain scientists and that 79% of the grantees were women.
Improve opportunities for publication
After decades of research showing that men get published far more than women in peer-reviewed medical journals, publications are changing their editorial structures and processes in an effort to increase the amount of content produced by women and underrepresented minorities.
“Everyone now is focusing on various aspects of diversity at the journal level,” says Fuentes-Afflick, who sits on the editorial board for several journals. “These are increasing priorities: What's the diversity of our editorial board? What's the diversity of our authors? What about the content that we are publishing?”
Pediatric Research looked at its editorial board recently and found that “we are male heavy,” notes Editor-in-Chief Cynthia Bearer, MD, PhD. For example, the journal reports that it has 14 men and six women as section editors and 27 men and 21 women as associate editors. (The journal’s two top editors and its managing editor are women.)
Now the journal is prioritizing qualified women to replace men as their board terms expire, says Bearer, a professor of pediatrics at Case Western Reserve University School of Medicine in Cleveland.
“Having more females on the board means there’s more of a female voice in deciding the types of content we put out,” she explains.
Pediatric Research also made changes to attract content by more diverse groups of authors by going beyond research papers to invite commentaries and creative pieces, such as poems and vignettes that it says are “insightful to the life of pediatric researchers.”
While leaders of these efforts hope such strategies will gradually shift the balance toward gender equity, significant change will also require larger cultural changes within the field and society at large, as well as leadership from the top. That kind of change is typically more difficult and slow to advance.
“The bigger piece we have to change is the underlying culture itself: that women belong and are equal to men in the profession,” Byington says. “We haven’t come far enough; not even close.”