Glass Ceiling Begins to Open, But Just a Crack

If one looks from a historical perspective at the number of American women who have become physicians, there has been a dramatic increase in the past few years. In 1900, for example, only 6 percent of American physicians were women. In 1985 the percentage was not much higher—only 14 percent. Yet in 1998 the percentage had increased to 23 percent, and in 2010 it is expected to be 30 percent. What’s more, women now comprise 45 percent of American medical students.

Yet for women physicians who want to work in academic medicine and achieve levels of considerable responsibility in that realm, there is still substantial room for progress, according to a report endorsed by the Association of American Medical Colleges’ (AAMC) Executive Council and slated to be published in the September issue of Academic Medicine.

The report is called “Increasing Women’s Leadership in Academic Medicine: Report of the AAMC Project Implementation Committee.” The committee was headed by Jane Bickel, associate vice president of the AAMC and director of the AAMC Women in Medicine Program.

For this report Bickel and her colleagues pulled together four years of data on the representation of women, whether M.D.s, Ph.D.s, or both, on medical school faculties. The data come from medical schools, interviews with medical school department chairs, and other sources. An analysis of medical school faculty from 1979 to 1993 found that while 36 percent of men on the tenure track—that is, assistant professors for at least two years—were promoted to associate professor, only 24 percent of women were.

In 1980 a study was launched of men and women who had been appointed to medical school faculties. Both the men and women in this study had similar levels of preparation for a career in academic medicine, such as board certification, advanced degrees, and research during fellowship training. By 1991, 83 percent of the men had achieved the rank of associate professor or full professor, compared with only 59 percent of the women; and 23 percent of the men had achieved full professor, compared with 5 percent of the women.

In 2001, 214 women chaired a medical school department. While that figure represented progress over 1995’s figure of only 115, the 214 chairs represented only 8 percent of all medical school chairs.

As of 2001, 117 men served as deans of American medical schools, compared with eight women.

Thus, “while the numbers of women faculty, department chairs, and deans have never been higher. . .this growth has not substantially reduced gender differences in advancement or sufficiently strengthened the pool of women candidates for administrative positions,” concluded Bickel and her colleagues on the project implementation committee.

The report also offers some perspective on how women in academic psychiatry are faring with regard to leadership positions. Compared with women in other academic specialties, women in psychiatry are doing better (see chart).

For example, in 2001, 36 percent of all medical school faculty positions in psychiatry were held by women, compared with 28 percent of all medical school faculty positions; 29 percent of associate professorships in psychiatry were held by women, compared with 24 percent of all associate professorships; and 14 percent of full professorships in psychiatry were held by women, compared with 12 percent of all full professorships in medical schools.

While low, this 14 percent compares favorably with the percentages of women holding full professorships in some other specialties: 10 percent in neurology, 6 percent in emergency medicine, 4 percent in surgery, and 1 percent in orthopedic surgery.

Even if these figures for women psychiatrists look fairly robust compared with those for women in other medical specialties, they also reveal that women are still not filling as many academic psychiatry leadership positions as men.

The report likewise offers suggestions on how medical schools can increase the number of women in faculty leadership positions. Among them: medical schools should emphasize faculty diversity in departmental reviews and evaluate department chairs on their development of women faculty; enhance the effectiveness of search committees to attract women candidates to top positions; identify issues of greatest concern to women faculty and target programs to their needs; guide the men on faculty on how to become more effective mentors to women on staff; assess practices that may favor promotion of men over women, such as rewarding unlimited availability for work; improve parental leave policies; consider the creation of child care centers; put less value on “rugged individualism,” commonly associated with men, and more value on collaboration, which women are often good at.

Psychiatric News asked Deborah Hales, M.D., director of APA’s Department of Continuing Education and Career Development, to comment on the report. “I think it is an outstanding work with concrete steps for institutions that wish to help women advance,” she said. “And I think APA should take their suggestions to heart. Tara McLoughlin, my right hand in charge of women’s programs at APA, and I are going to be working on how to implement some of those suggestions, with particular emphasis on psychiatry academic departments.”

Carolyn Robinowitz, M.D., a Washington, D.C., psychiatrist and former APA senior deputy medical director and dean of Georgetown University Medical School, said, “It is a wonderful report that will certainly preach to the converted, but it is also discouraging in the sense that there was an earlier AAMC report on women in academic medicine with recommendations, and it hasn’t had much of an impact. So the challenge is how to take the report’s recommendations and give them some teeth.”

For instance, Robinowitz helped conduct a study a few years ago on the needs of women in academic medicine. What women wanted most and needed most, the study revealed, were mentors. Robinowitz said that she is pleased that APA’s Women’s Mentoring Network is helping match women psychiatrists who want to advance in academic medicine with women psychiatrists who are already established in the field and willing to guide them (Psychiatric News, January 4).

Such efforts, Robinowitz believes, will benefit not only the individual women psychiatrists who receive coaching, but also academic psychiatry in general. The reason? There are few psychiatrists in academic medicine to start with, so whenever women psychiatrists drop out of academic medicine because they are not promoted, academic psychiatry loses valuable knowledge and skills.

The report, “Increasing Women’s Leadership in Academic Medicine: Report of the AAMC Project Implementation Committee,” is posted on the Web at www.aamc.org/members/wim/committees/increasing.htm. ▪