The first woman physician in the United States graduated from Geneva Medical College in 1849. Since then, according to the American Association for Medical Colleges (AAMC), the number of women entering medical school has continued to increase, with over 48,000 women applicants to U.S. allopathic medical schools last year.¹ This signifies a substantial increase since 1970, when women constituted only 10% of all enrolled students.² Now, women represent almost half of all matriculants (47%).¹

Unfortunately, significant underrepresentation in leadership positions still persists for women, who represent only 38% of full-time academic faculty, 34% of associate professors, and 21% of full professors in academic medicine.^1,2 Furthermore, the percentage of women department chairs (15%) and deans (16%) at U.S. medical schools still remains remarkably low.¹ Theses gender disparities are even more pronounced in certain specialties, particularly the surgical subspecialties of urology, neurosurgery, and orthopedics. In 2008, only 7.3% of full professors of surgery were women.³

Some authors have suggested that in actually no gender biases exist and that the reason for the disparity is simply due to the pipeline effect—that is, an insufficient number of women have been present in academic medicine long enough to have reached leadership positions. This explanation implies that after a time, eventually the gender disparities will resolve, even without any active intervention. However, analyses of gender differences over time have not supported this hypothesis.^2,3

Several studies, both quantitative and qualitative, have attempted to identify barriers to attaining leadership positions in academic medicine for women. Common factors include: (1) traditional gender roles and socialization patterns ingrained in the larger society as a whole; (2) sexism present in the workplace environment; and (3) lack of effective mentorship and early career guidance.^2,4

From an early age, men and women are subject to different social pressures and expectations. One qualitative study exploring the views of clinical department chairs on this topic revealed the impact of traditional gender roles on career achievement. “There are some very excellent women,” stated one female department chair, “… who would make superb department heads who are just never going to because of family and kids. And that’s a problem that I think is unique to women.”⁴

Sexism remains a pervasive problem as well, which is more of a reflection of the historical “old boys’ club” culture of medicine, rather than the larger societal context. Sexism manifests in many ways, ranging from subtle to the obvious, including a lack of recognition to outright pressure for women to engage in sexual relationships.^2,4 In addition to discouraging career advancement, sexism has other consequences for women, including lower levels of job satisfaction and presumably a higher risk of attrition from academic medicine.

Finally, a lack of mentorship has been frequently cited as a significant barrier to career advancement for women.^1,2,4 Effective mentorship significantly enhances academic success, as mentors can provide insight into potential obstacles to advancement as well as provide direct opportunities for promotion and leadership.

There is a pressing need to develop women leaders. Strategies for supporting and maintaining women in leadership roles in academic medicine target the individual and family, as well as the broader institutional context. Strategies for individual women include encouraging young women to have children earlier in their careers; counseling women on the importance of getting various types of help at home; promoting renegotiation of the division of family responsibilities among parents; speaking up when confronted by sexism; role modeling to younger women faculty when possible; and encouraging women to rely on multiple mentors. Strategies for institutions include altering meeting times to be more hospitable to families with young children; establishing day-care centers; creating part-time tenure track positions; assuring that important department issues are not conducted in settings in which women are absent; setting up formal and informal mechanisms for identifying and responding to inappropriate behavior; and participating in regional and national networks to link mentors with junior faculty.

As academic medicine continues to call for expanding medical school sizes and the importance of cultural diversity comes to the forefront, the needs of women in medicine must continue to be addressed to meet the challenges facing the profession of medicine in the United States. Although significant barriers still exist, hopefully with these continued efforts we can eventually take full advantage of our academic leadership potential in medicine in order to optimally provide care for our patients and guide the future of academic medicine.

References

1. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2013 – 2014. American Association of Medical Colleges. Downloaded on July 26, 2016. Accessible at: https://www.aamc.org/members/gwims/statistics/
2. Zhuge Y, Kaufman J, Simeone DM, Chen H, Velasquez OC. Is There Still a Glass Ceiling for Women in Academic Surgery? Annals of Surgery. 2011. 253(4):637-43.
3. Sexton KW, Hocking KM, Wise E, et al. Women in Academic Surgery: The Pipeline is Busted. Journal of Surgical Education. 2012. 69(1):84-90.
4. Yedidia MJ and Bickel J. Why Aren’t There More Women Leaders in Academic Medicine? The Views of Clinical Department Chairs. Academic Medicine. 2001. 76(5):453-65.