Fried_Career-Development-for-Women-in-Academic-Medicine-JAMA

Career Development for Women in Academic Medicine Multiple Interventions in a Department of Medicine Linda P Fried, MD, MPH; Clair A Francomano, MD; Susan M MacDonald, MD; Elizabeth M Wagner, PhD; Emma J Stokes, PhD; Kathryn M Carbone, MD; Wilma B Bias, PhD; Mary M Newman, MD; John D Stobo, MD Objective.\p=m-\Todetermine the gender-based career obstacles for women in an academic department of medicine and to report the interventions to correct such obstacles (resulting from the evaluation) and the results of these interventions Design.\p=m-\Interventionstudy, before-after trial, with assessment of faculty concerns and perceived change through structured, self-administered questionnaires Setting.\p=m-\TheDepartment of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md Participants.\p=m-\Full-timefaculty Interventions.\p=m-\Multifacetedintervention from 1990 through 1995 to correct career obstacles reported by women faculty, including problem identification, leadership, and education of faculty, and interventions to improve faculty development, mentoring, and rewards and to reduce isolation and structural gender-based career impediments Main Outcome Measures.\p=m-\Retentionand promotion of deserving women faculty, salary equity, quality of mentoring, decreased isolation from information and colleagues, integration of women faculty into the scientific community, and decreased manifestations of gender bias Results.\p=m-\Juniorwomen were retained and promoted, reversing previous experience, with a 550% increase in the number of women at the associate professor rank over years (from in 1990 to 26 in 1995) Interim 3-year follow-up showed a 183% increase in the proportion of women faculty who expected they would still be in academic medicine in 10 years (from 23% [7/30] in 1990 to 65% [30/46] in 1993) One half to two thirds of women faculty reported improvements in timeliness of promotions, manifestations of gender bias, access to information needed for faculty development, isolation, and salary equity Men also reported improvements in these areas Conclusions.\p=m-\Theoutcomes reported here indicate that it is possible to make substantive improvements in the development of women's careers, that an institutional strategy to this end can be successful in retaining women in academic medicine, and that such interventions are likely to benefit all faculty Long-term interventions appear essential JAMA 1996;276:898-905 From the Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Fried, Francomano, MacDonald, Wagner, Stokes, Carbone, Bias, Newman, and Stobo); Medical Genetics Branch, National Center for Human Genome Research, National Institutes of Health, Bethesda, Md (Dr Francomano); and Johns Hopkins HealthCare LLC, Baltimore, Md (Dr Stobo) Reprints: Linda P Fried, MD, MPH, Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E Monument St, Suite 2-600, Baltimore, MD 21205-2223 WOMEN ARE less likely to succeed in academic medical careers in the United States than men.1"7 Compared with men, women are underrepresented in lead¬ ership roles,1'8,9 have slower rates and lower likelihood of promotion,1·10'11 and are less likely to become professors in their departments.2 In an 11-year followup study of US medical school faculty appointed in 1980, only 5% of women became professors, compared with 23% of men, despite comparable overall rates of leaving academic medicine for women and men over this period.10 Women also received lower salaries in comparable positions.3,9,10 These data suggest that the low pro¬ portion of women faculty at senior and leadership levels may not result from a cohort effect alone Among the more subtle factors that may underlie the lesser likelihood of success for women in academic scientific careers are reduced access to mentoring12"14 and to rewards, including promotions, salary, and rec¬ ognition.1416 Other key factors are iso¬ lation from colleagues and career-related professional information.14·16·17 It has been shown that women receive fewer re¬ sources to accomplish their goals, in¬ cluding necessary personnel, space, and equipment.10,15 Further, academic insti¬ tutions are often organized on the as¬ sumption of a "social and emotional sup¬ port structure provided to the male scientist by an unpaid full-time house¬ wife or done without,"16 leading to struc¬ tural, institutional impediments to ca¬ reers for individuals without this support structure Outright gender discrimina¬ tion is another obstacle.6·7·14 While these findings prevail, there has been no com¬ prehensive evaluation of the differences in career development between men and women.1 The proportion of women on academic medical faculties increased from 13% in 1967 to 24% in 1994,1·2 and 42% of en¬ trants to medical schools are now wom¬ en.1·18 However, attaining a critical mass may not be sufficient to remove the ob¬ stacles that women experience in aca¬ demic scientific careers.16 For this rea¬ son, the American College of Physicians10 and the Association of American Medi- Downloaded from jama.ama-assn.org at Boston University on August 1, 2011 cal Colleges (AAMC)19 have urged all medical schools to design and implement institutional strategies that will foster the success of women faculty and their promotion to senior faculty positions This article reports the results of such an institution-based strategy, the first major effort of a US department ofmedi¬ cine to define and intervene aggressively to correct the structural and subtle impediments to the careers of women faculty This article describes, in phases, the identification of gender-re¬ lated career obstacles (phase 1), the in¬ terventions implemented to correct the multiple obstacles identified (phase 2), and the results of the first years of intervention, including improvements in promotion rates, career experiences, and gender-based obstacles for women in the department (phase 3) We also report data indicating that careers of male, as well as female, faculty benefited from these interventions PHASE 1: IDENTIFICATION OF GENDER-RELATED OBSTACLES (BASELINE EVALUATION) Background and Methods In 1989, the Provost's Committee on the Status of Women at The Johns Hop¬ kins University, Baltimore, Md, issued a report documenting lower salaries for faculty compared with men and substantially slower rates of promotion, women the latter a result of lower rates of nomi¬ nation.11 Consequently, in 1990, the chair of the Department of Medicine, The Johns Hopkins University School of Medicine (J.D.S.), appointed the Task Force on Women's Academic Careers in Medicine to evaluate whether there were career obstacles for women faculty in the Department of Medicine and, if so, to characterize them This task force (L.P.F., chair; CF., E.M.W., M.M.N.) performed structured interviews of wo¬ men faculty and trainees (a convenience sample of as many women as this small group had time to interview, approxi¬ mately half the women at all ranks) over a 6-month period These interviews iden¬ tified recurrently described, significant problems that appeared to be generic ones, to be gender-based and that crossed ranks and divisional lines These obser¬ vations were developed into the follow¬ ing hypotheses for further evaluation: (1) women faculty, compared with men faculty, were less likely to be nomi¬ nated for promotion, to have mentors who actively fostered their careers, to be sought for collaborative research ef¬ forts, to have equal access to resources and comparable salaries, and to partici¬ pate in informal institutional networks and decision making; (2) women faculty were more likely than their male coun¬ terparts to have a mentor who used the woman faculty member's research ac¬ tivities for the mentor's own career needs, to experience isolation and lack of support from the academic environ¬ ment, and to experience conflict between the expectations ofacademic culture and personal responsibilities (eg, regularly scheduled meetings on evenings and weekends conflicting with family respon¬ sibilities primarily carried out by wom¬ en); and (3) obstacles to women's ca¬ resulted both from institutional policy and structure and from the in¬ formal culture To evaluate these hypotheses, a selfadministered anonymous questionnaire20 was mailed to all full-time faculty in June 1990 by the department chair The goal of the questionnaire was to determine the career development experiences and future expectations of faculty and their perceptions as to gender-based differ¬ ences in these areas Response rates were calculated, and responses to indi¬ vidual questions were analyzed overall, by gender, and by faculty rank Statis¬ tical comparisons by gender and faculty rank were performed using or t tests, reers as appropriate Results of Baseline Evaluation Seventy percent of women (30/43) and 67% of men (97/145) on the full-time, tenure-track faculty completed the base¬ line questionnaire in 1990 (Table 1) Significantly more women than men perceived a wide variety of career impediments, many gender-based, in¬ volving promotions, collaborative inter¬ actions, networking, male-female in¬ teractions, and general climate, as shown in Table Of note, more than half of the responding women perceived gender- related obstacles in the department In contrast to the high frequency with which women perceived these relatively subtle obstacles to careers, only 10% of women faculty reported overt sexual ha¬ rassment on the job (Table 2) Table describes mentoring experi¬ ences One third of both female and male faculty reported having a mentor Low but equal proportions of women and men reported that their mentors critiqued their work and fostered their careers However, in other respects, the per¬ ceived quality of the mentoring differed by gender First, men's mentors were significantly more likely to facilitate their external visibility, such as through chair¬ ing conferences or participating in in¬ vited manuscripts Second, one third of women reported that their mentors used the woman faculty member's work for the mentor's own career benefit, rather than to benefit the woman's career; 10% Table 1.—Response Rates for Full-time Baseline Evaluation in 1990 Women, % Faculty Instructor Assistant professor Associate professor Professor Total (No.·) 43 (3/7) 68(19/28) 100(4/4) 100(4/4) 70 (30/43) Faculty at Men, % (No.*) 38 (3/8) (28/57) 84 (38/45) 80 (28/35) 67 (97/145) 49 "Number responding/total number in group of men (P=.004) reported similar experiences Four institutional policies that pref¬ inhibited women's careers were identified (Table 4) Meetings af¬ ter PM and on weekends caused prob¬ lems for two thirds of women and al¬ most one third of men because faculty members with competing personal re¬ sponsibilities were excluded from this essential information exchange and net¬ working The presence of rigid limits to time at rank was also cited by women as causing problems; this policy limited the ability of faculty to meet personal re¬ sponsibilities if they were to be com¬ petitive for promotion within the time allotted The lack of a part-time tenure track and the lack of on-site child care were seen as obstacles by women fac¬ ulty significantly (P=.001 and 04, re¬ spectively) more frequently than by men Finally, future expectations varied by gender (Table 5) A lower proportion of women expected to be promoted than did men; this did not differ significantly by rank (P=.66) Notably, only 40% of the women who wanted to be in aca¬ demic medicine 10 years later expected that they would be, compared with 66% of the men Conversely, almost two thirds of the women were seriously con¬ sidering leaving academic medicine, com¬ pared with 43% of the men (P=.22 for these comparisons) Among the reasons cited for considering leaving academic medicine, a perception of isolation was the only one that differed significantly by gender (cited as a reason by 80% of women compared with 34% of men, erentially P