Women face cultural barriers in academic medicine

Although men and women working in academic medicine strive toward advancement, significantly fewer women achieve leadership positions, says a study in the Journal of General Internal Medicine.

For the past decade, women have made up about 50% of medical students, according to the Assn. of American Medical Colleges. Meanwhile, the average medical school has 43 female full professors compared with 192 male full professors, said Linda Pololi, MD, lead study author and senior scientist at the Women’s Studies Research Center at Brandeis University in Massachusetts.

“Those numbers are still absolutely shocking, and without a good explanation,” she said.

To gain insight into the cultural barriers women face in academic medicine, researchers surveyed 4,578 full-time faculty at 26 U.S. medical schools. They found that women reported a lower sense of belonging and support and were more pessimistic about gender equity and their chances for advancement compared with men. Women also were less likely to believe that their institutions were family-friendly or to see their values as aligning with the institutions.

The findings, published online Aug. 31, demonstrate that medical schools have failed to create an environment where women feel fully accepted and supported to succeed, said Dr. Pololi, director and principal investigator of the National Initiative on Gender, Culture and Leadership in Medicine, also known as C-Change, which engages medical schools in research aimed at attaining equality in academic medicine.

The study proves wrong the notion that women are less ambitious than men. It shows that both genders have equal leadership aspirations and are equally engaged in their work, she said.

“Women care very deeply about having a rich professional life,” Dr. Pololi said.

The findings are not surprising and reinforce previous research, said Page S. Morahan, PhD, founding director and director of research at the Hedwig van Ameringen Executive Leadership in Academic Medicine Program for Women at Drexel University College of Medicine in Philadelphia.

“We have seen this over and over again,” she said.

Morahan was senior author of an August Academic Medicine study that found that despite an increasing number of female medical school students and faculty, few women advance to the level of dean. In that study, researchers identified that only 38 of 534 full and interim deans appointed from 1980 to 2006 were women. They also found that women took longer to advance in academic medicine and had shorter tenures than men.

A need for awareness

Medical schools face numerous challenges trying to enact positive changes regarding gender-related issues, said Dr. Pololi, author of the book Changing the Culture of Academic Medicine: Perspectives of Women Faculty. They are multilayered institutions with different levels and different agendas. Although relationships are central to the quality practice of medicine, little attention has been paid to relational challenges in academic medical centers.

“Medical schools are very, very complex organizational systems, and culture is very difficult to change in any system,” Dr. Pololi said. “It is clear there is a real problem in attending to the real human needs of the faculty.”

A major challenge is that there are few women in leadership positions for other women to look up to, Morahan said. The C-Change program pairs female faculty with leaders in academic medicine to try to change that, she said. Through mentoring, female faculty can receive external validation and demonstrate their unique skills to their mentors.

Leaders in academic medicine need to seek diversity in their top ranks, Dr. Pololi said. Women can provide valuable insights and a broader view of what an institution should strive for, she added.

“Leadership needs to be very purposeful in seeking out women as leaders,” she said.

The fact that women feel less aligned with the values of their institutions is a good reason to have more female faculty in leadership positions, Dr. Pololi said. Medical schools are failing to use some of their greatest assets, she said.

“It’s very important that we have people who see things differently in a position of leadership,” she said. “That’s a strong reason for having women in leadership.”

Morahan said she doesn’t think there will be real culture change until there is a critical mass of female leaders — when women make up 25% to 30% of leadership positions in academic medicine.

To effect positive changes, institutions first must be aware that there is a problem, said Scott White, EdD, lead author of the Academic Medicine study and deputy program manager with SRA International, an information technology and strategic solutions company. Many don’t realize there is a problem.

“Studies like this cause leaders to reexamine their institutions to see if any of these inherent biases are present,” White said.