Women
in Academic Medicine: Possibilities for a New Paradigm
Gabrielle Kane
University of Toronto
Abstract:
Historically, women have had difficulty
training to be doctors and then practicing their profession. Now they are able
to make career choices about their type of specialty and whether to enter
academic or private practice. Within the academic system, however, women are
less likely than men to be promoted and be represented in positions of
leadership and power. This paper explores some of the factors that act as
barriers to academic success, including the ‘time lag’ effect, issues of child
and family responsibility and some exclusionary practices of gender
discrimination. Solutions are discussed in terms of natural evolution (with
monitoring), and active intervention to implement a career paradigm that
accounts for gender differences.
Introduction:
T |
he purpose of this article is
to demonstrate that women in medicine are under-represented in positions of
power and leadership in their academic fields, and then to explore possible
reasons for this, and speculate on ways to overcome the obstacles to success.
This line of inquiry was prompted by my observation of a marked gender
imbalance at a medical education conference that coincided with the inauguration
of a new medical education program at a Canadian university. Most members of
the audience and participants at this event were middle-aged women with
respectable scholarly track records and a vast accumulation of experience in
medical education.
This
was in stark contrast to the academic leaders on the podium, all but one of
whom were men. However, women have advanced their numbers in medicine over the
past generation and now make up half of the graduates from Canadian medical
schools (Kazimirski, 1997). One quarter of medical school faculty consists of
women (Association of American Medical Colleges, 1997) but they are
concentrated at the junior ranks and still are not represented in the higher
echelons of the university.
This
article is based on a review of medical literature that focuses on women in
academic medicine and is grounded in my perspective as a female physician. My
background in medicine over the past 27 years has been diverse. It includes
several types of general practice that were mostly expedient employment to
maintain competence and earn money while I raised a family, a common pattern in
the 1970s. I was fortunate enough to have the opportunity to return to
university in my 40s for further postgraduate training and to be appointed to a
faculty position. These experiences have naturally influenced my
interpretations and shaped my personal framework.
The
demographic information is derived from statistics provided by the American
Association of Medical Colleges
(AAMC), the Association of Canadian Medical Schools (ACMS) and the Canadian
Medical Association (CMA). The Canadian information that is available pertains
mainly to women in all types of medical practice rather than in academic
practice in particular. The publicly available Canadian academic information is
10 years old; the results of a more recent survey are confidential (personal
communication, ACMS office). Many American statistics and studies are
generalizable to Canada because the medical education systems are similar, with
the exception of data about tenure, which rarely applies to clinicians in
Canada.
In this
article, I consider only the concerns of academic women clinicians, or doctors
with direct responsibility for patient care within a university system. This
excludes physicians without a clinical practice who specialize in the basic
sciences and medical humanities, and who normally research and teach junior
undergraduates in a preclinical university setting.
There is evidence
from the United States (Carr, Noble, Friedman, Moskowitz & Kasiz, (1993)
that financial remuneration is less for women than for men. In Canada, funding
is almost entirely public; evidence of financial inequity for salaries on a
rank-by-rank basis is not available, and this issue will not be addressed in
this article.
According
to a survey done by Wear and Bickel (1996), most women in academic medicine
support a classic liberal form of feminism. A majority of their respondents
agreed with the statement that “feminism is an educational, social, and economic
movement that works through the legal system to improve the quality of women’s
lives; the intent is not to dissolve gender differences but to rid society of
gender inequality.” Of those interviewed, only 28% identified with broader
definitions of feminism that included other issues of inequality. This may
reflect a lack of exposure to current feminist theory or the conservative
nature of the medical profession.
Medicine
uses a problem-based approach to disease diagnosis and management.
Symptoms and signs are elicited
by history and physical examination. Accordingly, this article covers
historical perspectives, educational and career choices, and the current status
of women in academic medicine. In the medical setting, the history is then
followed by a differential diagnosis, when the possible pathological issues in
diseases are identified. In this article, the issues that may contribute to the
lack of representation of women in positions of power and leadership in
academic medicine are diagnosed as ‘time lag’ effect, family issues and
exclusionary practices of gender bias. These issues are discussed and the
article concludes with some suggestions for therapy and prognosis.
Background: Historical Perspective
T |
he history of women in medicine
in North America provides important background information. The early
suffragettes provided the first wave of feminism in medicine. Their pioneering
struggles have been romanticized by the stories describing James Miranda Barry
and Mary Walker practicing medicine disguised as men. The first woman physician
to graduate in the U.S. was Elizabeth Blackwell in 1847 (Dickstein, 1996).
Canada lagged behind. No woman was allowed to train in Canada until the 1880s.
Because of their exclusion from Canadian mainstream schools, Jennie Trout and
Emily Howard Stowe had to train in the U.S. (Duffin, 1996) at small medical
schools that accepted only women. These schools became more numerous in the
U.S. by the turn of the century. However, the Flexner Report for the Carnegie
Foundation in 1910 outlined more rigorous standards for medical colleges and a
control on overproduction of doctors, resulting in closure of many smaller
schools, including all of the separate schools for women except for the Women’s
Medical College of Pennsylvania (Dickstein, 1996).
According
to Bonner (1998), Flexner himself felt that women should have access to the
great teaching hospitals on the same terms as men, and he wrote in the 1910
report that women’s efforts for educational opportunity were ‘predestined to
success’. Women were accepted into other medical schools in North America in
small numbers (5% or less) that were based on unspoken quotas. Because
scholastic entry standards for women were so much higher, these women were
usually at the top of their class. Societal expectations that women fulfill the
duties of nurse/midwife or helper/mother remained strong and were difficult to
overcome. Typically, women who entered male dominated professions during this
era had mothers with high levels of education and strong parental support,
possibly with a ‘substitute son’ syndrome (Dickstein, 1996).
The
shortage of men in World War II eased the medical school restrictions slightly,
allowing an increase in the enrolment of women to 6% of each entering class. This
changed little until the second wave of feminism, women’s liberation, started
in the late 1960s. Between the 1970s and 1990s the number of women applying and
admitted to medical school increased dramatically. In 1950, 6% of medical
graduates in Canada were women; this doubled to 12% in 1970, then almost
doubled again to 22% in 1975 (Association of Canadian Medical Colleges, 1987).
Restrictions on women’s entry into medical schools in both Canada and the U.S.
were eventually dropped with the introduction of equal opportunity legislation.
Over the past 20 years there have been dramatic changes in the pattern and
status of women in the workforce throughout Western society, as well as
profound societal changes. The changes demonstrated in medicine parallel those
in many other professions (AAMC, 1997).
The
numbers of women in medicine continue to increase in the 1990s. In the U.S.,
42% of medical students are now women (AAMC, 1997). However, 51% of students
entering Canadian medical schools in 1993 were women and this percentage
graduated in 1997. Over a quarter of currently practicing Canadian physicians
are women; assuming that women continue to be half of medical graduates and
that 65 remains the retirement age, by the year 2025 almost half of Canadian physicians
will be women (Canadian Medical Association, 1996).
Post-Graduate Choices
A |
dmission to medical school is
only the first hurdle to clear for a career in medicine. It is followed by
training and successful certification in a specialty. In Canada, postgraduate
training is now mandatory for licensure for all types of medical practice,
including family practice; in the past, a one year internship in a teaching
hospital and success at the Medical Council of Canada licensing examinations
were all that were necessary for general practice. Certain postgraduate
choices, such as primary care paediatrics, family practice, obstetrics and
gynecology have now commonly become identified as ‘women’s areas’, like the
traditional careers of nursing and midwifery. Over the past three years, more
women than men have entered these training programs (Cohen, 1997). Psychiatry,
dermatology and pathology also have high proportions (30 to 35%) of women.
The
most important determinant of career choice for women medical students appears
to be the flexibility of training and practice (Redman, Saltman, Straton, Young
& Paul,1994). Training in family medicine is short – two years – and can
lead to a flexible style of practice. Some female students consider career
choices at an early stage in their training to accommodate their future desire
to have a family, although over half a group of both male and female final year
students reported that having time for their family was an important
consideration in choosing a career (Field & Lennox, 1996). Although the
life-style of an obstetrician is not at all accommodating, in 1994 obstetrics
had more women than men trainees. This choice may reflect market forces and the
preference of many gynecology patients to be attended by women physicians. Thus
it appears that women doctors are sufficiently interested and attracted to the
specialty despite the compromise in their life-style. Other surgical
specialties continue to have small numbers of women.
Practice Choices
A |
fter certification in a specialty,
or sub-specialty, physicians must then decide
whether to enter private or
academic practice. In the former, they will make more money, have greater
autonomy and mobility, but command less prestige. An academic career is
associated with intellectual challenge, research and teaching opportunities. To
compete for an academic career, further training and credentialling may be
needed; candidates must have the potential to be academically productive and
display some outstanding research – laboratory or clinical – ability. Teaching
or administrative skills rarely carry weight at this point as it is assumed
that the candidates still lack experience in these fields.
Once
appointed to a university position, the faculty member is subject to
departmental reviews, external reviews and promotion expectations. Academic
rank at entry is usually at the level of lecturer or assistant professor,
depending on additional graduate qualifications and departmental policy. A
tenure track is rarely an option for clinicians in Canadian medical schools. It
is reserved for non-clinicians in the basic sciences who are salaried by the
university. In the clinical stream, billing the provincial health plans for
fee-for-service patient care generates money for salaries, support and academic
ventures. Usually, this income is signed over to university departmental
‘group-practices’ for income sharing based on academic rank and productivity.
Grants and endowments cover research. When stipends are given from the
university, they are usually small, for example, $10,000 per annum for an
associate professor of surgery in the University of Toronto, but most
appointments are for status only. Senior administrators have almost no clinical
income and are salaried by the university, often supplemented by ‘the group’.
Their salaries are public knowledge, and reflect the prestige of their
positions. It is interesting to note that the Dean of the medical faculty at
the University of Toronto earns more money than the President of the
University. Academic work also involves university and affiliated hospital
administrative duties. Success is indicated by productivity, measured by
publications and grants, and rewarded by promotion and appointment to positions
of leadership.
The Status of Women in Academic Medicine
W |
omen do choose academic
careers, although not in proportion to their representation in the profession.
According to the AAMC (1997), 26% of medical school faculty are women. The 1987
figures from the ACMC showed that 12% of physicians with full-time academic
appointments were women at a time when 17% of all physicians were women.
Furthermore, women physician faculty members are younger as a group than their
male colleagues, reflecting the increased proportion of women in the younger
age cohorts. In 1986-87, two-thirds of the women, but only 40% of the men, were
less than 45 years old (ACMC, 1987). More recent Canadian figures are not yet
available but have previously paralleled AAMC information.
Over
the years, women have gained absolute, but not proportionate, numbers with men.
Currently the percentage of women faculty in North American medical colleges
holding full professor rank is 10%, and for associate professor rank it is 20%.
The respective figures for male faculty are 30% and 25%. These proportions have
not changed in over 15 years (AAMC, 1997). It is more difficult to gather
information on the numbers of women occupying positions of leadership. The AAMC
Faculty Roster of 1993 and figures from 1997 (AAMC) show that only 4% of chairs
of departments are women (compared to 2.5% in (1983); none of these are in
internal medicine and surgery. Only 4 of 126 deans of North American medical
schools are women. The University of Toronto is typical. The dean, both vice
deans and three of the four associate deans are male. There are 32 departmental
chairs; 6 of these – anatomy, occupational therapy, speech pathology, health
administration, physical therapy and rehabilitation science – are occupied by 5
women (one woman holds two chairs). None of the five are clinical physicians.
In
summary, women are now well-represented in the profession, especially among
recent graduates, although not in all specialties. Many choose to enter
academia. Are the barriers to career development and promotion there any more
difficult for women to overcome than for men?
Differential
Diagnosis
T |
here are several,
multidimensional reasons why women are under-represented in positions of
seniority and leadership in academic medicine. The discrepancy could be due
only to a ‘time lag’ phenomenon, in that there may not be enough women of
seniority yet to occupy these positions. For those who have children, perhaps
childbearing and academic ambitions are mutually exclusive. However, not all
women have children and they still encounter barriers. It may be that women are
excluded by a patriarchal hierarchy. In a system where the number of
publications is more important than their quality, women in medicine and
throughout science have lower publication rates than men (Long, Allison & McGinnis,
1993). Most recently, Barnett, Carr, Boisnier, Ash, Friedman, Moskowitz, &
Szalacha (1998) examined the intrinsic motivation and publication rates without
finding any gender differences.
Time Lag Effect
H |
ave women simply entered the
profession in North America too recently to have risen to senior levels?
Between 1970 and 1992 the number of women faculty members increased by 130% and
men by 52% in the same period (AAMC, 1993). The fact that this influx of women
is relatively recent may contribute to the gender differences in senior
academic ranks.
Researchers
have performed cohort studies and have collected longitudinal data on
promotion. According to the data collected on academic progress, women spend
longer periods at lower ranks. For example, one study by Tesch, Wood, Helwig
and Nattinger (1995) showed that after 11 years as faculty, only 59% of women
had made the rank of associate or full professor, compared to 83% of men, and
5% of women versus 23% of men were full professors. The women also had fewer
academic resources at appointment. They worked slightly fewer hours per week
than the men and had published less, but even when this was accounted for in
the analysis, women were still less likely to be promoted. There was no gender
difference in attrition rate, and the data on number of children were not
associated with rank achieved. Similarly, in their 1987 cohort AAMC study of
1976 appointees, Bickel and Whiting (1991) found that 12% of the men but only
3% of the women had been promoted to full professor. Levinson and Weiner (1991)
prepared an American College of Physicians report in which they corrected the
data for age and date of faculty appointment by examining cohorts when
comparing gender differences in promotion rates. They showed that while women
faculty have made some progress up the academic ladder, they remain
disproportionately under-represented.
However,
Nickerson, Bennett, Estes and Shea (1990) claim that medical academic women at
Columbia University have already broken through the ‘glass ceiling’ that limits
the advancement of women beyond the junior ranks. These faculty members did not
have any time lag to promotion. One cannot say how generalizable this study
population is, but it does provide some encouraging evidence that advancement
is possible. It should be noted that despite these achievements, half of the
same population of women medical faculty in Columbia University reported in a
later study that they had been subject to gender discrimination in promotions
and had not had the same professional opportunities as men (Bennett &
Nickerson, 1992). Many believed that sexist comments and attitudes were common
in the environment. Almost all had experienced conflicts between professional
and personal demands.
When
considering studies that were written earlier in the decade, it is important to
realize that the proportion of women in the profession is changing rapidly.
According to the CMA statistics for 1986 to 1996, the proportion of women
physicians in the 35-44 and 45-54 year old groups almost doubled to 34.2% and
20% respectively.
Family Issues
A |
re child bearing and academic
ambitions mutually exclusive? Is this a humane expectation? Academic medicine
is temporally inflexible and demands long hours, both during training (at least
80 hours per week, including up-all-night call) and in staff positions (60 to
70 hours). It is difficult to accommodate domestic demands with this lifestyle.
Physicians
typically have left high school at age 18, completed their undergraduate degree
at 23 years, obtained their MD at 27 years and then have spent at least five
years in postgraduate training. This brings those on a fast straightforward
track to the age of 32. For a doctoral degree or a fellowship for travel or
research, extra time must be factored in to include extra training or
education, for example for a subspecialty or a master’s degree. At this point,
if accepted for an academic position, the physician requires a few years of
maximal productivity to become established and successful. Assuming this stage
is only five years, a woman faculty member is typically at least 37 years old.
If she has planned not to have a family until this point, she is already past
her optimal years for fertility and faces higher obstetrical and neonatal risks.
Maternity leave and the additional responsibilities of having a baby make the
pressures of residency and examinations even more difficult.
These
scenarios suggest that an academic career is not possible if a woman wants to
have children. It can be assumed that a significant number of women choose more
flexible career options for that reason. However, despite these conflicting
commitments, the majority of women in academic medicine do have children and
almost half of these women start their families before their training is
complete. A study of academic women physicians under 50 years of age showed
that 63% of the respondents – mean age 38 – were mothers, with an average of
1.9 children (Levinson, Tolle & Lewis, 1989). Approximately half of them
had their first child after completion of training, at a mean age of 30.6
years, which was 7.3 years later than the mean age of the general population.
They took very little time off for maternity leave, a median of six weeks
post-partum. Most (72%) took no time off before delivery and similarly, 83%
were back at work within 12 weeks. However, most of the respondents felt that
they would like to have taken a longer leave of absence. Almost all breast-fed
their babies and worked full-time. Seventy percent were married, 60% to
physicians, and 60% of these physicians were academics. Only 5.4% of the study
population were full professors and
19.5% were associate
professors. These women were the survivors in the system. According to
Eisenberg (1989), the playing field is hardly level if only superwomen, rather
than most women, can satisfy the needs of their families and meet their
professional goals. The aforementioned study does not describe the support, in
terms of childcare and domestic help, to which they may have had access. No
study has tracked the course of women who would have preferred an academic
career but did not apply or had to quit because they perceived that they were
unable to combine it with family responsibilities.
The
women academic faculty members in the Levinson, Tolle and Lewis study (1989)
believed that family or child-rearing responsibilities are a cause of slower
academic progress. Should biology prevent women from having the same
opportunities as men? Women in other professions are able to take maternity
leave and job share; they can even stop the tenure clock in other academic
positions without penalty. The child bearing/rearing period of a woman’s life
is relatively short. Even if a woman does not realize her full academic
potential until the age of 40, she can still contribute 25 productive years to
the institution that employs her.
Are Women Excluded by a Patriarchal
Hierarchy?
T |
he culture of medicine has been
shaped and reinforced by the historical exclusion of women from medicine.
Patriarchy is deeply embedded. The model of a doctor has been male for
centuries; women physicians were not wanted, but midwives and nurses were.
Pioneering women disguised themselves as men to work in their profession.
Despite advances in numbers, inequities are still perpetuated by discursive
practices that have been legitimized by acceptance and habit. Women can enter
the profession, but are encouraged to enter community-based practices. They
have limited access to academia and positions of leadership. This is where the
power is in medicine. These leaders make decisions that extend throughout the
profession by means of influence and example and by shaping future generations.
The
senior echelon of academic medicine is an established old boys’ club.
Interestingly, many medical school functions take place in clubs where women
cannot become members. Mahowald (1996) has described the medical academy as a
much more patriarchal and conservative system than the humanities, and as less
supportive of social and family needs than other academic fields. It is not a
meritocracy. Sponsorship, contacts and networking are as important in academic
medicine as they are in business and politics. Only a secure leader can afford
to take a chance to mentor and sponsor someone perceived by the members to be
an outsider. It is therefore very difficult for anyone, let alone a woman, to
break into the system. Selection and search committees naturally function
within a ‘comfort zone’ that fits the traditional look of a leader and this can
lead to bias. Leadership qualities are described as ‘aggressive, tenacious,
powerful and self-sufficient’. However, when these adjectives are applied to
women they become ‘strident, nasty, emasculating and stubborn’ words of
contempt and derision (Conley, 1993). Gender bias has a spectrum and can range
from unconscious slights to deliberate exploitation; the former category is
probably more common in this context. Micro-inequities that can erode
self-confidence and esteem include outmoded expectations and assumptions about
women. They are often beyond the control of policy making.
Therapeutic
Options
Evolution:
Conservative Therapy
A |
s younger cohorts of female
practitioners gain seniority, there will be gradual changes, and pressure will
be exerted from the increasing numbers of new female graduates. The present
generation of male deans and chairs typically has full-time wives to support
their career advancement and shelter them from life’s activities and demands.
This pattern is unlikely to persist in subsequent generations, as the future
leaders of either gender are more likely to have partners pursuing their own
career ambitions.
According
to Conley (1993), the top echelon at any academic institution sets the tone for
its workplace and educational environment. If those in positions of leadership
condone gender discrimination, it is emulated and perpetuated. Power and
stereotypes reinforce each other. The converse also holds true: good role
modeling by those in power can positively influence future leaders. However,
mere statement of politically correct policies will not camouflage an inherent
lack of true commitment.
The
American College of Physicians has suggested the introduction of a formal
monitoring process to evaluate the effectiveness of these gender equality
policies. The Royal College of Physicians and Surgeons of Canada (RCPSC) has
established an equity commission to address these issues. It will be
interesting to follow these initiatives to see if they will produce suggestions
of practical help by identifying and reporting a problem. However, this passive
approach will be slow to yield results.
Gender
equity is the opposite of gender bias. Attempts to bring it into mainstream
medicine by creating watchdogs are helpful but not adequate. More active
intervention is necessary. Monitoring progress does provide reinforcement by
recognizing appropriate behaviour with publicity. However, intervention may be
needed to overcome prejudices, which cannot simply disappear. The system can be
motivated by public accountability, the appearance of doing the right thing,
the fear of lawsuits, or even the avoidance of ridicule. There must also be
recognition that, while some men may well feel threatened and want to protect
their power base, there are many potentially supportive men who remain unaware
of the extent of gender inequities as well as men who actively support
advancement of women.
Active Therapeutic Intervention
I |
ncreasing the number of women
physicians who hold positions of power in academic institutions is vital to the
progress of women in academic medicine. They are needed as a voice in policy
setting and role modeling. However, when political correctness requires that
all committees have token female representation, this forces women faculty into
more committee work than their male colleagues because of their smaller
numbers. Women faculty thus risk burnout (Nadelson, 1989). Women should be
adequately rewarded for this effort. For example, their contributions must be
considered academic ventures and be recognized as merit for promotion.
Appointing more women allows responsibilities to be shared. Thus, affirmative
action would appear to help to offset the prevailing pattern of discrimination
(Eisenberg, 1989) but would be distasteful to women candidates who would rather
be appointed on their own merits. Therefore, intervention may result in a
backlash phenomenon.
Educational
intervention programs can have success. A faculty development initiative
undertaken to raise awareness of gender related issues at Johns Hopkins from
1990 through 1995 was documented by Friel, Francomano, McDonald, Wagner, Stokes
and Carbone (1996). Responding to the results of a survey, the medical school
ran workshops on eradicating gender bias and on multi-faceted interventions to
develop academic medical careers for women. Subsequently, the number of women
associate professors increased from 4 to 26 in five years. There was also an
increase in retention of junior faculty and both men and women reported an
improvement in the academic environment.
Women
can also learn to ‘play the game’ by the existing rules. The AAMC and the
Canadian Medical Association run professional development seminars for women
interested in a leadership style with which male managers are comfortable. This
will give women acceptance and visibility and thus may create opportunity for
the larger cohort of women to follow. However, there is a danger that this may
merely perpetuate the patriarchal mode of management.
Mentoring
W |
omen trainees considering an
academic career need the support, guidance and sponsorship of a mentor to help
them succeed. This liaison should be facilitated by the postgraduate training
programs and introductions made through program directors, who should also
monitor the effectiveness of the pairing. This is important because it has been
shown that junior faculty with mentors publish more articles, have increased
employment opportunities, feel more confident in their abilities and experience
greater satisfaction in their careers than those without mentors (Levinson
& Weiner, 1991). Unfortunately, no comparable information is available
about men without mentors.
Mentoring
can be done by either sex. Various reports about the influence of gender of the
mentor suggest that same sex mentoring may not be any more useful than a mentor
of the opposite sex. The mentor’s experience, rank and power influence career
sponsorship. However, having female, lower ranking mentors is associated with a
personally satisfying relationship (Ochberg, Barton & West, 1989).
Support
J |
ust admitting more women into
academia is not enough to ensure equality. Steps are needed to provide a more
humane environment. There are several practical measures that could be
developed to optimize support for women and their partners, especially in the
early stages of their career. There could be greater flexibility and the
development of a ‘slow track’ in promotion procedures. Part-time work could be
legitimized and job-sharing arrangements fostered. This could be an attractive
alternative to laying off faculty at times of economic downsizing, which
disproportionately affects those of the lower ranks. It is also possible that
some men may want to use this opportunity to develop other interests,
endeavours and responsibilities.
There
should be provision of time and opportunity for childbearing and rearing, which
should not be penalized, but should instead be recognized as part of normal
life for men and women. Childbearing and rearing are not necessarily
gender-specific, although women have traditionally tended to carry these
responsibilities. In an ideal world, there should be parental leave for both
genders, as well as high quality, flexible child care near training centres.
Fathers should be permitted and encouraged to participate in child rearing.
With women as 46% of the work force, this problem of accommodating child
rearing extends throughout society.
However,
the-round-the-clock nature of clinical medicine is unique to medicine. Shift
work does not allow for continuity of care and requires greater numbers of
staff. Part-time and flexible hours are difficult to integrate into the complex
scheduling model. Full-time colleagues become resentful when they carry a
heavier burden of the workload. The relative affluence of women doctors in
established practices or dual income families means that they can better afford
childcare and tolerate decreased income than most women in society. These may
not be viable options for junior doctors, who are not well paid and who usually
have a high load of education debt. Within the profession, an attitudinal
change to family responsibilities is long overdue and can only result in a
healthier society, consistent with the goals of providers of health care.
Questions
and Conclusions
A |
cademic physicians are a
valuable resource. They shape student learning, contribute to medical knowledge
through research and provide high quality medical care. However, the many roles
and expectations are often in conflict, especially in times of increasing
workloads and diminishing resources. Patient care, research, teaching,
administration and leadership all compete for time that should be used for
family and lifestyle. Can one person, regardless of gender, reasonably achieve
all these goals? What outcomes and performance indicators are we measuring to
define success? We have an archaic, rigid system that was developed to reflect
the realities of men’s careers. A paradigm shift in academic medicine could
produce a new model for productive and satisfying academic careers that would
benefit physicians of both genders.
References
Association
of American Medical Colleges. (1993).
Faculty Roster System. Report #43. Washington DC: AAMC.
Association
of American Medical Colleges. (1997).
Increasing women’s leadership in academic medicine [online]. Available:
http://aamcinfo.aamc.org [Access date unknown].
Association
of Canadian Medical Colleges. (1987). Canadian
medical education, statistics. Ottawa: ACMC.
Barnett,
R. C., Carr, P., Boisnier, A. D., Ash, A., Friedman, R. H., Moskowitz, M. A.,
& Szalacha, L. (1998). Relationships of gender and career motivation to
medical faculty members production of academic publications. Academic Medicine, 73(2), 180-186.
Bennett,
N. M., & Nickerson, K. G. (1992). Women in academic medicine: Perceived
obstacles to advancement. Journal of the
American Medical Association, 47(4), 115-118.
Bickel,
J., & Whiting, B. (1991). Comparing the representation and promotion of men
and women faculty at U.S. medical schools. Academic
Medicine, 66, 497.
Bonner,
T.N. (1998). Searching for Abraham Flexner. Academic
Medicine, 73(2), 160-166.
Canadian
Medical Association. (1996). Women in medicine: The Canadian experience. CMA News, 6(2), 7.
Carr,
P., Noble, J., Friedman, R. H., Moskowitz, M. A., & Kasiz, L. E. (1993).
Comparing the status of women and men in academic medicine. Annals of Internal Medicine, 119(9),
908-913.
Cohen,
M. (1997). Cracking the glass ceiling. Canadian
Medical Association Journal, 157, 1713-4.
Conley,
F. K. (1993). Toward a more perfect world: Eliminating sexual discrimination in
academic medicine. New England Journal of
Medicine, 328, 352.
Dickstein,
L. J. (1996). Overview of women physicians in the United States. In D. Wear
(Ed.), Women in medical education: An
anthology of experience (pp. 3-9). Albany, NY: SUNY Press.
Duffin,
J. (1996). Lighting candles, making sparks, and remembering not to forget. In
D. Wear (Ed.), Women in medical
education: An anthology of experience (pp. 33-45). Albany, NY: SUNY Press.
Eisenberg,
C. (1989). Medicine is no longer a man’s profession, or, When the men’s club
goes coed, it’s time to change the regs. New
England Journal of Medicine, 321(22), 1542-1544.
Field,
D., & Lennox, A. (1996). Gender in medicine: The views of first and fifth
year medical students. Medical Education,
30(4), 246-252.
Kazimirski,
J. C. (1997). Carpe diem. Canadian
Medical Association News, 7(2), 2.
Levinson,
W., Tolle, S., & Lewis, C. (1989). Women in academic medicine: Combining
career and family. New England Journal of
Medicine, 321(22), 1511-1517.
Levinson,
W., & Weiner, J. (1991). Promotion and tenure of women and minorities on
medical school faculties. Annals of
Internal Medicine, 114(1), 63-68.
Long,
J. S., Allison, P. D., & McGinnis, R. (1993). Rank advancement in academic
careers: Sex differences and the effect of productivity. American Sociological Review, 58, 703-722.
Mahowald,
M. B. (1996). A feminist in the medical academy. In D. Wear (Ed.), Women in medical education: An anthology of
experience (pp. 47-58). Albany, NY: SUNY Press.
Nadelson,
C. C. (1989). Professional issues for women. Psychiatric Clinics of America, 12(1), 25-33.
Nickerson,
K., Bennett, N., Estes, D., & Shea, S. (1990). The status of women at one
academic center: Breaking through the glass ceiling. Journal of the American Medical Association, 264(14), 1813-1817.
Ochberg,
R. L., Barton, G. M., & West, A. N. (1989). Women physicians and their
mentors. Journal of American Medical
Women’s Association, 44, 123-6.
Redman,
S., Saltman, D., Straton, J., Joung, B., & Paul, C. (1994). Determinants of
career choices among women and men medical students and interns. Medical Education, 28(5), 361- 371.
Tesch,
B., Wood, H. M., Helwig, A. L., & Nattinger, A. B. (1995). Promotion of
women physicians in academic medicine: Glass ceiling or sticky floor? Journal of the American Medical Association,
273(13), 1022-1025.
Wear,
D. & Bickel, J. (1996). Women’s programs at medical schools and feminism:
What is the intersection? In D. Wear (Ed.), Women
in medical education: An anthology of experience (pp. 21-29). Albany, NY:
SUNY Press.