Women in Pediatric Academia

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Women

in Pediatric

Academia

Over the past decade, the number of women medical students in this country has risen substan-tially; however, there has not been a parallel rise in the proportion of women faculty members with MD degrees. In 1967 to 1968 women comprised 13.3% of the 17,801 full-time faculty at medical schools in the United States; only 8.9% ofthese women faculty members had MD degrees. Ten year later in 1977 to 1978, women were 15.2% of the 41,161 full-time medical school faculty with only 10.5% of the women with MD degrees (Table 1). The largest

number of female faculty members was found in the following departments: physical medicine, pe-diatrics, public health, anesthesiology, and psychia-try. The smallest number of women faculty mem-bers was found in surgery and orthopedic surgery.1

A national statistical survey by Farrell et a12 from catalogs from 102 medical schools in the United States provides the first comprehensive report of the extent and pattern of underuse of women

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weresicians foundin medicalto be clusteredacademia. inInthethisuntenured,study, womenand/ or lower faculty positions. Witte et al,3 in a report of women physicians in the US medical schools in

1976 found that women professors comprised only 2.9% and associate professors 4.4% of the tenured and/or senior faculty positions. Even in the field of pediatrics, where there are a larger number of women faculty, only 11.7% held a tenured faculty appointment.

The status and problems of women in medicine

and women in academia have been the subject of several recent reports.48 Detailed information on the past and current number, academic status, and number of years for promotion to each professional

rank for women in medicine is not available. How-ever, academic promotion patterns were recently studied in the faculties of four US medical schools7; these limited data also suggested under utilization of female physicians in medical academia.

In 1981 there were 46,321 full-time faculty at US medical schools reported to the Faculty Roster of the Association of American Medical Colleges (AAMC); women represented 11.4% of the MD faculty and 5.6% of the MD-PhD faculty. Women

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comprised 27.7% of the faculty in the departments of pediatrics. The distribution of pediatric faculty by rank is seen in Table 2. Only 9.5% of women were full professors in contrast to 23.9% of men.

At the present time, few women hold administra-tive positions in the nation’s medical schools. Thomas Jefferson University in Philadelphia was the first school in the United States to appoint a woman (Leah Lowenstein, MD) to full dean of a

medical school in 1982, although one woman had been appointed provost of the Medical College of Georgia School of Medicine earlier. Fifty six women are associate deans (9.5% ofthe 563 such positions).

This latest figure is an increase from the 3.4% holding the position of associate dean in 1975 to

1976. Sixty one women currently are in the position of assistant dean. This is a substantial increase in the percentage of women (11.7%) holding similar positions in 1975 to 1976 (Table 3).

Wallis et a17 recently completed a study of aca-demic promotion patterns at four US medical col-leges, including one in the South, one in the Mid-west, and two in the northeastern section of the United States. The average number of years for promotion to each professional rank in each college was consistently greater for women than men. The data are consistent with the underutilization of female physicians in medical academia.

A Faculty Roster System has been developed by the AAMC for deans and heads of research corn-mittees who are interested in identifying women candidates for specific positions; it is hoped that this system will increase the opportunities for women to be selected for administrative positions.

In addition to the Faculty Roster System, devel-oping a support system for capable women candi-dates by both tenured female mentors and male mentors can help to improve the utilization of women faculty members in leadership positions. Leadership training in the form of workshops is also needed to allow women faculty members to improve leadership skills.

The report of the Committee on Opportunities for Women in Medicine by the Coordinating Coun-cil on Medical Education (CCME) in June i979

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TABLE 1. Number and Percent Distribution of Full-Time Faculty by Sex and Degree, 1967-1968 and 1977_1978* Type of Degree

Total Full-Time Faculty

MD and PhD MD PhD OHD Nondoctoral Unknown

Degree

No. % No. % No. % No. % No. % No. % No. %

1967-1968

Male 1,032 96.1 9,593 91.1 3,961 87.4 125 92.6 648 45.9 77 63.6 15,436 86.7

Female 42 3.9 934 8.9 570 12.6 10 7.4 765 54.1 44 36.4 2,365 13.3

Total 1,074 100.0 10,527 100.0 4,531 100.0 135 100.0 1,413 100.0 121 100.0 17,801 100.0

1977-1978

Male 1,833 94.7 21,728 89.5 9,360 84.1 347 92.0 1,262 43.1 382 74.8 34,912 84.8

Female 102 5.3 2,546 10.5 1,775 15.9 30 8.0 1,667 56.9 129 25.2 6,249 15.2

Total 1,935 100.0 24,274 100.0 11,135 100.0 377 100.0 2,929 100.0 511 100.0 41,161 100.0

* From Comparison of Characteristics of US Medical School Salaried

Faculty in the Past Decade 1968 to 1978, American Association of Medical Colleges, 1979.

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TABLE 2. Distribution of Faculty in All Departments of Pediatrics*

TABLE 3. Distribution of Medical School Administra-tive Positions, 1975-1976 and 1982_1983*

Dean

Associate Dean Assistant Dean

* From K. Turner, personal communication, Washing-ton, DC, Association of American Medical Colleges, Sep-tember 1982. Rank Male No. % Female No. % % of Rank (M/F) Professor Associate Professor Assistant Professor Instructor Other Unknown 880 23.9 863 23.4 1,444 39.2 434 11.8 35 0.9 31 0.8 134 9.5 275 19.5 640 45.4 312 22.1 43 3.0 7 0.5 86.8/13.2 75.8/24.2 69.3/30.7 58.2/41.8 44.9/55.1 81.6/18.4

Total 3,687 100.0 1,411 100.0

% of Total 72.3 27.7

* From Turner K: Women in Medicine Statistics. Wash-ington, DC, Association of American Medical Colleges, 1982.

legislation, closer monitoring of salaries, more ag-gressive efforts to utilize the formal and informal organizational networks, a larger pool of women to select from, the continued success of women who have advanced in medical education, women will make substantial progress during the next five years.” The American Academy of Pediatrics (AAP) Task Force on Opportunities for Women in

Pediatrics has reviewed the CCME report and con-sidered the opportunities for women in pediatrics including medical academia, with the goal of iden-tifying and analyzing the problems of women pe-diatricians not gaining access to leadership posi-tions. Braslow and Hems9 propose that the chal-lenge to academic medicine in the decade of the

1980s is to ensure the “full integration of women into medical academia.” How far are academic pe-diatricians from that goal?

In 1978, 20 women occupied chairs in academic departments in the clinical sciences, with the larg-est number in pediatrics (six) and the next largest number in physical medicine and rehabilitation. In 1980 the total number of women chairmen of

din-1975-1976 1982-1983

Men Women Men Women

119 0 126 1

369 13 (3.4%) 536 56 (9.5%)

220 29 (11.7%) 279 61 (17.9%)

ical departments had increased from 20 to 37, and again the largest number (eight) were in pediatrics.

Although physical medicine, public health, anesthe-

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siology, and psychiatry share with pediatrics a large percentage of women faculty members, the number of women who serve as chairmen in these depart-ments is disproportionately low. The latest infor-mation from the Association of American Medical Colleges (September 1981) lists 45 women chairing medical school departments, with another 13 who are acting or interim chairmen. Pediatrics and re-habilitation medicine have the largest number of women departmental chairmen.

In spite of the modest number of women holding pediatric chairs, women faculty are disproportion-ately skewed to the lower, nontenured positions.

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Braslow and Hems9 challenge us to find a

solu-tion to the problem of small numbers of academic

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womenriers to in leadershipleadership positionspositions. forAnwomenanalysis indicatesof bar-two problem areas: problems of opportunities and problems of perception.

Problems of opportunities include: (1) lack of

support (often subtle) from selection groups,

men-tors, peers; (2) lack of training for leadership roles; (3) poor visibility as potential leader; (4) geographic limitations, including lack of mobility, difficulty of moving with “two careers in family,” or concern over changing schools for children; and (5) temporal limitations, including interruption of career for childbearing and child rearing.

Problems of perception include: (1) perception by others (cultural and social bias of women’s role conflicts with need to compete); and (2) self-per-ception: (a) failure to make long-range career plans; (b) lack of self-confidence, overconcern with job security; (c) conflict of feminine role and leadership role; and (d) passivity, “wait to be chosen.”

Access to appropriate mentors or to the informal network system is often cited as a factor that limits opportunities for leadership of women in medical academia. Academic medicine is analogous in many ways to corporate business and to military

organi-zation. A schematic representation of the hierarchy

of academic medicine and that of the military and corporate business is shown in the Figure.

Women wishing to pursue academic careers should analyze the characteristics of the existing medical academic “establishment,” which currently is dominated by their male colleagues; they should also analyze their own personalities, strengths, and capabilities in the present “system” and acquaint themselves with the options open to them in aca-demia. Willingness to serve on committees as junior faculty is a helpful step along the academic ladder. Appropriate credentials and setting realistic goals are essential. For example, to be a successful wife and mother and to achieve full professorship in a prestigious department ofpediatrics, at an age corn-parable to that of male colleagues, may be feasible but will require sacrifice.

Often young physicians recruited for faculty po-sitions are unfamiliar with the scope of duties that they will be expected to perform; they are also unprepared for the competition for funding and promotion and for the academic politics they will encounter. The common concept for academic ca-reers for physicians is that they provide intellec-tually challenging patterns of professional life. Be-cause of this concept and the desire to teach, many young physicians aspire to academic careers. Since

the late 1940s, women graduates have held a higher

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percentage ofacademic positions than men, relative to the number of graduates, but their positions have been at lower ranks of the academic ladder.

There are special issues of concern to women in pediatrics about career opportunities in medical

academia. Among them is the conflict between professional roles and personal relationships, in-cluding time for childbearing and child rearing at a critical phase of early career development.

Although shared residencies and more flexible training programs have become available, less at-tention has been directed to the development of more flexible subspecialty fellowships, training pro-grams for junior faculty, or research fellowships on a part-time basis. Whereas time-out for childbirth and the need for good day care are critical to all women in professional careers, they are a special problem for the woman physician because of the extraordinary demands on her time when she is in medical training or in her subsequent professional career.

To lose valuable time in the period of early career development might be a barrier to maximum achievement of success in a competitive

profes-sional career such as academic medicine. This crit-ical factor of time loss results in inequality of career opportunities for the women who bear children at a time that is safest both for them and for the children, or who decide to take some time from the development of their professional career for child rearing. More careful early career planning with the help of both male and female mentors may prove productive and time saving to the young woman with aspirations for a career in academic medicine who wishes to take some time out for her personal

life. Shared research projects or organized retrain-ing programs should be helpful in diminishing the conflict over time lost from professional career.

In choosing a geographic location, any physician is influenced by personal factors such as preference for urban v rural home site, choice of specific cli-mate, or family wishes. This last factor may limit academic career opportunities for some female phy-sicians. Women physicians may be more likely than men physicians to decline an offer for advancement if it comes at a time when it would require their

children to change schools and possibly disrupt their education. Moreover, dual-career families present a special problem to the woman academi-cian; seldom, if ever, do career opportunities for advancement coincide for the woman pediatrician in academic medicine and her professional spouse. When one career must be placed first in making a choice to move, it is usually the husband’s career.

Many medical schools are located in large urban areas where crime rates are high. Women

physi-cians may decline opportunities for career advance-ment because of concern for their personal safety and that of their family.

Lack of adequate child care facilities for children of women professionals is a major constraint to the productivity and mental freedom of the conscien-tious professional mother, especially when she is a pediatrician and is sensitized to the emotional, so-cia!, intellectual as well as physical needs of the growing child. Academic salaries forjunior pediatric faculty do not allow for hiring essential household employees and child caretakers to satisfy the con-science of a dedicated mother. The current federal and state income tax laws allow only a token tax credit for child care costs and household expenses for the working mother.

If lack of achievement for academic women in-volves lack of self-perception as a leader, there is a need for critical self-analysis of one’s ability for leadership. Setting realistic goals is an important step toward any successful achievement. A check list of qualities considered essential for a successful leader is shown in Table 4. A critical first question is what priority an individual woman places on achievement of a leadership position.

The Equal Opportunity Act passed in November 1971 was intended to alleviate some ofthe financial, educational, and social biases aimed at women; however, having equal opportunity for employment is not the same as being prepared to take advantage ofjob opportunities or advancement into leadership positions. If women are to be included in the hier-archies of academic medicine in the near future

TABLE 4. Leadership Skills

Ability to delegate authority to others and trust th#{231}mto satisfactorily complete assigned tasks

Ability to motivate others to perform assigned tasks Ability to motivate others to utilize their optimal

poten-tial in job performance

Ability to create a work environment where others feel they have potential for career growth

Ability to communicate clearly to others assigned tasks, requirements or level of competence that achievement of tasks requires

Ability to communicate a sense of “openness” to others that will allow them to come to you for help in per-formance of their assigned tasks

Ability to make long-range plans and set realistic priori-ties for accomplishment of proposed goals

Ability to anticipate problems in meeting proposed goals

Ability to develop alternative methods of problem solv-ing

Ability to deal effectively with criticism Ability to take appropriate risks

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there is a need for training opportunities for lead-ership positions.

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A recent report of the Ad Hoc Committee on

Women Physicians to the Board of Trustees of the American Medical Association’ ‘ recommends the provision of workshops to teach leadership and organizational skills. This committee recognized that although initially these efforts would

specifi-cally benefit women, young physicians of both sexes could profit from this type of instruction. Leader-ship training for higher academic positions should also be developed to improve the quality of the academic leaders of both sexes.

An effort to create more women leaders has been spearheaded by Witte et al since 1976, through funded workshops designed to identify and promote those skills necessary to procure and hold leader-ship roles and to develop a support system for emerging leaders. These workshops have been well attended by women physicians, but as Rinke’2”3 has warned, the pathophysiology is much deeper than a matter of skills and training; it pervades the very heart of the medical structure, reflecting wide-spread cultural mores, which are slow to change.

The Ad Hoc Committee on Women Physicians of the AMA” recommended appointment of an ongoing committee to monitor the progress of

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_forimplementen’s _someparticipation_{of the}long-term_issuesin studiesorganized_raised. to_Inprovidemedicine_addition, continuityand_the _Adto Hoc Committee suggested the appointment of a staff person to coordinate activities and special interests and concerns of women physicians.

Review of the literature and personal communi-cations with the American Academy of Pediatrics, the American Medical Associations, and the

Asso-ciation of American Medical Colleges1 confirmed the absence of good objective data on the status of women in academic pediatrics. Collection of objec-tive data on women pediatricians in medical aca-demia is indicated.

The collection of data to substantiate the issue of differential salaries for women in academia is needed but will be difficult to acquire. No detailed

data are now available on the salaries of women v men physicians, and pediatricians in particular, in medical academia. Recently a female departmental chairman of dermatology’4 polled 58 women who were acting/interim chairmen of medical school departments about their salaries. Each was asked to compare her salary with a table from the AAMC

survey. The results of this inquiry indicated that

40% were at or below the 20th percentile, 14% were

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between the 20th and 49th percentile, 30% were above the 50th percentile but at or below the 80th percentile, and only 16% were above the 80th

per-centile. A similar study needs to be made for female full-time faculty for all academic ranks in pediat-rics.

In summary, a review of the literature and avail-able statistics confirms the lack of upward mobility for women into leadership positions and in the higher ranks of medical academia. This situation prevails at a time when the highest percentage of women ever have entered US medical schools. An analysis of opportunities for women in academic pediatric careers indicates six issues of concern to women physicians in medical academia:

1. Conflict between personal and professional roles and including time for childbearing and child rearing at critical phase of early career develop-ment.

2. Potential lack of proportionate increase in the number of women on medical school faculties in contrast to the substantial increase in the num-ber of women accepted to medical schools in the United States.

3. Decreased number of women choosing pediatrics as a specialty because of increased number of women entering previously male-dominated spe-cialties, thus a reduction in pool of potential pediatric faculty members.

4. Delayed promotion of women faculty members, leading to limited number of women in higher academic ranks and tenured faculty positions. 5. Geographic limitations on opportunities in

med-ical academia for women. Women physicians are less mobile than male physicians due to concern over the needs and welfare of their spouses and

children, especially in dual-career families. Other geographic considerations can also ad-versely influence career opportunities for women pediatricians.

5. Differential salaries with women receiving lower incomes for their professional activities than men with the same qualifications.

Dr Estelle Ramey, professor of Physiology and Bio-physics at Georgetown, summarized well the status of women in professions today. “I have worked all my life with men, and I have discovered that some of them are very smart, some of them are very stupid and most of them are mediocre hacks. Women fall into the same categories. We will have equality when a female schlemiel moves ahead as fast as a male schlemiel. That’s equality, not when a female Einstein gets promoted to associate pro-fessor.”

REFERENCES

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2. Farrell K, Witte MH, Holguin M, et al: Women physicians in medical academia, a national statistical survey. JAMA 1979;241:2088-2812

3. Witte MH, Arem AJ, Holguin M: Women physicians in United States medical schools: A preliminary report. JAMA 1976;31:211-213

4. Braslow JB: Current status of women in academic medicine. Presented at Regional Conference on Women in Medicine, Goals for Today and Tomorrow, Rockefeller University of New York, March 24, 1979

5. Anderson P: Descriptive Study of Salaried Medical School Faculty. Washington, DC, US Resources Administration, Division of Operational Studies, Association of American Medical Colleges, 1975, p 57

6. Jolly P: Women physicians on US medical school faculties. J Med Educ 1981;56:151-153

7. Wallis L, Gilder H, Thaler H: Advancement of men and

women in medical academia. JAMA 1981;246:2350-2353

8. Coordinating Council on Medical Education: A Report of the Committee on Opportunities for Women in Medicine, June 1979

9. Braslow JB, Hems M: Women in medical education: A decade of change. N EngI J Med 1981;304:1129-1135

10. Harragan BL: Games Mother Never Taught You: Corporate Gameship for Women. New York, Rawson Associates

Pub-lisher, mc, 1977

11. AMA Ad Hoc Committee on Women Physicians: Report to the Board of Trustees, 1980. Chicago, American Medical Association, 1981

12. Rinke CM: The economic and academic status of women physicians. JAMA 1981;245:2305-2306

13. Rinke CM: The professional identities of women physicians. JAMA 1981;245:2419-2421

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1983;71;693

Pediatrics