THE NUMBER OF WOMEN GRADUATING from the nation’s medical schools has steadily increased over the past several decades, yet their ranks among the leadership of these institutions continue to lag. According to a report in 2009 by the Association of American Medical Colleges, women composed 48 percent of students entering medical schools in 2008-09 – an increase of 12 percent over the previous 10 years. And while their numbers throughout the strata of leadership were up overall during that period – in some instances more than 100 percent – they still remained significantly below those of their male peers: 18 percent of full professors, 21 percent of division chiefs or section heads, 13 percent of department chairs and 12 percent of deans.
To better understand some of the challenges facing women in academic medicine, UCLA Medicine invited three senior faculty members who have participated in a unique leadership-training program for women through Drexel University College of Medicine to engage in a conversation about the issues. They are Margaret Stuber, M.D., the Jane and Marc Nathanson Professor of Psychiatry and Biobehavioral Sciences in the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Lynn Gordon M.D., Ph.D., professor of ophthalmology and associate dean for diversity affairs in the David Geffen School of Medicine at UCLA; and M. Ines Boechat, M.D., professor of radiology and pediatrics, chief of pediatric radiology and former chair of the UC Committee for Affirmative Action and Diversity. Dr. Stuber moderated the discussion.
MARGARET STUBER: Both of you have held leadership positions within the David Geffen School of Medicine at UCLA. Can you reflect on the ways in which being a woman in healthcare has either helped or hindered you throughout your career and as you’ve taken on leadership roles?
LYNN GORDON: It is tough for women to attain leadership positions, and I think that’s borne out by all the literature and by the statistics of the limited numbers of women in leadership in academic medicine across the country. Now, I don’t think for a minute that anyone gets up in the morning and says, ‘Oh, I want to choose a man or I want to choose someone with purple hair’ for a particular position, but there are unconscious biases that exist and are prominent in the academic arena, in medicine and in many other fields. And just a slight disadvantage at every step creates an accumulation of disadvantage that at the end can become very great.
Personally, my career has been like a pinball. I’ve been lucky enough to be bounced off of the right bumpers and wind up in the right slots at the right time, but it has been very circuitous. I didn’t go into academic medicine when I finished my training; I went into private practice, in part to have increased flexibility with my children for five years, and then I came back to academia. I feel fortunate that I have encountered mentors, both men and women, who at various points along my trajectory gave me specific advice and encouragement. I don’t think that there’s a single recipe for success; there are many paths. And in some ways, it’s believing in yourself that you can do a job, that you can do a task, and it’s that willingness to put yourself out on a limb to go for it.
M. INES BOECHAT: When we did a study in 2007 of diversity on the University of California campuses with health sciences, it became clear that the situation for women and minorities had not changed significantly in 20 years. And although half of the students in our medical schools are females, they are not representative at that scale in the faculty positions, particularly among ladder faculty. It makes one realize that we have significant work to do to change this scenario, and there’s an opportunity here because of a 10-year window of time with a high turnover of faculty due to retirement and possible changes in the composition of the faculty. That presents a unique opportunity to hire more women and minorities. And there is now, I believe, within the academic medical community the desire to actively promote change.
MS: How is this change to be brought about?
IB: I think it happens through changes in training and through education of faculty members and search committees, so that people are made aware of these unconscious biases that Lynn referred to. It’s not that we as women don’t have them ourselves, we do, but being conscious of them and going through a process of education, of consciously trying to change it, is what is important.
LG: There’s this wonderful article, “Women’s Health and Women’s Leadership in Academic Medicine Hitting the Same Glass Ceiling,” and there was an example involving the National Institutes of Health Director’s Pioneer Awards and about subtle cues and how they impact and create bias. The article describes how in the first round of the process, no women were selected. On review of the published criteria for the award, it stated that the NIH was looking for scientists who were willing to take risks. But we know from the social literature that risk-taking is not typically a female trait, and it was hypothesized that perhaps having this statement about risk-taking placed women at a disadvantage in terms of receiving the grant. Changes were made in the instructions, including, and I’m quoting from the article, “elimination of the word risk both from the solicitation and from the review criteria.” And since then, women have been among the recipients in each subsequent year.
MS: We started out talking about the bias of people who are selecting or interviewing or searching for leadership roles, but what you’re also describing are characteristics of the individual or his or her responses to internalized bias. Talk more about what we should do if women are reluctant to take on a leadership position or a position that feels risky.
LG: That’s a really important question because I think what we hear from a lot of younger women faculty members, or even young women in medical school or in residencies, is that they don’t necessarily want to do things the way we did. There are generational differences in priorities and how people approach their lives, and I think that we need to educate our young colleagues that there are many paths, and that leadership comes with some advantages and benefits of which they may not be aware, and that it may also not take the toll that they fear in terms of their personal and family lives. And I think we also can do a better job institutionally to provide resources, to both women and men, so they can create a work/life balance that is comfortable and still allows them to succeed at the highest level.
IB: Becoming more aware about how people perceive you is very helpful when facing a leadership position or a change in job or deciding about how to progress along the path of your academic career. It is important to identify possible derailing situations of which you may not even be aware. That is something that younger faculty should keep in mind. And also that it’s not such an impossible task to reconcile family and work and be successful.
MS: How has having women in leadership positions actually changed institutions?
IB: There is a recently published article that talks about how when you have more than three women on a board or in a council that it really changes the tone of the discussion. Many times women felt that they were on these bodies representing their gender and not necessarily their own ideas, but having three or more really distributes that responsibility and changes the dialogue, and their opinions are respected and listened to. In that situation, you’re no longer a token voice.
LG: There have been a lot of studies, also, that have demonstrated increased collaborations when there are women involved in leadership positions. And I think that corporate structures are in some senses ahead of the academic curve because they have, at least in some settings, very tangible goals, and if they achieve those goals, they succeed.
MS: Let’s talk a bit about some of the kinds of subjective, nebulous things that create glass ceilings for women.
LG: There was a study on letters of recommendation and adjectives used to describe men or women, and the adjectives that were describing men were much more powerful adjectives, ones that we typically associate with leadership. The adjectives that were describing women who, on the face of the matter, would have equivalent qualifications were adjectives that we as a society don’t tend to associate as much with leadership. So just having those descriptors skewed in a gender way led to lower success in terms of women being hired for those positions.
IB: Even the analysis of CVs was biased in that direction. A CV from a woman needed to be much stronger than one from a man to be considered to be a similar level.
MS: How important is mentoring in helping to guide women toward leadership roles?
LG: Very important, and it should start early on, even before they enter medical school. Nurturing these young women is critical to help them to figure out what their goals are, to give them the tools and information and the resources they need to choose a research career if that is what they want, or to choose a clinical career in academia if that is what they want, or to choose a leadership path if that is what they want.
IB: The most important thing is to help the person you are mentoring to recognize and believe in what she can accomplish. That recognition is what will keep her going and gives her the internal strength to move toward a higher goal. A good mentor not only will give the mentee tools to progress, but also help nurture feelings of self-esteem and confidence to achieve her goals.
MS: About 50 percent of current medical school students are female, yet that’s not being reflected in new hires of faculty. How much of the reluctance of women to enter academic medicine is a generation issue as opposed to a gender issue?
LG: In terms of balancing family and career, I think the distribution of family responsibilities by this new generation is even more equal than in the past. So, from that point of view, it should make it easier for women. But the older generation – the generation that is doing the hiring to fill positions in the academic medical setting – has to accept these new values. That’s why I say that when we do the hiring, there is a responsibility for accepting these generational changes and working with them.
IB: There also is the issue of debt. Physicians have tremendous debt when they finish college and medical school. So entering an academic career may be not so attractive. I think the NIH has recognized that there are so many problems related to the increase of diversity in the work force that they created an award to look for innovative solutions for this problem. I am very curious to see what proposals are selected for this NIH Director’s ARRA Funded Pathfinder Award to Promote Diversity in the Scientific Workforce and what their results will be.
MS: We have mentioned that the leadership in academic medicine is a little older. Is it possible to change the perspectives of the people currently in power who are in their 50s, 60s or even 70s?
LG: I think we can. If you look at the leadership in academic health centers or medical schools, they are incredibly bright, talented, hard working, energetic people. And I think by persuasive education and presenting data, you do get changes. Can we change everyone’s perspective? No. But we can change the perspective of many of them.
IB: If we didn’t believe that it could be done, we wouldn’t be here.
LG: That’s right. People can change over time, especially smart people, and these are all very smart people, and they want what’s best for their institutions.
IB: By mentoring and training the women who have already shown leadership potential and demonstrated their capabilities, giving them further tools and resources, we are working to both educate the current leadership and provide new leaders for the future.