Monday, December 15, 2008

Tearing Down the Glass Ceiling Once and For All....

Just a little ditty I wrote to speak my mind!  Maybe you will find it omoshiroi?

Now that we have broken through the glass ceiling, where does this leave women physician-scientists pursuing careers in academia? Once we step over the jagged edges, will we see wide-open spaces and the sunrise to a new day? If this were a Disney movie, we would see all this and more, including a prince named “Promotion” who would recognize our value and keep us in the system.

Unfortunately, this is not an animated movie with deep-seated words of wisdom, but a reality for women pursuing careers in academic medicine. Female graduates of the MD/PhD programs in America are not being retained in academia, despite a dramatic increase in the number of women accepted into such programs. According to a survey of roughly 2,000 MD/PhD graduates from 2000 to 2006, nearly 40% of current enrollees in MD/PhD programs are women (Andriole et al., 2008). This is indeed promising news, as it demonstrates the rapid movement towards parity within these elite programs. However, this same report also found that women are less likely to graduate from MD/PhD programs. Furthermore, among those female MD/PhD graduates who do complete the program, results demonstrate that they are less likely than men to pursue substantial career involvement in research. The golden question remains: Why?

According to a Nature Medicine paper published in 2002, this problem may stem from many sources. Women have to take into consideration the time, energy, and relative immobility that childbearing and family life may bring. In addition to this, there are also concerns about the lack of physician-scientist role models to help guide female MD/PhD candidates through what once was thought to be “no man’s land” (and, ironically enough, certainly not an “all woman’s land.”). The finding that a lower proportion of female MD/PhD graduates compared to male graduates designate research as a primary professional goal suggests that there is a major dichotomy in career intentions between the sexes. Having identified a few of the potential problems leading up to decreased graduation rates of female MD/PhD candidates, what can we do about it?

Before coming up with a solution, it is first necessary to clearly understand the complexity of the problem from beginning to end. Now that we have a relatively firm grasp of why or “where all the young girls have gone” (title of the Nature Medicine paper cited above), what about the pioneering women who not only graduated, but single-handedly kicked down the glass ceiling themselves? Where have all these women gone? Or, better yet, where are they going? In a recent report published by the Association of American Medical Colleges (AAMC, Analysis in Brief, November 2008), authors described some key differences in U.S medical school faculty job satisfaction by gender. After administering a comprehensive survey to fulltime faculty at 10 medical schools, significant differences were found between the sexes concerning issues of promotion, pay, and overall compensation. Specifically concerning promotions, when respondents were asked if female and male faculty members at their medical school had an equal opportunity to be promoted in rank, 66% of the men agreed, while a startling 39% of women agreed. Furthermore, when asked if the criteria for promotion at their medical school were consistently applied to faculty across comparable positions, 38% of the male respondent agreed, while only 26% of women agreed. This demonstrates a very clear problem: women in academia are unsatisfied with the opportunity and overall criteria used to determine aspects of promotion.

Moreover, in the same cohort, a striking difference was found between salary satisfaction of colleagues in the same department, with 42% of men being satisfied and only 30% of women being satisfied. Similarly, when the authors asked individuals to compare their salaries to colleagues in other departments, 30% of men felt satisfied, while only 20% of women reported satisfaction. Again, this demonstrates a crystal clear message that women faculty members feel unsatisfied with aspects of pay and compensation compared to their male counterparts. Where is the parity in promotions, pay and compensation?

Granted, one can argue that this may all be a figment of a very finely tuned imagination. Countering this argument exists a study conducted in 2008, evaluating the gender differences in research grant applications and funding outcomes for medical school faculty (Waisbren et al., 2008). Though the study does not focus on individual medical school pay and compensation protocol perse, it does present the other side of the same coin that determines financial satisfaction: extramural funding. Data was collected from eight Harvard Medical School-affiliated institutions on all research grant applications submitted by full-time faculty from 2001 to 2003. Significant gender differences were found to exist in the mean number of submissions per applicant, the success rate, the number of years requested, the median annual amount requested, the mean number of years awarded, and the median annual amount awarded, with women being consistently lower than men across the board. On top of this, after controlling for academic rank, women were awarded significantly less money than men at the ranks of instructor and associate professor. Oddly enough, these positions are where the majority of women in academia reside, as it is challenging to achieve promotion to the highest faculty positions available (i.e. full professor, etc). Again, we are left with a question: How do we tackle the problem of gender disparity in grant funding while also managing the gender disparity in academic rank? Why is this occurring?

Approaching these problems from an institutional perspective, there is evidence that women receive less administrative support than men in the sciences (Osborn et al., 2000) as well as less professional support from senior mentors (Blake et al., 2000). Moreover, the age-old problem of sex-based biases and stereotypes favoring men is alive and well, much to the dismay of women trying to navigate through the system (Singer et al., 2006). Women in academia are also experiencing the problem they may have encountered during their physician-scientist training, which is finding and befriending a more senior female faculty mentor to help with understanding how to overcome potential disparity. For all these reasons, women are finding that what they once considered a gaping hole in the glass ceiling of academia may only be a slight crack. What can we do about it?

Rather than construct a simple formulaic solution to “fix” the problem and conceal the crack, perhaps we should consider advocating for gender equality by literally tearing down the entire ceiling. No more cracks, no more holes, no more ceiling. If female and male MD/PhD candidates, MD/PhD graduates, and physician-scientist researchers can get together to unite some of the biggest and brightest minds in the world, I have faith a few approaches will take form. Perhaps department chairs will promote increased transparency in applying institutional policies to ensure that faculty completely understand the criteria by which decisions are made. Perhaps resource distribution will become more equitable at these same institutions. Perhaps great efforts will be gathered to actively work towards establishing an inclusive work environment, rather than facilitating a marginalizing, isolating one. Practically speaking, perhaps institutions will be more sensitive when it comes to issues of childbearing and daycare, with the understanding that this process is not an act of defiance, but a miracle of nature. Finally, perhaps mentoring opportunities for women pursuing academic medicine will be improved across the board, from the stage of physician-scientist training to the stage of securing faculty positions. These are just a few of the potential ways we can intervene to positively impact the education and application of female MD/PhD individuals in our nation. Let’s see what we can do together, clearing a space for Prince (or Princess) Promotion, of course.

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