Increasing the Proportion of Women in Academic Medicine: One Institution's Response

doi:10.4065/74.2.113

Mayo Clinic Proceedings

Volume 74, Issue 2, February 1999, Pages 113-119

https://doi.org/10.4065/74.2.113 Get rights and content

Objective

To increase gender diversity among the physician consulting staff (PCS) at a major medical center.

Design

Because the proportion of female PCS at academic medical centers in the United States has not increased commensurately with increases in the proportion of female graduates from American medical schools, a modeling and graphing technique was developed to analyze this problem and recommend solutions for one large academic medical center.

Material and Methods

Personnel data, by gender and year from 1980 through 1994, were collected for all PCS at Mayo Clinic Rochester (MCR). These data were compared with similar data from other US academic medical centers and were used to develop models to predict the proportion of female PCS at MCR yearly until 2005, assuming various hiring and resignation patterns. Novel techniques were developed to illustrate and compare the models. Model-based predictions were compared with national projections, and a realistic target proportion of female PCS was defined on the basis of assumptions about the proportion of female graduates from medical school and internship programs during the next 10 years as well as probable hiring, retention, and resignation rates at MCR. To identify issues critical to recruitment, retention, and professional growth of female PCS at MCR, we used factor analysis to assess responses to a confidential questionnaire sent to all female faculty members.

Results

In 1994 and 1995, the proportion of female PCS was 25% at US academic medical centers but only 15% at MCR, and the rate at which this proportion increased from 1980 through 1994 at MCR was also lower than the national rate. Model-based predictions demonstrated that gradually (1.5% per year) increasing the female percentage of new recruits from 26% in 1995 to 40% in 2005 would achieve the targeted 25% female PCS in 13 years. Questionnaire responses from 119 (68%) of the 175 female PCS at MCR identified 6 important-recommendations for recruitment and retention of female PCS: survey resignees and candidates who decline positions; appoint more qualified women to policy-making committees; require sensitivity and diversity training for all staff (especially leaders); develop explicit, gender-sensitive criteria for selecting department and division chairs; compare Mayo gender and diversity data with national data at the department or division level; and develop mechanisms for mentoring junior female staff members.

Conclusion

We developed useful methods for analyzing the PCS gender distribution, defined feasible hiring strategies, and identified specific recommendations to enhance the professional experience of female PCS. These methods can provide a model for other institutions seeking to optimize gender diversity among their staff.

Section snippets

Model Development

Data that described the size of the PCS, retirements, resignations, and hiring practices from 1980 through 1994 were collected from personnel records. The numbers of male and female physicians on the staff at MCR at the beginning of each year, together with the numbers of staff resignations, retirements, and new recruitments during each year, were obtained. The following key variables were calculated.

1.
The annual resignation and retirement rates for female PCS were calculated as the number

Gender Distributions of PCS From 1980 Through 1994

Administrative data that reflect the PCS at MCR from 1980 through 1994 are shown in Figure 2, and trends over time are summarized in Table 1, together with P values for associated Armitage trend tests. These data show that from 1980 through 1994 (1) the PCS grew at a mean rate of 2.4% per year, (2) mean resignation rates were 3.6% and 1.7% per year for women and men, respectively, (3) mean retirement rates were 0.8% and 1.8% per year for female and male PCS, respectively, and (4) the proportion

DISCUSSION

Despite intensifying pressures within academic medicine to downsize departments and reduce expenditures, in recent years academic medical centers have demonstrated a growing commitment to gender equity. Several explanations exist for this trend. First, numerous well-designed and meticulously conducted studies have conclusively demonstrated gender bias in academic medicine.1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 Second, medicine as a profession recognizes an ethical duty

CONCLUSION

We have described a systematic, quantitative approach to analyzing the gender distribution of PCS at MCR, comparing these data with national estimates for other academic medical centers, deriving a feasible target relative to the limitations of our setting, defining a hiring strategy to achieve this target, and identifying specific recommendations to enhance the professional experience of female PCS at MCR in order to increase recruitment and improve retention. We hope that this approach will

Acknowledgment

We gratefully acknowledge Deborah J. Fogarty for assistance with preparation of the submitted manuscript.

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Citation Excerpt :
Physician administrators at the Mayo Clinic Rochester, where female physician consulting staff were a full 10% below the national average of 25% in 1994, developed structured goals for female physician recruiting. Administrators used a mathematical model based on hiring and resignation patterns of female physician consulting staff to project the rate of female faculty hiring necessary (an increase in 1.5% per year) to achieve parity with the national average of female physician consulting staff in 13 years.35 The current progress of this initiative is unknown, but exemplifies a rigorous system that could be used to systematically track progress toward a defined recruitment goal.
Why don't female medical students choose diagnostic radiology? A review of the current literature
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While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of specialties including diagnostic radiology. While diagnostic radiology has many characteristics that might be desirable to women, such as reasonable call hours, flexible scheduling, and high salaries, women still do not choose diagnostic radiology as a career. This article examines the literature to discern possible reasons for why women are entering diagnostic radiology at a lower rate. We address trends among women in academic medicine, which resemble trends among women in diagnostic radiology, and examine the effects of gender and socialization in medical school on specialty choices among women. The current literature suggests a constellation of factors may be responsible for the gender differences in diagnostic radiology. We suggest that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school. Once these reasons are made clear, it will be possible for residency program directors and medical schools to ensure that women are making informed specialty choices, whatever those choices may be.
Factors Affecting Academic Promotion in Obstetrics and Gynaecology in Canada
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Objective: (I) To determine if women faculty members in departments of Obstetrics and Gynaecology were less likely than men to achieve promotion; and (2) to assess gender differences in attitudes towards promotion.
Methods: Department chairs at the 16 medical schools in Canada were approached to participate in this study. A questionnaire was mailed to the obstetricians/gynaecologists in faculties of medicine at the 15 Canadian medical schools that agreed to participate. Likelihood of promotion for women and men was compared using survival analysis, controlling for other factors. Survival (event) time was the time in years between completion of residency and achieving promotion.
Results: The response rate was 72% (376/522). Overall, 37% of respondents were women, and 63% were men. The women respondents were younger than the men, with a mean age of 43.4 ± 7.9 years compared to 52.8 ± 8.9 years. Of those in an academic stream, 39% of women (29/75) and 62% of men (90/145) had attained senior academic ranks. Completing residency more recently was associated with a higher likelihood of promotion to Assistant Professor (hazard ratio [HR], 1.05; P <0.001). The likelihood of promotion to Professor was lower for women than for men (HR, 0.40; P = 0.05). Having a mentor was associated with a higher likelihood of promotion to Professor (HR, 2.33; P = 0.002). Women were more likely to perceive barriers to promotion, such as family care responsibilities (P < 0.001).
Conclusion: Independent of the respondent’s gender, recent completion of residency and having a mentor were the most significant factors increasing the likelihood of promotion in Canadian medical school departments of Obstetrics and Gynaecology. As women were found to be less likely than men to achieve promotion to Professor, mentoring and strategies that focus on facilitating promotion for women should be encouraged to ensure there are academic leaders in obstetrics and gynaecology in the future.
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Méthodes : Nous avons sollicité la participation des directeurs de département des 16 facultés de médecine du Canada à la présente étude. Par la suite, un questionnaire a été posté aux obstétriciens-gynécologues des 15 facultés de médecine canadiennes ayant consenti à y participer. Les probabilités d’obtenir une promotion ont été comparées, chez les femmes et les hommes, à l’aide d’une analyse de survie, tout en neutralisant les effets d’autres facteurs. Le délai (en années) entre la fin de la résidence et l’obtention d’une promotion constituait le temps de survie (événement).
Résultats : Le taux de réponse a été de 72 % (376/522). Globalement, 37 % des répondants étaient des femmes et 63 %, des hommes. Les répondantes étaient plus jeunes que les hommes; en effet, leur âge moyen était 43,4 ± 7,9 ans par comparaison avec 52,8 ± 8,9 ans pour les hommes. De l’ensemble des résondents œuvrant au sein d’un volet de formation universitaire, 39 % des femmes (29/75) et 62 % des hommes (90/145) avaient atteint un niveau de cadre supérieur. Le fait d’avoir récemment terminé sa résidence a été associé à une probabilité accrue d’être promu au poste de professeur adjoint (coefficient de risque [CR] : 1,05; P <0,001). Les chances d’être promu au poste de professeur étaient moins élevées chez les femmes que chez les hommes (CR : 0,40; P = 0,05). Le fait de bénéficier d’un mentor a également été associé à une probabilité accrue d’être promu au poste de professeur (CR : 2,33; P = 0,002). Or, il était plus probable que les femmes perçoivent des obstacles à la promotion, telles que les responsabilités liées à la famille (P <0,001).
Conclusion : Sans égard au sexe du répondant, le fait d’avoir récemment terminé sa résidence et celui de béneficier d’un mentor ont été les facteurs les plus significatifs, en matière de multiplication des chances d’obtenir une promotion au sein des facultés canadiennes d’obstétrique-gynécologie. Puisqu’il a été établi que les femmes disposaient de moins de chances d’être promues au poste de professeur que les hommes, il faudrait favoriser, pour celles-ci, le mentorat et des stratégies axées sur l’obtention d’une promotion, et ce, afin d’assurer qu’elles feront partie des futurs chefs de file en obstétrique-gynécologie.
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¹: Current address: Sinzing-Kleinpruefening, Germany.

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Increasing the Proportion of Women in Academic Medicine: One Institution's Response

Objective

Design

Material and Methods

Results

Conclusion

Section snippets

Model Development

Gender Distributions of PCS From 1980 Through 1994

DISCUSSION

CONCLUSION

Acknowledgment

Women in medical education: a status report

N Engl J Med

Division of Institutional Planning and Development, Association of American Medical Colleges. Women in U.S. Academic Medicine: Statistics, 1994

Increasing Women's Leadership in Academic Medicine

Promotion and tenure of women and minorities on medical school faculties

Ann Intern Med

Comparing the status of women and men in academic medicine

Ann intern Med

Tests for linear trends in proportions and frequencies

Biometrics

Gender-associated differences in matriculating and graduating medical students

Acad Med

Promotion of women physicians in academic medicine: glass ceiling or sticky floor?

JAMA

The paradox of critical mass for women in science

Science

Discrimination and abuse experienced by general internists in Canada

J Gen Intern Med

Women as health professionals: contemporary issues

Sexual harassment and gender discrimination: a primer far women physicians

J Am Med Womens Assoc

Women in medicine since Flexner

NY State J Med