female_doctor_holding_stethoscope_400_clr_17638 smWe are very excited to present a special installment of the ALiEM Journal Club in collaboration with FeminEM featuring the JAMA article by Jena et al. entitled “Sex Differences in Academic Rank in U.S. Medical Schools in 2014.” 1 Despite correcting for a multitude of metrics such as time since residency completion and research productivity, women remain substantially less likely to attain the rank of full professor at academic centers. To many, this article’s conclusions come as no surprise. This journal club is meant to inspire discussion around gender disparities and brainstorm solutions of equality for all involved in academic medicine.

Untitled Infographic

Background

Looking back through the literature, the gender gap in promotion within academic medicine has been well documented. In fact, a similarly designed study, published in JAMA (1995) drew the same conclusions. 2 These disparities were initially attributed to the broader under-representation of women in the medical field as a whole; it was assumed that as more women steadily entered medicine, the gap would naturally close itself. In many senses, tremendous progress has been made with women now comprising 47% of the matriculants into medical school and 46% of residents. 3  This progress, however, has yet to be reflected when it comes to achieving high academic rank and leadership positions within departments.

As with all the ALiEM journal clubs, we intend to aim a critical eye at the study and its impact, but for this FeminEMs edition, we hope to direct our discussion towards addressing the persistence of gender bias within academic medicine and what we specifically can do to support and advance our colleagues. To that end, we hope you will join us for an online discussion of the impact of this article and the questions featured below from now until Friday 10/22/2015.  Please respond to the discussion questions below in the comments or tweet your response with the hashtag #FeminemJC.

Google Hangout with Dr. Anupam Jena (JAMA paper lead author)

Sit back and watch this 30-minute panel discussion with Dr. Jena (or listen to the audio-only Soundcloud version of the same discussion).

Discussion Panel with Dr. Jena:

  • Kinjal Sethuraman, MD MPH, moderator (@KinjNS)
    Assistant Professor, University of Maryland School of Medicine; Associate Director of Hyperbaric Medicine; R. Adams Cowley Shock Trauma Center
  • Anupam Jena, MD PhD, lead author JAMA paper
    Associate Professor, Department of Health Care Policy
    Harvard Medical School
  • Stephanie Abbuhl, MD
    Professor of Emergency Medicine, Executive Director of FOCUS on Health and Leadership for Women; University of Pennsylvania
  • Dara Kass, MD (@darakass)
    Assistant Professor,Director of Undergraduate Medical Education; New York University School of Medicine; Editor in Chief: FemInEM (www.feminem.org)
  • Alyssa Westring, PhD (@alyssawestring)
    Assistant Professor, Industrial and Organizational Psychology, Driehaus College of Business, DePaul University
[su_spoiler title=”Abstract” style=”fancy” icon=”caret”]

Importance The proportion of women at the rank of full professor in US medical schools has not increased since 1980 and remains below that of men. Whether differences in age, experience, specialty, and research productivity between sexes explain persistent disparities in faculty rank has not been studied.

Objective To analyze sex differences in faculty rank among US academic physicians.

Design, Setting, and Participants We analyzed sex differences in faculty rank using a cross-sectional comprehensive database of US physicians with medical school faculty appointments in 2014 (91 073 physicians; 9.1% of all US physicians), linked to information on physician sex, age, years since residency, specialty, authored publications, National Institutes of Health (NIH) funding, and clinical trial investigation. We estimated sex differences in full professorship, as well as a combined outcome of associate or full professorship, adjusting for these factors in a multilevel (hierarchical) model. We also analyzed how sex differences varied with specialty and whether differences were more prevalent at schools ranked highly in research.

Exposures Physician sex

Main Outcomes and Measures Academic faculty rank

Results In all, there were 30 464 women who were medical faculty vs 60 609 men. Of those, 3623 women (11.9%) vs 17 354 men (28.6%) had full-professor appointments, for an absolute difference of −16.7% (95% CI, −17.3% to −16.2%). Women faculty were younger and disproportionately represented in internal medicine and pediatrics. The mean total number of publications for women was 11.6 vs 24.8 for men, for a difference of −13.2 (95% CI, −13.6 to −12.7); the mean first- or last-author publications for women was 5.9 vs 13.7 for men, for a difference of −7.8 (95% CI, −8.1 to −7.5). Among 9.1% of medical faculty with an NIH grant, 6.8% (2059 of 30 464) were women and 10.3% (6237 of 60 609) were men, for a difference of −3.5% (95% CI, −3.9% to −3.1%). In all, 6.4% of women vs 8.8% of men had a trial registered on ClinicalTrials.gov, for a difference of −2.4% (95% CI, −2.8% to −2.0%). After multivariable adjustment, women were less likely than men to have achieved full-professor status (absolute adjusted difference in proportion, −3.8%; 95% CI, −4.4% to −3.3%). Sex-differences in full professorship were present across all specialties and did not vary according to whether a physician’s medical school was ranked highly in terms of research funding.

Conclusions and Relevance Among physicians with faculty appointments at US medical schools, there were sex differences in academic faculty rank, with women substantially less likely than men to be full professors, after accounting for age, experience, specialty, and measures of research productivity.

[/su_spoiler]

Discussion Questions

  • Q1. What are successful strategies for supporting the promotion and retention of women in medicine? At what level should we be intervening to recruit women into research and leadership tracks? Is there a make or break point when we are most likely to lose women?
  • Q2. Do promotion metrics reflect clinical performance/education/ the “non-quantifiable” contributions or additional responsibilities that women often assume – Do we integrate those extra-clinical responsibilities and make sure they’re taken into account when it comes to productivity measures?
  • Q3. As discussed at the end of the article, the disparity in promotion is often attributed to women preferentially placing themselves in clinician educator tracks. Does the solution lie in getting women into a research track OR in evolving how the clinician educator track is valued at academic institutions or both?
  • Q4. Cultivating mentorship early is frequently offered as a solution these disparities. What formal or informal mentorship programs exist for women in EM and how do you think they are beneficial?

 

Please participate in the journal club by answering either on the ALiEM blog comments below or by Twitter using the hashtag#FeminemJC. Please denote the question you are responding to by starting your reply with Q1, Q2, Q3, or Q4.

1.
Jena A, Khullar D, Ho O, Olenski A, Blumenthal D. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA. 2015;314(11):1149-1158. [PubMed]
2.
AAMC “The State of Women in Academic Medicine: the Pipeline and Pathways to Leadership” 2013-2014.
3.
Tesch B, Wood H, Helwig A, Nattinger A. Promotion of women physicians in academic medicine. Glass ceiling or sticky floor? JAMA. 1995;273(13):1022-1025. [PubMed]
Adria Simon

Adria Simon

Medical student
New York University School of Medicine
Adria Simon

@adria_r_simon

@templeEM Med Ed fellow, fan of rugby, feminism and RPDR, mother of house plants
Adria Simon

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Dara Kass, MD

Dara Kass, MD

Assistant Professor
Ronald O. Perelman Department of Emergency Medicine
NYU School of Medicine
Editor in Chief, www.feminem.org
Dara Kass, MD

@darakass

🚺 She, Her, Wife, Mom 🚻 Doctor, Boss, Ally, Advocate, and Accomplice
Dara Kass, MD

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