December 18, 2020
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Policy changes could help address persistent sex disparities in academic promotions

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In 2019, the number of women enrolled in U.S. medical schools surpassed that of men, according to the American Association of Medical Colleges.

Although this indicates substantial progress for women in medicine, other studies suggest there is work to be done.

Reshma Jagsi, MD, DPhil

According to a landmark longitudinal study conducted in 2000 by Nonnemaker and colleagues, women who graduated from U.S. medical schools between 1979 and 1993 had a lower likelihood than their male counterparts of being promoted to upper faculty positions at academic medical centers. A 2020 study conducted by researchers at University of Kansas Medical Center revisited this topic, evaluating 559,098 graduates of 134 medical schools over a 35-year period. Results showed that during that period, women physicians at academic medical centers had a lower likelihood than their male counterparts of being promoted to associate or full professor or being named department chair. This disparity did not decrease over time.

“Sadly, these findings suggest that until we address deeper challenges like unconscious biases, overt discrimination and harassment, and the gendered expectations of society with respect to the division of domestic labor, we will not have equitable access to senior positions in academic medicine,” Reshma Jagsi, MD, DPhil, Newman family professor and deputy chair of the department of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at University of Michigan, said in an interview with Healio. “Our field will then fail to benefit from the full talent pool available to help us pursue our worthy mission.”

Lack of progress

Jagsi pointed out that the landmark study published in 2000 was conducted at a time when men outnumbered women in the medical school student population.

“Women now constitute half the medical student body in the United States,” she said. “Many people assume that although women currently hold only a minority of senior positions in academic medicine, that will eventually work itself out as more recent classes of medical students reach the point of taking on these positions, leading to the eventual diversification of the top levels.”

Despite these hopes for change, the 2020 study did not show a reduction in sex disparities over time, with later cohorts demonstrating as much of a disparity in academic promotions and appointments as earlier ones — and an even larger gap in promotions to full professor.

Jagsi said many factors could have contributed to this finding. She noted that the roles men are conditioned to prefer in their careers may more frequently lead to promotion.

“It may be that men, who have been socialized to demonstrate agentic behaviors, are more likely to pursue scholarly discovery,” she said. “If that focus is more likely to lead to promotions than contributions to clinical service or teaching, and women are more likely to focus on the latter pursuits, these ‘choices’ might help to explain some of the differences.”

Jagsi said that although these choices might seem simply like individual preferences, they exist within the constraints of a gender-structured society.

“Even if this were the sole explanation for the findings, there would still be implications for policy changes that would help promote equity and diversity in more senior positions in the field,” she said. “But other work, including work by my own group, suggests that even men and women with similarly high aptitude and motivation to pursue scholarly research in academic medicine do not succeed at similar rates.”

Closing the gap

Jagsi said it is important to confront these disparities, particularly at the policy level. She said in February, the National Academies of Sciences, Engineering and Medicine released a report on strategies to address these challenges.

“There is ample evidence from decades of social scientific research that helps to identify mechanisms that must be targeted,” she said, “Institutions must be proactive in embracing programs and policies that address those mechanisms. For example, institutions should ensure training of all organizational members to address their own implicit biases and to understand that implicit bias is something we are all vulnerable to having, no matter how good our intentions are.”

She said candidates should be considered for leadership positions using standardized, deliberate processes that are structured to avoid bias.

“Institutions should develop a culture of civility and respect within which harassment is not tolerated,” she said. “Creative approaches to work-life integration, starting with provisions for parental leave during medical training all the way to on-site child care at medical conferences, can also be essential to allow equitable access to opportunities.”

For more information:

Reshma Jagsi, MD, DPhil, is a member of the Peer Perspective Board of Healio’s Women in Oncology. She can be reached at rjagsi@med.umich.edu.

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