Pediatric Annals

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pediatric annals 

Women in Academic Pediatrics

Jane G Schaller, MD

Abstract

In the past two decades, as more women have chosen medicine as a profession, a significant number of women have chosen pediatrics as a specialty and a significant number of women pediatricians have chosen to pursue careers in academic pediatrics.1 The perception of a dramatic increase in the numbers of women in academic pediatric departments has occasioned a number of questions and concerns. How many women are there in academic pediatrics, and will their numbers continue to increase? What roles will women play in academic pediatrics? Will the influx of women into academic pediatrics change the course of or the nature of academic departments? Are women as successful academically as men? What, if anything, needs to be done to preserve the academic standards of our profession?

Some grave reservations have been expressed about the possible deleterious effect of increasing numbers of women in academic pediatrics, based on the perception that women faculty are not as successful in academic pursuits as are men faculty.2 To address these questions and concerns, a study of all women and men in academic pediatric departments in the United States was commissioned by the Association of Medical School Pediatric Department Chairs, Inc. (AMSPDC) in 1992.3 This article addresses these issues and presents a current look at the numbers and status of women in various stages of pediatric training and in academics.

WOMEN IN TRAINING IN ACADEMIC PEDIATRIC DEPARTMENTS

The absolute numbers of women applying to and accepted to U.S. medical schools roughly doubled between 1974 and 1998 (Table I).4 However, the numbers of women have been stable since 1992, and the number of women applying to medical school in the 1997-1998 academic year was actually 1,500 fewer than in 1995-1996. The percentages of men and women applicants who have been accepted to medical school have been similar since at least 1974. Approximately 40% of applicants of both sexes are accepted. It would thus seem that the number of women entering the medical profession has stabilized, with approximately 57% of those entering medical school classes being men and 43% being women.

Table

In attempting to find explanations for these differences and to explain the gender differences in academic achievement as measured by authorship of papers and research grants, academic rank, and salaries, we found the following significant associations. For both men and women, higher salaries and ranks were related to greater academic productivity as measured by publications and grants, to longer working hours, to more institutional support for research, to greater overall career satisfaction, and to fewer perceived career problems. Importantly, it was clear that in this sample, greater academic productivity for both sexes occurred when less time was spent in teaching and patient care. Women, at the beginning of their careers in the junior ranks of instructors and assistant professors, spent significantly more time in teaching and patient care than did the men in these ranks (Figure). Surprisingly none of the personal variables related to family concerns, marriage, or children had any significant correlations with academic success, rank, or salary.

DISCUSSION

It appears from available data concerning women in various stages of training that the numbers of women applying to medical school have leveled off in the past 5 or 6 years, and we are left with entering medical school classes that are currently 57% men and 43% women. Concerning the numbers of women entering pediatrics, the absolute number is up somewhat and the percentages of women residents have been increasing at approximately 2% a year during the past decade.

The women we have been training tend to go into general pediatrics and primary care, and…

In the past two decades, as more women have chosen medicine as a profession, a significant number of women have chosen pediatrics as a specialty and a significant number of women pediatricians have chosen to pursue careers in academic pediatrics.1 The perception of a dramatic increase in the numbers of women in academic pediatric departments has occasioned a number of questions and concerns. How many women are there in academic pediatrics, and will their numbers continue to increase? What roles will women play in academic pediatrics? Will the influx of women into academic pediatrics change the course of or the nature of academic departments? Are women as successful academically as men? What, if anything, needs to be done to preserve the academic standards of our profession?

Some grave reservations have been expressed about the possible deleterious effect of increasing numbers of women in academic pediatrics, based on the perception that women faculty are not as successful in academic pursuits as are men faculty.2 To address these questions and concerns, a study of all women and men in academic pediatric departments in the United States was commissioned by the Association of Medical School Pediatric Department Chairs, Inc. (AMSPDC) in 1992.3 This article addresses these issues and presents a current look at the numbers and status of women in various stages of pediatric training and in academics.

WOMEN IN TRAINING IN ACADEMIC PEDIATRIC DEPARTMENTS

The absolute numbers of women applying to and accepted to U.S. medical schools roughly doubled between 1974 and 1998 (Table I).4 However, the numbers of women have been stable since 1992, and the number of women applying to medical school in the 1997-1998 academic year was actually 1,500 fewer than in 1995-1996. The percentages of men and women applicants who have been accepted to medical school have been similar since at least 1974. Approximately 40% of applicants of both sexes are accepted. It would thus seem that the number of women entering the medical profession has stabilized, with approximately 57% of those entering medical school classes being men and 43% being women.

Table

TABLE 1Acceptance to Medical School for Men and Women Applicants

TABLE 1

Acceptance to Medical School for Men and Women Applicants

Table

TABLE 2Distribution of Women Residents, 1997

TABLE 2

Distribution of Women Residents, 1997

The most recent data available (1997) concerning women residents in medical specialties (Table 2)4 indicated that the largest absolute number of women residents in any one specialty was in internal medicine with a total of 8,038 women residents. This represented 23% of all women residents. In pediatrics, there were 4,846 women residents (13.8% of all women residents). Other specialties with significant numbers of women residents included family practice with 4,719 (13.5% of all women residents), obstetrics and gynecology with 3,055 (8.8% of all women residents), and psychiatry with 2,086 (6.0% of all women residents). Pediatrics, and obstetrics and gynecology, had the highest percentages of women residents within their training programs: 63.7% of pediatric residents were women, and 62.6% of obstetrics and gynecology residents were women. In pediatrics, the percentage of pediatric residents who are women has continued to rise at a rate of approximately 2% per year in the past decade.

Of those taking the pediatric board examinations for the first time in 1998, 60.7% were women and 39.3% were men, according to data from the American Board of Pediatrics (Table 3). There are some interesting differences in the career paths chosen by residents in current pediatric training. Of those taking the board examinations for the first time in 1998 who stated an intention to go into general pediatrics, 64% were women and 36% were men. Combining all of the subspecialties together, 51.7% of subspecialty trainees were women and 48.3% were men. Within the various subspecialties, as measured by those taking subspecialty pediatric board examinations in 1998, there were several notable differences in the distribution of women and men. The subspecialties of cardiology, gastroenterology, nephrology, and pulmonology had a male predominance. The subspecialties of critical care, neonatology, hematology/oncology, and infectious disease had roughly equal numbers of men and women. The subspecialties of adolescent medicine, emergency medicine, endocrinology, and pediatric rheumatology had more women than men. These gender differences in pediatric subspecialties were also found in the study of pediatric faculty commissioned by the AMSPDC.3

Table

TABLE 31998 Pediatric Board Examinations

TABLE 3

1998 Pediatric Board Examinations

WOMEN IN ACADEMIC PEDIATRICS

In 1998, the largest absolute numbers of women faculty in any specialty were in internal medicine (4,866), followed by pediatrics (3,655), psychiatry (2,382), obstetrics and gynecology (1,308), and family practice (940) (Table 4).4 However, pediatrics had the largest percentage of total faculty who are women (40%), followed by obstetrics and gynecology (38%), psychiatry and family practice (34% each), and internal medicine (24%). The most striking increase in women faculty in any one specialty has been in internal medicine; the numbers of women in academic internal medicine have increased by a factor of approximately 7.5 since 1975. Obstetrics and gynecology has had a similar dramatic increase in the numbers of women, whereas the numbers of women in academic pediatrics have increased by a factor of approximately 4 since 1975. According to the 1997 roster of U.S. medical school faculty from the Association of American Medical Colleges, the overall numbers of faculty in academic pediatrics included 5,433 men (60.6% of faculty) and 3,531 women (39.4% of faculty); comparable figures for 1991 included 4,280 men (65% of faculty) and 2,218 women (35% of faculty). There has thus been a small but continuing proportional increase in the number of women serving on pediatric faculties.

Table

TABLE 4Women Faculty by Departments: 1975, 1994, and 1998

TABLE 4

Women Faculty by Departments: 1975, 1994, and 1998

Table

TABLE 5Faculty in Academic Pediatrics*

TABLE 5

Faculty in Academic Pediatrics*

Table

TABLE 6Women Chairs of U.S. Academic Departments, 1996

TABLE 6

Women Chairs of U.S. Academic Departments, 1996

When one looks at the breakdown of faculty rank, there are significant differences between men and women (Table 5).3,4 In 1997, the percentage of women full professors in any one specialty was 18% for pediatrics, 15% for family practice, 13% for psychiatry, 1 1% for obstetrics and gynecology, and 8% for internal medicine (Table 4)-4 Of all women in academic pediatrics in 1997, only 9.7% had reached professorial rank; 29.7% of men in pediatrics were full professors. The corresponding figures also show a preponderance of male faculty at the associate professor level, and increased percentages of women at the assistant professor and instructor levels. The percentages of women who have attained various academic ranks have changed little during the past decade. Indeed, in 1991, 10.7% of women in academic pediatrics were full professors as compared with only 9.7% today. Thus, although the numbers of women on pediatric faculties are increasing, the percentages of women who are attaining higher ranks do not seem to be changing.

Concerning the number of women who have attained leadership roles as measured by the chairmanship of departments, there has also been little change in the numbers of women pediatric chairmen during the past decade, as demonstrated by the 1998 pediatric department roster of the Association of Medical Schools. The overall numbers of women chairs in all academic departments combined, both basic science and clinical science, have not quite doubled in this decade (Table 6).5

Table

TABLE 7Representativeness of Sample to Date (2/18/93)

TABLE 7

Representativeness of Sample to Date (2/18/93)

In an attempt to learn more about the roles and career choices of women in academic pediatrics, the AMSPDC commissioned a study of all pediatric faculty, both men and women, in 1992.3 This study included all regularly salaried faculty in all departments of pediatrics in all medical schools in the United States. Of the 6,441 questionnaires distributed to faculty members, 4,285 (67%) were returned. This survey sought not only basic data about jobs and achievements, but also data concerning feelings and attitudes about professional lives.

The sample of the study was representative of the whole of academic pediatrics as reflected in similar comparisons with Association of American Medical Colleges data (Table 7 ).3 Of the respondents, 92.7% had full-time positions; the relatively few part-time faculty responding may reflect the selection of the study to include only faculty who received regular salary sources. The breakdowns of academic ranks and gender distributions were also statistically comparable with those of Association of American Medical Colleges data. There was a preponderance of men in subspecialty groups, with relatively more women in academic general pediatrics (Table 8). This is similar to the differences that are still present in the current data presented above.

This study was designed to explore whether differences existed between genders in academic achievement and productivity, rank, and salary, and whether any such differences could be explained by gender differences in personal attributes such as age and subspecialty, institutional structural variables, personal structural variables, attitudinal variables, values and aspirations, and quality of life variables. Because the study involved both men and women faculty, there was ample opportunity to discover gender differences.

Table

TABLE 8Gender Differences by Subspecialty Groups (N = 4,230)

TABLE 8

Gender Differences by Subspecialty Groups (N = 4,230)

Women faculty reported working 3.9 fewer hours per week than men faculty (60.5 weekly hours for women as compared with 64-4 weekly hours for men). Concerning academic productivity, women faculty wrote fewer papers and had fewer research grants than men faculty. There were significant differences in salaries, with men faculty being paid substantially more than women faculty at all academic ranks.

According to their self-reporting, women seemed to aspire to fewer high-level jobs, such as deanships, department chairs, and division chiefs, than did men. There were differences in gratification reported from career activities. More women than men reported that patient care was extremely or very rewarding to them, more men than women reported that research and administration were extremely or very rewarding to them, and equal numbers reported that teaching was an extremely or a very rewarding activity.

There were interesting gender differences in perceptions of activities or situations that caused career delays. Of the women, 56.8% felt that gender discrimination had delayed their career progress, as compared with only 3.2% of men with the same perception. Sixty percent of the women felt that child rearing had delayed their careers, and 38% felt that spouses' careers had been a cause of delay; the corresponding figures for men were 36% and 20%, respectively. On the other hand, significantly more men felt that financial problems had delayed their careers. Of the women, 56.3% reported feeling distressed by delayed progress of their careers, as compared with only 38.8% of the men. Women faculty reported a number of career-related problems more often than male faculty, including isolation from colleagues, professional stress, competitiveness, limited professional autonomy, work versus personal conflicts, lack of support staff, lack of physical resources, and lack of salary support.

Overall, 70% of men and 62% of women reported being satisfied with their career lives. However, more men than women felt that career achievements came easily and that they were happy with all aspects of their career lives. More women than men reported that at times they wanted to leave academic pediatrics. A high percentage of both women and men reported being proud of their career accomplishments and pleased with their professional performances, although there was a male predominance in these responses. More women than men commented that success requires mentoring, and 20% of women as compared with 14% of men reported feeling demoralized about their careers. Twenty percent to 25% of women ranked their status, collegiality, nonmonetary rewards, and humane treatment as only fair or poor; corresponding figures for men were approximately 15%. On die other hand, only 20% of women and 17% of men reported that they had little enjoyment in their pediatric careers.

Figure. Distribution of work time among 3,999 entry-level faculty members (instructors and assistant professors) in pediatrics. Reprinted with permission from Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement: results of a national study of pediatricians. N Engl J Med. 1996;335:1285. Copyright © 1996 Massachusetts Medical Society. All rights reserved.

Figure. Distribution of work time among 3,999 entry-level faculty members (instructors and assistant professors) in pediatrics. Reprinted with permission from Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement: results of a national study of pediatricians. N Engl J Med. 1996;335:1285. Copyright © 1996 Massachusetts Medical Society. All rights reserved.

In attempting to find explanations for these differences and to explain the gender differences in academic achievement as measured by authorship of papers and research grants, academic rank, and salaries, we found the following significant associations. For both men and women, higher salaries and ranks were related to greater academic productivity as measured by publications and grants, to longer working hours, to more institutional support for research, to greater overall career satisfaction, and to fewer perceived career problems. Importantly, it was clear that in this sample, greater academic productivity for both sexes occurred when less time was spent in teaching and patient care. Women, at the beginning of their careers in the junior ranks of instructors and assistant professors, spent significantly more time in teaching and patient care than did the men in these ranks (Figure). Surprisingly none of the personal variables related to family concerns, marriage, or children had any significant correlations with academic success, rank, or salary.

DISCUSSION

It appears from available data concerning women in various stages of training that the numbers of women applying to medical school have leveled off in the past 5 or 6 years, and we are left with entering medical school classes that are currently 57% men and 43% women. Concerning the numbers of women entering pediatrics, the absolute number is up somewhat and the percentages of women residents have been increasing at approximately 2% a year during the past decade.

The women we have been training tend to go into general pediatrics and primary care, and certain subspecialties such as adolescent medicine, emergency medicine, and pediatric rheumatology. The hightechnology subspecialties such as pediatric cardiology remain predominantly male, although some fields such as neonatology now seem to attract roughly equal numbers of men and women. We do not yet understand these differences in gender distribution of subspecialties. It is of interest that the other medical specialty that is attracting more than 60% of women residents is obstetrics and gynecology. It does not seem hard to understand that specialties that deal with women, children, and families might attract more women professionals to their folds. However, it must be noted that pediatrics is a good field for both women and men, and it seems unlikely that the field will be entirely dominated by women trainees in the future, particularly with the recent emphasis on primary care subspecialties occasioned by changes in the health care system.

A significant number of women choose careers in academic pediatrics and these numbers have continued to increase slowly during the past decade. In 1997, 40% of pediatric faculties were women. There seem to be differences in the academic productivity of women faculty as measured by the traditional markers of publications and research grants. However, the AMSPDC study3 offers some clues as to how these differences should be addressed if, indeed, we wish to have academically productive women faculty in the future. If women are to succeed in the traditional academic achievements of research and publication, we should look at their job descriptions and try to achieve equity in the amount of time junior faculty are expected to spend in activities such as teaching and patient care. More time allotted for research and scholarly activity and more institutional support for research may hasten academic achievement for women. It is of great interest that there was little evidence that family concerns, marital status, or numbers of children had any reflection on academic success or productivity for women in academic pediatrics. Similar findings have been recorded in studies of women in other professional scientific fields.6

We might also consider the values we place on the traditional academic tasks of teaching and patient care that fall disproportionately to women faculty. Perhaps these tasks should also be considered worthy components of academic success, and should be more rewarded in considerations of rank and salary.

Finally, although one might suspect that some of the salary inequity found in the AMSPDC study3 would be explained by higher numbers of men in highly paid subspecialties such as pediatric cardiology or by the slightly longer working hours of men, women's salary inequity could not be ablated by correction for all of the variables considered. It appears that salary inequity in academic pediatrics is widespread and should be rectified.

REFERENCES

1. Schaller JG. Women and the future of academic pediatrics. J Pediatr. 1991;! 18: 314-321.

2. Abelson HT, Bowden RA. Women and the future of academic pediatrics. J Pediatr. 1990;116:829-833.

3. Kaplan SH. Sullivan LM. Dukes KA, Phillips CF. Kelch RP. Schaller JG. Sex differences in academic advancement: results of a national study of pediatricians. N Engl J Med. 1996;335:1282-1289.

4. Bickel J, Kroft K, Marshall R. Women in US Academic Medicine: Statistics 1998. Washington, DC: Division of Institutional Planning and Development, Association of American Medical Colleges; 1998.

5. Bickel J. Kroft K, Marshall R. Women in US Academic Medicine: Statistics 1996. Washington, DC: Division of Institutional Planning and Development, Association of American Medical Colleges; 1996.

6. CbIeJ, Zuckerman H. Marriage, motherhood, and research performance in science. Sci Am. 1987;256:119-125.

TABLE 1

Acceptance to Medical School for Men and Women Applicants

TABLE 2

Distribution of Women Residents, 1997

TABLE 3

1998 Pediatric Board Examinations

TABLE 4

Women Faculty by Departments: 1975, 1994, and 1998

TABLE 5

Faculty in Academic Pediatrics*

TABLE 6

Women Chairs of U.S. Academic Departments, 1996

TABLE 7

Representativeness of Sample to Date (2/18/93)

TABLE 8

Gender Differences by Subspecialty Groups (N = 4,230)

10.3928/0090-4481-19990301-12

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