|Year : 2017 | Volume
| Issue : 3 | Page : 248-253
Women deans' perceptions of the gender gap in American medical deanships
School of Education, Johns Hopkins University, Baltimore, Maryland, USA
|Date of Web Publication||18-Apr-2018|
Johns Hopkins University, Baltimore, Maryland
Source of Support: None, Conflict of Interest: None
Background: Women account for 16% of deans of American medical schools. To investigate this gender gap, female deans were interviewed about the barriers facing women advancing toward deanships. Methods: The author conducted semi-structured interviews with eight women deans. Interviews were analyzed using provisional coding and sub coding techniques. Results: Four main themes emerged during the interviews: (1) the role of relationships in personal and career development, (2) leadership challenges, (3) barriers between women and leadership advancement, and (4) recommendations for improvement. Recommendations included allocating resources, mentorship, career flexibility, faculty development, updating the criteria for deanships, and restructuring search committees. Discussion: The barriers identified by the deans are similar to those found in previous studies on female faculty and department chairs, suggesting limited improvement in gender equity progress.
Keywords: Academic medicine, deans, female leadership, gender gap, women deans
|How to cite this article:|
Humberstone E. Women deans' perceptions of the gender gap in American medical deanships. Educ Health 2017;30:248-53
| Background|| |
As of 2014, only 21 out of 129 (16%) American medical schools had female deans. While women account for approximately half of incoming medical students in the United States, women's representation in academic medicine decreases as they progress through the faculty hierarchy– phenomena often referred to as a “leaky pipeline.” Past research on women's academic medicine careers suggests that complex interactions between factors such as work-life demands, institutional cultural and policies, lack of mentorship or role models' and overt and subvert discrimination play a significant role in women's advancement in the field.,,, Due to these impediments, fewer women are primed to assume leadership positions later in their careers. However, even when controlling for seniority, publication records and work hours, women are less likely to attain leadership roles.
Female deans may be integral in advancing gender equality in academic medicine for several critical reasons. First, they have gained unique insight of the challenges to female career advancement in the existing systems. Second, deans develop an intimate knowledge of the organizational structure, culture, policies, and implementation practices of the medical hierarchy. Finally, this combination of knowledge, experience, and leadership provides a unique opportunity for female deans to identify critical issues that limit women's advancement in the existing system, instigate change from the top down, and ultimately determine how efforts to encourage greater equality play out at a school.
Yet, little research has explored this topic. With most studies on women in academic medicine focusing on department chairs or lower faculty, and those on executive deanships taking a gender blind approach, an in-depth study on women deanships is needed. With their unique vantage point at the top of their organizations, women deans' perspectives are an important addition to conversations about women's equity in medicine more generally. Pragmatically, equity within medical leadership is paramount to effectively advancing medical organizations' missions. If women are deterred or excluded from advancement, the pool from which to draw the most capable talent is reduced. Organizations with women leaders report improvements in communication, teamwork, networking, faculty support, and expression of values and vision. Women deans report more faculty development programs and female appointments to committee and leadership positions than their male counterparts. Finally, faculty and leader variety provides a broader range of perspectives and may ultimately lead to better decision making at all levels of the institution. As such, the purpose of this study is to evaluate the obstacles and perspectives identified by women deans of American medical schools to shed new light on the path toward greater parity within medical institutions.
| Methods|| |
Participants were identified using the American Association of Medical Colleges (AAMC) lists of women deans at U. S. AAMC member institutions in 2005, 2006, and 2008 (lists available on the AAMC website in 2010).,, Deans were defined as full deans, acting deans, or interim deans (current or retired). Nineteen schools were identified, and of the 19 Deans contacted, eight agreed to participate, giving a 42.1% response rate. This response rate is expected given the notoriously busy schedule of deans; many of those declining the study invitation indicated time was a factor in their decision.
The sample had an average tenure of 5 years. The deans' institutions were AAMC members located in the AAMC Central, Southern, and Western regions, and all schools were public. Seven of the eight women interviewed currently held dean positions while one was retired. Four jointly held the title of dean and another leadership title within their institution. These deans differed from those contacted deans that did not participate in the study in terms of institution type and locations. A majority of nonparticipants came from private schools, and their institutions were based in the Northeastern, Central, and Southern regions. Given the small pool of women deans, I have omitted other demographic information to reduce the risk of deductive disclosure.
Semi-structured phone and in-person interviews were conducted by the author and covered the following topics: (a) participants' demographics, (b) their personal career trajectory, (c) availability of professional development supports (e.g., training opportunities, mentoring, etc.), (d) their perceptions on their leadership skills, (e) perceived barriers impeding career trajectories, and (f) their general perceptions about gender diversity in academic medicine [Appendix 1 A for protocol]. The interview protocol was piloted in two phases. First, written questions were reviewed for clarity by a nonmedical faculty member. Then, questions were pretested with a retired male dean; questions were first asked emulating an interview and then the questions and overall protocol were discussed to improve clarity and content. Interviews averaged 30 min in length and were audio recorded. This study protocol was reviewed and approved by a University Research Ethics Committee.
Interviews were analyzed using provisional coding and subcoding by the author. Provisional coding consists of establishing a list of codes to use during coding before the start of coding. For this study, a list of provisional codes was identified based on the semi-structured interview protocol and a review of the literature; this list was then used during the first round of coding. The excerpts identified during provisional coding were then subcoded. Subcodes are nested codes under a broader code to provide a more fine-grained analysis. For example, the provisional code “Institutional Barriers” was subcoded with: “Advancement Criteria,” “Search Committees,” “Part-time,” and “Culture.” [Table 1] provides the provisional codes and subcodes used in the analysis.
|Table 1: Provisional codes and subcodes used in interview transcript analysis|
Click here to view
| Results|| |
The results reveal that all deans in the sample noted multiple factors affecting women's leadership advancement that fall into three broad categories: (1) relationships, (2) leadership challenges, and (3) barriers. The final category of results includes the recommendations for improvement suggested by the deans, including institutional interventions and personal coping strategies. The results of these four topics are given below.
Lack of role models/mentors
Four deans reported lacking either role models (e.g., examples of women leaders) or mentorship (e.g., having a relationship with a mentor figure) at some point during their career. For example, Dean L explained “because there were no women in leadership positions when we were going through, maybe women did not see it as a possibility.” This early dissuasion may have made women less likely to seek out the opportunities that would have prepared them for deanships today. Further, a lack of role models may demotivate because, as Dean T explains, “the lack of seeing other women do it does not lead to any security that you can actually do it.” Two deans further noted that feeling like an outsider or detached in academic medicine could exacerbate insecurities. A lack in mentorship is also concerning because mentors may facilitate career progression. Three deans noted that a mentor or colleague in some way intervened in their career path (e.g., suggesting they consider leadership in the future, encouraging building business skills through further education like an MBA) to push them toward more senior positions and five deans were asked by someone else to assume a leadership position at some point in their career.
Six deans noted that coordinating family responsibilities with work hinders some women. One dean noted that balancing family obligations might have been a greater challenge for those growing up in the generation currently eligible for deanships. Moreover, institutional policies and/or work cultures may not accommodate those with family obligations. Dean L notes “criteria (and policies) may not be flexible enough,” for some women. In addition, Dean A also remarked on the shortcomings of the current criteria placed on medical faculty, noting specifically pregnancy leave policies, lack of work-based childcare, and rigid tenure clocks schedule as challenges. Five deans noted that women might also be hindered by a hesitancy to relocate families. A dean suggested that unless hiring committees are aware of this reluctance to move, they are less likely to bring forth female candidates and therefore, have reduced chances of hiring a woman.
Heightened attention on women leaders
Two deans expressed that they had higher visibility as a female dean, phenomena often referred to as “surplus visibility”. Dean J explained that women in positions predominantly or historically held by men might feel additional exposure or pressure. She described the challenge as follows:
“When there are so few [women], the light shines hotter and brighter on them. When they make mistakes, they tend to be very public. It makes it harder to succeed in that kind of environment when you're relatively lonely and the light shines hotter and brighter.”
Not envisioning women as leaders
Two deans mentioned experiences where others did not envision them as deans. These career assumptions based on gender also include expectations of women in the medical community. For example, Dean J recounted experiences in both professional and nonprofessional settings where people assumed that either her husband was the physician or that she was a dean of nursing instead of medicine.
Four deans identified covert and overt gender discrimination as limiting factors for women. For three, the discrimination was directly related to the hiring process. To Dean T, “if most of the people hiring you are men, […] they're still apt to look for another man.” Moreover, three deans noted that academic medicine's institutional culture might adversely affect women, with “many women [potentially] find[ing] that culture not accepting and supportive as they need or want” (Dean A). For example, one dean noted that academic medicine has a more “conservative culture” that views “women, especially young women, in a very specific way;” women leaders are “not the norm, and we stick with the norm” (Dean Y). The deans also suggested that unconscious bias and lack of accommodation of work-life balance needs contributed to an institutional culture that may discourage women's advancement. Due to this, Dean J recommended that “you have to constantly work on the institutional culture to make it a level playing field” for all.
Definitions of success
Finally, four deans pointed out that obtaining a leadership position is not every woman's goal. Success has different meanings for each and therefore, many women may elect not to pursue higher leadership roles. Dean I speculated that older women might have been more inclined to seek career advancement in an effort to advance gender equality. She explained:
“Women who are my age who […] fought the good fight and just fought for everything we could get as women thinking we were doing it for the next generation of women, I think the next generation of women, again big generalities, don't really want to be like us. Moreover, they won't do what I did to get here. It's not where they want to be [...] I have to say then that we had to have done it for ourselves because if we tried to do it for someone else it probably failed.”–Dean I.
To reduce women opting out of academic medicine, the deans suggested both institutional changes and personal coping strategies. Personal strategies included: setting up women mentoring groups and looking for leadership positions that can be assumed without relocation. Institutionally, they highlighted altering the tenure track, such as allowing for a more flexible timeline that would better accommodate women who have families. They also suggested updating the criteria for deanships, including prioritizing skills aligned with the job duties instead of research record and having more flexibility in criteria as women with families may not have as many traditional qualifications (e.g., papers, grants). Further suggestions include expanding faculty development resources (e.g., establishing an institutional office or advisor to facilitate aspiring leaders, one-on-one leadership training programs, leadership coaches), and increasing member diversity of search committees. The Deans interviewed did not offer a consensus on what an effective search committee might look like; for example, Dean J spoke of committees chaired by women where others talk in terms of percentage of women in the group. Dean T explained why a token attempt at diversifying a committee does not lead to change in the selection:
“I do think that search committees have to be more diverse and having one or two women on a search committee is usually not enough either because their voices aren't heard. Women on committees tend to not feel that comfortable, I think, unless there's at least three so I think it takes a fair number to actually be an appropriate representation.”–Dean T.
Dean Y offered the example of university presidency searches, which are often more likely to bring forth nontraditional applicants, as evidence of the influence diversity has on selection committee decisions. She explained: 59.
“When you're looking for a University President, usually [it is] the University Board of Regents or Board of Trustees that chooses the President and they are usually a very diverse group. [...] and academic medicine is pretty homogeneous. [...] Maybe it was the diversity of the selection committee for University Presidents that allowed them to be much more open to candidacies for women from a variety of different backgrounds.”–Dean Y.
The deans recommended reevaluating traditional views of leader qualifications because the current standards do not necessarily parse out strong leaders and are more likely to exclude women candidates. Assembling diverse search committees was suggested to mitigate unconscious discrimination and diversify candidate pools. One dean speculated that the more homogenized face of search committees in academic medicine compared to elsewhere in the university, such as Boards of Trustees selecting university presidents, exacerbates inequality in AHCs.
| Discussion|| |
The deans interviewed for this study identified relationship issues, leadership challenges, and general barriers to women's advancement in academic medicine. They also suggested both institutional and personal strategies to increase the likelihood of women assuming leadership roles. Many of the challenges identified in this study could also be said about higher education or industry in general. However, academic medicine provides an interesting case when discussing women's equity issues as women physicians have an alternate, lucrative career path that those elsewhere in academics may not.
The barriers discussed in these interviews were similar to those found by previous studies on female faculty or department chairs in academic medicine. When analyzing gender gaps, findings that show little change are meaningful as similar results suggest stagnation or limited growth in the equity progress. The findings of this work raise a larger and more troubling question: Why is gender inequity so static in academic medicine?
Many of the deans' institutional recommendations have been supported by past research, including: Promoting professional development programs,, facilitating work-life balance  and addressing unconscious bias that may hinder envisioning women as leaders. Further, mentorship has been shown to influence women's career satisfaction and advancement., The five deans who were solicited by others to move into leadership roles stand as testament to the impact that positive mentoring can have on women. It also substantiates claims that open communication about career advancement may facilitate women becoming leaders.
This study's findings and generalizability are limited by the small sample size. It stands to reason that the Deans interviewed may be systematically different from those who declined to participate. Further, women deans may be more likely to emphasize behavioral adjustments instead of institutional revamping, as this may have been their strategy for advancement. As such, it may be argued that the group is biased since it includes only those who sought and obtained these leadership positions; yet, interviews revealed that at least five deans were solicited at some point by others to advance their careers. Nevertheless, subsequent studies could assess the views of women uninterested or unsuccessful in seeking deanships. Future work would also benefit from the inclusion of male deans in the sample.
The author would like to thank Dr. Suzanne Clisby for her helpful suggestions and guidance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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