Gender dynamics in education and practice of gastroenterology.

BACKGROUND AND AIMS: With an increasing number of women joining procedural fields, including gastroenterology, optimizing the work environment for learning, teaching, and clinical practice is essential to the well-being of both physicians and their patients. We queried female and male gastroenterologists on their beliefs toward the endoscopy suite environment, as well as their experiences in learning and teaching endoscopic skills. METHODS: We distributed a web-based survey to 403 gastroenterology fellows and practicing gastroenterologists at 12 academic institutions and 3 large private practices. We used univariate and multivariate analysis to compare the responses of female and male gastroenterologists. RESULTS: The overall response rate was 32% (n = 130); 54 women and 61 men completed the survey in its entirety and were included in the analysis (15 respondents did not meet the inclusion criteria). Baseline demographics were comparable between the groups. Overall, fewer women than men were trained using tactile instruction (41% vs 67%; P = .004). Of those trained using tactile instruction, 60.3%, with no gender differences, felt it was also important for endoscopic learning. More women reported experiencing gender bias toward themselves during training (57.4% vs 13.1%; P = .001) as well as in their current careers (50.0% vs 9.8%; P = .001). When queried on treatment of gastroenterologists by endoscopy staff, 75.9% of women reported that men were treated more favorably, whereas 70.5% of men felt that both male and female gastroenterologists were treated equally. CONCLUSIONS: Inequities exist with regard to the experience of men and women in gastroenterology, and specific challenges for women may have an impact on their career choices and ability to safely and effectively learn, teach, and practice endoscopy.

A Summary Report from the Research Partnership on Women in Science Careers.

BACKGROUND: In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Following completion of the 4-year grants, the grant PIs formed a grassroots collaborative, the Research Partnership on Women in Science Careers. OBJECTIVE: To summarize the work of the Research Partnership, which resulted in over 100 publications. METHODS: We developed six themes to organize the publications, with a "Best Practices" for each theme at the end of each section: Barriers to Career Advancement; Mentoring, Coaching, and Sponsorship; Career Flexibility and Work-Life Balance; Pathways to Leadership; Compensation Equity; and Advocating for Change and Stakeholder Engagement. RESULTS: Women still contend with sexual harassment, stereotype threat, a disproportionate burden of family responsibilities, a lack of parity in compensation and resource allocation, and implicit bias. Strategies to address these barriers using the Bronfenbrenner ecological model at the individual, interpersonal, institutional, academic community, and policy levels include effective mentoring and coaching, having a strong publication record, addressing prescriptive gender norms, positive counter-stereotype imaging, career development training, networking, and external career programs such as the AAMC Early and Mid-Career Programs and Executive Leadership in Academic Medicine (ELAM). CONCLUSIONS: Cultural transformation is needed to address the barriers to career advancement for women. Implementing the best practices noted of the work of the Research Partnership can help to achieve this goal.

Challenges in Recruiting, Retaining and Promoting Racially and Ethnically Diverse Faculty.

BACKGROUND: Despite individual and institutional awareness of the inequity in retention, promotion and leadership of racially and ethnically underrepresented minority faculty in academic medicine, the number of such faculty remains unacceptably low. The authors explored challenges to the recruitment, retention and promotion of underrepresented faculty among a sample of leaders at academic medical centers. METHODS: Semi-structured interviews were conducted from 2011 to 2012 with 44 senior faculty leaders, predominantly members of the Group on Diversity and Inclusion (GDI) and/or the Group on Women in Medical Sciences (GWIMS), at the 24 randomly selected medical schools of the National Faculty Survey of 1995. All institutions were in the continental United States and balanced across public/private status and geographic region. Interviews were audio-taped, transcribed, and organized into content areas before conducting inductive thematic analysis. Themes expressed by multiple informants were studied for patterns of association. RESULTS: The climate for underrepresented minority faculty was described as neutral to positive. Three consistent themes were identified regarding the challenges to recruitment, retention and promotion of underrepresented faculty: 1) the continued lack of a critical mass of minority faculty; 2) the need for coordinated programmatic efforts and resources necessary to address retention and promotion; and 3) the need for a senior leader champion. CONCLUSION: Despite a generally positive climate, the lack of a critical mass remains a barrier to recruitment of racially and ethnically underrepresented faculty in medicine. Programs and resources committed to retention and promotion of minority faculty and institutional leadership are critical to building a diverse faculty.

Lower Rates of Promotion of Generalists in Academic Medicine: A Follow-up to the National Faculty Survey.

BACKGROUND: Prior cross-sectional research has found that generalists have lower rates of academic advancement than specialists and basic science faculty. OBJECTIVE: Our objective was to examine generalists relative to other medical faculty in advancement and academic productivity. DESIGN: In 2012, we conducted a follow-up survey (n = 607) of 1214 participants in the 1995 National Faculty Survey cohort and supplemented survey responses with publicly available data. PARTICIPANTS: Participants were randomly selected faculty from 24 US medical schools, oversampling for generalists, underrepresented minorities, and senior women. MAIN MEASURES: The primary outcomes were (1) promotion to full professor and (2) productivity, as indicated by mean number of peer-reviewed publications, and federal grant support in the prior 2 years. When comparing generalists with medical specialists, surgical specialists, and basic scientists on these outcomes, we adjusted for gender, race/ethnicity, effort distribution, parental and marital status, retention in academic career, and years in academia. When modeling promotion to full professor, we also adjusted for publications. KEY RESULTS: In the intervening 17 years, generalists were least likely to have become full professors (53%) compared with medical specialists (67%), surgeons (66%), and basic scientists (78%, p < 0.0001). Generalists had a lower number of publications (mean = 44) than other faculty [medical specialists (56), surgeons (57), and basic scientists (83), p < 0.0001]. In the prior 2 years, generalists were as likely to receive federal grant funding (26%) as medical (21%) and surgical specialists (21%), but less likely than basic scientists (51%, p < 0.0001). In multivariable analyses, generalists were less likely to be promoted to full professor; however, there were no differences in promotion between groups when including publications as a covariate. CONCLUSIONS: Between 1995 and 2012, generalists were less likely to be promoted than other academic faculty; this difference in advancement appears to be related to their lower rate of publication.

Race, disadvantage and faculty experiences in academic medicine.

BACKGROUND: Despite compelling reasons to draw on the contributions of under-represented minority (URM) faculty members, US medical schools lack these faculty, particularly in leadership and senior roles. OBJECTIVE: The study's purpose was to document URM faculty perceptions and experience of the culture of academic medicine in the US and to raise awareness of obstacles to achieving the goal of having people of color in positions of leadership in academic medicine. DESIGN: The authors conducted a qualitative interview study in 2006-2007 of faculty in five US medical schools chosen for their diverse regional and organizational attributes. PARTICIPANTS: Using purposeful sampling of medical faculty, 96 faculty were interviewed from four different career stages (early, plateaued, leaders and left academic medicine) and diverse specialties with an oversampling of URM faculty. APPROACH: We identified patterns and themes emergent in the coded data. Analysis was inductive and data driven. RESULTS: Predominant themes underscored during analyses regarding the experience of URM faculty were: difficulty of cross-cultural relationships; isolation and feeling invisible; lack of mentoring, role models and social capital; disrespect, overt and covert bias/discrimination; different performance expectations related to race/ethnicity; devaluing of research on community health care and health disparities; the unfair burden of being identified with affirmative action and responsibility for diversity efforts; leadership's role in diversity goals; and financial hardship. CONCLUSIONS: Achieving an inclusive culture for diverse medical school faculty would help meet the mission of academic medicine to train a physician and research workforce that meets the disparate needs of our multicultural society. Medical school leaders need to value the inclusion of URM faculty. Failure to fully engage the skills and insights of URM faculty impairs our ability to provide the best science, education or medical care.

Effects of sexual harassment on advancement of women in academic medicine: A multi-institutional longitudinal study.

BACKGROUND: Sexual harassment of women in academic medicine may impede advancement and productivity. This study analyzes the longitudinal effects of sexual harassment on academic advancement and productivity among women. METHODS: We undertook a longitudinal analysis to predict effects of sexual harassment reported in 1995 on career outcomes measured in 2012-13, among a sample of women in academic medicine (N = 1273) recruited from 24 U.S. medical schools. Measures included survey data from 1995 on sexual harassment (predictor), and 2012-2013 data on retention in academic medicine, rank, leadership positions, and refereed publications (outcomes), captured from surveys and public records. We used multivariable models to test effects of sexual harassment on study outcomes, adjusting for socio-demographics, employment-related variables, and gender discrimination. FINDINGS: In 1995, 54% of women reported any workplace sexual harassment, and 32% of women reported severe harassment (e.g., threats or coercive sexual advances) in the workplace. Multivariable regression models showed no significant effects of sexual harassment. However, severe sexual harassment was associated with higher odds of attaining full professorship by 2012-2013 (AOR: 1·70; 95% CI 1·03, 2·80; p = 0·04). INTERPRETATION: Contrary to our hypothesis, women reporting severe workplace harassment in 1995 were more rather than less likely to advance to full professor. Women seeking advancement may be more vulnerable to sexual harassment in academic medicine vis a vis greater exposure to those who abuse their position of authority. FUNDING: NIvH R01GM088470; Doris Duke Foundation 2016D007145; BMGF OPP1163682.

Evaluating the Role of Self-Esteem on Differential Career Outcomes by Gender in Academic Medicine.

PURPOSE: Gender differences in faculty advancement persist in academic medicine. Understanding of what drives these differences remains limited. The relationship among self-esteem, gender, and career outcomes has not previously been explored. METHOD: The authors evaluated the association between gender and 2012-2013 career outcomes, specifically, the number of publications, academic rank, leadership positions, and retention, and whether self-esteem as measured in the 1995 National Faculty Survey mediates this relationship. They measured self-esteem using the modified Rosenberg Self-Esteem Scale. The authors used multivariable logistic regression analysis to understand the association among gender, self-esteem, and the outcomes of rank, leadership, and retention, and negative binomial models for number of publications. Models were adjusted for race, specialty, effort distribution, and years since first faculty appointment. The authors performed a mediation analysis to understand whether self-esteem mediates the relationship between gender and these career outcomes. RESULTS: Overall, self-esteem scores were high. Women had lower self-esteem in 1995 than their male colleagues. In adjusted models, female gender was associated with lower performance on all 4 career outcome metrics. While self-esteem scores were positively associated with all 4 outcomes, the authors' mediation analysis suggested that self-esteem did not mediate the relationship between gender and these 4 career metrics. CONCLUSIONS: Female medical faculty members lag behind men on traditional metrics of faculty achievement. While higher self-esteem is positively associated with faculty achievement, it did not mediate the relationship between gender and career advancement over the 17 years of follow-up and, thus, may not be an ideal target for programs and policies to increase gender parity in academic medicine.

The culture of academic medicine: faculty perceptions of the lack of alignment between individual and institutional values.

BACKGROUND: Energized, talented faculty are essential to achieving the missions of academic medical centers (AMCs) in education, research and health care. The alignment of individuals' values with workplace experiences are linked to meaningfulness of work and productivity. OBJECTIVE: To determine faculty values and their alignment with institutional values. DESIGN: A qualitative hypothesis-generating interview study to understand the professional experiences of faculty and organizational approach in five AMCs that were nationally representative in regional and organizational characteristics. Analysis was inductive and data driven. PARTICIPANTS: Using stratified, purposeful sampling, we interviewed 96 male and female faculty at different career stages (early career, plateaued, senior faculty and those who had left academic medicine) and diverse specialties (generalists, medical and surgical subspecialists, and research scientists). APPROACH: Dominant themes that emerged from the data. RESULTS: Faculty described values relating to excellence in clinical care, community service (including care for the underserved and disadvantaged), teaching, intellectual rigor/freedom and discovery, all values that mirror the stated missions of AMCs. However, many faculty also described behaviors that led them to conclude that their AMCs, in practice, undervalued excellence in clinical care, and their social and educational missions. Themes were seen across gender, career stage, race and discipline, except that female leaders appeared more likely than male leaders to identify incongruence of individual values and organizational practices. CONCLUSIONS: In this study of five diverse medical schools, faculty values were well aligned with stated institutional missions; however, many perceived that institutional behaviors were not always aligned with individual faculty values.

Gender Differences in Academic Medicine: Retention, Rank, and Leadership Comparisons From the National Faculty Survey.

PURPOSE: Prior studies have found that women in academic medicine do not advance or remain in their careers in parity with men. The authors examined a cohort of faculty from the 1995 National Faculty Survey to identify predictors of advancement, retention, and leadership for women faculty. METHOD: The authors followed 1,273 faculty at 24 medical schools in the continental United States for 17 years to identify predictors of advancement, retention, and leadership for women faculty. Schools were balanced for public or private status and the four Association of American Medical Colleges geographic regions. The authors used regression models to adjust for covariates: seniority, department, academic setting, and race/ethnicity. RESULTS: After adjusting for significant covariates, women were less likely than men to achieve the rank of professor (OR = 0.57; 95% CI, 0.43-0.78) or to remain in academic careers (OR = 0.68; 95% CI, 0.49-0.94). When number of refereed publications was added to the model, differences by gender in retention and attainment of senior rank were no longer significant. Male faculty were more likely to hold senior leadership positions after adjusting for publications (OR = 0.49; 95% CI, 0.35-0.69). CONCLUSIONS: Gender disparities in rank, retention, and leadership remain across the career trajectories of the faculty cohort in this study. Women were less likely to attain senior-level positions than men, even after adjusting for publication-related productivity. Institutions must examine the climate for women to ensure their academic capital is fully utilized and equal opportunity exists for leadership.

Race/Ethnicity and Success in Academic Medicine: Findings From a Longitudinal Multi-Institutional Study.

PURPOSE: To understand differences in productivity, advancement, retention, satisfaction, and compensation comparing underrepresented medical (URM) faculty with other faculty at multiple institutions. METHOD: A 17-year follow-up was conducted of the National Faculty Survey, a random sample from 24 U.S. medical schools, oversampled for URM faculty. The authors examined academic productivity, advancement, retention, satisfaction, and compensation, comparing white, URM, and non-URM faculty. Retention, productivity, and advancement data were obtained from public sources for nonrespondents. Covariates included gender, specialty, time distribution, and years in academia. Negative binomial regression was used for count data, logistic regression for binary outcomes, and linear regression for continuous outcomes. RESULTS: In productivity analyses, advancement, and retention, 1,270 participants were included; 604 participants responded to the compensation and satisfaction survey. Response rates were lower for African American (26%) and Hispanic faculty (39%) than white faculty (52%, P < .0001). URM faculty had lower rates of peer-reviewed publications (relative number 0.64; 95% CI: 0.51, 0.79), promotion to professor (OR = 0.53; CI: 0.30, 0.93), and retention in academic medicine (OR = 0.49; CI: 0.32, 0.75). No differences were identified in federal grant acquisition, senior leadership roles, career satisfaction, or compensation between URM and white faculty. CONCLUSIONS: URM and white faculty had similar career satisfaction, grant support, leadership, and compensation; URM faculty had fewer publications and were less likely to be promoted and retained in academic careers. Successful retention of URM faculty requires comprehensive institutional commitment to changing the academic climate and deliberative programming to support productivity and advancement.

Negotiation in academic medicine: a necessary career skill.

AIMS: Negotiation and its use in academic medicine have not been studied. Little is known about faculty experience with negotiation or its potential benefits for academe. Barriers to negotiation and how they can be addressed, especially for faculty without perceived skill in negotiation, are unknown. METHODS: To better understand the problems that such faculty experience, we completed in-depth, individual telephone interviews of 20 academic medical faculty at 11 of the 24 medical schools in the National Faculty Survey, all of whom perceived difficulty in negotiation. Faculty were stratified by rank, gender, and degree. Semistructured interviews were audiotaped, transcribed, and analyzed by five reviewers. We explored the role of negotiation in academe, barriers to negotiation, what faculty and institutions can do to improve the use of negotiation, and possible differences in negotiation by gender. RESULTS: Faculty were relatively unaware of the possible uses of negotiation to advance their work in academe. Women tended to see negotiation as less important to an academic career than did their male colleagues. The perceived hierarchy and secrecy of many academic medical centers was believed to create a difficult environment for negotiation. For effective negotiation to occur, faculty stated the need to prepare, gather information, especially on compensation and resources, and to know their priorities. Preparation was particularly important for women, correlating with greater comfort with the degree of aggressiveness in the negotiation and greater self-confidence after the negotiation. These informants suggested that institutions need to provide more transparent information on salary and promotion guidelines. Further, institutions need to empower faculty with a solid understanding of institutional policy, goals, and resource needs of academic life. CONCLUSIONS: Many medical faculty are insufficiently aware of, or skilled in, the negotiation process and find significant barriers to negotiate in academe. Medical centers need to improve the climate for negotiation in academic medicine to maximize the potential contributions of negotiation to the institution.

Recruitment, Promotion, and Retention of Women in Academic Medicine: How Institutions Are Addressing Gender Disparities.

OBJECTIVE: Greater numbers of women in medicine have not resulted in more women achieving senior positions. Programs supporting the recruitment, promotion, and retention of women in academic medicine could help to achieve greater advancement of more women to leadership positions. Qualitative research was conducted to understand such programs at 23 institutions and, using the social ecological model, examine how they operate at the individual, interpersonal, institutional, academic community, and policy levels. METHODS: Telephone interviews were conducted with faculty representatives (n = 44) of the Group on Women in Medicine and Science, Diversity and Inclusion, or senior leaders with knowledge on gender climate in 24 medical schools. Four trained interviewers conducted semistructured interviews that addressed faculty perceptions of gender equity and advancement, which were audiotaped and transcribed. The data were categorized into three content areas-recruitment, promotion, and retention-and coded a priori for each area based on their social ecological level of operation. FINDINGS: Participants from nearly 40% of the institutions reported no special programs for recruiting, promoting, or retaining women, largely describing such programming as unnecessary. Existing programs primarily targeted the individual and interpersonal levels simultaneously, via training, mentoring, and networking, or the institutional level, via search committee trainings, child and elder care, and spousal hiring programs. Lesser effort at the academic community and policy levels were described. CONCLUSIONS: Our findings demonstrate that many U.S. medical schools have no programs supporting gender equity among medical faculty. Existing programs primarily target the individual or interpersonal level of the social ecological interaction. The academic community and broader policy environment require greater focus as levels with little attention to advancing women's careers. Universal multilevel efforts are needed to more effectively advance the careers of medical women faculty and support gender equity.

An Integrated Framework for Gender Equity in Academic Medicine.

In 2008, the National Institutes of Health funded 14 R01 grants to study causal factors that promote and support women's biomedical careers. The Research Partnership on Women in Biomedical Careers, a multi-institutional collaboration of the investigators, is one product of this initiative.A comprehensive framework is needed to address change at many levels-department, institution, academic community, and beyond-and enable gender equity in the development of successful biomedical careers. The authors suggest four distinct but interrelated aspects of culture conducive to gender equity: equal access to resources and opportunities, minimizing unconscious gender bias, enhancing work-life balance, and leadership engagement. They review the collection of eight articles in this issue, which each address one or more of the four dimensions of culture. The articles suggest that improving mentor-mentee fit, coaching grant reviewers on unconscious bias, and providing equal compensation and adequate resources for career development will contribute positively to gender equity in academic medicine.Academic medicine must adopt an integrated perspective on culture for women and acknowledge the multiple facets essential to gender equity. To effect change, culture must be addressed both within and beyond academic health centers (AHCs). Leaders within AHCs must examine their institutions' processes, resources, and assessment for fairness and transparency; mobilize personnel and financial resources to implement evidence-based initiatives; and assign accountability for providing transparent progress assessments. Beyond AHCs, organizations must examine their operations and implement change to ensure parity of funding, research, and leadership opportunities as well as transparency of assessment and accreditation.

Longitudinal Analysis of Gender Differences in Academic Productivity Among Medical Faculty Across 24 Medical Schools in the United States.

PURPOSE: To examine gender differences in academic productivity, as indicated by publications and federal grant funding acquisition, among a longitudinal cohort of medical faculty from 24 U.S. medical schools, 1995 to 2012-2013. METHOD: Data for this research were taken from the National Faculty Survey involving a survey with medical faculty recruited from medical schools in 1995, and followed up in 2012-2013. Data included surveys and publication and grant funding databases. Outcomes were number of publications, h-index, and principal investigator on a federal grant in the prior two years. Gender differences were assessed using negative binomial regression models for publication and h-index outcomes, and logistic regression for the grant funding outcome; analyses adjusted for race/ethnicity, rank, specialty area, and years since first academic appointment. RESULTS: Data were available for 1,244 of the 1,275 (98%) subjects eligible for the follow-up study. Men were significantly more likely than women to be married/partnered, have children, and hold the rank of professor (P < .0001). Adjusted regression models documented that women had a lower rate of publication (relative number = 0.71; 95% CI = 0.63, 0.81; P < .0001) and h-index (relative number = 0.81; 95% CI = 0.73, 0.90; P < .0001) relative to men, but there was no gender difference in grant funding. CONCLUSIONS: Women faculty acquired federal funding at similar rates as male faculty, yet lagged behind in terms of publications and their impact. Medical academia must consider how to help address ongoing gender disparities in publication records.

Inequities in Academic Compensation by Gender: A Follow-up to the National Faculty Survey Cohort Study.

PURPOSE: Cross-sectional studies have demonstrated gender differences in salaries within academic medicine. No research has assessed longitudinal compensation patterns. This study sought to assess longitudinal patterns by gender in compensation, and to understand factors associated with these differences in a longitudinal cohort. METHOD: A 17-year longitudinal follow-up of the National Faculty Survey was conducted with a random sample of faculty from 24 U.S. medical schools. Participants employed full-time at initial and follow-up time periods completed the survey. Annual pretax compensation during academic year 2012-2013 was compared by gender. Covariates assessed included race/ethnicity; years since first academic appointment; retention in academic career; academic rank; departmental affiliation; percent effort distribution across clinical, teaching, administrative, and research duties; marital and parental status; and any leave or part-time status in the years between surveys. RESULTS: In unadjusted analyses, women earned a mean of $20,520 less than men (P = .03); women made 90 cents for every dollar earned by their male counterparts. This difference was reduced to $16,982 (P = .04) after adjusting for covariates. The mean difference of $15,159 was no longer significant (P = .06) when adjusting covariates and for those who had ever taken a leave or worked part-time. CONCLUSIONS: The continued gender gap in compensation cannot be accounted for by metrics used to calculate salary. Institutional actions to address these disparities include both initial appointment and annual salary equity reviews, training of senior faculty and administrators to understand implicit bias, and training of women faculty in negotiating skills.

"Shotgun" versus sequential testing. Cost-effectiveness of diagnostic strategies for vaginitis.

BACKGROUND: Although vaginitis is a common outpatient problem, only 60% of patients can be diagnosed at the initial office visit of a primary care provider using the office procedures of pH testing, whiff tests, normal saline, and potassium hydroxide preps. OBJECTIVE: To determine the most cost-effective diagnostic and treatment approach for the medical management of vaginitis. DESIGN: Decision and cost-effectiveness analyses. PARTICIPANTS: Healthy women with symptoms of vaginitis undiagnosed after an initial pelvic exam, wet mount preparations, pH, and the four criteria to diagnose bacterial vaginosis. SETTING: General office practice. METHODS: We evaluated 28 diagnostic strategies comprised of combinations of pH testing, vaginal cultures for yeast and Trichomonas vaginalis, Gram's stain for bacterial vaginosis, and DNA probes for Neisseria gonorrhoeae and Chlamydia. Data sources for the study were confined to English language literature. MEASUREMENT: The outcome measures were symptom-days and costs. RESULTS: The least expensive strategy was to perform yeast culture, gonorrhoeae and Chlamydia probes at the initial visit, and Gram's stain and Trichomonas culture only when the vaginal pH exceeded 4.9 (330 dollars, 7.30 symptom days). Other strategies cost 8 dollars to 76 dollars more and increased duration of symptoms by up to 1.3 days. In probabilistic sensitivity analysis, this strategy was always the most effective strategy and was also least expensive 58% of the time. CONCLUSIONS: For patients with vaginitis symptoms undiagnosed by pelvic examination, wet mount preparations and related office tests, a comprehensive, pH-guided testing strategy at the initial office visit is less expensive and more effective than ordering tests sequentially.

Career satisfaction and retention of a sample of women physicians who work reduced hours.

OBJECTIVE: To better understand the career satisfaction and factors related to retention of women physicians who work reduced hours and are in dual-earner couples in comparison to their full-time counterparts. METHODS: Survey of a random sample of female physicians between 25 and 50 years of age working within 25 miles of Boston, whose names were obtained from the Board of Registration in Medicine in Massachusetts. Interviewers conducted a 60-minute face-to-face closed-ended interview after interviewees completed a 20-minute mailed questionnaire. RESULTS: Fifty-one full-time physicians and 47 reduced hours physicians completed the study; the completion rate was 49.5%. The two groups were similar in age, years as a physician, mean household income, number of children, and presence of an infant in the home. Reduced hours physicians in this sample had a different relationship to experiences in the family than full-time physicians. (1) When reduced hours physicians had low marital role quality, there was an associated lower career satisfaction; full-time physicians report high career satisfaction regardless of their marital role quality. (2) When reduced hours physicians had low marital role or parental role quality, there was an associated higher intention to leave their jobs than for full-time physicians; when marital role or parental role quality was high, there was an associated lower intention to leave their jobs than for full-time physicians. (3) When reduced hours physicians perceived that work interfering with family was high, there was an associated greater intention to leave their jobs that was not apparent for full-time physicians. CONCLUSIONS: Women physicians in this sample who worked reduced hours had stronger relationships between family experiences (marital and parental role quality and work interference with family) and professional outcomes than had their full-time counterparts. Both career satisfaction and intention to leave their employment are correlated with the quality of home life for reduced hours physicians.

Compensation and advancement of women in academic medicine: is there equity?

BACKGROUND: Women have been entering academic medicine in numbers at least equal to their male colleagues for several decades. Most studies have found that women do not advance in academic rank as fast as men and that their salaries are not as great. These studies, however, have typically not had the data to examine equity, that is, do women receive similar rewards for similar achievement? OBJECTIVE: To examine equity in promotion and salary for female versus male medical school faculty nationally. DESIGN: Mailed survey questionnaire. SETTING: 24 randomly selected medical schools in the contiguous United States. PARTICIPANTS: 1814 full-time U.S. medical school faculty in 1995-1996, stratified by sex, specialty, and graduation cohort. MEASUREMENTS: Promotion and compensation of academic medical faculty. RESULTS: Among the 1814 faculty respondents (response rate, 60%), female faculty were less likely to be full professors than were men with similar professional roles and achievement. For example, 66% of men but only 47% of women (P < 0.01) with 15 to 19 years of seniority were full professors. Large deficits in rank for senior faculty women were confirmed in logistic models that accounted for a wide range of other professional characteristics and achievements, including total career publications, years of seniority, hours worked per week, department type, minority status, medical versus nonmedical final degree, and school. Similar multivariable modeling also confirmed gender inequity in compensation. Although base salaries of nonphysician faculty are gender comparable, female physician faculty have a noticeable deficit (-11,691 dollars; P = 0.01). Furthermore, both physician and nonphysician women with greater seniority have larger salary deficits (-485 dollars per year of seniority; P = 0.01). LIMITATIONS: This is a cross-sectional study of a longitudinal phenomenon. No data are available for faculty who are no longer working full-time in academic medicine, and all data are self-reported. CONCLUSIONS: Female medical school faculty neither advance as rapidly nor are compensated as well as professionally similar male colleagues. Deficits for female physicians are greater than those for nonphysician female faculty, and for both physicians and nonphysicians, women's deficits are greater for faculty with more seniority.

Inadequate progress for women in academic medicine: findings from the National Faculty Study.

BACKGROUND: Women have entered academic medicine in significant numbers for 4 decades and now comprise 20% of full-time faculty. Despite this, women have not reached senior positions in parity with men. We sought to explore the gender climate in academic medicine as perceived by representatives to the Association of American Medical Colleges (AAMC) Group on Women in Medicine and Science (GWIMS) and Group on Diversity and Inclusion (GDI). METHODS: We conducted a qualitative analysis of semistructured telephone interviews with GWIMS and GDI representatives and other senior leaders at 24 randomly selected medical schools of the 1995 National Faculty Study. All were in the continental United States, balanced for public/private status and AAMC geographic region. Interviews were audiotaped, transcribed, and organized into content areas before an inductive thematic analysis was conducted. Themes that were expressed by multiple informants were studied for patterns of association. RESULTS: Five themes were identified: (1) a perceived wide spectrum in gender climate; (2) lack of parity in rank and leadership by gender; (3) lack of retention of women in academic medicine (the "leaky pipeline"); (4) lack of gender equity in compensation; and (5) a disproportionate burden of family responsibilities and work-life balance on women's career progression. CONCLUSIONS: Key informants described improvements in the climate of academic medicine for women as modest. Medical schools were noted to vary by department in the gender experience of women, often with no institutional oversight. Our findings speak to the need for systematic review by medical schools and by accrediting organizations to achieve gender equity in academic medicine.