Twenty years after a major study demonstrated that women who graduate from medical school are less likely to be promoted in academic medical centers, a new analysis of over a half million graduates from 134 U.S. schools shows that the trend continues unabated. In fact the trend, identified in a 2000 study, seems to be getting worse. Female assistant professors were 24% less likely than men to be promoted to associate professor. Women were also 23% less likely to achieve a full professorship and 54% less likely to be named head of their department. These differences very highly statistically significant. The analysis, published in The New England Journal of Medicine, "is documentation that there are forces at play that are making women have less equal advancement, and we need to find out what those forces are," chief author Dr. Kimber Richter of the University of Kansas School of Medicine, in Kansas City, told Reuters Health by phone. The study looked at 35 years' worth of data from more than 559,000 people who graduated from medical school through 2013 and faculty data through 2018. For a promotion from an assistant professor to associate professor, the rates were 25% lower than men for women who graduated from 1979 to 1997 and 24% lower for women who graduated from 1998 to 2013. For promotion to full professor, the rates were 21% lower for 1979-1997 graduates and 38% lower for 1998-2013 graduates. And for promotion to department chairwoman, the disparity was even higher, with rates that were 53% lower for earlier graduates and 74% lower for women who had graduated more recently. "Women have lost ground in terms of promotion," the researchers concluded. "it did shock me that women were less than half as likely to be appointed department chair compared to men," said Dr. Richter, expressing surprise that the patterns were "incredibly consistent and unfortunate" in almost every cohort she and her colleagues examined. The reasons for unequal advancement "could be discrimination. It could be some kind of issue on how work is structured that makes it difficult for women to continue on in a very competitive career when they're trying to also maintain clinical practice and also give birth to human beings, which is one of the wonderful skills women have," she said. Race also appears to have played a major role in academic promotions. Compared with whites, Blacks were 42% less likely to be promoted to associate professor and 26% less likely to be promoted to professor. However, they were 87% more likely to be named department chair. The probability of Hispanics being promoted to associate professor was 26% lower. The differences for promotion to full professor or head of a department were not statistically significant. Asians were 8% more likely than whites to be promoted to associate professor and 14% more likely to be named to a full professorship. The odds of being promoted to department chair were lower than for whites but not significantly so. Because the population of female associate professors is more diverse than males at that level, "you might think that maybe it's not gender, it's race. We adjusted for race and women were still less likely to be promoted to the upper ranks," said Dr. Richter, a professor of population health. "Women in underrepresented minorities may pay a double price," the researchers warned. Diana Lautenberger, co-leader of Association of American Medical Colleges' Gender Equity Lab, was not available for an interview about the study, but released a statement saying that "having data and evidence about inequities in promotion helps counter the pervasive, and sometimes misleading, cultural narratives about why individuals do or do not rise through the ranks of leadership. Examples of these narratives can include not asking for it or not being interested in promotion." "While we have known for some time what the problems are regarding gender inequity," she said, "continual research provides the floor that institutions can stand on when they choose to act and address it." Women in the United States typically earn 85 cents for every dollar a man earns, according to the Pew Research Center. A portion of that gap has been attributable to women being more involved in family caregiving responsibilities. The new study did not directly try to adjust for that, but it did exclude men and women who took a break from academia for three years or longer. "They might say, 'Hey, women take off time to have children. You don't account for that, so maybe that's why they're being promoted at more rates and more slowly,'" said Dr. Richter. "Women having babies is not a new thing. Women are an incredibly important part of the medical workforce and we should accommodate and account for that factor when we're examining whether women are promoted in equal proportions because that's part of being human." In the wake of the 2000 report documenting the gender disparity in advancement, some initiatives were launched to try to correct that. "We didn't take efforts to scale, in part because we were trying to figure out what works. It's time to take things that look like they might be helpful and bring them to scale. We also need to look at new programs and policies that might remove systemic barriers to women" Dr. Richter said. "Some things that are really promising include universities revisiting their policies on family leave time; the provision of child care and sick child care, making it readily available to faculty; networking programs to help women connect with women in upper ranks; and mentoring from the upper ranks to help them navigate the promotion process," she said. —Gene Emery Source
