Correspondence

Women Physicians in Academic Medicine

N Engl J Med 2000; 342:1839-1840June 15, 2000

Article

To the Editor:

Nonnemaker (Feb. 10 issue)1 presents her results without much editorializing about the woes of women in medicine. Articles on this topic always worry me, since the victim mentality is so prevalent in our society.

When I was in high school, I worked for a woman physician by watching her children. She told me some of the things she had to endure while in medical school in the 1960s. Some of the treatment she received was appalling. However, I believe that the climate in medicine has changed substantially since that time. I graduated from medical school in 1989. I have experienced very little prejudice on the basis of my being a woman. I cannot say that my experience holds true for all women in medicine, particularly women who are members of minority groups, but my own experience has been good overall, with only a few minor problems.

I was in academic medicine until the summer of 1999. I observed no inequalities with respect to the promotion of women as compared with men. I also saw that fewer women chose to put in the hours required to progress rapidly to full professorship. Most of these women cited the value they placed on family life as the reason for not putting in the required extra hours. I fall into that category. I recently left full-time medicine in order to care for my children myself. I still work part-time, but such a career choice, as compared with those of many men in academic medicine, could be one of the reasons for the skewed statistics on the promotion of women relative to men in academic medicine. I suggest that lifestyle choices are a possible cause of the lower numbers of women in the higher ranks of academic medicine.

Nancy P. Lawless, M.D.
25208 Woodfield School Rd., Gaithersburg, MD 20882

1 References

1
Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med 2000;342:399-405
Full Text | Web of Science | Medline

To the Editor:

If the goal referred to by Nonnemaker is to provide equal opportunity to women to advance academically, I suggest that her study has not proved that women do not have equal opportunity. To prove this, one would have to know the proportion of junior faculty members of both sexes who have met the criteria for advancement to senior rank and have not yet been promoted. At that point, one could determine whether equal opportunity did or did not exist. Likewise, it would be interesting to know the relative qualifications of recently promoted male and female faculty members at each academic level to ascertain whether efforts at affirmative action within faculty organizations have been successful. It is easy to imply sex bias through the use of statistics that show an imbalance, when in fact the imbalance may be due to factors not studied, such as time (and effort) spent away from academia, which would contribute to a lower level of academic achievement as compared with that of colleagues.

Mark E. Parker, M.D.
Barberton Citizens Hospital, Barberton, OH 44203

To the Editor:

Is it the goal of academicians to promote women, as opposed to promoting the best and most qualified candidates? It seems to me that medicine — at least as much as, if not more than, any other profession — should be blind to sex and color.

Leslie F. Safer, M.D.
Albany Dermatology Clinic, Albany, GA 31701

To the Editor:

Nonnemaker and De Angelis, in her accompanying editorial,1 highlight the continuing problems that confront women physicians in their pursuit of academic promotion. The problem of whether women physicians receive recognition equivalent to that of men is also highlighted on the page following the editorial in the same issue of the Journal.

The list of reviewers for the Journal in 19992 reveals that of a total of 447 reviewers who reviewed three or more papers that year, only 37 (8 percent) appear on the basis of their names to be women. Although the appointment of women physicians to the editorship of the New England Journal of Medicine and the editorship of the Journal of the American Medical Association is to be applauded as a step in the right direction, there is clearly still much work to be done.

Julia Gates, M.D.
Econometrics, Baltimore, MD 21209

2 References

1
De Angelis CD. Women in academic medicine: new insights, same sad news. N Engl J Med 2000;342:426-427
Full Text | Web of Science | Medline

2
Reviewers for the Journal, 1999N Engl J Med 2000;342:428-428
Full Text

Author/Editor Response

The authors reply:

To the Editor: The correspondents raise several important points concerning possible explanations for the underrepresentation of women at the senior ranks of academic medicine. Lawless's experience suggests that women may leave academic medicine at higher rates than men; I did not examine the rates at which men and women exit academic medicine. Additional study of the mobility patterns of academic physicians, including exit rates for men and women, would be helpful.

Parker is correct in stating that my study does not prove that women do not have equal opportunity to advance in academic medicine. It is not correct, however, to say that I imply a sex bias. As I state in the article, the imbalance seen in the study may result even from well-intended efforts to provide equal opportunities to women. Parker also misses the point of the study, which is to show patterns in the presence of women at the senior ranks of academic medicine over time. Whatever the explanation, women remain profoundly underrepresented in the senior ranks.

Safer asks whether academicians should be promoting the “most qualified candidates” rather than women. I hope we might do both. It is important to note that the system of promotion in academic medicine allows all those deemed qualified to advance; direct comparisons of one candidate with another are not necessary. My study suggests that the criteria used to identify qualified candidates have resulted in far fewer women advancing to senior ranks. This then raises the question of whether women are truly less qualified for senior positions or whether the criteria established for advancement undervalue the contributions and qualifications of women.

Lynn Nonnemaker, Ph.D.
Association of American Medical Colleges, Washington, DC 20037

Author/Editor Response

Gates's letter prompted me to gather analogous data for the Journal of the American Medical Association (JAMA). In 1999 there were 3651 peer reviewers, of whom 772 (21 percent) appear to be women.1 By comparison, of a total of 777,859 physicians in the United States in 1998,2 177,030 (23 percent) were women, and in 1999, women made up 24,566 (27 percent) of a total of 89,717 faculty members in U.S. medical schools.3

Does the sex of the editors who choose the reviewers affect the sex of the reviewers chosen or the outcome for the peer-reviewed articles? Gilbert et al.4 found that female reviewers for JAMA were as likely to review manuscripts for male editors as for female editors, but that male reviewers were chosen by male editors more frequently than by female editors. Most important, however, was that these sex differences in the choice of reviewers had no apparent effect on the final outcome of the peer-review process or the publication of the articles.4

Safer points out that the goal of academics is to promote the best and most qualified candidates. I am not aware of data that show that, in general, men are better or more qualified than women. The point is that both must have equitable opportunities. You cannot win a race if you are not allowed to enter under the same rules.

Catherine D. De Angelis, M.D., M.P.H.
, Chicago, IL 60610

4 References

1
Williams ES. The JAMA 1999 editorial peer review report. JAMA 2000;283:2019-2033
CrossRef

2
Pasko T, Seidman B, Birkhead S. Physician characteristics and distribution in the US: 2000-2001 edition. Chicago: American Medical Association, 2000.

3
U.S. Medical School Faculty, 1999. Washington, D.C.: Association of American Medical Colleges Faculty Roster System, 1999. (See http://www. aamc.org/findinfo/infores/datarsc/facros/frspubs/usmsf99/start.htm.)