How to Foster Academic Promotion and Career Advancement of Women in Gastroenterology

Abstract

Women face challenges that threaten their ability to climb the academic ladder. The reasons are multifactorial and include the impact of family responsibilities, gender role expectations, personal choices, institutional practices, and cultural biases1Flaherty S.M. Misra M. Scott-Vernaglia S.E. Taveras E. Israel E.J. Psyche meets the gatekeepers: creating a more humane culture for women in medicine.Acad Med. 2019 Apr 16; ([Epub ahead of print])Crossref PubMed Scopus (5) Google Scholar (Table 1). Factors affecting the academic life of young female faculty can delay or even derail their success. Alternatively, leveraging strengths and early support can have positive career-long impact. This article provides some strategies to support women, particularly female junior faculty, as they pursue careers in academics. A paucity of data specific to gastroenterology (GI) are available and it is hoped that this article will stimulate data collection and GI-specific practices that will help women to find a welcome home in academic medicine where they can thrive.Table 1Characteristics of Women that Impact Academic AdvancementCharacteristics positively impacting advancementHighly effective team leadership styleGood multitaskersDemonstrated clinical excellenceCharacteristics negatively impacting advancementPerfectionism; imposter syndromeReadily give credit to others; limited skills at self-promotionLimited flexibility to move or travelDifficulty negotiating: “Women Don’t Ask” Open table in a new tab Data suggest that medical school graduating classes are now slightly >50% women.2The American Association of Medical Colleges data.www.aamc.org/download/475558/data/16table9.pdfDate accessed: April 20, 2019Google Scholar This gender split is maintained during residency training. Even in traditionally male-dominated fields such as GI, women are increasingly represented. Gender distribution at the assistant professor rank is also near equal. However, at the full professor rank, only 25% of full-time faculty are women; this percentage is increasing slowly. The drop off from junior to senior faculty rank is a combined effect of slow trajectory and drop out. The pipeline for women is strong and the reasons why women are not reaching the highest ranks are complicated and likely similar to the business world where only 4.8% of the fortune 500 chief executive officers are women.3CNBCJust 24 female CEOs lead the companies on the 2018 Fortune 500—fewer than last year.www.cnbc.com/2018/05/21/2018s-fortune-500-companies-have-just-24-female-ceos.htmlDate accessed: April 20, 2019Google Scholar Women embarking on an academic career do so at a time of significant personal change. As they complete their arduous education, they typically start their climb on the academic ladder in their early to mid 30s. Many have delayed marriage, children, and buying their first home until their life situation is more clearly defined. They are faced with starting to pay loans and often move to a different community or across country. This formative life stage is significantly challenging for both genders. The desire to have children impacts women’s decisions on career track and locale. Many have spouses or partners in medicine, which can seriously complicate life choices. As they prepare to climb the academic ladder, they do so carrying the weight of complicated life situations. Women are less likely to be movable than their male peers and this reality, or even its perception, limits opportunities. Women scientists may not be as visible at national meetings as their male counterparts. Women are less likely to engage in their national societies. Data from the AGA suggest that there is a drop off in female membership in the first few years after fellowship. Thirty-four percent of American Gastroenterological Association (AGA) trainee members are women whereas only 22% of senior AGA membership ranks are women (AGA internal data). To address these factors, societies are sponsoring programs to engage women. In 2014, the AGA initiated the highly successful Women’s Leadership Conference (WLC) to provide mentorship, teach skills, and encourage engagement. The 2019 WLC, part of a broader AGA leadership initiative, brought a national group of junior and senior women in practice and academics together with AGA leaders, including 5 former AGA presidents. After the WLC, attendees professional information is added to a talent bank used as a resource for AGA committee assignments and speaking opportunities. Institutional leaders should encourage their female faculty to apply to the WLC or similar programs sponsored by other societies and support their participation. Leaders should also build their own talent bank of women they encounter to remind them of female choices who might not otherwise come to mind when opportunities arise. Rarely does onboarding of new clinical or research faculty include a discussion of the process of academic advancement. Clinical faculty are bombarded with compliance and billing rules, particulars of the electronic medical record, and relative value unit expectations. Researchers are kept busy with animal and human use protocols and OSHA regulations. They work to become master clinicians or researchers, striving to be like their role models and enthusiastically taking on the roles of teacher and mentor. Women readily volunteer for committee assignments, interviewing, and other uncompensated service tasks more often than their male counterparts.4Babcock L. Recalde M.P. Vesterlund L. Why women volunteer for tasks that don’t lead to promotions.Harvard Business Review. July 16, 2018; (Available:)https://hbr.org/2018/07/why-women-volunteer-for-tasks-that-dont-lead-to-promotionsDate accessed: April 20, 2019Google Scholar It may be several years until an institutional discussion of promotion takes place, often creating panic. If the need for scholarship, particularly publishing scholarly articles, has been put on the back burner, it is suddenly front and center. Most departments have an annual review process that can help to assuage the panic surrounding promotion. An annual review of accomplishments can seem painful, but it is particularly important because it shines a light on how faculty spend their time. The most valuable annual review should not be a review at all, and rather should focus on plans for the upcoming academic year, including a plan for publishing. If an annual review is not part of their institution’s processes, faculty should be encouraged to do a review with their mentor with a focus on a plan for publishing. The modern concept of mentorship includes junior faculty having mentors for several facets of their academic lives, including scientific direction, clinical performance, and work–life integration. This process ideally begins at or even before hire. Mentorship is an aspect of onboarding that is often overlooked but is perhaps the most important for timely faculty advancement, encouraging ongoing scholarship, and preventing conditions such as burnout. Although it does not require a woman to be a good mentor for a female faculty, having female role models in the department is important. The importance of mentorship is widely acknowledged, and a concrete plan for each faculty should be implemented at the time of hire with documentation and accountability.5Zerzan J.T. Hess R. Schur E. et al.Making the most of mentors: a guide for mentees.Acad Med. 2009; 84: 140-144Crossref PubMed Scopus (161) Google Scholar Perhaps even more important than mentorship is sponsorship, that is, actively advocating for an individual to fill a particular role. GI is lucky to have leaders of both genders, including many division chiefs, who regularly and enthusiastically sponsor women for local and national opportunities. Having a strong clinical or scientific niche encourages faculty to focus and provides a solid identity. The niche forms the foundation on which a local, regional, and national reputation can be fostered. Scholarship emerging from their niche, becomes the basis for promotion. A good working definition of scholarship suggests it must reflect new knowledge, be disseminated, and be peer reviewed. The classic form of scholarship is the peer-reviewed, published manuscript. For promotion purposes, this is the safest and most widely accepted form of scholarship. In recent years, academic institutions have struggled to promote clinical faculty who have little time for writing. Many institutions have adopted particular tracks for purely clinical faculty or have chosen to expand the definition of scholarship to include curriculum development, electronic medical record order sets, web development, social media platforms, clinical protocols, and so on. Work placed in the MedEdPORTAL is a good example of an alternative form of scholarship that is now PubMed cited and considered positively for promotion at most institutions. These expanded forms of scholarship assist clinician educators as they seek academic promotion. Indeed, the educational portfolio is now a valued part of promotion packets for most major medical schools6Sullivan G.M. A Toolkit for medical education scholarship.J Grad Med Educ. 2018; 10: 1-5Crossref PubMed Scopus (3) Google Scholar (Table 2).Table 2Recommendations for WomenKeep a master CV and create “offspring” for special purposes, such as an NIH biosketchPractice good time management: email, etcGive yourself a break at certain times in your careerDon't get overextended; say “no”Know your local institutional resources: Dean’s office of your school or collegeSeek out national resources: Association of American Medical Colleges (AAMC), American Gastroenterological Association (AGA), American Association Study of Liver Disease (AASLD), American Society of Gastroenterology Endoscopists (ASGE), American College of Gastroenterology (ACG), North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN)Cultivate mentors of all genders; be a good menteeLearn leadership skills through local or national courses (eg, AGA Women’s Leadership Conference) Open table in a new tab All clinical faculty struggle with scholarship (ie, publishing). This deficiency is the most common to result in denial of promotion or preclude faculty from seeking promotion. Mentorship, team science, and the annual review process can help to identify faculty at risk of not progressing owing to a lack of scholarship and can offer encouragement and strategies for success. Providing administrative assistance, statistical help, and editorial assistance can enhance the likelihood of publication acceptance and boost the impact factor of the targeted journal. Innovative faculty development initiatives such as writing circles can help to reinforce the need for continued scholarship. For physician scientists, published work is the basis for grant funding and helps to set research directions. Women’s tendency for perfectionism in submissions is particularly risky for basic scientists because experiments can be repeated countless times with endless controls. A delay in publication can lead to downstream delays in eligibility for grant funding and advancement. Mentors can provide a reality check on scholarly productivity and can help to overcome hurdles and brainstorm innovative approaches for improving scholarship. Most, if not all, institutions extend the promotion or tenure clock for childbearing. Many institutions have extended the tenure clock to 10 years for all eligible faculty. For many women, this buffer is needed to compensate for added family responsibilities during the early years. The untoward negative effect of extending the clock is a delay in obtaining senior status, resulting in fewer local and national opportunities. Women held in junior status may not be considered for leadership positions. Financially, this delay can have lasting negative effects on compensation and contribute to pay inequities. Women should be encouraged to seek promotion on par with their male counterparts. Mentors and leadership should know that sometimes they need to keep the timeline in mind as women are frequently reluctant to envision themselves in a senior role owing to the weight of their multiple roles and responsibilities, and the much written about “imposter syndrome.”7Butkus R. Serchen J. Moyer D.V. et al.for the Health and Public Policy Committee of the American College of PhysiciansAchieving gender equity in physician compensation and career advancement: a position paper of the American College of Physicians.Ann Intern Med. 2018; 168: 721-723Crossref PubMed Scopus (192) Google Scholar Women stuck at the assistant professor level, a too common occurrence, may need a gentle nudge toward promotion. Another commonly used strategy to address women’s time constraints is to decrease their commitment while family responsibilities loom large (ie, part-time or partial full-time equivalent status). This change is very welcome in assignment, particularly for faculty with a predominately clinical role. This strategy, although well-meaning, can also have untoward negative effects. Faculty with part-time appointments may be being taken less seriously by colleagues often effectively losing their voice in decision making. Somewhat unfairly, they often work the same number of hours but have purchased flexibility in scheduling their time. Generally, leadership should be creative rather than quickly moving to a decreased assignment. In negotiations, it might be necessary to take off your chief/chair hat and tell the faculty what they should be asking for or what they will need to succeed. A strategic approach with a short- and long-term plan that individualizes their needs is warranted. Overall, women should be encouraged and provided the support to stay in the game; academics is indeed a marathon and women should not be counted out because they take a decreased work assignment as a life choice (Table 3).Table 3Recommendations for InstitutionsKnow and share your local data by gender: track time in rank, promotion and tenure outcomes, faculty retention, pay equity, hiring, speaker ratesBe transparent and work with other institutions, share best practicesProvide faculty with promotion and tenure standards earlyMake professional development of faculty a priority for chiefs and chairsBe creative and supportive; tailor pathways to needsDo not be too quick to extend the clock or implement a part-time appointmentLimit time in rank of lecturer or instructor; watch for faculty who are stalledProvide sound mentorship and encourage sponsorship; provide networking opportunitiesCarefully assess “extra opportunities” for financial rewards or leadership to be sure you optimize gender equityListen/look for signs of burnout or crisis Open table in a new tab Our societies recently completed an historic year where the presidents of all four GI societies were highly accomplished women. This amazing confluence of achievements has heightened our recognition of how far women have come in GI. However, the fact remains that in the history of the AGA we have had only three women presidents. Further, although women make up 35% of trainees,8American Board of Internal MedicinePercentage of first-year fellows by gender and type of medical school attended.www.abim.org/about/statistics-data/resident-fellow-workforce-data/first-year-fellows-by-gender-type-of-medical-school-attended.aspxDate accessed: April 25, 2019Google Scholar they make up only a stagnant 17.6% of the active practicing GIs.9Association of American Medical CollegesActive physicians by sex and specialty, 2017.www.aamc.org/data/workforce/reports/492560/1-3-chart.htmlDate accessed: April 25, 2019Google Scholar Thus, there is much more to accomplish. We must learn from the diversity literature that small gains can backfire and create an illusion of fairness that can enable continued discriminatory practices. Let’s not let the outstanding accomplishments of our women GI leaders in 2017–2018 create an illusion of equity preventing us from moving forward. We should keep monitoring progress toward equity and keep seeking practices that will advance women in our field. Women have made great professional strides in GI as they have in nearly every facet of our society. As a result, academic medical centers are becoming more diverse and inclusive, enhancing departmental climate. Helping women faculty to successfully climb the academic ladder takes a nuanced approach to address challenges that are specific to women. Institutional strategies to enhance mentorship, advance scholarship, help faculty to develop a national reputation, and avoid burnout creates a more vibrant workplace for all faculty. Practices such as extending the tenure clock and use of part-time positions should be minimized in favor of flexibility, to help women stay in the game. Noncompensated service tasks should be parceled out equally and compensated assignments should be gender equitable. Understanding the new generation of women gastroenterologists and leveraging their strengths is key to creating and maintaining a vibrant academic home where all faculty thrive.