Abstract
Gender disparities in career advancement in academic medicine have persisted despite gender parity in medical school matriculation. Although numerous explanations for this gap exist, little is known about women's experiences of promotion and tenure in academic medicine. To examine women's experiences of promotion and tenure in academic medicine to uncover mechanisms associated with the gender disparity in career advancement. In this qualitative study, 52 in-depth, semistructured interviews with women academic medicine faculty members were conducted in 2019. The 52 participants were drawn from 16 medical schools across the US. Institutions were selected using a purposive sampling strategy to seek diversity of geography and ownership (private or public). Within institutions, purposive and snowball sampling were used to seek diversity with respect to respondents' degree type (MD, PhD, and MD and PhD), age, and career stage. Interview transcripts were analyzed using qualitative thematic analysis. Data analysis was performed from March to December 2020. Themes and subthemes in participants' experiences of promotion and tenure. The 52 women in this study ranged in age from 34 to 82 years (mean [SD] age, 54.0 [10.7] years). Eighteen respondents (34.6%) held an MD, 4 (7.7%) held both an MD and PhD, and 30 (57.7%) held a PhD. Fourteen respondents (26.9%) were assistant professors at the time of the study, 8 (15.4%) were associate professors, and 30 (57.7%) were full professors. Four main themes within participants' experiences of promotion and tenure that pertain to gender inequities were identified: ambiguous or inconsistent criteria for promotion or tenure; lack of standard processes for reviewing applications and making decisions; vulnerability to malicious behavior of senior faculty, department chairs, and division chiefs; and women seeing men have different experiences of advancement. The respondents' experiences of promotion and tenure suggest that promotion and tenure processes may be characterized by inconsistency and a lack of oversight, which have the potential to contribute to well-documented patterns of gender disparities in career advancement in academic medicine.
Highlights
For several decades, data have shown that women in academic medicine do not advance in their careers in parity with men.[1,2,3,4] Women in academic medicine are promoted at lower rates than men and are less likely to hold tenured positions.[3,4] Over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor, without any apparent narrowing in the gap throughout this time frame.[4]Numerous explanations for gender disparities in advancement in careers in academic medicine have been proposed
The respondents’ experiences of promotion and tenure suggest that promotion and tenure processes may be characterized by inconsistency and a lack of oversight, which have the potential to contribute to well-documented patterns of gender disparities in career advancement in academic medicine
The number of women applying to and matriculating into medical schools has steadily increased since the 1970s and is currently in parity with men, so many investigators have concluded that this gender gap likely cannot be attributed to a cohort effect or a weak pipeline.[2,3,5,6]
Summary
Data have shown that women in academic medicine do not advance in their careers in parity with men.[1,2,3,4] Women in academic medicine are promoted at lower rates than men and are less likely to hold tenured positions.[3,4] Over a 35-year period, women physicians in academic medical centers were less likely than men to be promoted to the rank of associate or full professor, without any apparent narrowing in the gap throughout this time frame.[4]Numerous explanations for gender disparities in advancement in careers in academic medicine have been proposed. The number of women applying to and matriculating into medical schools has steadily increased since the 1970s and is currently in parity with men, so many investigators have concluded that this gender gap likely cannot be attributed to a cohort effect or a weak pipeline.[2,3,5,6] Much attention has been devoted to the likelihood that women will shoulder a disproportionate burden of family-related responsibilities within their households and the possibility that the most intensive phase of these responsibilities will coincide with and adversely affect their productivity during the most critical stage of their career development.[6,7,8,9] Others note that implicit biases against women may impede their achievement of important markers of productivity, such as publication rates, upon which tenure and promotion decisions are predicated.[10] Some researchers have found that women are less likely to be familiar with the criteria for promotion and tenure, potentially resulting from inadequate or insufficient mentoring.[11,12] Others have reported that faculty on traditional tenure tracks are more likely to be promoted and that men are more likely than women to hold tenure-track positions.[13,14] Implicit bias on the part of promotion and tenure committees may favor men, and criteria for tenure may be based on stereotypically masculine traits and behaviors, such as leadership.[1,10,15] These diverse factors may occur in combination and have compounding effects.[10]
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