Volume 2 Number 2

Authors:

Ana Hategan, M.D., Associate Clinical Professor, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

James A. Bourgeois, O.D., M.D., Clinical Professor, Department of Psychiatry/Langley Porter Psychiatric Institute, Consultation-Liaison Service, University of California San Francisco Medical Centre, San Francisco, California, USA

Meghan McConnell, Ph.D., Assistant Professor, McMaster University, Hamilton, Ontario, Canada

Conflict of Interest: The authors declare that they have no conflict of interest.

Acknowledgments: The authors wish to thank Lowell Tong, M.D., for his thoughtful review and helpful suggestions in early drafts of this paper.

Address correspondence to:

Ana Hategan, M.D.
Associate Clinical Professor
Department of Psychiatry and Behavioural Neurosciences
Division of Geriatric Psychiatry
Michael G. DeGroote School of Medicine
Faculty of Health Sciences, McMaster University
[email protected]

ABSTRACT

Objective: Previous research has shown that the proportionate representation of women in academic medicine relative to their male counterparts decreases at higher academic ranks, particularly across the research-educator track positions often seen as more academically competitive than those in the clinician-educator series. Method: The authors analyzed gender distribution of convenience samples across academic ranks and series at two research-intensive departments of psychiatry: University of California San Francisco (UCSF) and McMaster University. Results: Similar trends in gender disparity distribution across the three academic rank positions (assistant, associate, and full professor) were found both at UCSF and McMaster University (P = .001 vs. P = .005). Gender and academic rank significantly varied from one another for both research-educator and clinician-educator series (P < .001, and P < .001, respectively).

Conclusions: Cross-sectional analysis showed that gender disparity persists, with a significant relative overrepresentation of academic women at entry levels and underrepresentation at full professor rank. A disproportionate percentage of women faculty members at higher ranks across the academic ranks was found not only within research-educator but also clinician-educator series. Using   rank distribution as a proxy marker for academic progression, these findings suggest a relative lag in academic promotion for women academics.

INTRODUCTION

Over the past two decades, women have comprised more than half of all admissions in medical schools across North America [1]. However, the advancement of women in academic medicine has not kept pace with the influx of women physicians in academic settings [1, 2]. Whereas productive faculty members are critical to academic medicine, studies have shown that the proportionate representation of women in academic medicine relative to their male counterparts decreases at higher academic ranks [3- 6]. The culture of academic medicine has been described not only as hierarchical and competitive, but also as less supportive of female faculty members [7]. Researchers have shown that, while academic men and women are equally engaged in their work and share similar leadership aspirations, medical schools somewhat have failed to create and sustain an environment where women feel fully supported to succeed [8].

Research has shown that, historically, research-educator track positions have been predominantly the province of male faculty members, whereas female academics may be relatively more likely to populate clinical and education-specific roles, perhaps partly due to a greater priority placed on work-life balance, roles which make these faculty members less competitive for (and often uninterested in) promotion to associate professor and, subsequently, to full professor [1, 4-6]. If this holds “true” then the real issue appearing to competitively favor researchers in academic promotion may be the research enterprise being more academically valued than the educators’ academic activities, and not necessarily a gender difference issue per se. Nevertheless, concerns regarding women’s advancement in medicine continue to be a focus of interest in the literature. In this view, one could argue that the gender differences in research-educator ranks are expected to be highest at high performing universities in which the level of time and commitment to succeed to the institution’s standards should also be greatest, and therefore perhaps more challenging for women. Therefore, one might expect considerably less evidence of a gender differential in the clinician-educator series, often seen as less academically competitive. We herein hypothesized better representation of women at the various academic ranks in the clinician-educator series.

The majority of research on women in academic medicine has previously been conducted in the US and UK, leaving little-to-no comparable data readily available in Canada. Both UCSF and McMaster University are high performing, research-intensive universities. An exploration of the status of gender distribution among UCSF faculty in academic psychiatry compared to their academic counterparts at McMaster University is herein proposed.

METHOD

This cross-sectional study compiled data for all level academic positions in the department of psychiatry at UCSF, compared to their McMaster University counterparts, based on a convenience sampling frame of the 2011-2012 academic year, and using the frequencies and proportions of the faculty gender makeup by academic rank and series.

Due to diverse university-specific terms pertaining to academic series at different institutions, there was a need for defining analogous groups of academic series at the two institutions in order to allow analogous group analyses comparing UCSF to McMaster group. The academic series at UCSF included ladder-rank (with partial state funding support and with high expectations of research, mentoring and university service productivity, and a traditional tenure mechanism), in-residence (similar to ladder-rank without state funding support), clinical psychiatry series (typically expected to generate substantial clinical revenue, hold clinical leadership roles and contribute to scholarship), health sciences clinical series (expected to teach and generate clinical income with lower scholarship expectations than the clinical psychiatry series), and adjuncts (researchers without teaching, clinical and institutional service expectations, funded through research grants). UCSF volunteer clinical faculty (similar to “adjunct” faculty at McMaster), who are significant in their numbers and contribution towards the teaching mission of UCSF, and do not receive salary support from UCSF, were not included in this study.

The McMaster “part-time” (or clinician-educator) track designation does not equate to “part-time employment” but describes clinical faculty with primarily patient-care centered roles (with reliance on clinical income generation for the majority of compensation) who also provide much of the clinical teaching mission, in distinction from  the “full-time” (or research-educator) academic faculty, who have expectations of grants, publications and other scholarly activity, in addition (for physicians) to varying degrees of clinical income generation. At McMaster University, the term “adjunct” faculty members refers to clinicians in non-academic practice who provide clinical supervision on a voluntary basis; their numbers were not included in this study.

The statistical technique was to report research-educator vs. clinician-educator faculty (using the McMaster terminology of “full-time” and “part-time” series as the main group distinction) and for the UCSF comparison groups to combine the ladder-rank, in-residence, and adjunct faculty, as one group “roughly equivalent” to McMaster full-time series, and to compare McMaster part-time faculty to UCSF clinical psychiatry and health sciences clinical faculty as the group “most comparable” to the McMaster part-time series. Chi squared (Χ²) tests of independence were used to examine whether the proportion of men and women academics varied across the three faculty groups (i.e., assistant, associate, & full professor ranks; research-educator vs. clinician-educator faculty members). Initial analyses examined UCSF and McMaster University separately, but given that equivalent trends were observed across the two groups, the data from the two schools were pooled for subsequent analyses. Significance was determined to be P < .05. This project was certified as exempt by the two University Institutional Ethics Review Boards.

RESULTS

Table 1 shows the number of research-educator and clinician-educator psychiatry faculty at UCSF compared to their McMaster counterparts by rank in the 2011-2012 academic year. Overall, the Χ² analyses showed similar trends in the data (in both direction and magnitude) across the three rank positions both at UCSF and McMaster University, although the effect was admittedly larger in the former (Χ² = 20.2, P = .001 vs. Χ² = 10.5, P = .005) (Table 1). Given a similar trend in rank distribution across academic series (given the cross-sectional nature of our data, this can serve as a proxy marker for academic advancement), the data were combined to examine whether the gender distribution of academic faculty varied across research-educator and clinician-educator series at the studied locations (Table 2). Overall, when comparing the pooled data from the two departments on the research-educator and clinician-educator faculty groups, gender and academic rank significantly varied from one another for both clinician-educator and research-educator series (Χ² = 21.5, P < .001, and Χ² = 17.2, P < .001,  respectively).

Table 1. Psychiatry Faculty by Rank and Gender in 2011-12 Academic Year.

Table 2. Total Psychiatry Faculty by Series and Gender in 2011-12 Academic Year.

DISCUSSION

Previous literature has reported that proportion of academic women in medicine who advanced to the senior ranks was lower than that of their male counterparts [3-6]. The results of this study echo these past findings, showing a continued gender difference in the academic ranks when compared to their male counterparts. Contrary to the hypothesis of better representation of women at the various academic ranks in the clinician-educator series, this cross-sectional analysis showed that a disproportionately higher percentage of male academics at higher ranks across the academic ranks was found not only within research-educator but also clinician-educator series (P < .001, and P < .001, respectively) when compared with their female counterparts (Table 2). Similar trends in gender disparity distribution across the three academic rank positions (assistant, associate, & full professor) were found both at UCSF and McMaster University (P = .001 vs. P = .005). The fact that both series had roughly twice the number of men than women at the full professor level was compelling (Table 2).

Using current faculty rank distribution as a proxy marker for academic progression, these findings suggest a relative lag in academic promotion for women academics in both series. There is however a possible confounding cohort effect, if there were proportionately less women entering the lower academic ranks at the time the current professors began their careers. Future studies using similar methodology, with analysis taking place after an extended number of years with similar numbers of men and women entering academic positions may show different results. If this is a cohort effect, then the disproportionate underrepresentation of women in higher academic positions may likely eventually change as more women enter the academic ranks; however, others believe that this effect may be mitigated due to continued personal/societal and professional cultural expectations of women [9]. One could argue that, while more women faculty may go into clinical-education roles due to an interest in balancing professional/personal roles, less research productivity is expected in these roles, while perhaps more men enter more academically productive research, hence earn more promotions achieved on that basis [10]. One study exploring the changes in female authorship patterns in 1994 compared to 2007 publication year across three high-impact specialty-specific journals found that women still remained underrepresented in academic domain [11]. If this holds “true” then the real issue may be that the research enterprise is more valued than the educators’ academic activities and not necessarily a gender difference issue, although this is a complex phenomenon.

However, results from this study show a similar distribution pattern of significant overrepresentation of women at the entry levels or, implicitly, career stagnation, which was found not only within research-educator but also clinician-educator series. The fact that UCSF has a relative overrepresentation of full professors (male and female) compared to their McMaster counterparts might be an artefact of a department with a higher level of academic productivity, suggesting perhaps that there was a higher rate of academic rank progression and/or a lower attrition rate among faculty members (Table 1).

Limitations of the present study included a cross-sectional examination and exploration of a single medical discipline. The distribution for age separately for men and women to determine whether a potential cohort effect was operating in the data was not examined and could not be ruled out.

CONCLUSION

Within both academic series there appears to have been a significant gender distribution incongruity in the academic ranks. Therefore, the gender differences amongst the academic professoriate and (implicitly) career mobility still appear to be a contemporary issue. Further exploration of possible gender contributing factors to career advancement within the academic series using a prospective design is needed.

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