by Jan Werbinski, MD, AMWA President Elect, and students of AMWA@WMED and WIMS
The American Medical Women’s Association Chapters of Faculty and Students at Western Michigan University Homer Stryker MD School of Medicine (WMed) honors International Women’s Day—March 8, 2021— by reflecting on our concerted efforts to promote a gender-diverse faculty and student body, and to promote a culture of safety and acceptance.
Progress in Women Entering and Graduating from Med School is Not Good Enough
In the recent Position Paper—Achieving Gender Equity in Physician Compensation and Career Advancement—by the American College of Physicians (ACP), these authors acknowledged an upward trend in the number of women accepted into and graduating from medical schools and training programs. However, they point out several areas of inequity, including promotion, mentoring and sponsoring opportunities, publication acceptance, awarding of research funding, and compensation. The authors identify a lingering 37% salary gender gap for women faculty across clinical specialties and a 16% gap in primary care fields.1 Disparities also persist in promotions to leadership roles and funding allocations for research support.
The ACP study indicates that women physicians attain the following leadership positions:1
- 21% full professorships
- 15% of department chairs
- 16% of deans
Like many other private medical schools, WMed does not publish compensation statistics for medical school faculty. While the diverse make-up of the medical school students is clearly promoted on the medical school website, similar diversity statistics for faculty and staff are not as evident. In fact, data on women in leadership are shared internally, but actual salary comparisons suggest that salary distributions were reviewed by a subcommittee that reported no obvious inequities. However, there was no data presented or made available to verify this statement.
It is our position that the most effective way to achieve gender and racial equity in salary compensation is to make the process and compensation data accessible and transparent. It is not enough to simply suggest that women must develop techniques to “ask” or “lean in” and to become better bargainers for higher compensation and other work benefits when negotiating for positions or promotions. The “Her Time is Now 2” report, published by Julie Silver, MD, associate professor, and founding director of Career Advancement & Leadership Skills for Women in Healthcare at Harvard Medical School, in Boston, Massachusetts, advocates for change in the process of advancement in academia—The traditional mandate that assistant and associate professors must achieve a predetermined number of peer-reviewed publications, awards, and keynote presentations in order to advance. These criteria are more difficult for women faculty to achieve given their often multiple pressures to perform clinical work, generate revenue, and continuing responsibilities for childcare and homemaking. The work/life balance for women physicians more often leads to leaving medicine rather than accepting the additional requirements for tenure. The overloaded experience is often too much; hence, the growing “leaky pipeline” and loss of talent and investment in training.
Celebrating Diversity at Western Michigan University Homer Stryker MD School of Medicine as a Start
Until the academic workplace recognized the need for and supports protected time, administrative assistance, and childcare, as a start, the dropout levels and low percentages of women advancing in positions of leadership will continue. In further support of this trend, Tulshyan and Burey published: Stop Telling Women They Have Imposter Syndrome!3, appearing in The Harvard Business Review. As far back as 1978, “imposter syndrome” was loosely defined as doubting one’s abilities and feeling like a fraud.
“Biased practices across institutions routinely stymie the ability of individuals from underrepresented groups to truly thrive. The answer to overcoming imposter syndrome is not to fix individuals but to create an environment that fosters a variety of leadership styles and in which diverse racial, ethnic, and gender identities are seen as just as professional as the current model, which Opie describes as Eurocentric, masculine, and heteronormative.” – Tulshyan and Burey
The student leadership of AMWA agrees but suggests the need, even opportunity, to go further. We see the necessity to recognize sex and gender differences as well as social determinants of health, and variable aspects of healthcare-specific to LGBTQIA people and women, particularly Black, Indigenous, and other people of color, and other cultures, which has been offered intermittently through their Professions of Medicine courses. We feel that diversity issues would be more effectively delivered if woven throughout the entire curriculum, which also needs to be redirected. The current system requires students to learn a “typical” clinical presentation (ie, one that is based on a standard 70 kg white male), and then presume to incorporate other variations of patient presentation, evaluation, and treatment relevant to the patient who may have many other physiological attributes from the so-called norm.
This lack of diversity in standardized patient cases relied on to develop clinical skills limits our ability to learn and deliver quality care. Clearly, the use of more diverse patient models would assure more accurate diagnostic skills and effective evaluation of patient conditions in actual clinical settings. For example, well-known sex differences in the clinical presentation, evaluation, and treatment of acute coronary syndrome.
Founding Dean Hal B. Jenson, MD and senior leadership have supported the establishment of a Cultural Committee, an AMWA branch, a student AMWA branch, AMWA mentoring breakfasts, and a Women In Medicine and Science (WIMS) committee, designed to mirror the WIMS section of the American Association of Medical Colleges. This is in keeping with the WMed Guiding Principles to foster diversity and inclusivity. Dr. Cheryl Dickson serves as the Associate Dean for Health Equity and Community Affairs, and assists with providing guidance for equity in practice and policies. And in 2020, WMed welcomed Dr. Donovan Roy as Assistant Dean for Diversity and Inclusiveness. He provides guidance in identifying diversity and inclusiveness needs for program development.
Given Dr. Jenson’s planned retirement in June of 2021, a national search for his replacement, with extensive input from WMed faculty, resulted in the appointment of Dr. Paula M. Termuhlen who will be one of the 16% of female medical school deans in the US. This is a big step forward for gender diversity. The fact that over 50% of WMed’s student body are women is also noteworthy. Yet the embedded unconscious bias pervasive in this and other countries is still difficult to avoid. While we appreciate our education at WMed and applaud our administration’s efforts toward increased diversity, there is room for further advances so our institution may stand as a model for others to follow.