Elizabeth Blackwell was the first woman to be admitted into a medical school in the United States. The year was 1847, over 80 years after the first U.S. medical school had opened its doors. Since that time, U.S. medical schools have made tremendous progress in the number of female medical students admitted and enrolled. Today women make up 47 percent of medical students and half of bioscience graduate students. In the face of continuing barriers, they are undoubtedly among the most accomplished and important figures in U.S. medicine.

More than a century after Dr. Blackwell’s achievement and despite their increased representation in medicine, only 20 percent of full professors in medical schools are women. Even more astonishingly, only 13 percent of medical school department chairs are women. What accounts for the scarce number of women in leadership roles? More pointedly, why are medical schools unable to recruit and retain women faculty in academic medicine? 

Dr. Linda Boxer, M.D., Ph.D., Vice Dean of the Stanford University School of Medicine (“SoM”), recently addressed these issues head-on at a faculty fellows talk hosted by the Clayman Institute for Gender Research. The talk was widely attended by interested members of Stanford’s medical school community as well as professors and students from other disciplines. Dr. Boxer candidly discussed some of the barriers experienced by women in academic medicine and highlighted how Stanford’s top-rated medical school is proactively addressing the gender gap.

Addressing the issues

Dr. Boxer pointed to a number of cultural factors contributing to the underrepresentation of women leaders in academic medicine. Based on research collected by SoM, female faculty often cited pressure from perceptions of “what it takes” in terms of balancing work and responsibilities for family as consideration for leaving academic medicine. Options such as flexible hours or working part-time are too often viewed as damaging to a woman’s career in academic medicine, and faculty think the institution should continue to do more to foster a culture that supports integrating work and life. Boxer admitted that the “motherhood penalty" continues to play a significant role in this field as it does in other professional careers. Mothers in medicine are often perceived as less committed than men and childless women.

In addition to cultural barriers, there are structural barriers that medical schools can address and that SoM is directly working on. For example, even after the incredibly long training period for both MDs and PhDs, the average work week at the SoM is a demanding 65 hours per week. This makes integrating work and life difficult for both women and men who wish to participate in childrearing or to have a life outside of their professional careers. 

Implementing solutions

Stanford School of Medicine, beyond its position at the cutting edge of modern medicine, is working to be in the vanguard of medical faculty gender issues under the leadership of Dr. Boxer and others. Two years ago the SoM, launched the Academic Biomedical Career Customization (ABCC) program, aimed at redefining the way work and careers are conceptualized in the medical school and increasing flexibility. In her talk, Dr. Boxer shared that SoM has rolled out more new initiatives including trainings aimed at overcoming unconscious bias and the implementation of “diversity dashboards,” in which each department is broken down statistically by gender and ethnicity. Those numbers are provided to the department, which in turn uses the information to develop a diversity initiative each year in collaboration with the SoM Dean’s office. To ensure impact, implementation will be assessed as a part of the department chair’s annual incentive. 

Dr. Boxer also pointed to the growth and nurturing of formal mentoring and networking groups for faculty with children. In response to suggestions that have grown out of these groups, SoM is also working on preemptive strategies to tackle work-life integration issues by providing annual counseling to identify and address concerns. The school is making sure that expectations are clearly and consistently outlined, so that unsustainable work standards become myth and not the standards by which people are judged for reappointment and promotion. 

Growing the vision for all

“We want to help provide positive role models for women,” said Dr. Boxer. “We need female faculty who can openly discuss the need for work flexibility to manage work and life responsibilities.” Being a mother and a leader in her field herself, she intimately understands the necessity of both recruitment and retention strategies. Her willingness to serve as a role model and to openly discuss the issues facing women in academic medicine bodes well for the future of gender diversity. As more organizations adopt initiatives that support work-life integration, restructuring work, and investing in workforce professional development, this benefits all individuals who are thinking about how to manage their careers and family.

Although medicine has come far since the days of Dr. Elizabeth Blackwell, much needs to be done to close the gender gap in academic medicine, and Dr. Linda Boxer is committed to ensuring it happens for the Stanford community.