Thursday, May 10, 2007

A glass ceiling in academic medicine?

Rosie the Riveters of academic medicine: the first women admitted to Harvard Medical School, in 1944. Women limited to 5-10% of the class for decades thereafter. From the Countway Library, HMS.

Medical academic extraordinaire Orah Platt putting a white coat on med student Tara Benjamin in 2001. Women are becoming a majority of entering medical students, but it's not yet clear how quickly the highest ranks of academic medicine will catch up with the lowest. From HMS's Focus newsletter.'s "White Coat Notes" has a brief article about recent adding-up-the-basic-numbers findings, showing a lack of women in leadership positions in medical schools in Boston. A man who has been one of those looking into the problem says, "People might reflexively think that it's discrimination or a glass ceiling, and there may well be an element of that."

Right. There may well be.

Then he says, "It may be in some cases that women choose not even to apply for these positions or don't aspire to them because they are not appealing to women at that stage in life."

So, let's take the second proposition as true, for the sake of argument. Let's say that the medical schools have designed a set of powerful positions that they realize may not be appealing to women. That IS discrimination and a glass ceiling. It's discrimination against women the same way a set of stairs without a ramp is discrimination against wheelchair users. It's a way of saying we don't want you here, we don't want to find a way of getting you to come here, and in fact, we can't even imagine you being here--without actually having to say it to anyone's face.

For my part, I don't think there's really much functional difference between that kind of discrimination and the kind of discrimination that happens when some department chair just plain hates women in some kind of more personal and visceral way.


MAK said...

I have to take issue with the assumption you take arguendo, that a position is not appealing to a woman, but it would be appealing to a man. Isn't it discrimination per se to assume that doctors with an academic interest who happen to be female have a different set of parameters to similarly situated men?

Joe Wright said...

To excerpt (and edit and revise and add to) a longer email:

First there is just blatant “I don’t like women” discrimination, which there’s plenty of, at least one part of it. But I have to say that the part that looks to be affecting my female colleagues’ choices the most pervasively right now is about institutions and the structure of work, at least in medicine. Many high positions in academic medicine (and elsewhere, of course) arrange things so that you basically have to have a wife and nanny at home in order to have a high position within the organization while also having kids, because of the logistical demands of the position. It is a cultural choice that essentially is a tactic to exclude anyone who doesn’t have a wife and a nanny, but wants kids.

Since many fewer women have wives or their equivalents, and many women want kids, this forces many women into a bind: kids or career. It forces men into that bind too, but more men are willing to just say, yeah, so I’ll guess I’ll choose career and let the wife and nanny handle most of the kids part. And I think that a job that is structured this way is structured to discriminate against women. That is, although some women are able to make it work, with stay-at-home spouses/partners, or dedicated nannies, most women can't. So although it's possible to imagine a society where this wouldn't be a form of gender discrimination, in our society it is.

Changing this requires changing the workplace values about family vs work; and/or changing the society’s values about how we share child-rearing responsibilities. Since leaders of academic medicine and other institutions are directly in charge of the first but have much less to do with the second, it seems to me like the first is the area they are responsible for changing.

The larger issue, which I think is just as important, is how institutions think about their role in raising children: that is, if it takes a village, then where does the medical school administrator fit in to the village? In the current arrangement, the administrator says, yeah, so, that village is somewhere in the suburbs and has nothing to do with my job; I have no responsibility to think about whether you can be a good parent while also being in this job. Again this isn't unique to medical schools; it's pervasive in much of the culture to ask people to flexibly squeeze their family lives in between the rigid structures of work, when in fact it is work that probably could be more flexible than family if we wanted it to be.

MAK said...

Yes, the cultural expectations we have of people in the workforce, and physicians especially, is that you can be dedicated to your job/career, or you can be dedicated to your family, but not both. Take this with our ingrained expectation that since women gestate the babies, it is their role to continue being the primary caregiver for the next 20 years, and you have a construct that artificially keeps women from the more demanding jobs.

One place I worked, the senior partner regularly left the office at three, so he wouldn't miss his kids' games. If more Dads were willing to do that, we'd start seeing more gender neutrality in the workplace. He could do it because he owned the business. I feel bad for men who feel like they are not given the choice to do that.

As long as we hold on to the notion that bright people only have something to contribute to leadership positions if they are willing to forsake time with their families, we will skew our institutions toward that kind of person, be they male or female.

When I look at social work, and some of the (traditionally female) lower paid professions, I see a more balance approach. But then, we don't pay people who chose that for their life's work as well, do we?

Good discussion; though provoking post. Thanks.

Joe Wright said...

Thanks for reading, and writing!

A couple of my male professors have done some nice role-modeling:

1. At the beginning of med school, a dean got up to explain what his white coat meant to him (talking about the meaning of the profession), and then said, "And the best thing about it is that it comes off," and then put on his Polartec jacket and explained how it was great for hiking, and talked about the hiking trips he went on with his kids.

2. A mentor of mine interrupted our conversation to take a call from one of his kids, then explained that he was going to have to go in a minute to a soccer practice or something along those lines, and then said: "I only mention it so that you know that this can be a part of life as a doctor."