The other day a colleague asked me how this month’s ECCMID congress on infectious diseases and clinical microbiology in Amsterdam went. By all accounts it was a great success, and I told him as much. But I added that, again this year, only 25% of invited speakers were women. (If you mix in chairpersons of sessions, the number rises to 38%.)

This colleague—who is neither from my hospital nor my city, but is my age and had roughly the same training—offered an explanation. “That’s just because women don’t really want to stay in academic hospitals. They want to work in private practice; they want to work part-time.”

Sigh. Happily, there is yet another piece of evidence now on display to debunk the old platitudes. A few days ago, Lancet published “Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence.” This Oxford and Brandeis group performed a systematic review of 52 studies published between 1985 and 2015 to determine whether there is evidence for eight “main themes” to explain the low numbers of women in academic medicine. Those studies had participants from 13 countries; 39 (75%) of the studies were conducted in the USA and Canada. They were mainly questionnaire surveys (n=29) and cohort studies (n=19), with a few case-control and qualitative studies. And those themes?

1 – Women are less interested in research than men.

This may be one of the most harmful notions, because it lets people and institutions off the hook. There was no consistent evidence for this.

2 – Women lose commitment to research as their education and training progress.

This is tricky, because the word “commitment” could so easily be substituted with the words “the realistic means to perform.” The reality is that as we progress from single life (medical school and PhD programs) to family life, women still take on more of the family and household responsibilities. (Not in all cases, by any means. But old habits die hard.) The balloon is squeezed. Money has to come in, and private practice is probably the easiest source. There was no consistent evidence for this theme.

3 – Participation in research can encourage women into academic medicine.

This was consistently borne out across studies: “Participation in formal research training during medical school and residency was associated with decisions to pursue academic medicine and increased the likelihood of full-time faculty appointments for both genders.” The burden is on us – training programs, medical schools, and academic societies.

4 – Women are interested in teaching more than research.

“Women’s greater preference for teaching rather than research seemed to be consistent over different investigation periods…” This sounds faintly damning (and does not reflect what I see among the young women in my academic center), but the authors add a sizeable caveat: “this might also be a result of a greater flexibility and availability of teaching roles, rather than a lack of interest in research primarily.”

5 – Women lack adequate mentors and role models.

In a majority of studies, fewer women than men had mentors and role models during medical school and residency.

6 – Financial considerations deter women from academic medicine.

Evidence here was highly conflicting. See point 2 above.

7 – Concerns about work-life balance deter women from academic medicine.

The evidence was also not conclusive. It was noted, though, that “although a smaller proportion of women than men prioritized work over personal life, a greater proportion of women than men felt that they had to make a choice between a career in academic medicine and having children.”

8 – Women experience gender discrimination and unconscious bias in medical school and residency.

On this, the evidence was consistent. This should come as no surprise—except of course to those who are harboring the unconscious bias.

And that may be all of us, my colleague and myself included. That bias is deep-rooted. Here it is, in a lovely story told by a professor in another field, which may well have been medicine. Although it opens a whole new subject for future posts, I will close with it here. It may just stay with you:

When my son was three months old, I went out of town for several days to the Academy of Management meeting, which is a major professional conference in my field. My family did not attend; my husband was the child care giver/ child care arranger during that time. Many colleagues knew that I had recently given birth. However, the reactions that I received when people discovered that I was at the conference, alone without my infant, was nothing short of awe and horror. A sample conversation with male colleagues generally went something like this:

Him: “So I hear you had a baby a few months ago. Congratulations! Where is he?”

Me: “He’s at home.”

Him: “Who’s with him?” Mind you, most colleagues know that I am married.

Me: “My husband.”

Him: “Really? Wow.” Speculative silence…

My male colleagues were clearly surprised that I left my infant son to attend the conference and, more significantly, that my husband was “home alone” with the baby. However, they confined their judgments to questioning facial expressions and indiscreet head shakes. With my female colleagues, it was an utterly different story. The following typifies my conversation with women, irrespective of whether or not they were mothers.

Her: “So I hear you had a baby a few months ago. Congratulations! Where is he?”

Me: “He’s at home.”

Her: “Who’s with him?” Again, most colleagues know that I am married.

Me: “My husband.”

Her (in a horrified tone): “Oh my God! You left your baby alone?? Wow? How could you do that?? I could never do that.”

Me: “He’s not alone. He’s with my husband…… who is his dad.”

Her: “I know, but there’s no way I could leave my baby with my husband. I mean, he wouldn’t know what to do. I’d be worried if my baby had enough to eat!” (This statement was always accompanied by a rueful laugh).

Categories: Gender Balance

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