Promotion of women physicians in academic medicine. Glass ceiling or sticky floor?

OBJECTIVE: To assess possible explanations for the finding that the percentage of women medical school faculty members holding associate or full professor rank remains well below the percentage of men. DESIGN: Cross-sectional survey of physician faculty of US medical schools using the Association of American Medical Colleges (AAMC) database. SUBJECTS: Surveyed were 153 women and 263 men first appointed between 1979 and 1981, matched for institutions of original faculty appointment. MAIN OUTCOME MEASURES: Academic rank achieved, career preparation, academic resources at first appointment, familial responsibilities, and academic productivity. RESULTS: After a mean of 11 years on a medical school faculty, 59% of women compared with 83% of men had achieved associate or full professor rank, and 5% of women compared with 23% of men had achieved full professor rank. Women and men reported similar preparation for an academic career, but women began their careers with fewer academic resources. The number of children was not associated with rank achieved. Women worked about 10% fewer hours per week and had authored fewer publications. After adjustment for productivity factors, women remained less likely to be associate or full professors (adjusted odds ratio [OR] = 0.37; 95% confidence interval [CI], 0.21 to 0.66) or to achieve full professor rank (adjusted OR = 0.27; 95% CI, 0.12 to 0.63). Based on the AAMC database, 50% of both women and men originally appointed as faculty members between 1979 and 1981 had left academic medicine by 1991. CONCLUSION: Women physician medical school faculty are promoted more slowly than men. Gender differences in rank achieved are not explained by productivity or by differential attrition from academic medicine.

Women physicians in dual-physician relationships compared with those in other dual-career relationships.

This study compared the career and domestic responsibilities of women physicians whose domestic partners were physicians (WP-Ps) with those of women physicians whose domestic partners were not physicians (WP-NPs). In 1988 the authors surveyed 602 women physicians in a large midwestern city regarding their career and domestic roles; 390 were physicians in training (students and residents), and 212 were physicians in practice (academic medicine and private practice). Overall, 382 (63%) responded; of the 382, 247 (65%) had domestic partners; of these 247, 91 (37%) were WP-Ps and 156 (63%) were WP-NPs. The WP-Ps were found to be twice as likely as the WP-NPs to interrupt their careers to accommodate their partners' careers. The WP-Ps also assumed significantly more domestic responsibilities and worked fewer hours practicing medicine than did the WP-NPs. The 163 women physicians in training (44-48%-of the WP-Ps and 119-76%-of the WP-NPs) demonstrated a more egalitarian division of labor overall, with no significant differences between the WP-Ps and the WP-NPs. The authors recommend that longitudinal studies be undertaken to determine whether women physicians in training continue this trend as they enter the practice of medicine.

Medical and nursing students' attitudes about AIDS issues.

A 12-item questionnaire was administered in late 1987-early 1988 to 445 medical students, 133 medical school applicants, and 111 nursing students to assess any differences in their attitudes toward medicine-related AIDS issues. These groups were also given a 31-item test of their knowledge of AIDS issues. Significant differences by levels of knowledge were obtained for eight of the 12 attitude items. For example, the more knowledgeable the student, the less likely he or she was to refuse treatment to an AIDS patient, to require mandatory AIDS testing of physicians, or to require medical personnel to wear gloves. The findings strongly suggest that education has an important role in changing attitudes about AIDS in a direction that fosters better health care for AIDS patients.

Knowledge of AIDS among health care students.

To assess the level of understanding about AIDS among future health care professionals, we developed and administered a 31-item test covering five AIDS-related knowledge domains to selected undergraduate students, medical school applicants, medical students and pre-clinical nursing students. The percentage of correct answers ranged from 74% for questions about mechanisms of transmission to 59% for items related to testing and interpretation. Seventy-two percent of questions on clinical illness and disease were answered correctly. The number of questions answered correctly was a function of educational level. The students were generally knowledgeable about the risk factors related to sexual transmission, interpretation of the AIDS antibody test, and symptoms of AIDS. They were less informed about issues related to occupational acquisition of human immunodeficiency virus (HIV) and clinical details. Medical educators need to develop educational programs providing accurate and up-to-date knowledge about this disease.