Not that Julie Freischlag expected an easy go two years ago when she stepped down as chief of vascular surgery at UCLA to accept what is arguably the world’s most prestigious post in surgery. After all, every one of the five men who’d preceded her as chairman of this Johns Hopkins department had taken the job amid an undercurrent of controversy. But the charge to the search committee that chose Freischlag had been specific: Pick someone who would shake up the status quo. Did they ever.

In the 112 years since the School of Medicine began, Freischlag was only the second woman to reach the level of full professor. To describe her first year here as rocky would be like calling Mt. Everest a hill. “No matter what I did, someone criticized,” she recalls. “I was in the operating room too much, or not enough. I was here too much, I was away too much. Things weren't like they used to be.

“The person who saved me,” Freischlag says, “was Janice Clements, and I'll bet she doesn't even realize it. I went to her and said, I just don't think I fit in. You know what she told me? They hired you to be different. Your job isn't to fit in. Your job is to lead.”

> With fellow dean (of education) David Nichols.

Janice Clements, vice dean for the faculty, director of the Department of Comparative Medicine, head of the 30-member retrovirus laboratory, stands five-feet-four (and a half). Which is surprising, because tiny isn't the impression she leaves. It could be the elegant posture, a legacy of early ballet training. Or the impeccably tailored clothes, neither quiet nor flashy. But the more likely explanation comes from the man who's today at the helm of the National Institutes of Health. During his tenure here as executive vice dean, from 1997 to 2002, Elias Zerhouni was fond of reminding Clements, “Remember what I told you—I just saw leadership stamped across your forehead.”

Written there, above her line of sight, the word has only recently taken hold in Clements' self-image. She didn't set out to influence the make-up of search committees, act as the voice of the faculty in the dean's office, insist that a poorly understood and nearly invisible medical school division be elevated to departmental status. If Clements were limited to a single word to describe her professional life, it would be scientist. It's the goal she set for herself at the age of 10; it's what she'd be happy doing for the next 30 years. And interestingly, that passion may be what first showed Ed Miller that Clements had the tickets to become the next vice dean for the faculty.

In 1999, when Miller, the School of Medicine's dean, set out to pick one full professor to take responsibility for keeping him attuned to issues weighing on the more than 3,000 physicians and basic scientists who make up the full- and part-time medical faculty, he knew he needed someone with unusual leadership skills—and Clements had made an impression on him.

As acting director of comparative medicine, she'd put herself directly in the dean's line of sight. The ill-defined discipline she headed had begun in the 1960s with a scattering of veterinarians who took charge of the animals scientists used in their research. But as animal models of human diseases became the basis for biomedical research, comparative medicine had grown increasingly sophisticated. Now, Clements felt strongly that if Hopkins was to be at the forefront of biomedical discovery, the School needed a state-of-the-art mouse facility to house its tens of thousands of research animals. Furthermore, she didn't hesitate to educate the dean that comparative medicine had acquired all the earmarks of an academic mission and was ready to be made a full-fledged department.

Miller liked the way Clements sized up a situation, giving him a balanced view. He liked the way she combined toughness with respect. “Janice convinced me,” he says, “that comparative medicine has a unique body of information and does research and teaching just like any other department. She wasn't afraid to tell me when I was wrong and what I needed to do.”

And so, in December 1999, Miller announced to the faculty that his new vice dean would be a relative unknown—Janice Clements. If he surprised people who assumed he'd name someone from the clinical ranks, the dean had no doubts he'd made the right choice. “Janice,” he says, “was extremely well respected by every member of the faculty who knew her.”

Her job would be humongous.

Since the School of Medicine opened in the final years of the 19th century, it's adhered to an unwavering standard for recognizing the achievements of its faculty. To be promoted from assistant to associate professor, candidates must achieve a national reputation in their field. Full professors, the academic pinnacle, need an international reputation.

In the past, this kind of widespread recognition could only be attained by publishing work that offered new insights into disease. But today, with financial and regulatory pressures bearing down on medical centers nationwide, faculty face even more overwhelming challenges in trying to scale the academic ladder. As academic physicians struggle to carve out time for scholarly work amid heavier patient-care responsibilities, cumbersome new federal and accrediting rules have emerged that govern everything from patients' safety and privacy to how researchers receiving federal grants account for their time.

These worries plus hundreds of others that crop up daily in the lives of physicians and researchers here are the concerns of one person—the vice dean for the faculty. This senior School of Medicine administrator acts as the sounding board for young doctors trying to rise through the ranks at the same time they care for growing families. She is the advisor to young scientists as they struggle to gain prominence amid a lab of large egos. And it is to her also that chairmen recruiting new faculty come to express concerns about Hopkins ' pay scale. The job requires all the skills of a diplomat, an interpreter, a seer and a navigator.

Clements, 58, grew up on Long Island , the first of four girls born to an Irish mom (“with flaming red hair”) and an Italian dad who started as a delivery boy for a neighborhood grocer after World War II and worked his way up to vice president of the burgeoning company. “He was a bootstrap kind of guy,” Clements says, “and he gave job opportunities to anyone who came in the door. He was always saying, You can do anything you want.”

From her mother, very much a mid-20th-century homemaker who decided there was no reason she couldn't tackle making her own drapes, Clements absorbed the same lesson. Neither parent balked when their oldest daughter bypassed home economics and typing in high school and instead took every science and math class offered.

“I was a little nerdy,” says Clements of her years at Roosevelt High in Yonkers , “the only girl in advanced-placement physics. I knew I didn't want a traditional role. But it wasn't about rebellion. I had a lot of friends; I was editor of the yearbook.”

Her sights on chemical engineering, Clements won a full scholarship to NYU but capitulated when her parents insisted she attend a small Catholic women's college. She graduated with a degree in chemistry, and after earning a Ph.D. in biochemistry at the University of Maryland , arrived at Hopkins in 1974 as a postdoctoral fellow in the Department of Molecular Biology and Genetics.

> A rare moment back in the lab.

Clements soon discovered she'd have her own personal tug of war as a scientist. “I found something very novel,” she says about one of her early experiments. “My boss didn't believe my results. I knew I was right, but I didn't have the confidence to push. He got someone else, another man, to re-do the work; then he believed the outcome. I learned then that I loved science enough to fight for it—nobody was going to separate me from doing my science at the best place.”

In the Department of Neurology, where she was recruited for a second fellowship in 1976, Clements landed on her feet. “Meeting Dick Johnson,” she says, “was magical for me.”

Johnson, who later headed the department for nearly a decade, had assembled an eclectic group of researchers—

including a doctor of veterinary medicine—who each brought a unique perspective to the question that was driving his lab: how viruses interact with cells to cause disease. “We'd jam into my office every Monday morning,” Johnson says, “to talk about our ideas. We relied on each other's expertise. And we enjoyed it.”

For the first time, Clements saw herself as a scientific contributor (“she knew more than I did about molecular biology from day one,” says Johnson). Working with an obscure group of viruses that take a long time to produce disease symptoms, she played a key role in showing that the microbes could mutate within a single host. “That led to my faculty position in Neurology,” Clements says, “and when HIV came along two years later, it was clear that everything we'd been studying really foreshadowed it. We were already saying, This is a very complex disease.”

In 1986, the vet in Johnson's group was given space in another building to work with primates and launch what became the retrovirus lab. Clements went with him to Comparative Medicine. Four years later, she was named a full professor. Only then, no longer concerned that she wouldn't be taken seriously, did she finally put pictures of her children—Elizabeth and Daniel, then 7 and 4—in her office. Clements had reached a perch that only 23 women before her had attained at Johns Hopkins.

Whatever Harvard President Lawrence Summers intended by remarking early this year that “intrinsic aptitude” might explain why there are so few women in the top ranks of science, his comment propelled into the national spotlight a problem that many thought had been pretty much solved.

Over the last two decades, women have achieved increasing prominence on the faculties of U.S. medical schools. In the 15 years since Clements became the medical school's 24th woman promoted to full professor, nearly five times that number have followed her. (Only Harvard, with a faculty total more than twice that of Hopkins , has also passed the 100-women-professor mark.)

Still, by most measures, the rise of women through the ranks has been glacial. Despite a steady increase since the 1960s in the number of female medical students, 70 percent of women faculty remain, as they have for years, clustered at the instructor and assistant professor levels. At the School of Medicine , almost eight times as many men have held the rank of full professor as women.

“It's not about the pipeline,” Clements says, referring to the long-cherished belief that once enough women hold junior faculty positions, their rarity at higher echelons would cease. “It's about having mentors, opportunities, doors opened.”

> Clements with science colleagues (counter-clockwise) Justyn Dudaronek, Susan Follstaedt and Sheila Barber, puts finishing touches on a grant to study HIV treatment. “It’s about having mentors,” she says.

Clements considers the issue a looming crisis that could be the downfall of academic medical centers. Attracting and retaining the best and brightest of a talent pool that is increasingly female, she says, is simply common sense: “ We're here to make this medical school as good as we can make it. Women bring a different perspective. The notion that the female gender had to be included in clinical trials, for example, was put in place only when a woman was at the head of the NIH.”

Still, one visit to Clements' office makes clear that her dedication to supporting the careers of women faculty isn't a bandwagon she's jumped on. It's a mandate as old as the School of Medicine itself. Displayed on her walls are three portraits. Over her desk hangs Jamie Wyeth's painting of Helen Taussig, the pediatric cardiologist whose idea for repairing the heart defect in “blue babies” ended up launching modern cardiac surgery and who, in 1959, became the second woman named a full professor here.

But it's the pictures on the opposite wall that make the strongest point. One is John Singer Sargent's 1904 portrait of Mary Elizabeth Garrett; the other, an 1879 group photograph of Garrett and the four other women whose philanthropy allowed the School of Medicine to open in 1893. Among the non-negotiable stipulations these benefactors insisted on in making their gift was that women be admitted to the school and enjoy its advantages on the same terms as men.

Three years ago, Clements and the Women's Leadership Council—an advocacy organization of senior women here—presented the dean with a decade's worth of data showing only slim change in the percentage of School of Medicine female professors. Miller immediately charged a faculty committee with identifying the roadblocks that stall women's careers. Today, report in hand, the dean's office is committed to the committee's overarching recommendation—that the equal treatment, promotion and retention of women should become an essential mission of the medical school. “Janice has been one of my strongest advisors,” Miller says, “on what we need to do to recruit and keep talented women.”

Yes, says Clements, there's a bit of work ahead to catch up with the 800 or so men here who've earned the right to wear the label professor.

Despite such adamance, Clements doesn't play a one-string bow. “Janice,” says surgery chair Julie Freischlag, “has ears for both men and women.”

Male department heads, such as Peter McDonnell, head the Wilmer Eye Institute, are in fact among her big supporters. “She's interested in seeing my whole faculty flourish,” McDonnell says. “If she just said, I'm going to be the vice dean who gets women their rightful place, there would be people who'd say, Well, what about gays? Under-represented minorities? Are you just waiting for the white guys to fade away? But every time I hear her say, These are the things younger women faculty need to be successful, I feel that they apply to all young faculty.”

Indeed, every change that Clements has championed falls under a single heading—nurturing faculty development. She'd been in the dean's office barely a year when she created a program to ease new faculty gently into the School of Medicine before they had to jump into the fray. Incoming researchers and physicians now have a way to meet colleagues across departments and learn about everything from the oversight of clinical studies to child care options. “One of the biggest issues we face,” Clements says, “is retaining people. Competition from other institutions can be fierce.”

She's also put her weight behind a swath of other initiatives that send the message that Hopkins is a faculty-friendly place. At her urging, the Medical School Council and department chairs crafted guidelines for leaves for new parents. And a small guide she encouraged, called the Silver Book, now outlines for faculty what they need to do to advance up the promotions ladder. Promotions criteria have finally been revised to give assistant and associate professors additional time to move through the ranks to full professor, and excellence in teaching will now receive official recognition.

And yet, this fall, on Nov. 1, it will be a hallowed group of only faculty women who receive special recognition at the School of Medicine . These are the female full professors, the 111 women who have fulfilled Mary Garrett's long-ago vision by achieving the University's most esteemed academic rank. Spearheading the daylong celebration will be the vice dean for faculty affairs—a once-shy postdoc named Janice Clements. Her guest list for the unprecedented event includes the most illustrious female academics and scientists in the nation, with Nobel laureate Linda Buck as the keynote speaker.

“For the longest time,” Clements says, “I didn't see myself as a leader. Now, I love to think about where we could go. It's like coming through the clouds in an airplane—you have a completely different view.”