Poised for Power

By Anne Bennett Swingle | Photographs by Bill Denison

The struggle to reach the top has proven so elusive for women in academic medicine that many abandon the climb. Now, if a group of faculty women has its way, all that will change.

Janice Clements, Susan MacDonald, Cynthia Wolberger and Joan Bathon

Just before noon one day last January, some 40 faculty women gathered around the long table in the School of Medicine's wood-paneled boardroom. They were there for the monthly meeting of the Women's Leadership Council, and on this day, they were going to meet with the very personification of leadership: Dean Edward D. Miller. Cynthia Wolberger, a professor of biophysics and biophysical chemistry, pushed back her chair and stood up. As the council's co-chair, she would make the group's presentation to Miller. "We are here," she began, as the group settled in over lunch, "to initiate a dialogue. We want to explain a problem and come up with solutions."

Wolberger, one of a handful of basic scientists at Hopkins who carries the prestigious title of Howard Hughes Full Investigator, pressed a button on her ultra-slim Mac laptop and the show began. Onto the screen flashed a succession of bar and line graphs highlighting a stunning reality: there had been little change in the percentage of female professors at the School of Medicine in more than 10 years. Women held pitifully few of the School's leadership positions. They were clustered instead at the instructor and assistant professor ranks. Before reaching the point in their careers where they would have to show a body of scholarly work to be promoted to associate and then full professor, floods of them were leaving the institution.

Cynthia Wolberger

A succession of slides laid out approaches to deal with the problem: a faculty task force to gather data on the hiring and promotion of female faculty and pinpoint barriers to advancement; a study of how other institutions have redressed under-representation of women; involvement of top leadership in improving the numbers.

Miller liked it. He is a practical sort who appreciates crisp, clear-cut presentations. The fact that he had brought a top-notch child care center to Hopkins last fall, he said, demonstrated his sensitivity to issues that affect women's careers. He was surprised, he admitted, to see the data and invited Wolberger to make her presentation to the advisory board, an influential group of department directors and deans.

"We are eager to work with you," responded Wolberger. As she brought the meeting to a close, she made one final remark to the dean: "Now we need data to find out where the problems lie and come up with solutions. We hope we can count on your support."

"I'm glad to move forward," Miller said.

In the spring of 1994, an article called "Women in the Promised Land" in this magazine took a look at how women were faring in the once almost-100-percent-male bastion of the faculty of The Johns Hopkins School of Medicine. The article examined salary equity and recruitment and retention numbers and concluded that at 25 percent, women finally were permeating every level of this distinguished body. What's more, the huge Department of Medicine had begun an initiative called the Task Force on Women's Careers in Academic Medicine aimed at addressing issues (the need for mentoring, adjusted schedules to allow for childbearing, etc.) that might be impeding the progress of female faculty. Throughout the School, women slowly were making their way into the senior ranks. Eleven percent of all full professors, in fact, were female. Several, like Janice Clements and Diane Griffin, were running big basic science laboratories while juggling family responsibilities. Most exciting, the very senior administrative post of vice dean for faculty and academic affairs was held by pediatrician Cathy DeAngelis. And for the first time in the School's 100-year history, there was even a female department head, Barbara de Lateur of Rehabilitation Medicine. Today, many of those women have gone on to even greater heights. DeAngelis has moved to Chicago and now is editor of the Journal of the American Medical Association—the first woman to hold that role. Clements has moved into part of DeAngelis' former position and is now the School of Medicine's vice dean for the faculty. And Linda Fried, who in 1996 published in JAMA the results of her work as head of the Department of Medicine's Task Force, has become a national advocate for gender equity at U.S. medical schools.

"Especially with women, someone has to recognize that you're a leader and then give you a hand up." — Janice Clements

And yet, in the eight years since "Women in the Promised Land" appeared, the proportion of female full professors at the School of Medicine has held at around 10 percent. The sole female department head will soon retire, leaving no woman at the helm of any of the School's 27 departments. (Nationally, 9 percent of all medical school department chairs are women.) Meanwhile the Department of Medicine has seen its hard-won gains at the associate professor rank slip away. Even in the basic science departments, where acclaimed researcher Carol Greider now is serving as interim chair of Molecular Biology, women comprise only 22 percent of the faculty and 11 percent of full professors. (Nationwide, half of all Ph.D. candidates in these fields are women.) In sum, despite the fact that throughout the nation, the number of women entering medical school has risen from 23 percent in 1979 to 46 percent this year, women make up just 30 percent of all 1,611 faculty in the School of Medicine's ranks from instructor to professor.

And so, in 2002 gender equity has resurfaced as a key issue here. For now at least, the action is centered in the Women's Leadership Council, a forum established in 1993 by DeAngelis for female full professors and which Clements has expanded to include senior associate professors. The Council numbers some 80 faculty women and includes representation from all the basic science and clinical departments. It represents the new generation of women in academic medicine, poised to step into leadership roles and determined to figure out why more of them aren't advancing to senior ranks when statistics show that female M.D.s are even more likely than men to pursue academic careers. (One recommendation from the American Association of University Professors clearly is aimed at easing pressure nationally for academic women racing the clock to produce a sufficient body of work to be promoted. Late last year, the AAUP advised that all faculty be granted an extra year on the tenure clock after the birth or adoption of a child.)

For Janice Clements the need for more women leaders at the School of Medicine is front and center. When she moved into the dean's office in 1999, a number of things conspired to make it so. MIT had just issued a report admitting it had unintentionally discriminated against female faculty. At Stanford University Medical School, Frances Conley, the first tenured woman neurosurgeon in the country, had published a scathing expose of routine sexual harassment there. And the Provost's Committee on the Status of Women at Johns Hopkins University, which 10 years earlier had found discrepancies in promotion and a 25 percent difference in salary between men and women at the same rank, issued a follow-up report noting little improvement. The report mandated that every division within the University initiate formal interventions.

Then, two years ago, Virginia Valian, a City University of New York psychologist whose studies meticulously document the nature of institutional bias against academic women, lectured at Hopkins. "It was a turning point," recalls Georgia Vogelsang, a professor of oncology and Council member. "It really hammered home the importance of firm data. If we wanted things to change at Hopkins we needed hard evidence."

How do you become a leader? How do you go from toiling in a research laboratory to running it? From being a beginning-level clinician to handing down important decisions from high-level committees? Part of it, says Janice Clements, comes from within. She is a case in point. As a basic scientist, Clements completed two postdocs, one in microbiology, another in virology and neurovirology. She joined the Hopkins faculty in 1978 as an investigator in the retrovirus lab, a big interdisciplinary group studying animal models of AIDS. Fifteen years later, when the head of her lab left and she heard they were recruiting for the position, she approached the dean to ask if she could take over the job. "I didn't have to think for a minute," she says. "It was like, of course I want to do this, this is what I've been working for."

But the path to leadership, Clements adds, is also shaped by others. Early on, she had mentors who read her grants and made sure she was establishing a scientific area of expertise and independence. And she had a role model in established researcher Diane Griffin, who was a few years ahead of her and also had children. "But mainly," Clements emphasizes, "I wouldn't be here if Cathy DeAngelis hadn't identified me as someone with leadership potential. She made sure I was on committees and that I got visibility. I didn't even realize what she was doing at the time. Especially with women, someone has to recognize that you're a leader and then give you a hand up."

Today, Clements continues to run her lab while she's serving as vice dean and interim chair of Comparative Medicine. And yet, she says, even for a woman who is very much at the top of her game, there are still hurdles to mount. "You're fighting to be heard. You're different. The guys get together. They don't mean to exclude you, they just don't mean to include you. When they think of important, powerful people, they're not thinking about you. I go to meetings, and frequently I am the only woman at the table who's not a secretary or administrative assistant."

Toby Gordon says she used to take the moral high ground in such male-dominated situations. "Even though I've always liked sports, I used to be anti-sports talk," admits the vice president of planning and marketing. "I never talked about my kids and I never had pictures in my office." But Gordon, who's also an associate professor of surgery, has changed her strategy and today talks sports or kids whenever it suits. Still, she says, "a certain amount of playing the game helps when you need the attention of leadership. Leadership people are corporate types, and you've got to relate on their terms. You need to think about the culture. Women are the minority culture, and you have to adopt the traits of the majority to advance your cause."

When you talk to Dean Ed Miller about why women aren't more prominently represented at the senior ranks of the School of Medicine—why for instance only one of 28 department heads is a woman—the answers don't seem so simple. Miller says there are too few women to choose from. He needs more associate professors he can tap for leadership positions. High-level search committees require people with rank. "Putting very junior people in important roles just doesn't work," he says. "They have no credibility."

But the dean is quick to point out that the actual decision to hire more junior faculty women who can come up the pipeline doesn't rest with his office. "Let's face it. A lot of this happens at the departmental level," he says. "I don't work at that level. The department chair and the division directors are the people who do the recruiting."

What Miller can do as dean is to make the School of Medicine a desirable workplace for women faculty. And that he is trying to do. He's gone out of his way, for instance, to make certain there is no disparity in salaries or other resources between men and women at the same faculty rank. "In some departments we've had to do an acute fix," he admits. He is also the person who singlehandedly gave the go-ahead for a Hopkins child-care facility, something faculty had been importuning deans to do for close to a decade. Miller was in the top job less than a year when he agreed to establish on-site daycare-largely, he say, because he saw it as a way to help women faculty perform the career and family juggling act. He will be just as quick, he says, to respond to other problem areas for female faculty. "When the Women's Leadership Council reports back with data on the areas where the dean's office can be helpful," Miller affirms, "we'll address those issues."

Another thing Miller says the dean can do is make the point over and over to department heads "that I consider the hiring of female faculty a top priority. It's my intention to keep that issue in front of their faces all the time," he says.

No School of Medicine department has made more of a push to move women forward than the biggest one-Medicine. Eleven years ago, John Stobo, then the department's director, set up a Task Force on Careers for Women in Academic Medicine, with the purpose of retaining and promoting excellent women faculty. Linda Fried, whom Stobo asked to head the task force, remembers making several agreements with him before accepting. "One was that he wouldn't kill the messenger. And I was being told to be a messenger. The other was that he would stand behind whatever he and I agreed needed to be done."

Looking back, Fried says her role with the task force helped her career. "If you can exercise leadership on this issue—which is the most stressful for everybody—you can do it in other areas that aren't this thorny." She maintains, however, that the dean's role is pivotal in promoting the hiring of women. "A simple and essential intervention is to [have him] articulate that this is a problem," Fried says. "The person at the top makes clear to everyone that this issue is important. It creates a sense of legitimacy."

The principal investigator of several huge NIH-funded long-term studies of older adults, Fried sits on University and national committees, is the recipient of an NIH merit award, and last year was elected to the Institute of Medicine. During her tenure as head of the task force, the number of female associate professors in the Department of Medicine increased from three in 1991 to 21 in 1994. And yet today, because of marked attrition at the associate professor level, that number stands at 13.

Gains have proved transient in Medicine. In 1990, 8 percent of the department's associate professors were women. By 1997, that number had climbed to nearly 40 percent. Today, the figure has sunk to 20 percent. Joan Bathon, the associate professor who now heads the task force (as well as co-chairing the Council), believes that somewhere along the way the issue of retaining female faculty took a back seat in the department. "You have to constantly look at the policies and practices that may have gender bias built into them," she says. "And that's the hardest thing to do."

Mike Weisfeldt and Susan MacDonald

Myron (Mike) Weisfeldt, who became director of the Department of Medicine just last July, has taken on that issue as his personal challenge. For him, correcting the department's gender inequity (along with the hiring of minority faculty) is a priority. "I am demanding that every division chief assess every assistant professor—male and female—to see if they are being proposed in a timely fashion for promotion to associate professor," Weisfeldt says. "I will do my own assessment, and I intend to add to that the assessment of Susan MacDonald."

In December, Weisfeldt appointed MacDonald, an associate professor in clinical immunology, associate chair of the department. No one was more surprised than MacDonald herself. "I had no clue," she says, "that I would be named the first woman associate chair in the 113-year history of the department." In her new post, she will oversee quality control in the recruitment and appointment of department faculty. As an active member and past chair of the task force, MacDonald has an abiding interest in eradicating barriers to career advancement for women.

Weisfeldt is sanguine that together the two of them will succeed. "We are going to be a model for success," he says of his department. He even views the fact that female faculty are clustered at the lower ranks as good news. "If 50 percent of the medical house staff and almost 50 percent of assistant professors are women, that means more women will be coming up through the ranks." Five of the last 10 promotions, to full professor, he points out, have been women. And although only one of the department's 13 divisions is headed by a woman, five searches for division chiefs now are either under way or likely. "I would be surprised," Weisfeldt says, "if one appointment were not a woman."

But except for Medicine, no other department has undertaken the organized approach to gender equity. "I didn't do it," says George Dover, director of Pediatrics. "I felt there were enough successful junior women faculty, and if they came along at the same pace as males, then it was all right." Pediatrics has long been a specialty that attracts female physicians, and women now make up 50 percent of Hopkins' pediatric faculty. Four of the department's 12 division chiefs also are women, one of four vice chairs, and 12 of 20 interns. Out of seven promotions to professor of pediatrics last year, five were women. The credit, Dover is quick to assert, is due more to the large numbers of women coming into the field than to his efforts on their behalf.

In his annual state-of-the-department address, Dover benchmarks his goal of evening out the distribution of women faculty at every rank. He'd like to get to the point, he says, where "we're not singling out one subset of faculty. Frankly, there are lots of issues for all faculty now in academic medicine. People feel that they are underpaid, overworked and always being asked to do more. After all," he asks, "doesn't everyone want equity?"

Still, gender equity remains a legitimate issue at Johns Hopkins, Dover concedes. "The data support the fact that we have a long way to go. We've known about this problem for a long time. What bothers me is that more and more women are going into medicine, and if we're not capturing our share here and giving them an environment in which they can prosper, then we can't remain a strong institution."