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Make Way for Women
Despite a founding commitment to gender equity at the school of medicine, delivering on the promise has been a work in progress. Could the summit finally be in sight?
Illustration by Traci DeBarko
History in the Making
The Ladies Who Launched
As the old saying goes, “money talks.” It was 1890. The Johns Hopkins University was 14 years old. In his will, Johns Hopkins had also set aside substantial funds for a hospital and school of medicine. The Johns Hopkins Hospital had opened just a year earlier. All the plans for the medical school were in place. The founding professors had already moved to Baltimore.
And suddenly, the well ran dry. The B&O Railroad stock that had formed the bulk of Mr. Hopkins’ bequest had lost considerable value. The trustees found themselves $500,000 short of the funds they needed to open the medical school. They were desperate and willing to make a deal with anyone.
They didn’t have to look far. Up stepped five women, including four feisty, fearless daughters of the university’s original trustees. (One of the women, Julia Roberts, had not had a father on the university’s board.) They were rich, single, independent and highly educated, and they fervently believed a woman should go anywhere she wanted to go—including medical school. Roberts, Martha Carey Thomas, Mary Gwinn, Elizabeth King and Mary Elizabeth Garrett saw an opening and made university leaders an offer they couldn’t refuse: The women would raise the funds to cover the shortfall, in return for admitting female applicants to the school of medicine.
There were the predictable gasps of horror and teeth-gnashing on the part of many of the male trustees and leadership who, on “moral” grounds, could not abide women studying medicine aside men, if at all.
Then they did what men do in these sorts of circumstances. They made the deal. The Women’s Fund Committee delivered the cash, with the final $300,000-plus coming personally from the account of Mary Elizabeth Garrett. And with that, the Johns Hopkins University School of Medicine was open to women.
What these feminists promoted soon became reality, as opportunity for women paved the way for their achievement. Yes, there were some chuckles at the expense of female medical students at the outset: When one in the first class of three women accepted a marriage proposal from her teacher, it was left to William Osler to inform attendees at a Harvard lecture, “As to the women students, it has been a great success: 33 and 1/3 percent of them were engaged to their professors at the end of the first year.”
But there were far more women who, perhaps begrudgingly, earned the respect of their male peers during the school’s early years. They included:
Florence Rena Sabin (M.D. 1900, Johns Hopkins’ first female full professor, 1917), an anatomist who discovered the modern theory of the workings of the lymphatic system and revolutionized public health. She was named the first female president of the American Association of Anatomists (1924) and was the first woman elected to the National Academy of Sciences in 1925.
Helen Brooke Taussig (M.D. ’27; professor ’59), considered the founder of pediatric cardiology, who developed the “blue baby” operation together with Johns Hopkins surgeon Alfred Blalock and master technician Vivien Thomas. First successfully tried in 1944, it saved the lives of thousands of children born with a congenital heart defect. Along with Blalock, Taussig won the Albert Lasker Award (1954), and she became the first female president of the American Heart Association (1965).
Cardiologist Caroline Bedell Thomas (M.D. ’30; professor ’70), who discovered that the drug sulfanilamide interrupted rheumatic fever’s destructive effect upon the heart. Thomas would become the first female member of the Association of American Physicians.
It was these pioneering women, funders and faculty members alike, who created a legacy found in the works of later Johns Hopkins superstars: Women such as Nobel Prize winner Carol Greider, former National Institutes of Health head Bernadine Healy, MacArthur “Genius Grant” winner Lisa Cooper and former Johns Hopkins Director of Surgery Julie Freischlag.And if that legacy has a motto, it’s simply this: At the Johns Hopkins University School of Medicine, a woman’s “place” is wherever she wants it to be.
On July 1, 2016, internist Redonda G. Miller ’92 (HS, internal medicine, 1996) smashed through the glass ceiling at Johns Hopkins when she became the first woman president of The Johns Hopkins Hospital. The appointment of Miller, an associate professor of medicine at the school of medicine, was hailed by some as the culmination of 40 years of informal and institutional efforts by women faculty members at Johns Hopkins to achieve gender equity in hiring, salaries and promotion.
“I’m very proud to be the first female president,” Miller told The Baltimore Sun, “and it does send a message to other women aspiring to leadership roles.”
Delivering on the promise of gender equity remains a work in progress and an ongoing challenge for Johns Hopkins University School of Medicine leaders: Though many significant gains have been accomplished, the struggle for equal pay, equal promotion and equal recognition for women faculty within the institution continues.
Gaining a Seat at the Table
In 1892, Baltimore’s Mary Elizabeth Garrett, an outspoken suffragette, put up $306,977 of her own money to complete the endowment of the Johns Hopkins University School of Medicine. She was the only daughter and close business adviser of B&O Railroad President John Work Garrett, a founding trustee of The Johns Hopkins University, and she had already given $147,787 to that fund over the preceding two years. Mary Garrett and four female compatriots, including three other daughters of founding trustees, made specific demands in return for their support. Among them were the pointed conditions that women be admitted to the school of medicine “on the same terms as men,” that they “enjoy all the advantages on the same terms as men” and be on equal footing regarding “all prizes, dignities, or honors.”
At the time, the first president of the university, Daniel Coit Gilman, and several of the school of medicine’s founding faculty members were ambivalent about admitting women. William Henry Welch, the school of medicine’s first dean, feared embarrassment at discussing medical matters in front of female students and faculty members. But Welch later changed his view, becoming a staunch advocate of medical coeducation. And Sir William Osler would later write that it had been “a pleasure to be bought.”
And indeed, it seemed that the school, at least by the standards of the times, more than lived up to Garrett’s stipulation. The medical school’s first class included three women. By the turn of the century, the Class of 1900 had 13 female graduates, including the woman who in 1917 would become the school’s first female full professor, anatomist Florence Sabin.
Over time, however, the school’s commitment to female students and to recruiting and promoting women faculty members clearly waned. No class from 1952 to 1969 graduated more than eight women, with that 1969 class having but three. Promotion through the ranks was beyond dismal; it took 42 years for the school to promote a second woman, pediatric cardiologist Helen Taussig, to full professorship in 1959. No woman achieved that distinction in the 1960s.
“In 1984, I became a full professor,” says pediatrician Catherine DeAngelis. “At that point, Hopkins [school of medicine] was 91 years old. You know what number female professor I was? I was only No. 12. That … drove … me … crazy!”
DeAngelis surveyed the landscape and didn’t like the view. The few women faculty members hired were populating “female-friendly” specialties, such as internal medicine, pediatrics and dermatology. Surgery? Forget it. The stereotype insisted women eventually desiring families were unwilling to endure the physical and emotional rigors of the long, grueling training and extensive hours required to enter and succeed in that specialty. Consider these words, uttered matter-of-factly, during a television interview with a longtime Johns Hopkins male surgeon who practiced during DeAngelis’ tenure: “I think [the time demands are] one of the reasons that more women don’t go into surgery; it’s a lifestyle that’s not as compatible with what many women want to do with their time. Men are more likely to accept this sort of unifocal, monotonous existence of being in the hospital and following a surgeon’s way of life.”
DeAngelis sought and found the power to battle this mindset. A former Johns Hopkins pediatric resident (1970), she had returned here in 1978 as chief of the new Division of General Pediatrics and Adolescent Medicine, eventually becoming Pediatrics’ deputy chair. She intimately knew the school’s hiring culture and fiercely advocated for change. By 1990, following a promotion to senior associate dean of faculty and academic affairs, she had personally done the first schoolwide survey that proved salaries for women faculty were 25 percent less than their male counterparts. Among the reasons? In one instance, she says she was told, “a faculty member ‘has a husband who is making a lot of money.’”
Throughout the 1990s, DeAngelis’ push led to reports coming out of several departments, many of which focused on issues of unequal salary, promotion rates and time to promotion. Those reports weren’t just sitting on a shelf either: Her dean’s role (and a promotion to vice dean in 1994) ensured her a seat and a voice on the advisory board of the medical faculty. She also created the Women’s Leadership Council in 1995 to bring in female faculty concerns from across the school of medicine. Time and again, DeAngelis and the council presented sound data to leadership capturing both the problems and, just as importantly, potential solutions.
Most notably, the Department of Medicine, under rheumatologist John Stobo, embarked on a series of comprehensive initiatives aimed at assisting women faculty members. This work, initiated between 1990 and 1995, was analyzed in what became a landmark 1996 JAMA paper by lead author Linda Fried, a Johns Hopkins epidemiologist and geriatrician (and female full professor No. 50).
Fried’s paper meticulously examined which Department of Medicine initiatives were successful, including those aimed at increasing salary equity, providing faculty mentors well-versed in the path to academic promotion and offering a workspace culture that didn’t penalize women (or men) for attending to family needs. Her data-driven, methodologically precise framework helped to set in motion a fundamental change in academic medicine at Johns Hopkins. It showed that the Department of Medicine’s initiatives got results: Between 1990 and 1995, the department experienced a 550 percent increase in women who became associate professors, and an interim survey showed a 183 percent increase in women who expected to be in academic medicine 10 years down the road.
The study confirmed what DeAngelis and her colleagues long believed: In order to succeed, women in medicine needed equal access to the same opportunities as men.
The plethora of data moved the needle. When DeAngelis left Johns Hopkins in 2000 to become editor-in-chief of JAMA, the number of women full professors had climbed to 58, up from 23 just a decade earlier.
Stuck in the Junior Ranks
When molecular virologist Janice Clements, a longtime faculty member (female professor No. 24), took over as the vice dean for faculty in 2000, she recognized that, yes, women faculty members were being recruited, but at numbers still far below both the overall female population of the United States and the percentage of women entering medical school nationwide (45.8 percent in 2000–01).
Even worse, many female faculty members languished in nonleadership roles, with some leaving for better opportunities. In response to the situation, which was also being seen in academic departments outside of medicine, Johns Hopkins University Provost Steven Knapp in 1999 had issued a formal request to all university deans requiring them to establish working groups to recruit more female faculty members at all levels and provide the resources they needed to succeed.
It was a call to action that Clements took to heart upon becoming vice dean.
Gambling that Edward Miller, then a few years into his long term as the school of medicine’s dean and its first CEO, would take action if shown data proving that women lagged behind their male counterparts in salary and promotion, she utilized the Women’s Leadership Council to further her cause.
In 2002, the council issued findings that got the attention of Miller and the school of medicine’s advisory board: Women faculty made up only 11 percent of current full professors and accounted for only one department head. Indeed, there was stagnation occurring; over the previous decade, the percentage of female faculty members remained exactly the same (still 28 percent), and those stuck in the junior ranks as instructors or assistant professors had hardly changed (71 percent of all female faculty).
By 2005, Dean Miller, working with Clements, created the Committee on Faculty Development and Gender. Its role was to look into every nook and cranny of the school’s departments and divisions to expose inequities. Their initial retrospective report, which looked at data from 1994–2004, was deeply concerning. Among the 2005 findings:
- Women faculty members were still paid 6.3 percent less than male peers, with three departments showing double-digit wage gaps.
- 80 percent of women faculty members surveyed felt that, within their own departments, men and women were not treated equally.
- Women were less likely than men to be promoted to a higher professorial rank, and women took longer to be promoted than men.
- 20 percent of women said they had been sexually harassed at work.
The report’s damning conclusion? “Women faculty at all ranks are much more likely than their male colleagues to encounter obstacles to their career success and to their full and equal inclusion in the Hopkins community.”
The report made 13 recommendations involving serious ongoing commitments of money, resources, leadership, time and resolve. These included making the treatment, promotion and retention of women an “essential mission” of the school (comparable to compliance and patient safety); requiring all department directors to rectify salary discrepancies that can’t be justified based on objective criteria; and dedicating “significant financial resources” to the “recruitment, retention and promotion of women to the senior ranks of the faculty.”
“We held Ed’s feet to the fire,” says Clements of the recommendations. “He told me to implement them,” mandating a schoolwide gender equity movement. In this, Miller joined a cadre of senior male faculty members—Myron “Mike” Weisfeldt, George Dover, Richard Ross and Michael Johns—who used their leadership positions over the years to promote gender equity.
Not long after, pediatrician Barbara Fivush (No. 72) approached Clements with an idea to formalize something women had already been doing informally: seek each other out for ideas and support. The Office of Women in Science and Medicine (OWISM) was launched in 2008.
“Women faculty can be siloed here. I didn’t see that initially because pediatrics, my department, was really not this way. We had lots of women faculty, division chiefs and now a department chair [Tina Cheng, No. 138],” says Fivush, division chief of pediatric nephrology from 1993 to 2015. “But when I first joined the Women’s Leadership Council in 2003, I was so shocked and disappointed that we were so separated as women faculty across the school of medicine. We didn’t really know how to communicate with each other and be effective as a networking group.”
OWISM became the programmatic arm of the women’s leadership-building effort at the school. Newsletters celebrated every new hire and promotion of women faculty members, mentors reviewed CVs and offered advice, workshops helped tweak those CVs and other promotion-critical skills, and special longitudinal courses, such as the Leadership Program for Women Faculty, clearly changed career trajectories. In 2018, the new Mary Elizabeth Garrett Executive Leadership program for Women Faculty (MEG ELWF) will launch, putting a small (10 to 12) cohort of women faculty members through a 10-month intensive leadership training.
The impact of these efforts is undeniable, says Fivush: “Many departmental leaders feel that our women faculty members are different now, more confident. They see changes in their leadership potential.”
Little by little, that old (some might say macho) way of faculty life is changing. By FY 2016, women faculty salaries were nearly equal to that of men (a 1.9% difference). Parental leave for a newborn or adoption, which formerly involved a negotiation with one’s department chief, is now automatically granted for any expectant mother (or father) who requests it. Health insurance coverage for IVF procedures is now (as of 2017) offered for female residents and fellows.
Current CEO/Dean Paul Rothman is viewed as championing many of these gender equity efforts. Clements notes, “He’s an incredible supporter who has pushed to hire women in leadership positions,” while Fivush says, “Paul Rothman has really allowed my colleagues and me to do what needs to be done. That’s amazing.”
The efforts of DeAngelis, Clements, Fivush and a host of other leaders who simply wouldn’t accept the status quo is even changing the notion (here and across the country) that “serious” academicians must choose work over family to climb the career ladder. Witness the research of associate professor Rachel Levine, associate vice chair for Women’s Academic Careers in the Department of Medicine. Her work, which has appeared in Journal of Women’s Health, Journal of General Internal Medicine, and Academic Medicine, is showing that faculty members who opt to work less than full time early in their careers can return to full-time work later on and, in some cases, remain on track for academic advancement.
Is there still work to do? Absolutely. Upper leadership positions are still largely male dominated, with only five of 32 departments chaired by women. But those numbers should move, as the lower ranks have swelled with outstanding female faculty.
Women now make up roughly 40 percent of both the combined pool of instructors, assistant, and associate professors, as well as all associate and assistant deans. And when it comes to NIH funding for independent research, a recent Johns Hopkins study, led by endocrinologist and associate professor Rita Rastogi Kalyani and published in the Journal of Women’s Health, found that women faculty in the Department of Medicine here received just as many key career-development K and R01 grants as men.
Today, 125 years after Mary Elizabeth Garrett forced the hand of school of medicine planners, some 251 women faculty can now proudly put “Professor, Johns Hopkins School of Medicine” on their CVs.
Such numbers give many women faculty here encouragement that though there’s work yet to be done in achieving full equity, the summit may finally be in sight.
‘‘In 1984, I became a full professor. At that point, Hopkins was 91 years old. You know what number female professor I was? I was only No. 12. That… drove… me… crazy!”
– Catherine DeAngelis
On the eve of becoming the 11th president of The Johns Hopkins Hospital, Redonda Miller tells what she loves most about Hopkins and what has kept her here.
‘‘I was so shocked and disappointed that we were so separated as women faculty across the school of medicine. We didn’t really know how to communicate with each other and be effective as a networking group.”
– Barbara Fivush