More women than ever before are becoming physicians, but academic medicine still to a large extent is a man's domain. Even as the ranks of women in junior faculty positions grow, observers say it will take a combination of top-level leadership and females taking stronger rein over their own career development to help women find their place in academic medicine.

"The data shows that if we just rely on natural turnover without changing how we think about leaders and promote diversity it will be another 40 years before 50 percent of department chairs and full professors are women," says Diane Magrane, MD, associate vice president for faculty development and leadership and co-director of the Women in Medicine program at the Association of American Medical Colleges in Washington, DC.

According to the AAMC, as of 2003, women represented 50 percent of first-year medical students, 41 percent of all residents and 30 percent of all faculty members. While these numbers represent gains from even five years before, a glass ceiling still hangs over women's entry into senior leadership positions. In 2003, females represented just 14 percent of full professors and they remained disproportionately in junior ranks, with 70 percent in instructor or assistant professor positions, compared with 47 percent of male faculty. Women accounted for only 10 percent of all department chairs and 10 percent of all medical school deans. At the same time, women leave academia in greater numbers than their male counterparts.

Assessing the Gender Gap

The reasons for the gender gap run the gamut from the biology of childbearing to societal views of leadership. Women who want families have to take time out in the early stages of their careers and in general assume a greater on-going responsibility for child-rearing. "Academic medicine is set-up as a career for someone who has complete support at home and who has complete unfettered devotion to their career development. It rewards people with a narrow, deep focus; not those with broader multi-tasking orientations. Women multi-task better, but men are better at focusing, and the reward structure is all about focusing," contends Ann Brown, MD, associate dean for women in medicine and science at Duke University Medical School in Durham, NC.

Women also are in need of a stronger guiding hand and career advice from both male and female mentors, according to Nanette Wenger, MD, professor of medicine at Emory University and chief of cardiology at Grady Health System in Atlanta. "If you have a good mentor, much of [career advancement] happens. That's a challenge for us all to provide better mentorship," she says. Wenger has been on faculty at Emory since 1958 and has focused particularly on educating and mentoring female students, residents and faculty. She was recognized nationally in this regard as the inaugural recipient of the American Heart Association Women in Cardiology Mentoring Award.

Another factor may be hard-wired notions about the image of leaders. "It's not an overt discrimination, but has more to do with a model of who we think is an ideal leader and how we present positions of opportunity to men and women," suggests Magrane.

Raising the Profile of Women

Given the complexity of the challenge, medical schools are implementing a number of initiatives to raise the profile of women, including extending the timeline for gaining tenure and advancing to full professorship, and exploring policies for part-time faculty. Duke created Brown's position as "an effort to reflect priority on these issues," she says. Among other things she oversees a monthly seminar series designed to educate providers about women's health issues and sponsors a housestaff mentoring program, one-on-one woman-to-woman support for new interns. Some institutions are assigning more women to key administrative activities such as dean and department chair selection committees, while others are factoring diversity initiatives into performance evaluations for senior leaders.

At the macro level, AAMC began benchmarking the status of women in academic medicine in 1998, and through its Women in Medicine program sponsors separate annual career development seminars for early, mid, and advanced career women. Other professional groups also have interest groups and initiatives devoted to women's career development. For instance, the American College of Cardiology Women in Cardiology Committee seeks to encourage more women to enter cardiology and to increase their involvement in ACC committees and task forces.

What Women Can Do

There also are a number of steps women can take to enhance their own careers and help build a climate that encourages other women to pursue and stay in academic medicine.

Focus on the basics. As medical schools continue to evaluate tenure timelines and promotion criteria, women already in academic medicine will do well to keep pursuing career milestones that lead to advancement. For instance, Rinaa Punglia, MD, MPH, instructor in radiation oncology at Harvard Medical School/Dana Farber Cancer Institute is focused on obtaining outside support for her research involving breast cancer. "I was given funding for three years and have one more year to go. I'm learning about grant funding and hope to stay in academic medicine," she reports.

Increase your visibility. Although it takes precious time away from activities more directly associated with promotion, serving on medical school, hospital and professional association committees and task forces will help highlight you as a professional and create other opportunities.

Learn about academic medicine. "People know so little about their career development," observes Brown. Change that paradigm by participating in any faculty or leadership development programs and learning all you can about research administration and the business of practicing medicine.

Seek mentors. Although Wenger is approaching the end of her career and Punglia is just staring out, both cite the importance of having positive role models take an active interest in their professional lives. "It's nice to have female mentors. They're a constant reminder that things are possible, especially those from generations when things were harder. Their perseverance means a lot when you run into obstacles and frustrations," says Punglia.

Collaborate. Whether it's through joint research, professional associations or administrative activities, invest in developing a professional network. Through the years, Wenger has found those personal connections to be "invaluable," she says. "When you're on a first-name basis with faculty you can do things together over lunch that are probably more binding than a 20 page contract."

These efforts combined with top-level guidance can move the day closer when academic medicine fully embraces women leaders.