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[Correspondence] Achieving women's equity in academic medicine: challenging the standards

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Despite extensive work for decades to improve gender equity in academic medicine, women continue to lag behind men in the number of tenure and leadership positions. This status quo hampers access of women faculty to the power and decision-making authority necessary to effect change.

By the 1990s, women accounted for 40% of US medical school enrolment. However, these enrolment increases did not address inequities in the recruitment and advancement of women into faculty ranks. As this Lancet theme issue attests, these inequities are well documented, and progress has been inadequate. In 2004, Columbia University Irving Medical Center (CUIMC) commissioned a taskforce to identify and study issues that women faculty face in its medical college, the Columbia University Vagelos College of Physicians and Surgeons (P&S), and to make recommendations to the Dean of the Faculties of Medicine and Health Sciences to improve equity. This taskforce identified a need for transparency and prioritised monitoring progress of women faculty through the ranks. Several task force suggestions were implemented, including work–life and parental leave policies, provisions to stop the promotion clock and to improve and increase childcare resources, and on-site lactation rooms. Faculty career tracks were also modified to allow greater flexibility between research, teaching, and clinical care. A range of faculty professional development offerings was implemented, with targeted interventions at crucial career points.

The Columbia University Senate Commission on the Status of Women (a permanent commission of the Columbia University Senate Executive Committee) was charged with inquiring into the status, equity, and opportunities available to women at all levels at Columbia University. The Commission sought the assistance of the Office of the Vice Provost for Faculty Affairs, who provided aggregated data on the counts of faculty with full-time salaried appointments within P&S. Data on gender and faculty appointment type were drawn from the centralised Human Resources database and reviewed line by line for accuracy. Additionally, the Commission collated data on leadership: department chairs, divisional chiefs, and centre directors (only centres recognised by the university trustees were included in these analyses). Once collated, these data were submitted to the Office of the Provost for review and confirmation of accuracy. The Commission analysed these annual cross-sectional data on faculty positions by gender for the period between 2007 and 2017, to examine the progress (detailed methodology and data analysis is provided in the appendix).
The findings are shown in the figure (full results are provided in the appendix). Women accounted for 46% of total P&S faculty in 2017, an increase from 40% in 2008. However, these strategies did not result in substantial increases in the number of women faculty in tenured or leadership positions, with women accounting for only 18% of tenured positions, a percentage essentially unchanged over the 10-year period. The overall increase in women faculty over this 10-year period was isolated to the hiring of women to non-tenure track positions. In fact, the percentage of men faculty who are tenured or in a tenure-track position remained stable at 28%, whereas, unfortunately, the comparable percentage of women faculty who are tenured or in a tenure-track position decreased from 16% to 12%. In summary, more than four in five women faculty do not have the job security of tenure or the institutional investment and support that comes with the tenure track.
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FigureTotal faculty by tenure status

Regarding CUIMC leadership, only three (11%) of 27 P&S departments and only two (13%) of 15 centres are led by women, which is less than the national average of 18%.
Association of American Medical CollegesDepartment chairs by department, sex, and race/ethnicity.