Ann Thorac Surg 2001;71:S22-S24
© 2001 The Society of Thoracic Surgeons
Training women surgeons and their academic advancement
William A. Baumgartner, MDa,
Elaine E. Tseng, MDa,
Catherine D. DeAngelis, MDa
a The Johns Hopkins Hospital, Baltimore, Maryland, USA
Address reprint requests to Dr Baumgartner, The Johns Hopkins Hospital, 600 N Wolfe St, Blalock 618, Baltimore, MD 21287
e-mail: wbaumgar{at}csurg.jhmj.jhu.edu
Presented at the Women in Thoracic Surgery Symposium, Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31, 2000.
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Abstract
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The responsibility for those of us involved in residency training programs is to foster the development of future leaders in thoracic surgery. Although the actual training of female surgeons is no different than training male surgeons, academic advancement after training can be more difficult for women due to a variety of reasons. The education and training of female surgeons has its origin in admission to medical school followed by recruitment into a residency program. Following completion of a residency program, the retainment of women and men faculty should be the goal of departments and divisions of thoracic surgery. Specific recommendations are made for retainment of faculty. In addition to academic promotion and financial reward, creating the proper environment is an important consideration to allow women the chance to succeed in medicine. This report addresses the training aspects involved in the thoracic residency program and the state of professional academic advancement at the Johns Hopkins University School of Medicine.
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Introduction
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The responsibility for those of us involved in residency training programs is to foster the development of the future leaders in thoracic surgery. Training residents of both genders is one of the most gratifying experiences in academic surgery. Although the actual training of female surgeons is no different than training male surgeons, academic advancement after training can be more difficult for women due to a variety of reasons. This report addresses the training aspects involved in a thoracic residency program and the state of professional academic advancement at the Johns Hopkins University School of Medicine (JHUSOM).
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Recruitment
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The education and training of women surgeons has its origin in medical school. Surgical role models are important to attract both genders of medical students into general surgery and its subspecialties. The 1999 JHUSOM first-year class was represented by 41% women.
There also has been a general rise in percentage and in absolute number of women trainees in the surgical specialties. In 1987–1988, there were 10 women (7%) of 138 surgical residents. In 1998–1999, of 162 surgical residents, 20 (12%) were women. In this most recent group of 20 women, the breakdown by general surgery and subspecialities is as follows: 9 general, 3 orthopedics, 3 otolaryngology, 1 pediatric surgery, 1 oral-maxilo-facial, 1 urology, and 2 plastic. In 1999–2000 a female resident matriculated into our thoracic residency component as part of the integrated surgery/thoracic surgery program.
Although these numbers represent a gain over the past decade, the percentage of women in both general surgery and the subspecialties at the Johns Hopkins Hospital is less than the national averages. The 6% involved in general surgery and the 7% involved in the subspecialities at Johns Hopkins is contrasted with 21% of women in general surgery and 18% of women in subspecialties nationally [1] (Table 1).
Training women surgeons requires an excellent residency program. The fundamentals of a good residency program include always placing the patient first, establishing teaching and education as a priority, respecting the individual, creating a collegial working atmosphere, having an adequate operative volume, and evaluating the resident as well as the faculty [2].
Our own residency program adheres to a set of JHUSOM core values (Table 2). The core value of "foster leadership through education and teaching" is one that should be present in all residency training programs. This commitment is crucial to the initiation and maintenance of a good residency program [3]. Further observations of a good residency program are summarized in two previously published reports [2, 3].
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Retainment
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Retaining women and men faculty should be a goal of all departments and divisions of thoracic surgery. These experienced clinicians often have large practices vital to the success of the clinical enterprise. The percent of women faculty within the JHU Department of Surgery is comparable to the national percentage (10% versus 12%, respectively). Many elements are essential for the retainment of faculty, including academic advancement, financial remuneration, and maintaining a collegial environment. These elements have been addressed at JHUSOM over the past decade.
Catherine DeAngelis, MD, Vice Dean for Academic Affairs and Faculty, provided the first annual report on the status of women at Johns Hopkins University in 1988. Under her leadership and with her enthusiasm and sense of fairness, three initiatives were developed over the ensuing decade. These included the Women’s Leadership Council established in 1993. This organization is composed of all female professors in the School of Medicine and provides a forum for both communication and discussion of important issues affecting all faculty, and in particular women faculty. This Council also provides mentoring programs for women faculty.
Mentoring women faculty is an essential component to their advancement [4]. In 1994, the School of Medicine with the cooperation of all Department Directors achieved salary equity for the entire faculty, and that achievement continues. Finally, in 1995, a school-wide initiative was developed for the annual review of individual faculty by departmental directors. This initiative provides assurance to all faculty that their academic progress will be addressed on a yearly basis.
Probably the most important element for retainment of faculty is academic advancement or promotion. As of 1998–99, 27% of women faculty are Professors or Associate Professors (5% and 22%, respectively) compared with 51% of men (24% and 28%, respectively). The 1986–87 figures showed that 17% (4% Professors and 13% Associate Professors) were women and 47% (16% Professors and 28% Associate Professors) were men. During these past 10 years women faculty have been advancing to the Associate Professor level. We expect that over the next 5–10 years, there will be further advancement to full Professor, similar to that seen with men faculty.
Only recently have women been promoted to higher academic ranks, especially Professors. Of the 58 women who have been promoted to the rank of Professor in the School of Medicine, over the 105-year history, 35 (60%) have been promoted in the past decade (Fig 1).
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Fig 1. Appointment/promotion of female professors at Johns Hopkins School of Medicine since 1883 (n = 58).
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Environment
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Creating an environment for women faculty is an important consideration for women to succeed in medicine [4–6]. The major responsibility for child care has historically been relegated to women. It is important to have a convenient and dependable day care facility on campus. Plans are presently being developed for a facility at Johns Hopkins. Serious consideration should also be given to limiting important departmental functions that occur at breakfast and dinner hours, important times that can be spent with family. Reasonable parental leave policies should be maintained and career advancement should not be limited by pregnancy. Safety issues, especially in the urban academic medical centers, should be a main priority for the institution. Finally, academic functions should not be held on Saturday, reserving that day for spouses and families. These environmental policies should also be applied to men faculty.
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Satisfaction of women surgeons
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Based on a recent study [7], women surgeons, especially those in general surgery, were generally satisfied with their careers and would become physicians again (Table 3). A further conclusion of the article was that correctable factors such as work stress, harassment, and poor control over work environment (predictability of schedule) should be addressed to improve both the recruitment and the retainment of women physicians.
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Summary
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Training women surgeons is similar to training men surgeons. Resident training and education has to be a core value of any residency training program. Candidates should be judged based on quality not gender. A proper working environment should be created to encourage recruitment, retainment, and promotion. Although the percentage of female surgical residents at JHUSOM is below the national average, there are significantly more women residents today than 10 years ago. Initiatives such as the Women’s Leadership Council, department assurance of salary equity, and annual individual faculty review all foster an environment that will allow women to succeed in academic surgery.
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References
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Women in U.S. academic medicine statistics 1998–99. Washington DC: Association of American Medical Colleges, 1999.
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Baumgartner W.A. Retooling thoracic surgery education for the 21st century. Ann Thorac Surg 1998;65:13-16.
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Baumgartner W.A. Reassessing our core values. Ann Thorac Surg 2000;69:321-325.
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DeAngelis C.D. Women in academic medicine: new insights. N Engl J Med 2000;342:426-427.
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DeAngelis C. Women in medicine: fantasies, dreams, myths, and realities. Am J Dis Child 1991;145:49-52.
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DeAngelis C.D., Johns M.E. Promotion of women in academic medicine: shatter the ceilings, polish the floors. JAMA 1995;273:1056-1057.
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Frank E., McMurray J.E., Linzer M., et al. Career satisfaction of US women physicians: results from the Women Physicians’ Health Study. Arch Intern Med 1999;159:1417-1426.
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Abstract
Introduction
