BOSTON -- Child care responsibilities appear to be the major reason why female medical school faculty members often advance more slowly in their careers than their male counterparts. In a study in the Oct. 1 Annals of Internal Medicine, researchers from the Massachusetts General Hospital (MGH) and Boston Medical Center (BMC) report results of a survey of almost 2,000 representative faculty members at 24 US medical schools measuring their career progress, satisfaction and academic productivity. While differences between male and female faculty members without children were slight, women with children published fewer peer-reviewed research studies, reported less career progress and less satisfaction with their careers than did men with children.
"While there have been several studies that have compared the progress of male and female faculty members, this is the first paper to show that children and family specifically have effects on the careers of women in academic medicine," says Phyllis Carr, MD, of the MGH Women's Health Associates, the paper's lead author. She notes that previous studies that focused on women's promotion to associate and full professor showed little effect probably because they controlled for standard measures of academic productivity, such as research grants and publications. "Our results show that those productivity measures are exactly the factors most powerfully impacted by family responsibilities," she says.
"People looking at these issues often consider them just in light of gender," says Robert Friedman, MD, of BMC's Department of Medicine, one of the paper's coauthors. "What this paper points out is the need to take into account each individual's personal life circumstances. In this case, it is the responsibility for the care of children that is the distinguishing issue, not simply whether one is a male or female." Friedman and Carr are co-principal investigators of a larger project -- including this study - to evaluate advancement of women, minorities and primary care physicians in academic medicine. Earlier this month the researchers published a study in the Journal of the American Medical Association showing that minority faculty achieved lower academic ranks than did non-minority faculty with comparable academic achievements.
In the current study, the researchers randomly selected 24 US medical schools and mailed surveys to more than 3,000 male and female faculty members, chosen to be representative by age, gender and medical specialty. Of those, 1,979 completed the 177-item questionnaire, which included demographic information and questions about career goals, ambitions and experiences.
The survey found that women with children reported fewer peer-reviewed publications, slower career advancement and less career satisfaction than did men with children. Women with children also reported receiving less research funding from their institutions and less secretarial support. No significant differences in any of these areas were seen between female and male faculty without children.
Parental status had no major effect on respondents' career aspirations and goals (for example, aspiring to become a full professor or department chair), although men tended to be more ambitious than women overall. The study also asked about responsibilities for other family members -- such as aged parents -- and found that women devoted more time to overall dependent care. But the overwhelming majority of dependent hours (95 percent) were devoted to child care.
Specific obstacles to career advancement for women with children included meetings held before 8 am, after 5 pm or on weekends; lack of on-site child care, emergency leave, or other leave options; and the absence of part-time tenure tracks at their institutions.
"The limitations of the current system mean that academic medical centers are not taking full advantage of the talents and skills of many women," says Carr. "And something that this survey was not able to show us is how many women have decided to leave academic medicine because of their family responsibilities, a number we would expect to be significant."
Friedman adds: "This information can help direct the kinds of actions medical schools and hospitals should take to reduce these very real obstacles that face women with children -- and may also face men with children in future years. Seriously addressing the issue of the glass ceiling takes more than providing opportunities, it also involves dealing with the very real differences in circumstances of individual faculty members."
The study's coauthors are Arlene Ash, PhD, Amy Scaramucci, MPH, and Mark Moskowitz, MD, of Boston Medical Center; Rosalind Barnett, PhD, of Radcliffe College; Laura Szalacha, EDM, of the Harvard Graduate School of Education; and Anita Palepu, MD, MPH, St. Paul's Hospital, Vancouver, Canada. The study was supported by a grant from the Robert Wood Johnson Foundation.
The Massachusetts General Hospital conducts the largest hospital-based research program in the United States, with an annual research budget of more than $200 million. In 1994, the MGH joined with Brigham and Women's Hospital (BWH) to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.
Boston Medical Center is a private, not-for-profit academic medical center affiliated with Boston University School of Medicine (BUSM). Committed to providing high-quality health care to all, Boston Medical Center offers a full spectrum of pediatric and adult care services. BMC and BUSM are partners in the Boston HealthNet, which comprises 12 community health centers.