Recently the AAMC expanded its public database on faculty compensation to include data from the deans’ suites of medical schools. The AAMC should be applauded for collecting and analyzing these data. Given that schools vary in their revenue sources, levels of clinical integration, range of research intensity, along with the organizational structures of their dean’s offices, interpreting the data is indeed a challenging task. A thoughtful commentary (Gottlieb, Amy S. et al, Equal Pay for Equal Work in the Dean Suite. Academic Medicine DOI: 10.1097/ACM.0000000000005087) notes the biggest reveal: that even when one attempts to compare the salaries of the most similar senior titles, women are paid less than men for what appears to be the same role. The data did not control for time or experience in the role, which could potentially contribute to some difference in pay. However, given the history of gender pay inequity overall, even with more extensive analysis, it is highly likely that these differences would persist.
What is most apparent in these data is the findings that across the three classic missions of a medical school (education, research, and clinical care), women most frequently occupy educational positions, both at the more senior levels and in the roles that relate to students and faculty. The senior research and clinical affairs titles are occupied by men, though there may be more women as associate or assistant deans in these areas which have not been regularly tracked (i.e., associate deans of clinical or basic research, or chief medical officers). So, why are more women in education?
The bias that women advance in education careers appears to occur much earlier than medical school and is both explicit and implicit. During post-secondary education, gender segregation is already apparent, with women more likely to pursue education and healthcare degrees than their male counterparts. In medical schools, there are now a plethora of educational roles, where women have excelled; and our students, trainees, and colleagues benefit from the enormous commitment of women to education. Clinical educator tracks have made academic medicine more appealing to many, including women. In an attempt to address this bias in my own case, I decided to obtain an MBA degree. Although for many years, I had balanced a complex budget, run a practice plan, and/or overseen the research of my department, I recognized that those three letters, MBA, were a better foil to the continued bias that I should pursue educational roles, than were my past experiences. One may see this as an expensive time-consuming response to signal other skills. Yet, the biases that exist within our society, our institutions, and ourselves will continue the occupational segregation in academic medicine and science, if we do not make an intentional effort to call these out and address them. We must begin by assuring women that they have opportunities in any realm: mentoring, sponsoring, supporting, and encouraging them to pursue their strengths and passions. Only then will women rise to the leadership roles where they control resources and implement policies that affect all missions of our academic enterprises, thus ultimately influencing the culture of our long-standing environments.