Climbing Through Medicine's Glass Ceiling

Nancy C. Andrews. Courtesy of Children's Hospital Boston

This past fall, I was named the first female dean of Duke's medical school, an event that National Public Radio summed up as: "Andrews Makes History at Duke Med School." Why should the appointment of a woman dean still be big news? Perhaps because, with a few localized exceptions, there has been little change since the 1970s in the barriers to women's full participation in academic medicine.

I happen to believe strongly that diversifying all levels of academic medicine is not only politically correct, it is also the way to make our institutions better. The history of Harvard University, for example, where I spent many years before moving to Duke, is one of gradually increasing diversity. When the university was young, 350 or so years ago, its faculty and students were Puritan men from good local families. Over the centuries, the Harvard community gradually became diversified in terms of geographic origin, religion, socioeconomic background, sex, race, nationality, and other personal characteristics. It has always seemed to me that it was only by choosing to recruit the individual scholars whom it viewed as the best, regardless of such characteristics, rather than limiting itself to a narrow circle of candidates, that Harvard was able to build a world-class faculty and student body worthy of the reputation it now enjoys.

Given that the proportions of men and women in medical school classes have been similar for some time, it seems puzzling that there are not more women in leadership positions in academic medicine. I suspect that some of the reasons for this disparity are the same as those that apply at the entry level for physician-scientists—concerns about balancing work and family, perceptions that women need to be better than men at their professions in order to be considered equal, and a dearth of female role models. But I also believe that if we are to have more female deans, we must be able to envisage female deans.

Recently my husband, our children, and I went to visit a school in North Carolina where Duke staff members had made an appointment for the family of the new dean of the medical school. As we entered the school, its principal vigorously shook my husband's hand and welcomed him, saying, "You must be the man of the moment." Unfortunately, it is quite understandable that it wouldn't have crossed his mind that I might be the "woman of the moment" instead.

The principal had the odds with him. Only fourteen of 124 U.S. medical school deans are women. Deans are often former department chairs, most frequently chairs in internal medicine. But in the U.S., only ten medicine department chairs are women—that pipeline is almost empty. Strikingly, only 9 percent of the chairs of all clinical departments are women, and many schools have no female department chairs at all. Since these leadership positions turn over slowly, the situation will not change anytime soon.

If institutions are to accelerate the emergence of more female deans, then they will need to consider women who have not stepped on every rung of the traditional academic career ladder. Never having served as a division chief or a department chair, I was a somewhat atypical dean candidate. Interestingly, Duke has recently appointed a whole cadre of new deans who have had unusual careers—not only for its medical school, but also for its business school, its law school, and its Nicholas School of the Environment and Earth Sciences. I think that taking a creative view of leadership will enrich academic medicine.

Part of the answer for universities aiming to pursue such benefits is to work harder to identify and recognize women who are leaders. The Rosalind Franklin Society (of which I am a founding member) was recently created to draw attention to leading female scientists, on the premise that "there still exists a prevailing perception that women do not have the same talents and abilities as their male colleagues and that the contributions of women scientists are not as important." The goal of the group, made up of prominent scientists of both sexes, is to ensure that outstanding women are recognized in ways that its namesake, Rosalind Franklin—the British scientist whose work contributed to the understanding of DNA, for which Watson and Crick received the Nobel Prize—was not.

It is also important not to make assumptions about what women will and will not do. After my appointment at Duke was announced, many people told me that they'd assumed I would not be willing to move out of Boston—that I would not leave Harvard, that I would not move my children before they finished high school, that I would not uproot my husband. Obviously, all those assumptions were incorrect. My own choices notwithstanding, however, the "two-body problem"—finding a position for a new appointee's spouse—remains a major obstacle to the recruitment of women in particular and of academic leaders in general. Though Duke found a creative solution in my case, offering a faculty appointment to my husband, many academic institutions do not do as well on this front.

As I look to the future, I wonder what my fifteen-year-old daughter thinks about all the publicity surrounding my new deanship. Until recently, she had been telling people that she was interested in medicine, but she's been uncharacteristically quiet of late. Will she end up being a top clinician, a chief, a chair, or a dean someday? Or will she compare academic medicine with other fields that seem more open to women and decide that it's not the right place for her?

— Andrews, who started work at Duke in October, was formerly dean of Basic Sciences and Graduate Studies at Harvard Medical School. This essay originally appeared, in slightly different form, in The New England Journal of Medicine (vol. 357, no. 19, November 8, 2007).