Women in Medicine and Science: Building an Inclusive Culture

1. Women in Medicine and Science:Building an Inclusive Culture Claire Pomeroy, M.D., M.B.A.Vice Chancellor, Human Health SciencesDean, School of MedicineUniversity of California, Davis Texas Tech University Health Sciences CenterPaul L. Foster School of MedicineDean’s Diversity Seminar SeriesJanuary 15, 2013

2. Number of women leading medical colleges • The percentage of female applicants to U.S. medical colleges increased from less than 10% in 1965 to nearly 50% in 2011. In 2011, what percentage of medical school deans were women? • 10 – 15% • 20 – 25% • 30 – 35% • 40 – 45% • more than 50%

3. Gender gaps in salary • Studies show • Salary gaps exist in private practice but not academia • Gender gaps in salary are shrinking for recently graduated physicians • Gender gaps in salary for NIH grant recipients are eliminated when productivity is taken into account • (a) and (b) • (a), (b) and (c) • None of the above

4. Gender gaps in salary • In 1999, the gap in starting salaries between male and female physicians was $3,600. In 2008, it was • $3,428 • $4,710 • $8,322 • $13,608 • $16,819 • $27,230

5. Definition of equity • The concept of “equity beyond compensation” refers to • Career flexibility policies • Career development opportunities • Institutional culture • Access to resources • (a), (b) and (c) • All of the above

6. Barriers to use of career flexibility policies • UC Davis studied medical faculty’s experience with career-flexibility and family-friendly policies. Which factorsdid faculty identify as barriers to use? • Face-time bias • Job security • Financial impact • Research timelines • Burden on colleagues • Increase in future assignments • (a), (b) and (c) • All of the above

7. Leadership A girl’s dream

8. National challenges Medical schools: The changing demographicsof the next generation Women as a percentageof applicants to U.S. medical schools Women as a percentage of applicants to UC Davis School of Medicine

9. National challenges The “leaky” pipeline 10-year comparisonof women’s representation among full-time U.S. medical school faculty by rank U.S. medical school full-time faculty distributionby rank and gender, 2012 Source: “Women in U.S. Academic Medicine and Science: Statisticsand Benchmarking Report 2011-2012,” Association of American Medical Colleges

10. National challenges “Leaky pipeline” under-representationof women in leadership Source: “Women in U.S. Academic Medicine and Science: Statistics and Benchmarking Report 2011-2012,” Association of American Medical Colleges

11. National challenges Why is the pipeline leaking? • Institutional issues • Recruitment(the comfort zone) • Salary equity • Infrastructure support, e.g., child care, life-maintenanceservices • Role models, especiallyin leadership • “Stretch assignments” • Mentoring • Individual issues • Personal aspirations, expectations • Negotiating skills • Family obligations • Work-life balance • Generational differences • Societal issues • Childhood “gender-based” tracking • Educational opportunitiesin math, science • Gender-based differencesin societal role expectations

12. National challenges U.S. gender-based salary inequities - academia • University of Michigan studyof National Institutes of Healthgrant recipients • Male salary: $200,433 • Female salary: $167,669 • Pay gap $12,001 per year afteradjusting for factors, e.g., specialty,title, productivity, work hours • If women maintained credentialsbut were men, salary wouldincrease $12,194 Jagsi, R., et al., JAMA 307(22):2410-7 (2012)

13. National challenges U.S. gender-based salary inequities – clinical practice • Men’s salaries outpace womenin every specialty • e.g., male gastroenterologists earn$120,000 more per year than women • Male physicians outearn womenby 13% at career outset, increasesto 28% eight years later • 23% gender-based earnings gapfor all physicians; varies by specialty • 10% in family and general practice • 12% in internal medicine • 8% in pediatrics MGMA survey, 2010 Esteves-Sorenson, C., et al., Economics Letters 116:37-41 (2012)

14. National challenges Gender differences in starting salaries • Widening gapin starting salariesfor women • 1999: $3,600 • 2008: $16,819 Lo Sasso, A.T., Richards, M.R., Chiu-Fang Chou & Gerber, S.E., “The $16,819 Pay Gap For Newly Trained Physicians: The Unexplained Trend Of Men Earning More Than Women,” Health Affairs 30:193-201 (2011).

15. National challenges Gender differences in practice styles • Hours worked • Women: 52 hrs/wk;95 patient visits/wk • Men: 59 hrs/wk;110 patient visits/wk • Minutes with patients(primary care) • Women: 17 • Men: 13 AMA report, 2008 Medscape survey, 2011

16. National challenges Salary litigation suit settled for $4.65 million • Ten female professors from University of Medicine andDentistry of New Jersey • Brought in more research fundsthan male colleagues • Male counterparts outpacedin salary, promotions • Average $20,000 gap in faculty salaries across university between women, men with similar credentials • Estimate up to 200 former, current female professors paid lessthan male colleagues • Settled December 2012for $4.65 million Christine Rohowsky-Kochan, left, and Ellen Townes-Anderson, among the ten women professors, The Record, 12/26/2012

17. National challenges Lack of women in societal leadership positions • Women in business • 3.8% of Fortune 500 CEOs • 9% of Fortune 500 CFOs • 17% of 5,000 board positions at Standard & Poor’s 500 companies • Women in government • 17% of U.S. Congress • Women in law • 31% of federalappellate judges • 26% of state court judges • 15% of law firmequity partners

18. National challenges The chore gap • “Second shift” • Organisation for Economic Cooperation and Development study • U.S. men: 2.7 hrs/dayU.S. women: 4+ hrs/day • Work of raising children still falls overwhelmingly to women • “Having children didn’t changemy career goals, but it didimpact the trajectory” • Challenge of dual career families

19. National challenges Unconscious bias • Unconscious bias is social stereotypes about others that individuals form outside of their own conscious awarenessand result in differential perceptions and treatment • Forms barrier to workplace equality despite articulated commitment to increase diversity

20. National challenges Micro-inequities • Ways that individuals are singled out, overlooked, ignored or otherwise discounted based on an unchangeable characteristic, e.g., gender or race • Different gesture, language,treatment, tone of voice • Seemingly small, ephemeral, hard-to-prove events • Often unintentional, frequentlyunrecognized by perpetrator • Occur when people are perceivedto be “different” • Perceptions that cause manifestationsof micro-inequities are deeply rooted, unconscious

21. UC Davis leadership Equity is a core value at UC Davis • Organizational cultureincorporates equity for all • Institutional roadmapemphasizes equity for all • Vision – A healthier worldthrough bold innovation • Mission – Improving livesand transforming health care • Strategic plan – Combiningacademic excellence with apassion for social justice to improve health for all

22. UC Davis leadership Impact of “leveling the playing field” Women Chairs Women Faculty

23. UC Davis culture of equity Actions, priorities promote equity • UC Diversity Pipeline InitiativeLeadership Conference • Annual event encourages UC minoritywomen students underrepresentedin health professions to pursue academiccareers in health sciences • Office of Diversity • Women in Medicine and Health Science group • Latino and African-American welcome dinners • Endowed chairs, professorships focus on diversity • Faculty mentoring program • Underrepresented in medicine faculty mentoring group • Executive Leadership in Academic Medicine program for women • Support for GLEE (LGBT faculty/staff group)

24. UC Davis culture of equity Recruiting equity is the foundation • Faculty search committeesaddress unconscious bias • Assistant Dean of Faculty Diversity advisesleaders of search committees how to conduct adiverse search; identify, avoid unconscious bias • Search committee members use trainingmodules addressing unconscious bias • Initiatives target residents, fellows • Office of Student and Resident Diversityoversees advisory committee to improverecruitment of women, veterans,disabled persons, as well as URMs;increase retention as faculty

25. UC Davis culture of equity Salary equity is just the first step • UC Davis Health System’ssalary “fairness” • Benchmark: AAMCWestern Region salary table • No differences by gender • Importance of “equitybeyond compensation”, e.g. • Career flexibility • Access to resources • Career development andleadership opportunities • Institutional culture

26. UC Davis culture of equity The next step is career flexibility policiesand practices • Expanded leaves for adoption,child bearing, child rearing, elder care • Flexible work hours, alternativework schedules, job sharing • Part-time faculty appointments • Family leaves for illness, disability • Extension of promotion clock,time to achieve tenure; deferralof merit reviews

27. UC Davis culture of equity The next step: Career flexibility policies • Medical faculty’s perspectiveson career flexibility policies • More than 83% of faculty, both sexes, all generations, indicate career flexibility policies help career satisfaction even if policies unused • Knowing policies exist improves satisfaction • Medical faculty’s use of career flexibility policies • Still low use by both sexes • Women use more often than men

28. UC Davis culture of equity The next step: Career flexibility policies • UC Davis medical faculty identifiedbarriers to use of career flexibility, family-friendly policies • Lack of awareness • Financial impact • Job security • Grant/research timelines • Burden on colleagues • Increased future assignments • Fear of repercussions • Appearance of lowercommitment; “face-time bias”

29. UC Davis culture of equity Ensuring equitable access to resources • Research space • Start-up funds • Special assignments • Academic opportunity experiences • Important committee assignments • Mentoring • Career development opportunities • Leadership training

30. Career development Providing tailored career developmentopportunities for women • Building Interdisciplinary ResearchCareers in Women's Health • Dean’s monthly breakfast meetings • Time management workshop • “Work-in-progress” monthly meetings • Interdisciplinary retreats, symposiums • Mentoring Academy • Develop skills to build researchteams, improve networks, leverage interdisciplinary interactions

31. Career development Teaching work-life balance andtime management • Make clear decisionsabout what you will, will not do • Keep track of commitments • Develop home, work lists;update weekly • Create short, strategic daily plan • Identify urgent, important, new tasks • Stay focused • Work on one project at a time; minimize distractions; take advantage of 5, 10, 25 minute units of time • Streamline work processes • Control email – open, immediately handle; delete, file, reply, delegate, next steps to action Susan R. Johnson, MDSusan@SusanRJohnson.com www.thrivingamidstchaos.com

32. Career development “First, have a definite, clear practical ideal;a goal, an objective. Second, have the necessary means to achieve your ends; wisdom, money, materials and methods. Third, adjust all your means to that end.” − Aristotle

33. Career development 10 strategy tips • Do not expect to always get it right • Ask people on the front-linesfor solutions • Identify allies to carry your message • Chart the course by analyzingthe business case • Be willing to say no • Be willing to say yes • Empower diverse teams • Think strategically – not reactively • Live “servant leadership” • Always be true to your organizational core values

34. Leadership training Providing leadership training opportunitiesfor women • Core competencies for leadership • Chart the course – strategic vision,systems thinking • Develop work relationships – understanding,empowering employees • Use broad influence – team building,create trust • Structure the work environment – delegating, empowering, leading change • Inspire commitment – careful listening • Communicate • Self management – time management,work-life balance Hoffmeir, P.A., WELSH Leadership Journal, Summer 2012

35. Leadership training Providing leadership training opportunitiesfor women • UC Davis School of MedicineWomen in Medicine and HealthScience group • New faculty welcome reception,workshops, panel discussions,mentorship program • Hedwig van Ameringen ExecutiveLeadership in Academic MedicineProgram for Women (ELAM) • Association of American Medical Colleges’professional development seminars • Early Career Women Faculty • Mid-Career Women Faculty

36. Leadership Leadership to create an inclusive culture “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” - John Quincy Adams The Sixth President of the United States, 1825-1829

37. UC Davis leadership Creating a welcoming environment • Women in Medicine and HealthScience group • Promotes policies, practices,programs to advance women’sparticipation, success • Provides opportunities for networking, recognition, leadership development • Trains, mentors through workshops,lecture series, panel discussions • Engages group through blogthat highlights accomplishments,creates interactive exchange of ideas • Introduces, welcomes new women facultyat receptions with school leadership • Sponsors leadership panelsfor medical students

38. Empowering women Empowering women to createan inclusive culture • Negotiating skills • Conflict management • Proactively highlight yoursuccesses, self-promotion • Accept “stretch”assignments • Practice persistenceand resilience • Tell your story - The Philadelphia Inquirer, July 2012 • Dr. Jo Buyske, salary negotiationsto become chief of surgery at PennPresbyterian Medical Center • Offered $150,000 less than peerinstitution offered male colleaguefor same position • After salary agreement, prior male chief of surgery still made $125,000 more

39. Empowering women Power of role models • Unable to gain acceptanceto graduate school in physics • Accepted secretarial positionto biochemist at Columbia University’sCollege of Physicians and Surgeonsas entrée into graduate courses;required to learn stenography • Accepted teaching assistantshipin physics at University of Illinois • Only woman among 400 faculty at Collegeof Engineering, first woman since 1917 • Second woman awarded Nobel Prizein Physiology or Medicine (1977) fordevelopment of radioimmunoassay technique Rosalyn Sussman Yalow (1921–2011)

40. UC Davis culture of equity Creating a culture of equity • Education • Rural-PRIME, San Joaquin Valley-PRIME, TEACH-MS train physicians committedto underserved communities • 67% of students are female • 31% of students are URM’s • Summer Institute on Race and Healthprovides community-based experiences that address disparities • Clinical care • Medical Center EHR, PHR include dataon race, ethnicity, primary language,sexual orientation and gender identity • Health Shack provides virtual medicalhome for at-risk, homeless youth • Physicians consult via telemedicineat 100+ sites to reduce geographic disparities

41. UC Davis culture of equity Creating a culture of equity • Research • Mother’s Wisdom Breast Healthprogram for American Indians • Asian American Network for CancerAwareness Research and Training • Center for Reducing Health Disparities study on Latino mental health • Community engagement • English and Spanish mini-medical schools • Students, faculty volunteer at free health clinics for underserved populations

42. UC Davis culture of equity Gender equity as part of a largerculture of equity • Do not “silo” gender equity • Special issues facedby women of color and otherunder-represented groups • Collaborate • Do not compete with othergroups, programs • Men must participatein the change • Equity benefits everyone!

43. UC Davis culture of equity Ensuring equity is a continuous process • Current research (ACE-SloanInnovation Award) addresses • “Face-time” bias in rewardstructure, i.e., compensation plans,academic reviews • Needs of “at risk” groups,i.e., young men, older women • Influence of social determinants,e.g., family structure, salary source,loan repayment culture, sexual orientation

44. Leadership Key steps to building an inclusive culture • “Dare to dream” – aspire to greatness • Embrace core values of social justice and equity • Ensure institutional leaders message the importance of inclusion to achieving excellence and women have a “seat at the table” • Transparency and equity in salaries, other compensation • Ensure equitable access to resources • Career flexibility policies and practices • Career development and leadership training;mentorship programs • Battle “micro-inequities” • Invest in women and programs that benefitwomen, “money talks” • Celebrate women’s successes across the organization • Work for gender equity throughout society

45. Number of women leading medical colleges • The percentage of female applicants to U.S. medical colleges increased from less than 10% in 1965 to nearly 50% in 2011. In 2011, what percentage of medical school deans were women? • 10 – 15% • 20 – 25% • 30 – 35% • 40 – 45% • more than 50%

46. Gender gaps in salary • Studies show • Salary gaps exist in private practice but not academia • Gender gaps in salary are shrinking for recently graduated physicians • Gender gaps in salary for NIH grant recipients are eliminated when productivity is taken into account • (a) and (b) • (a), (b) and (c) • None of the above

47. Gender gaps in salary • In 1999, the gap in starting salaries between male and female physicians was $3,600. In 2008, it was • $3,428 • $4,710 • $8,322 • $13,608 • $16,819 • $27,230

48. Definition of equity • The concept of “equity beyond compensation” refers to • Career flexibility policies • Career development opportunities • Institutional culture • Access to resources • (a), (b) and (c) • All of the above

49. Barriers to use of career flexibility policies • UC Davis studied medical faculty’s experience with career-flexibility and family-friendly policies. Which factorsdid faculty identify as barriers to use? • Face-time bias • Job security • Financial impact • Research timelines • Burden on colleagues • Increase in future assignments • (a), (b) and (c) • All of the above