Brea C. Lipe, MD, is a professor of medicine and clinical director of the multiple myeloma program at the James P. Wilmot Cancer Center of the University of Rochester Medical Center in New York.
Some time ago, I was promoted to full professor of medicine. Frankly, I feel like so much of my career has been spent grinding away on the day-to-day that I never entertained aspirations of rank. The small raise accompanying my promotion was nice and tangible, but otherwise I wasn’t sure the new title meant much. A couple of years later, the promotion still hasn’t brought about a plethora of desirable leadership opportunities nor does my word seem to carry more weight or influence. Nevertheless, even though the title hasn’t seemed to change my impact on the world or my navigation within it, I have felt a heightened sense of place and responsibility within academic medicine.
Modern academic medicine is grounded in, and remains influenced by, the Flexner Report, published in 1910.1 The report, commissioned and written by men, was an attempt to understand and improve the quality of medical education. The report embraced a hierarchical structure of education that forced the closure of many medical schools, including those of lower cost or with more permissive entry requirements that allowed women access to medical education. More than 100 years later, the gender bias instilled by the Flexner Report maintains a grip in academic culture.2
The enrollment of women into medical school has increased since 1910 and is now greater than the enrollment of men. However, women remain underrepresented in academic medicine. According to a 2020 report from the Association of American Medical Colleges, women comprise only 25% of faculty positions at the full professor level.3 When considering women from underrepresented groups, including first-generation students and students from low-income backgrounds such as myself, we make up only 2% of academic medical faculty at the level of full professor.4
The reasons for such disparity in female representation are many, but the toxic culture of academic medicine and higher rates of female physician burnout contribute.5,6 I’m not sure I have ever met a female physician who doesn’t have her own stories of gender bias, discrimination, or sexual harassment. Much less common, in my experience, are the women with stories of how they overcame such aggressions while also managing to institute some foundational change that protected future women from recurrent offense. Outside of work, a disproportionate 70% of women are responsible for the care of others, which contributes to burnout and career stagnation or change. Many times, I’ve been told the simultaneous paths of mother and academic physician aren’t available to me, so I must choose one. Indeed, at a college graduation this May, even professional footballer Harrison Butker felt qualified to advise graduates that real women can only make one responsible decision.
The challenges of women in academic medicine and the importance of diversity, equity, and inclusion in the academic workforce are gaining increasing programmatic attention and commitment. Yet, change takes time, and on the individual level, women struggle. So, how did I become part of this 2%?
It seems absurd to think that I have some profound insight to offer the next generation of women — I have no roadmap to follow and still live with my own imposter syndrome. I interact with junior female faculty and remember with humility the dark circles, the yearning, the guilt, and the insecurity during our conversations but also realize that I speak from a different place these days. My hair is grayer, my kids are a little older, but I am among the small percentage of women sitting here and still typing away in an academic career. Maybe profound and life-changing wisdom isn’t as important as the reality that I’m not just here to have words and a voice to use them, but that I have also found satisfaction with my career and joy in my life.
So, my unsolicited advice to the wide-eyed and sleep-deprived generation of women making their way is:
Be kind to yourself. Some days I find infinite patience in dealing with my rambunctious children and am the best mom in the world, have a great connection with a new patient, and complete an outstanding grant application. Other days I binge on sweets, yell at my kids, and put off a difficult patient phone call until tomorrow. I am a work in progress, and I don’t win every day.
Break rules. At one point in my career, I was supposed to “lean in,” then I was supposed to set boundaries and say no. As a woman, I’ve always felt that society had lots of inconsistent rules for me to follow that served to benefit society’s expectations rather than my own needs. I have also found that women often set limits and define rules for themselves to make life simpler. I prefer a messy life. My laundry is rarely folded, my desk is a mess, I don’t have a fancy power outfit that makes me feel strong or look put together. I do have a basement full of orchids that need repotting, dinner reservations with my husband, a ticket for my son to sit with me at the next medical conference, and a lot of crazy stories about the consequences of consistently breaking the rules.
Find your people. We can’t be all things to everyone at all times. We need help, and women should neither be afraid to ask for it nor feel lost as to where to get it. Find practical people who can watch your kids when you have to get up to speak at the podium, honest people who tell you the hard truths with love and compassion, cheerleaders who never doubt your abilities.
Be the person. I don’t have all the answers or a roadmap, but I do know that the path of academic medicine is hard. I also know it’s rewarding and amazing and that there is nothing I would rather be doing, even when it’s hard. I have learned some things along the way, and I am ready and available to help the women coming up behind me.
Brea C. Lipe, MD
Associate Editor
References
- Flexner A. Medical education in the United States and Canada. Science. 1910;32(810):41-50.
- Duffy TP. The Flexner report — 100 years later. Yale J Biol Med. 2011;84(3):269-276.
- Association of American Medical Colleges. The State of Women in Academic Medicine. 2020. Accessed June 10, 2024. https://www.aamc.org/data-reports/faculty-institutions/report/state-women-academic-medicine.
- Center for Women in Academic Medicine and Science. Roadmap for Advancing Gender Equity. Accessed June 10, 2024. https://www.cwams.org/the-challenge.
- Jagsi R, Griffith K, Krenz C, et al. Workplace harassment, cyber incivility, and climate in academic medicine. JAMA. 2023;329(21):1848-1858.
- Lufler RS, McNulty MA. The glass ceiling thickens: the impact of COVID-19 on academic medicine faculty in the United States. Med Educ Online. 2022;27(1).
The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.
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