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Wake-Up Calls for Women’s Equality, from Academic Medicine to Washington

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On Jan. 21, the Women’s March on Washington swathed the U.S. capital in pink, as a crowd of approximately half a million protestors gathered to support a variety of progressive agendas headlined by women’s rights. With several million participants in total at more than 100 sister marches across the U.S. and worldwide on all seven continents, the Women’s March events could represent a change in the tides for the women’s rights movement.

“One of the biggest challenges that we have had in continuing to make progress for women in medicine is convincing women, especially younger women, that there is still a problem,” Sarah Millar, PhD, told me when we met a few days before the Washington march.

Millar, who is the Albert M. Kligman Endowed Professor and vice chair for basic science research in Dermatology at the Perelman School of Medicine at the University of Pennsylvania, realized there was still a need to take action and began actively working more to address barriers to women’s equality in academic medicine just a few years ago. She sees the rising national awareness of women’s contemporary challenges as a larger and louder booming echo of that re-awakening experience. Before then, though she espoused feminist views and mentored younger women from early on in her career, she was heavily focused on pursuing her own research to earn tenure, and spent her personal time on raising her family—not actively working to make the system more equitable.

“But now I’m a full professor, I have tenure, my kids are almost grown up, and so I have time to think about it a little bit,” Millar said.

Today, Feb. 3, is National Women Physician Day—the perfect time to look at the steps Millar has since taken here at Penn Medicine to benefit women physicians and biomedical scientists.

Millar’s List

Beginning in 2012, Millar convened a group of colleagues to meet informally and discuss areas where they felt they could make progress. That meeting occurred in the context of longstanding efforts to address gender equality at the Perelman School and across academic medicine. FOCUS on Health & Leadership for Women (FOCUS) has been an active program at the Perelman School since the 1990s, working to support the advancement and leadership of women in academic medicine and to promote education and research in women’s health and women’s careers.

Medical student classes and doctoral programs in biological sciences today generally include equal numbers of men and women, but as women move up through the ranks in academic medicine, their representation shrinks.

“It’s actually a relatively easy issue to address because there is a pipeline,” Millar said. “You have women getting educated, you have them going to medical school and graduate school, and getting tenure track positions in reasonable numbers. It’s much more feasible to address the issues underlying this imbalance once you recognize their existence.”

So when Millar’s group got together, they brainstormed specific ideas to correct the imbalances and remove remaining barriers to women’s advancement.

They came up with a list: An on-site daycare for the medical campus; greater transparency about faculty salaries and research space allocation; and greater consideration of, and attention to compensate for, unconscious or implicit biases.

Translating the List to Action

Before long, with the support of J. Larry Jameson, MD, PhD, dean of the Perelman School of Medicine and Executive Vice President of the University of Pennsylvania for the Health System, every item on Millar’s group’s list became an action item.

Millar chaired a taskforce to identify a vendor for the childcare center—which was already a part of the school’s strategic plan—working with other faculty and administrators and a consultant to visit and evaluate local centers. The taskforce presented its top-choice vendors to Penn Medicine leadership, and a daycare facility on Penn’s medical campus is projected to open in January 2019, supplementing the existing Penn Children’s Center. The on-site childcare center for Penn Medicine may help female faculty better manage an extra juggling act that could limit some opportunities for professional progress: Studies show that women often have disproportionate family caregiving roles—which might cut into their available time to match male colleagues’ extra hours spent in the office or lab, or networking.

Addressing unconscious biases remains an area of ongoing effort and awareness-raising. Millar said that everyone—men and women—can benefit from taking implicit bias tests created by Harvard researchers who study the phenomenon. Implicit biases are unconscious and can’t be readily eliminated, Millar noted, and they have disproportionate effects on minorities compared to women—but the first step toward correcting them in any context is knowing that they exist and taking deliberate steps to compensate in actions and decisions.

Although she considers herself a lifelong feminist and supporter of women, “I have to remind myself to be aware of implicit bias whenever I’m making a decision,” Millar said. “And I’m making decisions all the time as a vice chair, chairing search committees, being on committees that select prestigious speakers at conferences.”

Millar said that to compensate for her own implicit biases, she often makes a double effort for such decisions, initially listing the names of the people who come to mind first, who are often mostly men, and then making a deliberate second attempt to list qualified women. Often, when she evaluates the combined list, the women are equally as good. She also speaks up on committees when asked to review a list of predominantly or exclusively male names that were submitted for an opportunity. Speaking up is not easy, she said, but she often receives thanks from other women on the committees afterward—something she finds heartening and hopes will lead to more people of all backgrounds speaking up for equality in the future.

Millar’s attention to unconscious biases also extended beyond Penn’s campus to the arena of scientific publications. In 2016, together with Anh Le, DDS, PhD, chair of Oral and Maxillofacial Surgery at Penn’s School of Dental Medicine, Millar co-organized a symposium on gender bias in academic publishing at Penn. Editors from several of the most prestigious journals attended and discussed trends they observed by analyzing their own publications.

“The Symposium raised awareness among the editors and among faculty and trainees here, that gender bias in publishing exists,” Millar said. “I think that for some of the journals, this problem has been acknowledged and is being addressed, and in some it hadn’t been. Our hope and perception was that the Symposium stimulated some of that conversation at the journals.”

Transparency about salaries and space allocation soon came into sharper focus, too. Before Millar and her group sought greater transparency about salaries, they already suspected there was a problem. The Penn Almanac publishes annual aggregate data about salaries that suggested women and men do not receive equal pay for similar faculty responsibilities. “The reasons that are given for that are things like the fact that women don’t have as many honors and awards, or they don’t have as many publications, but those things all feed on one another, right? It’s kind of a negative feedback loop,” Millar said. “So we thought it was important for the School of Medicine to have a bit more transparency with respect to those issues.”

Under the leadership of Eve Higginbotham, SM, MD, vice dean for diversity and inclusion at the Perelman School, the Office of Inclusion and Diversity converted existing data about salaries into a reportable, anonymous form to show trends. Data about research space was also compiled and released.

“At most levels, women’s and men’s salaries appear to be fairly even, but that does break down at the highest end,” Millar said. Similarly, research space allocation turned out to be fairly even except at the full professor level, where women have less space in proportion to their grant funding. But the quality of space may vary and was not taken into account.

“There has been a commitment to continue to analyze these issues,” Millar said.

Millar’s efforts to advance women through this list of action items earned her the 2016 FOCUS Award for the Advancement of Women in Medicine. They illustrate that, after the wake-up call, the next steps toward progress begin with taking action. 

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