Is it a question of time?

The absence of women in senior roles has been explained as a consequence of women's historical under-representation at undergraduate level, and that over time, with more women entering medical school, this would likely correct itself. However, as yet there is no good evidence for this. Despite the steady increase in the number of female medical school graduates in both the USA and the UK in the past four decades, there has been no substantial increase in the numbers of women in senior roles. ^{Reference Nonnemaker13} One study in fact suggests that women in more recent cohorts are less likely to be promoted to senior positions than women from older cohorts. ^{Reference Nonnemaker4} It is possible, however, that this could be a consequence of insufficient follow-up time of more recent cohorts. Alternative career patterns, where women resume full-time academic research after completing their family, mean that many may not attain a professorial role until they are considerably older than men.

Are women inferior academically?

One possible hypothesis is that there are fewer women in senior positions in academic psychiatry because they do not perform as well as men either at medical school or at a postgraduate level. However, there is considerable evidence to the contrary; more women than men undertake intercalated degrees and women often gain a higher intercalated degree classification than their male counterparts in degrees with a substantial research component. ² Furthermore, there is evidence that pass rates for the MRCPsych examination are higher for women than men (51.9% for part I v. 39.8% for men and 54.0% for part II v. 45.1% for men), ^{Reference Oyebode and Furlong14} although such statistics are indicators of overall academic ability rather than performance in research.

There are important gender-based differences in self-assessed competencies of research knowledge and skills, which are thought to influence women's decisions about applying for promotion. ^{Reference Bakken, Sheridan and Carnes15} Similarly, many women report anecdotally that despite academic and professional accomplishments, they have a persistent sense that somehow they do not deserve their status/position. ^{Reference Clance and Imes16} Although such doubts are also found in senior men, they are more common in high-achieving women, ^{Reference Clance and Imes16} and if persistently held, such beliefs are likely to impede further career progression.

Are women less ambitious?

Gender stereotypes, such as that women are less ambitious or career-minded than men, have been used to explain women's lack of career progression. ^{Reference Todd and Bird17} However, the rise in the number of young women in medical schools points to early ambition and there is a lack of evidence to support or refute an assumption of less ambition in later years. Evidence does show that female academics have more concerns about potential conflict between being a parent and having a career, and often suffer ‘role strain’, or ‘a divided or uncertain sense of identity experienced many times at all stages of their professional career’. ^{Reference Symonds18} In addition, women at all career stages are less likely than men to recommend parenting to their peers, ^{Reference Cujec, Oancia, Bohm and Johnson19} which suggests that academia does not facilitate the balancing of a professional career and family responsibilities. ^{Reference Palepu and Herbert20}

Are women discriminated against?

Despite large and increasing numbers of women in medical practice, experiences of gender-based discrimination and sexual harassment remain widespread. ^{Reference Frank, Brogan and Schiffman21} Few studies have examined gender discrimination and sexual harassment among academic medical faculty, and those that have tend to have been based on small samples or populations at only one site or in one discipline. In a national survey in the USA of 24 randomly selected medical schools, 77% of women faculty reported gender-based discrimination (defined as gender-based behaviours, policies and actions that adversely affect work by leading to disparate treatment or creation of an intimidating environment) and harassment (covering a spectrum from generalised sexist remarks and behaviours to coercive sexual advances, and from unconscious patronisation and subtle innuendo to blatant sexual threats). ^{Reference Carr, Ash, Friedman, Szalacha, Barnett and Palepu22}

In relation to promotion, women are promoted more slowly than men and are less likely to achieve a professorial position even when the amount of time they have spent on the medical school faculty is taken into account. ^{Reference Tesch, Wood, Helwig and Nattinger23} A study of National Health Service hospitals in Scotland found that even after part-time working, years since graduation and all other covariates are controlled for, women are less likely to be promoted than men as hospital consultants. ^{Reference Mavromaras and Scott24}

Lack of networking opportunities, role models and mentors

Compared with their male colleagues, women experience reduced access to informal networks, possibly owing to the time commitment required for effective networking. They suffer from reduced access to information, particularly that supplied by ‘the grapevine’, and thus miss out on information relevant to career advancement such as advice on applying for research grants and promotion procedures. ^{Reference Gardiner, Tiggemann, Kearns and Marshall27}

Role models are vital; not only can role models lead by example in terms of work culture and work-life balance, but junior women that can see other women in senior posts are encouraged to aspire to the same position. ¹²

Women report greater difficulty than men in finding mentors; ^{Reference Sambunjak, Straus and Marusic28} this may be because there are still so few senior women with whom they can engage. In a study of cross-gender and same-gender mentoring relationships, Ragins et al ^{Reference Ragins and McFarlin29} found that compared with other gender combinations, female mentees with female mentors were more likely to agree with the idea that their mentor served a role-modelling function. Some women feel that advice or mentoring from male colleagues is less applicable because they lack experience with career-oriented women and/or find it easier to relate to women in social roles rather than professional roles. ^{Reference Bickel3,Reference Brown, Swinyard and Ogle30}

Evidence shows that women with mentors report more publications and more time spent on research activity than those without mentors, and women with a role model reported higher overall career satisfaction. ^{Reference Levinson, Kaufman, Clark and Tolle31} It has been argued that women's chances of promotion would be improved if they could access mentors, role models and networks for information and support. ^{Reference Todd and Bird17}

Measures of success and productivity

Promotion criteria used in universities traditionally require academic productivity in the shape of research, the amount of grant funding and number of publications. This acts as a barrier to women as they tend to have higher lecturing, administration, and pastoral workloads when compared with their male counterparts. ^{Reference Bagilhole32} Women are less likely to obtain research funding, ^{Reference Blake6} or have high publication records, ^{Reference Levey, Gentile and Jolly9} than men. When women apply for grant money they are just as successful as men, but they are less likely to apply. ^{Reference Blake and LaValle33} Data from a survey of 3090 academic staff drawn from higher education institutions in the UK shows that grant applications are lower among female academics with dependent children; only 50% applied for grants v. 62% of men with families. ^{Reference Blake and LaValle33}

The impact of career breaks and part-time working

Todd & Bird recognise that women's academic career patterns do not fit the traditional model of academia, in which there is a high productivity at the start of one's career and a slower pace later. ^{Reference Todd and Bird17} Instead, women's work-life balance and domestic responsibilities mean that they are more likely to take career breaks and/or work less than full-time in their early years while establishing their families, with productivity then increasing after these early years. Therefore early research output can be heavily compromised by maternity leave, ongoing responsibilities of childcare and household tasks. ^{Reference Howard34} The Women in Academic Medicine report ¹² found that 58% of female respondents had taken a career break compared with 10% of males, and that since their first appointment in medicine, 38% of female respondents but only 6% of male respondents had periods of working less than full time. It is not clear whether, when assessing academics' performance, particularly in the current economic climate, the rate of outputs, in terms of grants and publications, is adjusted appropriately to account for part-time working and for career breaks.

Experiences outside work

Research shows that the family situations and experiences outside work differ for men and women, and that this may have an impact on women's positions within academic departments. Data collected by Shollen et al from the University of Minnesota Medical School reveal a striking difference between men and women in the number of hours spent on family and household responsibilities per week, with women reporting spending an average of 31 hours per week on these tasks and men spending 19 hours per week. ^{Reference Shollen, Bland, Finstad and Taylor26} In addition, women are less likely to have a partner who is either part-time employed or not employed outside the home (only 12% of women v. 59% of men) and are therefore less likely to have help from their partner with family and household responsibilities. ^{Reference Shollen, Bland, Finstad and Taylor26}

Yet the impact of a family on work does not have to be negative. Outside help can be sought for household chores and emotional relationships with children and family can be very supportive and help with keeping a sense of perspective. A study reported in the Conference Proceedings of British Psychological Society by Beninger ^{Reference Beninger35} compared the challenges faced by 60 women academics from the UK, Australia and the USA in balancing work and non-work responsibilities. The more desirable work-life balance promoted by institutional and governmental policies in Australia was found to reduce stress and minimise guilt among academic women, specifically with respect to childcare.