Women in academic psychiatry

Despite recent gains in admissions to medical school and most specialities, a glance at the list of academic staff of most university departments of psychiatry makes it clear that women are under-represented at senior academic ranks. There is evidence from the USA that although women are now more likely to enter academic medicine than their male counterparts, women are less likely than men to advance to the senior ranks of academic medicine (Nonnemaker, 2000). Killaspy et al (2003, this issue) have examined academic psychiatry in the UK and claim that women are less likely to pursue an academic career in psychiatry and within academia, they are less likely to reach professorial positions the glass ceiling again. Unfortunately, it is impossible to be entirely systematic in a study of this kind in the UK because there is no centrally collected source of the necessary data. Many researchers start as honorary specialist registrars, funded by project grants, and would not have been included in this survey. Some of the data collected does not support Killaspy et al ’s main argument.Women appeared just as likely to obtain Wellcome Trust and Medical Research Council training fellowships in the future, these women could do just as well as men. However, they argue that although there are equal numbers of men and women at specialist registrar level and the gender disparity at consultant level may therefore reduce in the future, this seems less likely in academic psychiatry. Does it matter whether women are underrepresented in academic psychiatry? The profession needs the best people to contribute to our understanding of psychiatric disorders, develop innovative treatments and improve our mental health services. If women are excluded, institutions are drawing on only half of the talent pool and there is therefore a potential loss of intellectual capital. There is also a potential loss of investment. If women are being trained as psychiatrists and junior researchers, it would make sense to ensure a return on such investment.Women may also bring a varied perspective on mental health issues. Why then are women less likely than men to advance to the senior ranks of academia? The research career is based around publishing in refereed journals and raising one’s profile at key conferences, both of which can be heavily compromised by maternity leave or a partner relocating to a new institution or country. Carr et al (1998) reported that women with children had significantly fewer publications and slower self-perceived career progression compared with men with children, whereas there were no significant differences between the sexes for medical academics without children. The short-term contracts also make it difficult for women to sustain a career and manage a family. Mobility is an important element of research training through experience in different units and, although this can be exciting, it can be difficult for women with other responsibilities. Although there is now a greater use of information technology to keep in touch, global travel is still seen as important. The recent Greenfield Report (Greenfield et al, 2002) acknowledges the under-representation of women in the higher echelons of the scientific research community and suggests that causes of this problem include few visible role models and mentors, the short-term contracts used for relatively senior academic positions, lack of transparency for pay and promotion procedures, gender imbalance in the decision-making processes of promotion and organisational policies, slow setting up and take-up of work life-balance policies and, particularly challengingly, the intangible cultural factors that seem to exclude women from the corridors of power. American studies also suggest that sexual harassment and gender discrimination are still common in academic medicine (Carr et al, 2000). Women’s perceptions might also contribute to the problem. The lack of female role models in senior positions might leave women feeling that there is no place for them in academic psychiatry. In addition, women might suspect that maternity leave and/or parttime working would not be looked on favourably by academic institutions. In fact, the main providers of research grants in the UK, for example theWellcomeTrust and the Medical Research Council, are now very flexible about part-time working and maternity leave in an attempt to redress the gender imbalance in academic life. However, there are few part-time jobs in academia and the concept of a senior part-time academic job holds little credibility, despite the fact that all clinical academics are to some extent part-time as they leave their academic Howard Women in academic psychiatry


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. 13One study in fact suggests that women in more recent cohorts are less likely to be promoted to senior positions than women from older cohorts. 4It 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. 2urthermore, 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), 14 although such statistics are indicators of overall academic ability rather than performance in research.
There are important gender-based differences in selfassessed competencies of research knowledge and skills, which are thought to influence women's decisions about applying for promotion. 15Similarly, many women report anecdotally that despite academic and professional accomplishments, they have a persistent sense that somehow they do not deserve their status/position. 16Although such doubts are also found in senior men, they are more common in high-achieving women, 16 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. 17However, 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'. 18In addition, women at all career stages are less likely than men to recommend parenting to their peers, 19 which suggests that academia does not facilitate the balancing of a professional career and family responsibilities. 20e women discriminated against?
Despite large and increasing numbers of women in medical practice, experiences of gender-based discrimination and sexual harassment remain widespread. 21Few 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). 22n 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. 23A 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. 24

Organisational barriers
In addition to experiences of gender-based discrimination, the nature of academic medicine gives rise to organisational barriers to career progression for women, with perhaps the most serious being limited opportunities to work part-time.For instance, fewer than 20 of the 784 tenure track, nontenure track, or Medical Center Line Faculty at Stanford University (USA) have less than full-time schedules. 25urthermore, research shows that significantly more women than men indicate that the inability to work parttime is an obstacle to their career success (22% of women v. 3% of men). 26The same study also highlights other barriers to career progression, such as a lack of on-site childcare provision at work and meetings that are scheduled for evenings or weekends.

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. 27ole models are vital; not only can role models lead by example in terms of work culture and work-life balance, but EDITORIAL Dutta et al Women in academic psychiatry junior women that can see other women in senior posts are encouraged to aspire to the same position. 12omen report greater difficulty than men in finding mentors; 28 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 29 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. 3,30vidence 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. 31It 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. 17

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. 32Women are less likely to obtain research funding, 6 or have high publication records, 9 than men.When women apply for grant money they are just as successful as men, but they are less likely to apply. 33Data 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. 33e 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. 17Instead, women's work-life balance and domestic responsibilities mean that they are more likely to take career breaks and/or work less than fulltime 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. 34The 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 parttime 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. 26n 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. 26et 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 35 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.

Interventions
A number of interventions have been proposed to address the under-representation of women in senior academia and make it easier for women to fulfil their professional potential.These include implementing arrangements for less than full-time working, making promotions criteria and processes explicit and transparent, methods to increase the visibility of female academics and to recognise the impact of career breaks on career development, integrating gender equality into procedures and policies, having a diversity of staff on appointments committees and panels, and provision and monitoring of mentoring. 12Mentoring is defined as 'the process whereby an experienced, empathic individual guides another individual in the development and re-examination of their own ideas, learning, and personal and professional development'. 36Mentoring can make a substantial contribution to an individual's career development in academic medicine, particularly in areas of research, publications and promotion, by providing junior academics with a means to find out more about career management and institutional networking and being aware of what is appropriate to the stage of career progression. 37,38Mentoring has also been recognised as a way to improve the success of those perceived as disadvantaged minorities in clinical academia (women can be considered to be a minority among successful clinical academics), 39 as well as promoting the advancement of a diverse faculty. 40 number of interventions, including mentoring, leadership development, education of faculty about the nature of gender-based obstacles and motivation for change, and academic rewards, were implemented at Johns Hopkins University School of Medicine between 1990 and 1995 to correct gender-based career obstacles reported by women faculty. 41Results showed more junior women being retained and promoted, with a 550% increase in the number of women at the associate professor rank over 5 years.Furthermore, a half to two-thirds of women faculty reported improvements in timeliness of promotions, manifestations of gender bias, access to information needed for faculty development, isolation and salary equity.
A new project, the Women's Advancement Initiative, based at the Institute of Psychiatry, King's College London, has been developed to identify the issues influencing career progression for UK women in academic posts in psychiatry and medicine, and to develop a series of interventions to reduce the gender gap in senior academic roles.Based on the Department of Health report, Women Doctors: Making a Difference, 42 which recommends improved access to mentoring and career advice, as well as the outcome of local focus groups, a pilot scheme offering mentoring to women in academic posts was launched at the Institute of Psychiatry in July 2008.The scheme aims to deliver confidential support and career development (that is separate from appraisal) within a formal mentoring scheme structure in which mentors receive training and support.The scheme has proven popular, with 46 mentoring pairs formed.The scheme will be evaluated at 6 months and again at 12 months after the initial formal mentoring relationships have begun.Our intention is that this pilot will inform a randomised controlled trial of mentoring to be trialled at the Schools of Medicine and Biomedical and Health Sciences, King's College London; to our knowledge, this will be the first randomised controlled trial of mentoring in an educational setting in the UK.

Conclusion
Women are under-represented in senior roles within academic psychiatry.One potential explanation, with some research evidence to support it, is that women lack mentors and networking opportunities compared with their male counterparts.Individual factors such as personality, confidence, perceptions of barriers or opportunities, and sheer persistence and patience will always be important in achieving success, but organisational strategies to improve gender inequality should not be overlooked as important levers for change.The provision of initiatives such as formal mentoring schemes to support women with career progression, coupled with reform to ensure transparency in performance and promotion procedures, underpinned by systematic wide-ranging integration of gender equality into culture, policies and programmes, will be vital for institutions that are serious about equality.