The number of women going into medicine and choosing psychiatry is on the rise. By 2005, approximately 50% of all medical students nationally will be women (1). The percentage of women receiving new certificates from the American Board of Psychiatry and Neurology more than doubled between 1980 and 2000 (2).
The increasing number of women entering psychiatry has positively impacted the presence of women in academic psychiatry. The proportion of women currently acting as full-time psychiatry faculty members at U.S. medical schools is now 37% nationally, and the proportion of women acting as medical school instructors is now 46% (3). The bad news is that women only constitute 29% of associate professors, 15% of full professors, and 6% of medical school psychiatry department Chairs (3). Furthermore, the average annual attrition rate of women psychiatry faculty is 9.5%, as compared to 7.8% for men (3). More women in psychiatry has not translated into more women full professors and deans at the rate one might have expected, suggesting that there is still cause for concern regarding a gender gap in our profession.
Despite this gender gap, women in training largely discount the ongoing disparity between men and women and have little appreciation for the impact of "mental models of gender" (3). I include myself in this group because prior to being asked to edit this special issue, I knew little about the historical and ongoing challenges facing women in our profession. Although I have been blessed with several wonderful male mentors, I had never before experienced the professional advantage that a female mentor can confer. I was given the opportunity to edit this special issue by a remarkably accomplished female psychiatrist, and the experience was intellectually rewarding for me, and it opened my eyes to the importance of women helping women.
Women in power have the ability to create opportunity and advantage for other capable and qualified women coming up through the ranks. A powerful female mentor can provide a qualitatively different experience from that provided by men in power. Just by way of example, we talked about our babies instead of college basketball.
I am not advocating cronyism of a reverse kind, but rather trying to emphasize that women to women relationships combined with knowledge, skill, and hard work, create opportunities for women that are crucial toward their professional development. Women mentors also may change a woman’s internal sense of what she is capable of doing. This special edition of Academic Psychiatry is intended to bring awareness, attention, and coherence to an ongoing and under-recognized issue in our profession.
Dr. Hirshbein’s article "History of Women in Psychiatry" reveals "the more things change, the more they stay the same" (2). Women were originally welcomed into the profession of medicine in the 1800s because it was thought they could provide a more nurturing presence to female patients. In the early 1900s, when medicine became more "scientific," women were largely pushed out of the profession. When the pendulum swung in the 1960s toward a more humanistic and holistic approach to disease, women were encouraged to return, and did so. Clearly other factors have played a role, but as Janet Bickel so eloquently states in her article "Women in Academic Psychiatry": "No matter how complex the technical requirements of a woman’s occupation, Western culture expects her to be more nurturing and emotionally accessible than a man" (3). Hirshbein points out that this bias has both helped and hurt women’s professional development over the centuries.
Janet Bickel’s article is an eye-opening account of the status of women in the field today. She specifically highlights the fact that increasing numbers of women in psychiatry have not mitigated the paucity of women achieving senior ranks or attaining positions of leadership. Less important than overt sexism appears to be the issue of "mental models of gender," and our view of "what a leader looks like." She provides creative and constructive suggestions, such as changing promotion policies to better fit women’s early-career family obligations (3).
The articles by Drs. Bogan and Safer on "Women in Psychiatric Training" (4), by Drs. Jain and Ballamudi on "Women in U.S. Psychiatric Training" (5), and by Dr. Verlander on "Female Physicians: Balancing Career and Family" (6) all highlight the issues of pregnancy, child rearing, and balancing Career and family, both in residency training and early postresidency. Although the response of medical institutions to these concerns has improved over the years, the authors all agree that we have yet a long way to go.
Drs. Hirshbein, Fitzgerald, and Riba (7) perform an interesting small-scale study of the distribution of teaching responsibilities in their department of psychiatry ("Women and Teaching in Academic Psychiatry"), and, contrary to hypothesis, find that women are underrepresented in all areas of didactic teaching. This finding suggests that women are not publicly represented, at least at one institution, as symbols of knowledge and power, thereby perpetuating the inherent and unconscious bias of "what a leader looks like." As Bickel points out, these conceptualizations of leadership are then internalized by women themselves and "translate into a virtual ‘personal glass ceiling‘" (3).
Survey studies by Dr. Garfinkel et al. ("Gender Differences in the Practice Characteristics and Career Satisfaction of Psychiatrists in Ontario") (8) and Dr. Olarte ("Women Psychiatrists: Personal and Professional Choices—A Survey") (9) show that female psychiatrists, and women academic psychiatrists, tend to enjoy their profession. On the other hand, Garfinkel et al. found that women are less likely to publish, be involved in research, or receive pharmaceutical funding than men.
This special issue also includes three very personal perspectives from very remarkable female psychiatrists who are at the peak of or reaching the end of their professional careers. Dr. Juthani’s essay "Challenges Faced by International Women Professionals" (10) emphasizes the challenges and rewards associated with being an international female psychiatrist who obtained her medical degree in India and completed her psychiatric training in the U.S. Dr. Weerasekera’s essay "Swimming Upstream: Reflections of a Career Educator" (11) illustrates the importance of mentoring and support that was critical to her professional success and personal happiness. And Dr. Goodwin’s "Autumn: Thoughts on Commencing a Fourth Decade in Academic Psychiatry" (12) describes a career that went from being told by her Harvard medical school interviewer that she should choose Harvard "so you can marry one of our boys" to being dubbed the "first pregnant full professor." Her incredible journey straddled the age of psychoanalysis and biological remedies, and is full of poetry and the wisdom of a woman who has "seen it all" and can still sit back and laugh and wonder.
I hope you enjoy this collection of manuscripts, and learn from them, as much as I did.
The author would like to thank her Chairman, Dr. Alan Schatzberg, and Dr. Laura Roberts for their unflagging support and guidance over the years.