Women are seriously underrepresented in leadership positions in academic medicine, despite increasing numbers (1). In 2003, more than 50% of applicants to medical school were women, yet they represent only 14% of all full professors, 10% of all department chairs, and 10% of medical school deans. Of all faculty, males represent 21% of full professors, whereas only 3% are women (2). These percentages are an improvement over American Association of Medical Colleges’ 1998 data. These are the ranks from which leadership positions are often drawn. In recent years, investigators have identified several factors that may affect women’s progress in academia. These include constraints on traditional gender roles, sexism in the workplace and lack of effective mentors (1–4).
Psychiatry lags behind other disciplines. In 2002, 11% of all female faculty and 31% of all male faculty were professors, but in psychiatry only 8% of women were full professors compared to 26% of men (5). In 2002, 214 (8%) of all medical school chairs were women, but only eight (6%) psychiatry chairs were women. In 2005, this number for psychiatry was 10.
An academic chair today must possess not only high academic qualifications, but excellent administrative (including interpersonal) skills and financial know-how (6). Psychiatry departments throughout the country experience a decrease in funding, problems with academic faculty retention and recruitment, and a dearth of physician scientists. A chair’s job today is far more complex than it was 20 years ago. Women psychiatrists at all stages of training have expressed that special consideration in terms of career advancement, as well as effective mentoring, is needed during the early years when women juggle career and family (4, 5, 7). Juggling additional administrative duties may be difficult without clear guidance and role models.
Though there are many associate chairs, vice chairs and associate deans, there are few women deans and only 10 psychiatry chairs; thus, women in psychiatry departments have even fewer women administrative role models. It is unclear if the lower number of chairs in psychiatry can be attributed to traditional barriers for women leaders or to additional barriers that exist to prevent women from becoming chairs in spite of possessing the necessary skills. For example, are qualified women applying for chair positions and not being selected, or is the perceived lack of skills preventing women from applying? The even more probing question is, are women even thinking of becoming chairs?
Before some of these questions can be studied and answered, I will examine the 10 departments that have women chairs and the experiences of these women on their journeys to becoming a chair.
I e-mailed all women chairs in psychiatry, asking them to share their personal experiences as chair. Seven of 10 women chairs agreed. As I was specifically interested in examining personality or environmental characteristics that separate women chairs from women in other leadership positions, a similar invitation was extended to a few other female academics. I also wanted to have a male perspective of chairship and leadership, and I extended personal invitations to colleagues and mentors in the field of academia. These included associate deans, deans, and other administrative leaders. Each individual was assured of anonymity and interviews were semi-structured. Each individual was asked to describe her present position, the role of her mentors, her own sense of her strengths and weaknesses, her work setting, work unit structure, and coping strategies. On average, interviews lasted for about 30 minutes. Appendix 1 lists the questions that I asked.
Descriptive Characteristics of the Women Chairs and Their Departments
The chairs interviewed have been in their positions for 3 to 10 years. About 50% serve in public universities and 50% work in private schools. All but two departments have a residency program. Most departments do not have research as a main component of the department and are considered small departments. Almost all of the chairs were recruited internally after having served as vice chairs, associate chairs, or residency directors. The majority of chairs spend more than 50% of their time in administration, and the remaining time is distributed between clinical and educational activities. Only a few spend a percentage of their time in funded research activities. None of them had any prior business training, although most participated in a short executive leadership program after they were offered or assumed the position.
Reflections on Being a Chair
Most women chairs reported that after an initial difficult transitional period, they had no difficulty in establishing their authority. This experience is consistent with other women leaders I interviewed. Male leaders I interviewed did not describe this initial transitional difficulty. When compared to other women leaders, chairs did not identify gender as either positively or negatively playing a role in their getting the position or their ability to function as a chair. Almost all women chairs did not plan to be chairs or have an administrative career. According to them, “It just happened.” A few, once they were vice chairs, did express a desire to be chair. Again, this career track is consistent with all women leaders, whereas most men I interviewed decided on a leadership role much earlier in their career. When asked about the level of stress, most women in positions as chairs, deans, and CEOs experienced less stress compared to when they were in positions as associate deans, vice chairs, or residency directors. Although seemingly counterintuitive, this finding is understandable. In their current positions, these women have a greater sense of control over their professional lives and, thus, feel less stress.
When reflecting on their role, many women chairs expressed a sense of aloneness as a chair. Although most sought counsel from department members, deans or mentors, few felt a sense of camaraderie with other chairs in the school or with other chairs in psychiatry.
Strengths and Weaknesses as Chair
When women chairs are asked about their strengths and weaknesses, interesting patterns emerge. The majority of women (chairs and nonchairs) I interviewed listed their strengths in terms of the relational aspects of the position. For example, “Know how to deal with people,” “Intuitive,” “Caring,” “Know how to listen.” Most described their weaknesses as lack of financial knowledge or inability to do fundraising. Some also felt that they were overcommitted. Men I interviewed described their strengths in terms of abilities, “Knowledgeable,” “Intelligent,” “Confident, skilled at the job” as well as the relational aspects, such as “Good listener” and “Know people.” Interestingly, male leaders credited women role models as being influential in the development of their interpersonal skills.
Not all of the men and women I interviewed identified mentors as playing a significant role in their career development. Women chairs had both men and women as mentors, who were either chairs or deans of the medical centers. For many, mentors still served as sounding boards or individuals they sought when counsel was needed. Those who did seek counsel found mentors to be crucial to their development. Even those who did not have an identified mentor recognized the influence that many role models have on their career development. A couple of women chairs also identified the American Association of Chairs of Departments of Psychiatry (AACDP) as a source for advice.
The observations above are exactly that—observations. This was not a formal research study and, therefore, these reflections and observations are not generalized. The interviews were either face-to-face or over the telephone, and most individuals did not know me well. It is, therefore, understandable that some people were less than fully candid about their experiences and opinions. Formal research is needed to draw any specific conclusion that can be generalized to women chairs as a group. Nevertheless, it is apparent that women in chair positions come from smaller schools and departments, have clinical and educational backgrounds, have fewer grants than their male counterparts, and are more likely to be recruited from within. These women have the same comfort level in their positions as their male colleagues, do not experience their gender as a hindrance in their careers, and have benefited from formal and informal mentoring. One of the important findings is these women initially did not aspire to be chair, but their skills, abilities, and chance led them to their position. However, they did not acknowledge competence as a strength, but attributed traditional female characteristics as their strengths.
Another interesting observation is the lack of researchers among the women chairs. This may be attributed to the fact that most of the women researchers work in larger departments where it may be much more difficult for women to become chair. It is also possible that women researchers do not have an interest in administrative positions.
To increase the number of women chairs, it is important that leadership programs be instituted early, especially during residency, and that women be encouraged to aspire to leadership positions early in their careers.
Organizations, such as the AACDP, need to take a more active role in encouraging their members to identify female faculty with leadership and managerial skills and help them in getting on the “chair” track. Managerial skills needed to be chair can be taught and women should be encouraged to learn them.
Writing this article was one of the more pleasant tasks I have undertaken in many years. I am indebted to my fellow chairs and other leaders in academia for their willingness to share their experiences. This process was not without personal benefit and therapeutic impact on me. The few months I spent interviewing were quasi-therapy. Each interviewee had an impact on me. Some gave me the freedom to have “controlled ambition,” an ambition that is pragmatic, as well as humanistic in a sense that it does not exist at the cost of hurting others. Others helped me manage stress by sharing that “stress is when you tell a patient’s family that their loved one is dead.” “The rest is all challenge.” One person gave the advice, “On the success ladder, do not forget to take at least one woman with you.” Successful women admitted to having weaknesses that I, too, possess, and strong men attributed their administrative successes to traditional female qualities and recognized the influence of women role models.
The work that has been done on behalf of women is evident in the fact that today there are more women chairs, deans and professors; however, there is still more work to be done, and that work does not involve increasing awareness within the establishment alone, but also raising the bar for career goals for women. It is true that not every woman psychiatrist who wants to become a chair will become a chair, but neither does every man. I hope that women and men who read this article recognize that all individuals who have necessary skills and desire can become academic leaders and, eventually, the need for such an article as this will become obsolete.
I wish to thank all my fellow chairs and other academic professionals for their reflections and assistance in the preparation of this manuscript.