Women and academic psychiatry.

This special issue of Academic Psychiatry provides an excellent and varied series of articles that celebrate the richness of women in psychiatry and highlight many of the challenges facing female psychiatrists in academia. The articles include surveys of female psychiatrists’ activities (1–3), reviews of the issues facing women in medicine and psychiatry during training and throughout their careers (4–7), and descriptions of the personal journeys of three academic psychiatrists with different backgrounds (8– 10). Since women now constitute approximately 46% of U.S. medical students and more than 50% of psychiatry residents, a better understanding of the issues and career paths of women in medicine and psychiatry is vital for those responsible for training physicians and structuring academic and medical care systems if we are to realize the full potential of women in our field. Psychiatry, pediatrics, and, more recently, obstetrics/gynecology have been the specialties most frequently chosen by female physicians due to the patient populations these specialties serve and the skill sets they require. In addition, many women choose psychiatry because it can be better time-defined than most other specialties and less intrusive to the rest of the practitioner’s life, therefore making its practice more compatible with parenting and other family roles. Although not overly-abundant, psychiatry has visible female leaders and role models, with several women having served as presidents of major psychiatric organizations and female psychiatrists holding prominent practice roles in the community. Today, female psychiatrists are more likely to enter academic careers than they were in the past but less likely than men to remain in academia or rise to the highest ranks. As a result, female psychiatrist role models at the highest academic ranks are sparse, and most Chairs and departmental leaders are still men. Many senior female psychiatrist role models are master clinicians and therapists, often serving as parttime or clinical faculty rather than full-time academics. Some suggest that this is a cohort effect that will change as more women enter our field and that women will eventually rise to academic and organizational leadership roles proportionate with their numbers. However, I believe that this prediction is unlikely, as women have a harder path than men in medicine and psychiatry because of both societal and professional cultural expectations. Our society continues to expect women to be primarily responsible for child and family care giving and the maintenance of the home, an issue, noted in one of the articles (9), that is even more significant in certain subcultures and for some international medical graduates. With the increasing number of dual career families, one member, usually the man, is expected to work full-time and earn the majority of the family income, while the other, usually the woman, is expected to decelerate her career and if necessary work only part-time in order to allow for time to take care of the children and the home. The training and junior faculty years coincide biologically with the usual time for child bearing and child rearing, resulting in female physicians with children being unable, and often unwilling, to devote full-time to a career that conflicts with their concurrent family responsibilities. This puts them out of step with the usual academic expectation that junior faculty are to devote full-time attention to their careers and establish a track record of productivity if they wish to be successful. In addition, postresidency research training, in either a formal fellowship or as a member of an ongoing research group, is often required for a physi