Leadership and Gender Inclusiveness in Academic Psychiatry

Nine of 10 academic departments of psychiatry in the USA are led by men, according to Doyle et al. [1] who report on a 2014 survey study of chairs in this issue of Academic Psychiatry. Men were more likely than women to lead large departments, to have stronger h-index scores (a signal of scholarship impact), to have been recruited through a national search, and to have held their leadership positions for a longer period of time. Men serving as chairs were more commonly married and had fewer children. Men identified fewer obstacles along the path to leadership, whereas women identified insufficient mentorship, gender discrimination, and family duties as barriers. For women, the main bit of good news from the study was the observation that women serving as chairs on average were younger, suggesting that there has been some recent upward movement through the “glass ceiling” in academic psychiatry. How do we best interpret the findings from this study? It is important to look at the results first in light of the greater context of the physician and physician-in-training workforce in the USA. The Association of American Medical Colleges (AAMC) recently commissioned an analysis to assess and project physician workforce needs, finding that women comprise close to one third (31 %) of the overall physician workforce [1]. Of physicians who were in their 50s and 60s, however, women represented less than one quarter of the workforce. In residency and fellowship positions overall, women have 46 % of the slots—they are most highly represented in primary care fields and least represented in highly competitive procedural areas, such as orthopedic surgery. In psychiatry, men have outnumbered women in the field historically, although recently the number of women entering the disciplines of psychiatry and child and adolescent psychiatry has grown, with 54 and 61 % women matching in these roles in 2013 [2]. Taken in context, then, one might expect that two of three academic departments of psychiatry would be led by men—not 9 of 10—and that, in time, womenwill increasingly be placed in the role of chair. In absolute numbers, more women have been appointed as chairs since the time of the Doyle et al. study. In October 2015, 21 of 148 (14 %) of all academic departments of psychiatry listed with the AAMC were led by women in permanent (n= 16) or interim (n=5) chair positions (personal communication). The number of medical schools continues to increase, however, so there is still quite a distance to travel before the proportion of women in top academic psychiatry leadership roles reflects the underlying proportion of women in the field. A recent study of women in higher education [3] found that women constituted a larger share of faculty at community colleges (53 %) and bachelors/masters-degree granting institutions (45 %) than at doctoral-degree granting institutions (38 %). Women leading as presidents and chief academic officers were not proportional to the underlying base population of female faculty at each kind of institution, however. The authors interviewed 35 women with senior-level leadership roles in higher education and identified several barriers to leadership, including different expectations for men and women, discouragement and sabotage by colleagues, lack of opportunity and support, and not having a leadership identity. These issues were endorsed more, overall, for underrepresented minority women in the study. Negative aspects of leadership roles identified by women engaged in this study included the time demands of the positions, scrutiny and criticism, the feeling of pressure for ultimate accountability, personal and professional isolation, the broad scope of the job, and a sense of not fitting or not being * Laura Weiss Roberts LWRoberts.EIC@gmail.com