Progress over 100 years

If Louise Farnam, PhD ’16, MD ’20, one of Yale’s first women medical students admitted, were to stroll past Sterling Hall of Medicine today, she might be struck by the number of female students, faculty, and administrators on campus. Just over a century ago, Yale School of Medicine wasn’t training women to become physicians. Today, women make up about half the student body and 39 percent of full, associate, and assistant professors, according to January 2018 data from the medical school. Two women now serve as deputy deans in the medical school’s leadership. Out of 29 total chairs, five women—the highest number in the school’s history—lead Yale’s academic departments: anesthesiology, emergency medicine, and surgery, as well as the Child Study Center (CSC), and Center for Musculoskeletal Care. Linda Mayes, MD, chair of CSC, and the Arnold Gesell Professor of Child Psychiatry, Pediatrics and Psychology, is the first woman to hold the title of special advisor to the dean.

The pace of progress

In some ways, Yale School of Medicine is a pioneering place for women in medicine. Women have been teaching at the medical school longer than in any other school at Yale University. Florence Bingham Kinne, a pathologist, was hired in 1905 as Yale’s first woman instructor. When Yale established the Office for Women in Medicine in 1975, it was the first of its kind in the country. The Committee on the Status of Women in Medicine (SWIM) was founded in 1979 to address issues related to gender equity at the School of Medicine. That same year, a group of women faculty and postdoctoral students created the Phyllis Bodel Childcare Center, whose namesake, a mother of three, was the first director of SWIM. By the 1990s, the medical school, matching a national trend, accepted male and female medical students in near-equal shares. In January 2017, Darin Latimore, MD, became the school’s first deputy dean for diversity and inclusion. “That was a huge step forward,” says Susan Baserga, MD/PhD ’80, professor of molecular biophysics and biochemistry, of genetics, and of therapeutic radiology, and author of several monographs on the history of women at the medical school.

The school is also making progress on the contentious issue of equal pay. A cornerstone project of the dean’s office is an annual review of medical school salaries in an effort to ensure that every faculty member is fairly compensated. Every spring, Robert J. Alpern, MD, dean and Ensign Professor of Medicine, meets with each department chair and section chief, along with other leadership and administrators, to examine how faculty are being paid for their work. “We go through about 2,000 salaries in two months, department by department, and faculty member by faculty member,” Alpern says. “While we had tried to address this with a regression model that considered education, rank and years in rank, Association of American Medical Colleges median salaries by specialty, grant dollars and clinical collections, there were too many qualitative characteristics that could not be quantified but were critical to define excellence, causing the model to be a poor predictor of individual salaries. Reviewing each faculty member in depth was much more effective in our achieving equity, and resulted in significant salary corrections for men and women, but with a higher percentage of corrections for women.” But after all that, we still end up with somewhere between a 2 and 3 percent gender difference, which is why we undertake the detailed process of conducting individual faculty reviews.”

A more challenging issue is the total number of women faculty at the medical school. There should be more women in some departments as endowed chairs and in leadership positions, according to Paula Kavathas, PhD, professor of laboratory medicine, of immunobiology and of molecular, cellular, and developmental biology; and former chair of the Women Faculty Forum (WFF). Every five years, the group publishes a report, Women, Men, and Yale University: The View, on female and male faculty numbers across Yale University. For the 2016-17 report Kavathas served as co-author. “We really need to look at the departments where women are so few,” Kavathas says. “I think we need to be leaders in this area.”

Other significant steps have included the establishment of a mentoring program in 2010, with Linda K. Bockenstedt, MD, HS ’85, the Harold W. Jockers Professor of Medicine as its initial director. The position was created to promote mentoring systems and to focus on helping women and underrepresented minority groups. At that time, results of a survey found that when faculty in Yale’s Arts and Sciences departments were promoted to tenured professor, career satisfaction levels went up significantly. This was also true for men at the medical school, but not for women faculty members. “We didn’t have specific reasons for this,” Bockenstedt, now deputy dean of faculty affairs, says, noting that one possibility related to the overall climate.

In a more recent faculty survey to assess culture at the medical school, one of the issues identified was that women—and men—wanted to have a better understanding of and more transparency in the promotion process. “What became clear [is that] even the fundamental aspects of being a faculty member were not understood,” Bockenstedt says. Through junior faculty training and meetings, the dean’s office has redoubled its efforts to clarify the pathways to promotion. In terms of gender equity, the past decade has seen some progress for full tenured professors. In 2002, 16 percent of tenured faculty at the medical school were women, according to The View, published for the first time that year. By 2016, that number increased to 23 percent.

“We want to be thought of as a women-friendly school that is thinking about these issues and addressing them as a high priority,” says Alpern. “Equality, inclusion, and a respectful environment for everyone are major priorities for the school.”

Addressing unconscious bias

Louise Farnam dealt with outright bias, but women today fight a more nuanced battle against what is now recognized as unconscious bias. Unconscious, or implicit, bias remains widespread in American society. In many professions, a person may rate a job performance lower if told the worker is a woman, for example. When writing letters of recommendation, scientists and doctors may unconsciously refer to men as “researchers” and “colleagues,” and to women as “teachers” and “students.”

Unconscious bias has its start in childhood, when children are taught different gender roles. While it will take more time to address a deep-seated and generations-long issue, the effort to do so is a sign of progress, says Carla Rothlin, PhD, associate professor of immunobiology. “What appeals to me is that we recognize that this is a problem, and that society has an obligation to address this problem,” she says.

Latimore explains that bias is built into institutions and who their leaders have traditionally been as well. “We still think of the two genders very differently, and our role expectations of gender are still different,” he says. Unconscious bias training can be effective for a hiring committee during the recruitment process. However, for unconscious bias training to stick, it must become ingrained in the school’s culture. “If you don’t change the culture to reinforce it on a daily basis, you will go back to your biases,” Latimore says.

Shirley McCarthy, MD, PhD, professor emeritus of diagnostic radiology, was a former co-chair of WFF. She retired in 2016, and believes the recent reinvigoration of SWIM (where she is currently an executive committee member) has the potential to help alleviate biases. “We have our own liaison system where we meet with representatives from every department four to six times per year,” McCarthy says.

Elizabeth Jonas, MD, a current SWIM co-chair and professor of internal medicine and neuroscience, joined the organization last year. “I want Yale to be the place I have in my dreams,” Jonas says. “I want it to meet expectations for a modern university.” Jonas says that retaining women at Yale remains a problem, in part due to scarcity, but Yale could do more to keep the women that it hires. “If you get someone who is doing well, she will be wooed by other universities, and the problem is there just aren’t enough women in general—and underrepresented minorities in particular—in senior positions yet,” she says.

At least one alumna is tackling unconscious bias issues head-on in her current career. Esther Choo, MD ’01, MPH, an associate professor of emergency medicine at Oregon Health & Science University in Portland, has received acclaim for her efforts to call out bias. She recently co-founded Equity Quotient, an app-based service designed to enable academic medical centers to gather data points on their institutional climate based on five criteria: respect, value, safety, pay, and general culture. At the forefront of every institution’s goals related to gender equity should be pay, Choo says. “It’s a concrete thing, it’s not hugging a marshmallow. People hired for the same position should get paid the same amount.” Choo acknowledges that salary equity has many moving parts, but notes that if leadership makes pay equity a priority, it will likely happen.

More work to do

The number of women scientists at the medical school continues to grow, but progress is slow. Whereas there are roughly equal numbers of women and men among students and assistant professors at the medical school, women’s representation decreases with each step up the academic hierarchy. “Yale has made tremendous progress in my opinion,” Latimore says. “But we still have more to do.” He has begun developing a diversity strategy.

Mayes says that progress on gender equity may move more quickly if medical school culture focuses on the family as a whole rather than on traditionally accepted male and female roles. “Changing the culture is fundamentally about how we work together and have equitable and civil conversations,” Mayes says. As an example, a department head could suggest that a new father take a month off to be at home with his child, Mayes notes. “Quite frankly, we never think to say that to a man,” she says. “I think women’s issues—if we call them that—would be better advanced if we talked instead about family issues.” This point aligns with Alpern’s conviction that equality, inclusion, and a respectful environment ultimately benefit everyone.

Every year the dean meets with every department to present the state of the school. This year, he has ended each of these talks with a quote long attributed to Ralph Waldo Emerson that defines the meaning of success. After one such presentation, Naftali Kaminski, MD, the Boehringer-Ingelheim Endowed Professor of Internal Medicine, and chief of Pulmonary, Critical Care and Sleep Medicine, pointed out that the original version of “Success” was written in 1904 by a woman: Bessie A. Stanley, an American author. Alpern has since incorporated the quote’s tangled attribution history into his departmental meetings. “At every talk,” he says, “I point out that once again a man received credit for a woman’s work—and that over time, that injustice has been remedied by careful historians.”