Why aren't there more women leaders in academic medicine? The views of clinical department chairs

Purpose. A scarcity of woman in leadership positions in academic medicine h as persisted despite their increasing numbers in medical training. To under stand the barriers confronting women and potential remedies, clinical depar tment chairs with extensive leadership experience were interviewed. Method. In 1998-99, open-ended interviews averaging 80 minutes in length we re conducted with 34 chairs and two division chiefs in five specialties. in dividuals were selected to achieve a balance for gender, geographic locale, longevity in their positions, and sponsorship and research intensity of th eir institutions. The interviews were audiotaped and fully transcribed, and the themes reported emerged from inductive analysis of the responses using standard qualitative techniques. Results. The chairs' responses centered on the constraints of traditional g ender roles, manifestations of sexism in the medical environment, and lack of effective mentors. Their strategies for addressing these barriers ranged from individual or one-on-one interventions (e.g., counseling, confronting instances of bias, and arranging for appropriate mentors) to institutional changes (e.g., extending tenure probationary periods, instituting mechanis ms for responding to unprofessional behavior, establishing mentoring networ ks across the university). Conclusion. The chairs universally acknowledged the existence of barriers t o the advancement of women and proposed a spectrum of approaches to address them. Individual interventions, while adapting faculty to requirements, al so tend to preserve existing institutional arrangements, including those th at may have adverse effects on all faculty. Departmental or school-level ch anges address these shortcomings and have a greater likelihood of achieving enduring impact.