 And in the, we are really excited to have Dr. Tracy Weiler here today. I'm going to go ahead and introduce her. And as you know, we are, this is our second to last in the gender equity and ethics series. We're going to be closing out next week on the 17th. I'm going to be summarizing our talks today. So let me go ahead and introduce Dr. Weiler. She's an associate professor on the educator tract in the Department of Human and Molecular Genetics at Florida International University in Miami, Florida. She delivers a significant portion of the medical genetics education to the medical students at the Herbert Wytham College of Medicine. And she's also the academic program director of the Graduate Certificate in Molecular and Biomedical Sciences and a rigorous post-bac pre-med program that prepares students for medical school. She earned her PhD from the University of Manitoba in Winnipeg Canada in 2001, focusing on the genetics of muscular dystrophy in unique Manitoba populations. She moved to the US in 2006 to join the Cincinnati Children's Hospital and Medical Center, working on the genetics of juvenile idiopathic arthritis and treatment resistance. She moved to Miami in 2013. You got warmer and warmer and warmer, right? Right. Dr. Weiler is a member of the WMC Council on Faculty and Academic Societies, which she shared, she'll be most of the data she's sharing today comes from that society and the Mission Alignment Committee since 2019. At the time, a working group of the Mission Alignment Committee has convened to study gender parity in academic medicine, both nationally and now at the level of the Academic Medical Center. So welcome, Dr. Weiler. Thank you so much for inviting us to talk to you today about our work. This is similar to Julie. This is kind of an unfunded passion of ours as well. So the talk I'm giving today is called Gender Disparities in Rank and Tenure at Academic Medical Centers. And I wish this would just go away, but we'll see if that's better. Can we hide it? Excellent. I was supposed to be giving this talk with Dina Calamore from St. Louis University. She sends her regrets. She had a family emergency and couldn't join us today. Financial disclosure wise, we really have no actual or potential conflicts of interest in relation to this presentation, no grants, no products, no patents, no companies, etc. And we don't even know what that would look like for gender parity. But we do represent a work group of the Council of Faculty and Academic Societies, but this is entirely volunteer. Another thing we, Dina and I, but all of the seven of us, we're really not huge fans of lecture format and would really like your participation today, whether it is on Zoom through the chat or in person. Okay, so the work that I'm going to be presenting today is based on this paper that we published in Academic Medicine in 2022, entitled Rank and Tenure amongst faculty at Academic Medical Centers, a study of more than 50 years of gender disparities. And you can see the, my colleagues that are a part of the working group here. The individuals, Nandini Calamore is from St. Louis University, Eileen Cowan is from Madison, Wisconsin. Mark Danielson is from Georgetown, Anka Dobrian is at Eastern Virginia Medical Center. Adam Franks, who is our fearless leader really is from Marshall University. Serena Newman is at the Hampton VA and I'm down in Florida and Miami. So the learning objectives for our talk for this talk today and for this presentation are to appreciate the evolution of gender parity and academic medicine over the past 50 years. Describe the gender disparities in academic medicine with respect to basic and clinical science departments, academic rank and tenure status, and then recognize large historical changes that have happened in academic medicine that have shifted gender curves over the past half century. And so I'm going to start actually with a provocative question here and that is, do you think that this current state of gender representation at your institution or in the nation national broadly is adequate. What do you think gender representation means, how would you measure. What are your thoughts. I mean I'm assuming yeah. Yeah, it's better than it was absolutely or totally right. I'm glad you brought up this idea of, you know, if you're in pediatrics or you're in one of these other female friendly specialties it's different than if you're in some other specialties. Anyone else have any comments. Right. So Julie was just saying that at the medical school level and at the residency level are our, we are pretty close to even. But as we go further up, it's not. And it hasn't been that way for decades. Right, like we have we were just talking about this earlier. We had equal numbers of medical students in the 90s. And still, we do not have equal numbers of people up at the associate and full professor level. Okay. So, what does gender parody mean to you. Okay. Julie saying equal pay equal promotion. You guys agree. Equal representation. So equal numbers. Yeah. Equal opportunity. Yeah. Okay. All right. So we took a very, very narrow view of what gender parody means, because we couldn't do the we couldn't do the research without something that was very defined and and simple, but lots of rich data came out of this definition. And what we define so we kind of split out different categories here equality, parity and equity and define them a bit differently. And so we define equality as when the inputs are equal. Right. So everybody is getting the same thing. We define equity as when outcomes are equal. When outcomes is up for debate right, but then we define parody is simply when the numbers are the same. So, for gender parody. If we were to just talk about the binary male female man woman scenario. That would be 5050 split. There's not to say that equity is not a goal. Right, but this is where we started was with parody and just looking at the numbers. I really like this graph this one actually came from Reddit but there's lots of different versions of it. So in reality, we have some people who get much more than is needed. We have somebody who gets just what is needed, and then somebody else who not only doesn't get what is needed but actually is in a hole to start with. We have the current state of reality, right. Equality is when the inputs are the same everybody gets crate to stand on for some people it's does not needed for others it's not enough. And for some it's so it's just fine equity is when you think about the outcomes, and then justice is when you remove the barriers to start with. So, I'm hoping eventually we will get to justice, but that that this is kind of how I look at these different, different terms. Okay, so we're going to talk about faculty growth and academic medicine. And that comes from data that we have obtained from the double AMC faculty roster. So allopathic medical schools are members of the double AMC accredited medical schools of the double AMC. And as such, you can create an account. And that's the double AMC dot org, and sign in and access all kinds of great data. And when you do that, and you go to the home screen, you can go over to data and reports. Look at faculty and institutions and find the faculty roster. There is data there extraordinary amounts of data there for faculty but there are also several other databases that you can play with. Including characteristics of medical schools characteristics of medical school classes, for example. The faculty roster itself was initiated in 1996. So this is the first point I wanted to make is that the data starts when the database started right to support national policy studies by collecting comprehensive information on the characteristics of faculty members at accredited us MD granting medical schools. So this data that we're going to talk about today is not including do schools. Okay, and it is not including Canadian schools, or international schools. And here is the link to that to the faculty roster. Okay. So, some clarifying definitions here just for the purposes of this talk. Keep dancing this thing around. For the purposes of the faculty roster gender is defined as male and female non binary genders were did not exist formally in the database, you know, or in in the world as a recognized gender in 1966 and I don't think they've changed things they haven't changed anything since regarding departments. We talk about faculty as members of either basic science departments and clinical science departments. So when I say this is BSC versus CSC, it doesn't matter whether I'm an MD or PhD it matters whether I'm in clinic and a clinical department or a basic science department. Academic ranks that we looked at assistant professor associate professor and full professor these were pretty standard across most institutions. There are other ranks that we, which actually comprises about 13% of faculty and we kind of the numbers of each of those were small, and they were so varied as to be difficult to analyze so we excluded them from our data. And then 10 year we looked at non tenured tenure track and tenured professors. Okay. So, let's just look at academic medical centers and faculty over time. You can see that the total number of faculty in 1966 was about 13,000, and has increased to about 157,000, which is about a 12 fold increase pretty linear for that time, about 3000 faculty increasing every year over the past 55 years. When we split that out into BSC faculty and CSC faculty. It's crazy. You can see that there is a 15 fold increase in clinical science faculty over these, these 50 years, and a five fold increase in faculty in the basic science side. So, look carefully you can kind of see a difference in the slopes here. So, up until about 2000, we were just under 2000 faculty, increasing per year that almost doubled in the next 17 years, and it has really stabilized to about 1268 in the past three years. We haven't done any more work since 2019. When we zoom in, this looks pretty linear with a little skip here that is actually real. When you zoom into that and here we're looking at thousands and here we're looking at absolute numbers. You can see three different slopes. It's just about just about 500 people per year up to about 1976, and then 216 it's leveled off in the next 30 years, and then 64, an increase of 64 per year since then. So, we still are increasing but clinical faculty really is driving that increase. I mean, think about why that might be, it might be because of academic medical centers increasing right the numbers of those of medical centers. And so if we look at that over the time we see that there were just about 90 medical centers in 1966, and that has ended with about 140, just about 150 I think it's 152 might be right now. We had a rate of about two and a half per year over the first almost, you know, 10 years, and then stabilizing to almost no growth over the next decades, and then now up again, increasing, not as quickly as it was at the beginning but still an increase. Now that compares to medical students. What we see as a similar curve, which isn't surprising. We increased 712 students per year over the first slope, and then another 399 per year going from here to there, and then 410 per year in the next gap and this, this correlates really quite beautifully. When we think about that what that really means then, although CSC department faculty dominate the total volume, the BSC department faculty has the slopes and mirrors that medical school demand more, more closely. So what's driving that growth of clinical science faculty over these past 50 years, I'm going to leave that as a thought for you to consider. So now let's talk about gender parity. Both male and female numbers are increasing over time. You can see down here, less than 20,000 total. And up here we're now in the almost 100,000 men. And when we put this same graph on a linear scale, 1100, 1200, sorry, women at the start, and almost 12,000 for a 10 fold difference at the start of the faculty roster to about a 1.5 folding difference at the end in 2019, which is great. I mean, this is definitely, you know, one and a half is definitely better than 10 fold. When we look at the on a logarithmic scale the difference between, you know, where men started and where they ended an eight fold increase in men over these past 50 years, and a 53 fold increase in women. So we're doing something right. So that's a good start. And if we change that to a measure of the percent female. We see that we started out at 9%. And we are now up at 40%, which isn't, you know, it's not parity yet, but it's, it's definitely heading in the right direction and it's a nice slope. Initially that slope was at about 0.3%. 0.35% per year, until about 1982. And then that's about doubled almost to a 0.69% per year since so. So I'm going to now put all this together into a kind of an academic medicine timeline. That will, it's a bit complicated. So I'm going to do it a bit slowly. It's going to summarize a lot of that data. Medical center faculty have increased to about 3000 per year. And really no changes. Basic science faculty have increased more in this middle period in the 2000s, and that has dropped off a bit since started at about 2000 per year. Basic science faculty, these, these, this is a conditional formatting just from, you know, red is slow dark green is fast. And so yellow is kind of in the middle. And the red 64 is the reddest. We aren't getting very much increase in faculty basic science faculty recently. Academic medical centers themselves over this increased a lot at the beginning, almost none, and then are in the kind of an intermediate phase now. Similarly, that's paralleled by our student numbers. And we see that the percent female faculty has changed from 0.36% increase to 0.69% increase. So we see a very rapid expansion of academic medical centers in this time period. So looking at what was going on in medicine at this time we saw that there was a decreased federal federal grant research funding in the 80s and 90s, and decreased reimbursements for clinical activities. And we can start to correlate the things that are happening. And with our numbers. When we had this flip, or not flip but increase in percent female. We can kind of correlate that with an increased number of clinical faculty required. And no men to do the job so they hired women to do it. At some point we started to see the rise of the medical educator track, which was an advent, you know, a big intervention in the late 90s and 2000s. And then again we had another expansion that's still going on today with new medical schools. As we move forward into some of the subsequent slides, I'm going to keep this up there, and you can kind of, you know, remind yourself of kind of what was going on over time. So, the next question for you is gender parody 50% which for this purpose we're defining as 50% female 50% male is not desirable is that what we want. What do you think. And is there a, like is there an error bar is 55 still parody, or, you know, 45, when is too little or too much too much, right. Interesting. So, and, depending on the parody should reflect where the representation should reflect the patient population. That's a great idea. Yeah, I like that we were doing is actually Dina is doing a similar project on on Jen on race. She is talking about parody being representations of races compared to the general population. And so that's an interesting way to think about it. Okay. So let's look at some historical changes associated with these gender curves and split out some of these things it is hot in here isn't it. We're going to start with academic rank zoom in a bit and look at how academic rank is has changed over time. Again, here is the same per same thing that I was showing you earlier I've just kind of put it up at the top to remind you of what's going on over time. And you can see that the basic science assistant professors pretty linear across the across the whole 50 years, and a rate of change of about 0.5% female per year. And that's going to change consistently. The clinical folks are changing differently. We saw a shift in 1977. Okay, we saw another shift in 1994, and the rate of change went from 1% per year and shifted downward. This is where our basic science we think that there might have been something going on right up front, and then our clinical science in 1977, and then again, another change in 1994 associate professors. So what was going on here. Actually, let's talk a little bit about that. The science folks started to really ramp up here. We were in finishing up a stage of rapid growth. But at the same time remember this is a stage when we had reduced funding for clinical work, and we had reduced research funding. And so the hypothesis we have is that they hired a lot of clinical folks to drive the academic enterprise because that's the only money. That's where the money could come from. At the same time, medical schools turned into academic medical centers and pulled in the hospital systems, and all of those people from the hospital system also all of a sudden became faculty in in the medical schools. So at the associate professor level as you can see the rate of change hasn't is no different from assistance to associates for basic science we have just a chain of consistent half a percent for year per year, and we're reaching up to 40% almost 40% now. One last thing I wanted to say about assistance, we're up at 4845% for basic science, and really close to parity for clinical folks. So, at this level we're doing right, we're doing, we're doing a good thing. For associate professors, our clinical science folks have a change in about 1977. And, sorry, in 1985 and if you remember from our previous slide, the basic, the, the assistant professors had a change at 70 in 1977. So this is kind of promotion. So we've entered in set, you know, in that, you know, kind of a more of a bolus and 77 and are graduating on to become associates in 85. And so we're seeing an increase of almost, you know, three quarters of a percentage point annually to date. When we look at full professors now. We see things change a bit basic science full professors all of a sudden have a point, a change point here, starting at point to 3% annually and changing in about 1986 to about the same rate as the other assistants and the associates. And we think what's happening here is that there was this increase when funding was good and academic medical centers were increasing. There were a lot of new folks who came in as assistant professors. And you saw a little bit of a bullet in that first graph. We think those people are starting to graduate into the full professor category by 1985. On the clinical science side, we see some other differences 1980. The students are moving into full professors. In 1994, we've got another blip. What happened here. This is when again, our funding was low. Right. And we saw an increase in we were sorry, we have low amounts of MDs. The MD schools and the MD students at this point. And so people are, I think the hypothesis here is this might be about the time when medical educators started to become more, more prevalent. If we haven't done this work yet, but it would be interesting for us to look to see what the proportion of gender, you know, the percent female for medical educator faculty versus the straight clinical faculty and so on. We haven't, we haven't teased that out yet. But the other thing to notice the axis here is different. Now we're down at 30%. And so our basic science full professors are at less than 30%, as are our clinical science full professors. If when you were a medical students, medical students were at parody by now full professors should be close. And that's not happening. So, um, to summarize this, we see large periods of stable rates. And then we see changes that we assume coincide with large events that are happening in academic medicine, medical educator track, rapid expansion events, and then decrease funding for both clinical and research are changing things. So what about tenure, how does tenure look. The gap is closing. For non tenure track faculty, but what is interesting, look at this, this is in hundreds, this axis. So this is almost 150,000 people. You can see how the increase is being driven by of total faculty is being driven by the non tenure track faculty. 106 fold increase in non tenure track faculty over these this time period, which is 71%, sorry, 71 times for the males, and 240 fold increase for the females. So that's good. We are improving. But we're not float, not not parody yet closest here though in non tenure track. And you can see the, the, the change point is it about the year 2000. So right in the middle of the stagnant points for growth, as well as the funding, you know, is stagnant as well. So then we think about tenure track. Notice the, the, the access here, rather than 150,000 people here we're now talking about 25,000 people. Lots of changes over this time. Women are improving quite consistently, and the men have stable have have stabilized in the past 20 years. So their increase over time over this past, the men have increased at an eight fold rates, and women have increased at a nine fold rates for tenure track faculty. I've popped these things in here, but I have difficulty mapping this. One of the concerns that we have with tenure track is that tenure track faculty often have to be basic science, or full professors, right. So if you were a medical educator you're not, I am a medical educator I'm not eligible to be on the tenure track. And so as we are increasing the tenure track and as we are increasing clinical folks with an entirely clinical practice, they aren't eligible to be on that tenure track. tenure track. Well, there are requirements from budget budget wise, right and department wise and so people will say oh we can only have you know we've lost one tenure track person we need to get another one or whatever but there's no defined limits. Yes. Yes, we think that is one of the biggest things that we can do to make this a better situation as males retire, replace them with females. All right. So if we then look at tenured faculty turns out that female tenured faculty are actually increasing, as you can see here. The male tenured faculty, although they increased up until 1994 and then stabilized over the next 10 years. Then they have been dropping since. So, and as you can see here, our total number of tenured faculty is pretty solid, which again supports that as the tenured males are retiring they must be being replaced by tenured females. And so this delta here is four fold so we still at this point in time, have a four fold higher number of males in tenured positions than females. Yeah. Okay. So when do we get to parody. This is the question when we had some we did some statistics to figure this stuff out. And really assistant professors will reach parody in less than 10 years if we maintain our course, the way it currently stands. So 2023 based on our projections. And if we were to do this analysis again, we would hope that we would be at that position. And then the question becomes, are we going to continue that trajectory, or are we going to ease off, because policies must change in order for us to change our trajectory. Basic science 2034. So another 10 years for basic science assistant professors to reach parody at the associate professor level. 2033. So about the time the basic science assistants will reach parody. We think our clinical science associates would reach parody. But our basic science associates. Not for another 25 years to 2047. And the bad news is here with the full professors. Clinical science full professors aren't going to reach parody if we don't make any changes until 2053. So if you look at the basic science 2065, I don't think I'm going to be around long enough to see that happen. And remember when we're talking about these, these are clinical science departments and basic science departments, right. So, so, I am a PhD in a, you know, in the genetics basic science department. But if I were in the clinical, you know, in a clinical department like internal medicine, I would be in Cal, Cal classified in this category. So, that's pretty much the data that we wanted to present to you. And our message in the paper is that large act changes in academic medicine. We talked about the changes in the numbers of medical centers changes in reimbursement rates changes in grant funding changes in tracks, right. Those things have been impactful changes in academic medicine that might that have altered our steady state over the past 50 years. And so what do you think is coming next. What is going to alter our steady state. Yes. Maternity parental leave in general. Where I live and work. There is a pervasive attitude that if you are not in the on the campus visible. You must not be working as hard as you could be. And so there's a very big push for us to be on campus all the time. My commute is, you know, 45 minutes on a good day, and two hours on a bad day. And we've got, then I get to chat with people and not do work. I am considerably less productive when I'm at work than when I am at home. And my family keeps saying, you know, when you're commuting, if you're not commuting that's Tracy time that's not FIU time, but I just think of it as bonus time that I can get my stuff done right. I think we as a team think that this is, this is where we've got to go to make change, right. We've got to be intentional about making these chains recognize that giant changes have to occur system wide in order for us to really make a difference. And, and, and improve our trajectories. And then the next provocative question really is this idea that, and up until now really most of what we've been talking about has been volume based change, right. We need more people to make more money to produce, you know, to produce the students or to run the medical sector, or to, you know, account for all of these residents that we need to train so we need more medical educators. But our idea is that that's not enough, and we won't get there in any reasonable amount of time continuing that kind of thinking, and that we need to start to shift our thinking to FIU based policies, which comes out with some of the things that you guys have been raising here. And so when we think about value in academic medicine at a quantitative level and this is this is work that we are now doing for our second paper, where we are trying to create a metric by which we can and score individual medical schools on the basis of things that we think are important in terms of of academic medicine at the faculty level. So one thing it's important that we just have people right we have women men at equal levels in positions. So we call that the numbers or the total amount. Then we think we have the what's called the advancement measure, and we, you know, you can have parity at assistant professors, but that's kind of tokenism, right, what we really need is parity at full professors because the full professors are the ones that drive the policy. So we have created an advancement kind of portion of our metric to say, let's count the number of full professors let's count the number of tenured faculty we have and use that as a portion of our value based system. And then the last one is leadership. We haven't done the work in this particular paper but department chairs percent female is less than 30% C sweet, probably less than that deans definitely less than that. We need those to be up there too. Right. And so, in our, our metric that that we are going to use to score medical schools, we are kind of incorporating just total percent F, as well as an advancement measure and a leadership measure to kind of reflect all of the things that we value as academic as members of the academic fact medicine faculty. We are in the midst of that work and trying to figure out where to take it. We're also intrinsic cultural characteristics of institutions that make some good and at parity already, and others very, very not at parity, very, very disparate levels of males and females. And one of the other things that we want to do is look at intrinsic cultural characteristics of these institutions. What does salary look like, and does does salary, which kind of you would think is a, you know, an equality thing, right, it's an input into the system is the fact that salary is is not at parity, resulting in women dropping daycare availability of daycare availability of daycare close to where you are availability of daycare that that that fits the needs of a, of a mom who's, you know, in the hospital for 30 hours at a stretch. And then those moms that are still breastfeeding, for example, they need accommodations to be able to do that. And Eileen has a brand new baby, I think the babies, maybe seven or eight months old. And her eyes have just, you know, opened so much to, to these kinds of things. Work at home options. For all kinds of different reasons, mentorship and sponsorship. I hear that the males are sponsored or mentored more frequently than the females. And so the timeline of promotion from assistant to associate from associate to full is one level for males. And it's stretched for females because these things are different. And there is an extra level of struggle there. Back to my initial reality slide where we were dug into a hole before we begin faculty development support as well. And so this is an opportunity for you to provide your thoughts and I can type them in. What do you think are value based characteristics of medical schools that can, that we might be able to kind of more broadly implement to make change to increase gender parity in less than 40 years. Absolutely. Absolutely. Thank you that we never look very well almost never look very good. But you, you saw that as we were just talking about medical school, our increases at 40%. We bring 12 fold increase we're doing not badly until you split it out. And whether you split it out into rank tenure. One, one of the things that we have found in this work is that when a specialty is considered male dominated salaries are higher. And there's a whole lot of cash a etc etc that goes along with it that gets removed once the women move in. Yeah, right. One of the things that one of the other things to consider about the about the faculty roster is that the data is self reported, but it's self reported the medical school level. I really have no idea how I am reported right to the WMC. I'm hoping that I'm reported as basic science associate professor but I really non tenure track right because that's reality but I don't know. That's what it's self reported. I don't know how the cleanup is done. But yeah, and, and really, you know, for it, one of the other things that's that's interesting at FIU right now, we don't have a clinical partner. So we have a bunch of community hospitals. And the folks that work in those hospitals are clinical. Like they are employed by the hospital they are voluntary faculty with us. So we have thousands of voluntary faculty but our hardcore FIU HW com faculty is about 150. Most full time but some version of part time as well. What that looks like in different places is different right so Georgetown where Mark Danielson's from. They have MedStar and MedStar employees the all of the clinical faculty right at all of the MedStar places, and they all have an appointment and our faculty at Georgetown. So they have 1000, I don't know how many 1000 people they have. Some of them are just clinical folks some have clinical and educational responsibilities some do research, etc. So, it's, I don't know. Okay. Sure. Yeah. Yeah, so the last questions. We have policies implemented improved gender parity. I don't think anything much has changed. And where do we go now, really. Yeah, yeah. Well thank you. The last question the one of the questions that came online was, thanks for the wonderful talk we're worried that coven is set back the trajectory for gender equity among faculty. And would be interested in knowing how to ensure that we get there faster, especially with the concern of attrition like people leaving after coven, I think. Yeah, so the data that we've seen, although we haven't done that work we the data we captured started ended right as coven started. But women took the burden of, of family care of, of so much of this stuff and that is probably stretched out some of their, their trajectory. Some of them have said, I give, I can't, and have left. So, yeah, I do think it's probably set us back. And, you know, to your point about creating policies for promotion and tenure. We need to keep in mind that people have a life outside of this place. Right. And what is what is good for women is going to also be good for men too. And, you know, that will allow men to become more, you know, just take care of their families to. And so, you know, it's kind of like universal design principles if we can do stuff may implement policy that can change. And so the policies that so that everybody, you know, is, is, is benefits I think that's the way it's got to go. My last question is like, as there's been like a decrease in private practice, you know, the numbers of private practice like this academic medical centers at least here in Chicago. We're buying up private practices we're like expanding we're like, everything is, you know, fallen under the academic medical center and they're fewer and fewer private practices. How do you think that affects your data. Or do you think that is the rise and that some of the rise of academic middle center is as they became more or for instance like if I you were to like take all those volunteer faculty and make them like Georgetown yet. Yeah, right. How does that affect that data. Well, I think that is the, there was a significant increase in the 80s, when we went from point three six to point six seven, right. And I think we think that was when a lot of people started buying up medical center buying up, you know, include pulling more people into the academic medical center, and a whole lot of women came with it. We think that's what was going on there. Yeah. Yeah. Thank you so much for this talk. We usually end the recording online. You don't have to do it. Thank you so much. Thank you.