 I'm Mark Siegler, and I have the honor of welcoming you all to the fifth annual symposium hosted by the Bucksbaum Institute for Clinical Excellence. I'll take just a brief moment to tell you a bit about the institute. The Bucksbaum Institute was founded in 2011 with a foundational gift of $42 million for Matthew and Carolyn Bucksbaum Family Foundation. Mrs. K. Bucksbaum is with us today, and I hope you'll join me in welcoming her warmly, Kay. Thank you. The purpose of the Bucksbaum Institute and its mission is captured on this slide. The goal was always to improve patient care, to strengthen the doctor-patient relationship, and to enhance communication and decision-making between patients and physicians, doing that through research and teaching programs addressed to medical students, junior faculty, and master clinicians. Since the institute's founding almost five years ago, we have continually looked for new and better ways to achieve our mission. Currently, the institute has appointed more than 130 master clinicians, senior faculty scholars, junior faculty scholars, associate faculty scholars, and medical student scholars. In addition, we've appointed 100 undergraduate pre-medical student scholars. The institute supports 28 programs, and that includes pilot grants, an annual lecture and seminar series, two or three new courses for fourth-year medical students, and a new academic clinical excellence track in partnership with our undergraduate college. I hope you'll join me in recognizing our extraordinary advisory board members, most of whom are with us today. Dr. Arthur Rubinstein, thanks, Arthur. Dr. Jordan Cohen, Dr. Laura Roberts, Dean Kenneth Polanski, K. Bucksbaum, Matt Sorrentino. Unfortunately, Holly Humphrey and John Bucksbaum were not able to be with us today. No, both had college matters to deal with. Finally, in honor of the Bucksbaum Institute and its commitment to improving patient care and strengthening the doctor-patient relationship, I just wanted to call your attention to a new sculpture called Caring that has been created and is on display in the West Lobby of this building. This work in Carrara marble was created in Italy by the sculptor, Virginia Ferrari, during the months of May, June and July of 2015. Virginia has described his thinking about the sculpture, saying that using abstract forms that encircle each other, this work conveys the complex and dynamic relationship between doctors and other caregivers, patients, and the hospital. The outer circle represents the healing nature of medicine and the ongoing work of our physicians. The elements in the center represent patients as they are cared for in a healing environment and the base represents the hospital where caring and healing take place. With that brief background, I'd like to introduce Ken Polanski, our dean, who will introduce Dr. Arthur Rubenstein, our opening speaker. Kenneth. Thank you, Mark. And I'm also delighted to be here at this wonderful occasion and it gives me a particular pleasure to introduce our keynote speaker, Arthur Rubenstein, who is well known to many of you, but maybe not all of you. So for those of you who don't know Arthur, he came to the University of Chicago many years ago to work with Don Steiner. Soon after Don Steiner had discovered pro-insulin and Arthur and Don had a wonderful collaboration that spanned many years in which Don focused particularly on the very basic elements of insulin synthesis and processing and Arthur did absolutely beautiful studies at our landmark studies on the clinical applications of the insulin biosynthetic pathway, described see peptide, pro-insulin and at many studies on genetic syndromes of diabetes had a very distinguished career with many awards and recognitions. He was the chairman of medicine here for about 17 years and under his leadership the department really flourished with outstanding recruitment of faculty and students, fellows. He then went on to be Dean at Mount Sinai and then also Dean at University of Pennsylvania and he was extraordinarily successful there. He's currently a faculty member at the University of Pennsylvania and we are very delighted that he's here today and we are particularly interested in the topic that he's chosen, which is women in leadership roles in academic health centres. So thank you very much Arthur for being here. As always I'm delighted to be back here and enjoy seeing old friends and seeing the progress that's so obvious. Just a few words of introduction first to pay tribute to Kay Buxbaum and her institute that Mark Siegler runs. It's a huge success and every time we come back every year it's more and more impressive what's been accomplished so congratulations. I also want to thank Angela Pace Moody who I think runs it kind of not even behind the scenes I think without her Mark couldn't do anything. And so Angela thank you for all your work and then I do want to say he'll probably wish I didn't but it's really wonderful to see what Ken Polonski has accomplished here in these six years I think as Dean and EVP and you know the progress and quality of the faculty and students and the emphasis on research and patient care all balanced is really wonderful and so Kenneth I want to congratulate you it's really terrific to see. I also want to say this is a challenging topic and so I probably will offend a number of you and if I do you can only not invite me back that's the worst can happen but it's an important topic and I've been interested in it for a long time and when I thought of some of the reasons I thought I would give it to you first I've been married to a physician for more than 50 years Denise who many of you know an extraordinary person in many role gods I won't go through all the details but many of you know her I also have a daughter-in-law who's a physician and I've watched her career at Columbia and it's been very interesting for me to see her as a family member but also to watch at a distance her challenges and so on and then I've been particularly interested over many many years to mentor and be privileged to interact with women students residents faculty chairs and to have a look at what they've accomplished and some of the challenges or many of the challenges they face and to try to be involved in many ways in helping them as much as possible so that's been a real honor for me to be able to do that so you might ask well why did I kind of choose this the catalyst for choosing this talk today actually came from an interaction I had I have all this background then thinking of these things but a couple of months ago I had a visit from Claire promeroy I don't know if any of you know who she was a Dean at University of California Davis and now she's the president of the Elbert and Mary Lasker Foundation and we were talking about various issues in academic medicine and I was saying I mentored a lot of women and had appointed a number of women chairs and so on and she said to me I just wonder if you have any idea how difficult and challenging it is for women to rise in the ranks of academia and become successful leaders and I said I had some and then she told me her personal story and I just began to really realize the depth and issues that she had dealt with which for my own leadership thing I had none of that and it was really kind of instructive and eye-opening and she's written an editorial about some of her own experiences in Scientific American in January 2016 and some of what I'm going to talk about came out of that conversation I actually will show you one or two of the slides she shared with me and so on so that's the background let's begin by looking at the situation in academic medicine because it's always good to look at the data and then evaluate it and see what the kind of situation is and what we can think about doing it and why did it come that way so the best survey of all this has been published by the Association of Academic Medical Colleges the double AMC they did a survey in 2014 which was answered by a huge number of faculty women across the country and it seems it's a very good snapshot statistically valid of what the situation is in academic medicine the report is available online you can read it and I've talked to some of the people who initiated and analyze the report and you will find it very interesting but basically what it actually says if you look at this first slide is that although there are almost equal but not quite 46 47% of women as applicants matriculants for medical school and then as residents once you get to the faculty you'll see 38% of full-time faculty 21% of those are full professors and if you want to be a dean not everyone does but still 16% of people in that leadership position are women so as they point out if rising to these leadership positions is important which I think we would do we would agree they are at least I think so then there is a big attrition from entry into medical school all the way down to senior leadership positions when you look at what's happened over the last several years this is perhaps the most challenging and disappointing issue there was a similar survey done in 2003 and 4 with some of the same data and as best we can say the results are fairly comparable and as you can see at that time there were full-time faculty about 30% were women and that went up over the next 10 years to about 38% so there's been some increase in full-time women faculty and these are in medical schools here's what's been most disappointing in many many ways if you look at the number of full percent professors as a percentage of the total number in 2003 it was 14% women and this was at a time that the number of medical students had become parity with men and the view was the pipeline was going to gradually or rapidly increase so that women would move through it into more senior faculty ranks and you can see 10 years later it had gone up some about 7% to 21% of the total number of professors were women and of the associate professors about a third from 26% so there was a discernible increase but it was relatively modest compared to what might have been I think you can also see even more striking that if you look in leadership positions right across these positions that in terms of change from 2003 the changes have been relatively modest so some increase in division chiefs you can see vice chairs department chairs which are really very very important maybe even more important than deans and so on because of the influence on faculty and students and residents the increase was 2% over that period of time a really mild modest increase that is quite striking system deans about the same associate deans and so on and then you can see in terms of the deans themselves gone up from about 10% at that time to 16% now one can argue about these numbers one way another but I think overall it would be fair to say in 2014 the number of women in leadership positions in medicine is modest and most disappointing perhaps is the fact that over the last 10 years or so the increment has been relatively small and so the issue is you know is this important why is it happening what are the issues related to this and is there things we can do about it you'll see even across all the chairs so we pointed out that the chairs tend to be less than 20% and I view these as key leaders in academia for all the kind of reasons I mentioned you can see the number is almost except for public health which has a special discipline in itself it's around 20% or less and on the right you can see if you want to look at this report all the departments pretty much across the country and you can see that less than one in five leaders in those departments of women now in terms of many aspects of women medical students residents and young faculty having role models and mentors as women in leadership positions from many points of view has turned out in kind of objective analysis to be very important and so this small number one in five is particularly serious I think in terms of that concept so you might say well what's the situation outside medicine because medicine of course has a very special connotation and this issue is not unique to medicine so I've read a fair amount of the literature there's a huge literature on this as many of you might know hundreds and hundreds of papers a variety of studies some good some not so good people's opinions and ideas right across the board in architecture engineering business particularly business has achieved a lot of recognition recently in terms of a dearth of women on boards of companies in terms of CEOs on Wall Street and so on and much of this literature is fascinating and worth reading it's just kind of very interesting I picked out a couple to just recommend to you and I can make these available to you if you're interested but these are highly personally selective there are many many others some of which I've read and some of which I haven't that are extremely fascinating so this paper by Ann Marie Slaughter in the Atlantic in July August assumed a huge amount of attention it was written in response to the view that if women only tried harder and society was a little more flexible women would rise rapidly to high level she's actually a career diplomat so her background is in foreign policy and she was a major player in the Clinton administration very high in terms of the State Department and she wrote this really I think insightful article that's worth reading about pointing out the challenges she faced in terms of the demands on her in terms of the work versus family demands children and others and why she felt it was still not an equal proposition with men her husband Andrew Moravzig wrote something else in addition to what she wrote in a later edition because everyone wanted to know about him he's a faculty member at Princeton and he wrote about it too of course most of you have heard about or read Cheryl Sandberg she's a CEO and I mean a CEO at Facebook and her book lean in pretty much says you can do it all although I guess if your salary is $25 million a year it gives you some minor advantage as some of our politicians are saying today so her book is kind of the opposite to Ann Marie Slaughter I don't agree with her by the way but it's an interesting book and then there are a variety of really interesting analyses some by women and some by men about this topic that are very instructive Robin Ealy wrote talks about salaries and all kind of things as you would imagine from the Harvard Business School where she is Wendy Williams and her husband Stephen Ketchy talk about the challenges of motherhood in society they both PhD scientists you might think well the survey that was done in 2013 14 maybe it's outdated and two years later now but there are very good indications that not much has changed in the last two years there's two good papers in JAMA recently which are pretty much a little more up-to-date they come up with the same kind of data and there are repeated articles in the New York Times and other journals about this issue of women and leadership in society and a whole variety of places there are some who've pointed out that there are some successes and this paper by Jeremy Hefney which talks about leadership at a Rochester Polytechnic Institute and what he and the president have done to increase women and leadership roles is instructive so it's not a monolithic issue and there are many interesting papers I picked out just these few there are many others so that's the background I think the data is pretty incontrovertible I mean most people agree with it but exactly why it's happened and what to do about it is the most interesting and challenging issues so the first is why does this happen or what is the best view we have as to the origins of this issue and there are a variety of variables and some people give different weights to different ones I picked out a couple here this is not all inclusive but they perhaps some of the more dominant ones that people discuss in the literature and in various fora and so individual issues you may not be surprised by any of these personal aspirations expectations work like balance issues which of course are very important societal issues societal expectations of young girls and as they grow up in terms of what their career possibilities might be and then a variety of issues in educational opportunities in the disciplines we talk about science technology engineering and mathematics and then there are undoubtedly and I'll be interested to discuss a few of these with you institutional issues some of which we can really do something about and that's why I'm particularly interested in them salary inequities recruitment and retention through unconscious bias a really interesting topic that I know you're well aware of and I'll comment briefly on that and issues of culture institution that are either friendly or inimicable to women's progress up the career ladder so there are a variety of things that are worthwhile thinking about analyzing and which there's a fair amount of data in the literature some of which is quite rigorous and some of which is not let's start with the thing we can really measure and that's salary inequity it is actually surprising and I think somewhat shocking that when you look at equal work for equal pay idea that in many many studies it's been shown repeatedly that women are less well paid than men for the same amount of work and the same quality of work it's kind of a shocking but real phenomenon here's one study about starting salaries for physicians in practice and I won't go through the details but you can see that overall women earn quite a lot less than men in 1999 it was a difference of about thirty six hundred dollars as a starting salary for equal qualifications as best as anyone could tell and some ten years later had had risen to sixteen thousand there seemed to be absolutely no good reason for this except bias here you can see another study that was interesting some years along in clinical practice male physicians out and women by 13% at the beginning and then up to 28% eight years later now of course you might argue there are many variables and of course there are but mostly these studies have tried to remove the discriminating variables and try to equalize the issue of the quality of work and the amount of work and you can see 23% gender based earnings gap and so on over many years this amounts to many many hundreds of thousands of dollars maybe close to several million dollars over a lifetime of 4050 years this is really a serious issue and for everything one can tell unsupportable by any reason so here I have a question for you and I'm gonna ask you to put up your hands so think about it do the study show that salary gaps exist in private practice but not in academia which is by the way us right gender gaps in salary for NIH grant recipients are eliminated when productivity is taken into account so there are easy sheets to look at for NIH study sections where you put your salary in you ask for a percentage of your salary on the grant so these analyses have been done and there is really really good data on this so my question is is A and B do studies show that A and B are correct so salaries exerts differences do not exist in academia for equal work and that when all the variables are equalized at the NIH study section grants they are paid equally all those who agree that that's the outcome put up your hand so that we do not have discrepancies in academia none of you believe that it's been a cultural thing you know like women have found working in surgical areas very difficult for many many years and there's a kind of a male dominating culture of you know alpha male kind of stuff it's just a fact of life if you look at some of these leaders in surgical departments one chair in the country in surgery two three so there are areas in medicine that have been more friendly to women and some that have been more challenging and they may not only be because of the culture I mean some may be the demand you know it's not a simple matter what's really important is that we remove those things that we have control over you know if people can't do or don't want to do surgery because it's so demanding and you know the whatever that's one thing but if the reason they don't do it is because we make it miserable for them to do it that's unacceptable so you know the variables are really important to analyze before we give blanket answers to these kind of things but there are very big discrepancies all across medicine in terms of both gender and underrepresented minority people populating these areas yes ma'am you're absolutely right and I didn't want to get into that because it's such a it's so far out into I was trying to talk about the subtle thing relatively subtle but what you talk about and Claire promeroy in her editorial writes about an experience she had you know in one of her mentors men mentors made sexual advances and how this disadvantaged her when she said no so and the New York time and you know there have been faculty members recently at Berkeley and others it's an editorial in science so that's like one way out but as you point out it seems to be much more common than we previously believed I can answer that but all of you women can you know and I don't know exactly in medicine verse some of these other fields but clearly that kind of behavior is totally unacceptable and destructive and it's clearly more common than we had even imagined so I'm pleased you brought it up and it's really important yes the institutional culture is inimicable to women you know we're already behind so that just depends on the head of the hospital the dean chairman division chiefs and often as we see 80% of them are men and if their behavior encourages this kind of bad institutional culture we have a very real problem and that should be rooted out in a university or medical school and you know the leadership should find it unacceptable and if individuals are repeatedly doing that they should be terminated you know there's easy to say difficult to do but that's what has to be done you know because it's just unacceptable it's a critical question of course because I didn't spend a lot of time on it because I think most of you and Anne Marie Slaughter writes about that very poignantly so there are some things we can do you know men haven't learned how to have babies yet that's one of our challenges right but there are other things you know daycare men spending time at home helping with children or parents who are needing care expanding the time to evaluation to give women more time off opportunities for part-time work at critical times in their careers how they paid and kept on without discrimination and people find it positive so yes there are you know the fact is it is a very very big issue and how we deal with it can mitigate the negative impact of it on careers to some extent clearly not completely and that's underlies many of women's frustrations in terms of successful careers on the other hand as you point out there are things we can and should do about it and many of these things have a big impact institutional culture childcare men doing their part being sure the salaries support them part time work so yes I think we should focus on that as well I think that's it