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Table 1.  Characteristics of 131 Participants by Race/Ethnicity
Characteristics of 131 Participants by Race/Ethnicity
Table 2.  Risk Factors Associated With Attritiona
Risk Factors Associated With Attritiona
1.
Horowitz  J, Parker  K, Brown  A, Cox  K,. Amid national reckoning, Americans divided on whether increased focus on race will lead to major policy change. Pew Research Center Social and Demographic Trends. Published October 6, 2020. Accessed October 22, 2020. https://www.pewsocialtrends.org/2020/10/06/amid-national-reckoning-americans-divided-on-whether-increased-focus-on-race-will-lead-to-major-policy-change/
2.
Haggins  AN.  To be seen, heard, and valued: strategies to promote a sense of belonging for women and underrepresented in medicine physicians.   Acad Med. 2020;95(10):1507-1510. doi:10.1097/ACM.0000000000003553PubMedGoogle ScholarCrossref
3.
Association of American Medical Colleges. US medical school faculty (USMSF) report. 2019. Accessed October 7, 2020. https://services.aamc.org/famous/
4.
Grisso  JA, Sammel  MD, Rubenstein  AH,  et al.  A randomized controlled trial to improve the success of women assistant professors.   J Womens Health (Larchmt). 2017;26(5):571-579. doi:10.1089/jwh.2016.6025PubMedGoogle ScholarCrossref
5.
Chang  C, Ferris  DL, Johnson  RE, Rosen  CC, Tan  JA.  Core self-evaluations: a review and evaluation of the literature.   J Manag. 2012;38(1):81-128. doi:10.1177/0149206311419661Google Scholar
6.
Yancy  CW.  Academic medicine and Black Lives Matter: time for deep listening.   JAMA. 2020;324(5):435-436. doi:10.1001/jama.2020.12532PubMedGoogle ScholarCrossref
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    Research Letter
    Medical Education
    March 25, 2021

    Career Trajectories of Women From Underrepresented Minority Groups at an Academic Medical Center

    Author Affiliations
    • 1Driehaus College of Business, DePaul University, Chicago, Illinois
    • 2Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
    • 3Critical Path Institute, Tucson, Arizona
    • 4Perelman School of Medicine, University of Pennsylvania, Philadelphia
    JAMA Netw Open. 2021;4(3):e212723. doi:10.1001/jamanetworkopen.2021.2723
    Introduction

    Combined effects of the coronavirus disease 2019 pandemic and multiple high-profile events, such as the police killing of Breonna Taylor, have prompted a widespread reckoning with the systemic racial and gender inequalities that threaten the safety, livelihood, and well-being of women of color.1 In academic medicine, gender disparities in career advancement are well established; however, this work frequently sidelines conversations about racism and the double jeopardy facing women of color.2 Current Association of American Medical Colleges roster data show that, of full-time medical faculty, Black and Hispanic women together represent only 3.7% of faculty across ranks and 1.5% of full professors.3 Understanding career trajectories of women from groups underrepresented in medicine is important to developing strategies for the retention and promotion of a diverse academic faculty. Using data from a longitudinal study of women faculty at 1 research-oriented institution, we hypothesized that women from racial/ethnic minority groups were more likely to leave their assistant professor positions compared with White women.

    Methods

    As part of a National Institutes of Health R01–funded cluster randomized intervention trial at 1 research-oriented institution, women assistant professors were recruited for participation in a study approved by the University of Pennsylvania institutional review board and tracked during 3 years.4 Participants provided written informed consent, their racial/ethnic identification, and personal and professional characteristics via a web-based survey in 2010. Three years later, as part of a secondary observational analysis on cohort attrition, participants reported their employment status at the institution. The primary randomized clinical trial followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.

    In this cohort study, statistical analyses identified factors associated with attrition, including racial differences. A multivariable generalized linear model was used to estimate risk of attrition, using a generalized estimating equations framework to account for clustering by departments or divisions. The multivariable model included years in rank, marital status, and a validated measure of core self-evaluation.5 Analyses were conducted with Stata version 14 (StataCorp). Statistical significance was set at P < .05, and all tests were 2-tailed.

    Results

    Of 178 eligible individuals, 134 women assistant professors (75.3%) from 27 departments and divisions participated in this study. Three years later, 131 faculty (98.5%) provided employment status at the institution. The racial composition was 15 individuals from groups underrepresented in medicine (11.5%; mean [SD] age, 40.5 [1.4] years), 37 Asian women (28.2%; mean [SD] age, 41.0 [0.9] years), and 79 White women (60.3%; mean [SD] age, 41.1 [0.6] years). Of the faculty from groups underrepresented in medicine, two-thirds (10 of 15 [66.7%]) were Black women. Overall, 21 faculty members (15.6%) departed from the institution during the 3 years: 6 of 15 women (40.0%) from groups underrepresented in medicine, compared with 9 of 79 White women (11.4%). Twenty of the 21 women faculty (95.2%) who departed completed postexit surveys describing their new positions. Of those women, 17 (85.0%) accepted positions primarily as assistant professors in academic medical health centers affiliated with medical schools. The other 3 faculty (15.0%) moved to nonacademic tracks at large health systems. No racial differences in subsequent employment were discernable, given the small sample size. Participant characteristics by race/ethnicity are reported in Table 1.

    Table 2 provides multivariable model results. Women underrepresented in medicine were 3.3 times more likely to leave the institution than White women during the study (risk ratio, 3.30; 95% CI, 1.38-7.91; P = .007). Attrition did not differ between Asian and White women (risk ratio, 1.67; 95% CI, 0.75-3.74; P = .21). Low core self-evaluation scores and being unmarried were also independently associated with attrition.

    Discussion

    The future of academic medicine depends on the ability to harness the talent of diverse faculty.6 Our study found that women assistant professors from groups that are underrepresented in medicine were 3 times more likely to leave their positions compared with White women during only 3 years. Although these findings represent 1 institution during a defined period, they signal a need for ongoing and targeted intersectional research on attrition in medicine. A limitation of this study is that the sample size was too small to allow a detailed analysis of subsequent employment by race. Regardless of the nature of postdeparture employment, these differences suggest a mandate for every institution to closely monitor and analyze attrition data. It is clear that the host institution lost full-time faculty and diversity with these departures, along with the investments made in recruitment and early faculty support. Indeed, the success of academic institutions, as well as the future of medical research and practice, hinges on the ability to develop and implement evidenced-based initiatives that nurture and advance the careers of all faculty.

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    Article Information

    Accepted for Publication: January 21, 2021.

    Published: March 25, 2021. doi:10.1001/jamanetworkopen.2021.2723

    Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Westring AF et al. JAMA Network Open.

    Corresponding Author: Stephanie B. Abbuhl, MD, Perelman School of Medicine, University of Pennsylvania, Emergency Medicine Administrative Ste, Ground Floor, Ravdin Bldg, 3400 Spruce St, Philadelphia, PA 19104-4283 (abbuhls@uphs.upenn.edu).

    Author Contributions: Drs Westring and Abbuhl had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: All authors.

    Acquisition, analysis, or interpretation of data: Westring, Sammel, Speck, Abbuhl.

    Drafting of the manuscript: Westring, Sammel, Abbuhl.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Sammel.

    Obtained funding: Sammel, Abbuhl.

    Administrative, technical, or material support: Westring, Sammel, Speck, Grisso.

    Supervision: Sammel, Abbuhl.

    Conflict of Interest Disclosures: Dr Abbuhl reported receiving grants from the National Institutes of Health (NIH) (R01 GM088441-01) during the conduct of the study and receiving nonfinancial support as a founding member of TIMES UP Healthcare outside the submitted work. No other disclosures were reported.

    Funding/Support: This research was funded by NIH grant R01 NS069793-03.

    Role of the Funder/Sponsor: The NIH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: We gratefully acknowledge and thank Emily F. Conant, MD, Perelman School of Medicine, University of Pennsylvania, for her contributions and important role in the NIH Transforming Academic Culture Trial. Dr Conant’s participation was supported through NIH R01 NS069793-03.

    References
    1.
    Horowitz  J, Parker  K, Brown  A, Cox  K,. Amid national reckoning, Americans divided on whether increased focus on race will lead to major policy change. Pew Research Center Social and Demographic Trends. Published October 6, 2020. Accessed October 22, 2020. https://www.pewsocialtrends.org/2020/10/06/amid-national-reckoning-americans-divided-on-whether-increased-focus-on-race-will-lead-to-major-policy-change/
    2.
    Haggins  AN.  To be seen, heard, and valued: strategies to promote a sense of belonging for women and underrepresented in medicine physicians.   Acad Med. 2020;95(10):1507-1510. doi:10.1097/ACM.0000000000003553PubMedGoogle ScholarCrossref
    3.
    Association of American Medical Colleges. US medical school faculty (USMSF) report. 2019. Accessed October 7, 2020. https://services.aamc.org/famous/
    4.
    Grisso  JA, Sammel  MD, Rubenstein  AH,  et al.  A randomized controlled trial to improve the success of women assistant professors.   J Womens Health (Larchmt). 2017;26(5):571-579. doi:10.1089/jwh.2016.6025PubMedGoogle ScholarCrossref
    5.
    Chang  C, Ferris  DL, Johnson  RE, Rosen  CC, Tan  JA.  Core self-evaluations: a review and evaluation of the literature.   J Manag. 2012;38(1):81-128. doi:10.1177/0149206311419661Google Scholar
    6.
    Yancy  CW.  Academic medicine and Black Lives Matter: time for deep listening.   JAMA. 2020;324(5):435-436. doi:10.1001/jama.2020.12532PubMedGoogle ScholarCrossref
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