Earlier this year, the National Institutes of Health announced that the agency’s nearly 300 laboratory and branch chiefs will be limited to 12-year terms to increase the gender and racial diversity among leadership. But in general, the idea of term limits to encourage diversity has been slow to catch on in other research settings, especially medical schools.
Among department chairs and other leaders in academic medicine, there is a large gender and racial disparity: Women make up only 18% of medical school deans, while those from other underrepresented minority groups account for 12% of deans.
A new perspective paper published Wednesday in the New England Journal of Medicine argues that without a policy shift to set term limits and rectify these gaps, “academic medicine won’t reach gender parity for another 50 years.” At that point, event the youngest physicians — those who are in medical school right now — would be past retirement.
The paper’s authors, all of whom are physicians, looked at the more than 2,100 clinical department chairs across various medical schools in the U.S. and found that men, on average, served as deans for about nine years, compared to women’s six years. Among those who served as department chairs for at least 12 years, only about 7% were women. And fewer than 10% were not white or Asian.
STAT spoke with Dr. Reshma Jagsi, a radiation oncologist at Michigan Medicine and senior author of the piece, to learn more. This interview has been lightly edited and condensed for clarity.
What is the problem in academia right now?
We know that now for the first time ever, over half of all U.S. medical students are female. And despite the fact that women really started entering the profession many decades ago, we have not seen a similar diversification of medical school department chairs or deans. When we see that women have constituted over 40% of medical school faculty, but under 20% of leaders, we start to worry that it’s not just the long time it takes to get through the pipeline, but other reasons as well.
Why do you think this problem persists?
In my mind, there are three major challenges: Unconscious biases that exist, overt discrimination and harassment, and finally gendered division of labor, where women in our society bear a greater burden of domestic responsibility for child care or elder care. Those come together to make it more challenging for women to ascend senior leadership positions in academic medicine.
Why term limits?
The tendency is for leaders to remain in those positions for a long time.There are people who have been serving for 43 years. In academic medicine, clinical departments in particular have access to very large budgets and department chairs tend to wield substantial power to allocate these funds. Even a very altruistic person will tend to want to have continued access to those resources.
But institutions should consider whether at some point there are diminishing, marginal returns to the implementation of one person’s vision, and if there’s a benefit from bringing in other points of view.
Is there an ideal limit?
I don’t know that 12 years [like the NIH proposed] is the magic number, and there are many institutions that have their own terms built in, like five-year renewable terms. Maybe you have a norm of two five-year terms, and for really good service, you allow a third five-year term and allow people to have 15 years. But something shy of 43 is probably what we want.
Fifteen years might seem like a long time, but even that would be progress compared to what we’re seeing right now.
Do you think people will take this proposal seriously?
Presidential candidate Elizabeth Warren spoke to my 13-year-old daughter at a campaign event recently and my daughter asked her why she thought sexism was still a thing today. Warren tossed it back to my daughter, who said, “I think men like to be in power.” Warren said she was going to say the same thing, and I think that people who have power don’t like to give it up.
It’s a natural response to think that if you turn over all this leadership, there’s going to be chaos and you’re going to have inexperienced people and lose institutional memory, but that’s not what I’m proposing. I’m saying we should have a mindful approach to succession so that we are not dependent on one person’s vision for multiple decades, and term limits are one way to ensure that there is a regular turnover of perspectives.
What’s to say that setting limits will lead to change?
There’s absolutely no guarantee. I would argue [that term limits] are potentially necessary, but certainly not sufficient. Certainly it’s possible that if you replace leaders with inexperienced versions of themselves, you’re not going to bring new perspectives. But with mindful job posting, search processes that try to inhibit the influence of unconscious bias, and leadership training, we could create an environment within which turnover of leadership positions would actually end up bringing new perspectives to the table.
What about other institutional barriers — how might term limits affect them?
One of the big challenges is imposter syndrome, which is this feeling that one is not qualified to be where one is. It’s often approached as an individual thing, but it’s not exclusively that. We see that being more common in people who don’t have role models in leadership. To some extent, diversifying the leadership can help transform and change that culture.
[Changing leadership could also lead to] some differences in the types of research promoted. It’s not just about achieving parity, but being more attuned to issues of equity, diversity, and inclusion. There are other benefits: A woman may not think that a 70-kilogram white male is the anatomic norm and a smaller black woman is a deviation from the norm. [Diversity in leadership] might actually ensure that there are adequate numbers of clinical trial participants who are women and minorities.
The evidence is really compelling that when people from different life backgrounds and experiences interact, they come up with more innovative approaches that help not just women but human health. It’s not just about promoting gender equity to help women. In the end, diversity is also likely to help our achieve our mission to help men as well as women.