Reflecting on Gender and Success in Academic Medicine

As members of the HMS Class of 1999, we recently celebrated our twenty-fifth reunion, an occasion that inspired us to reflect on where we and our peers are now.

Some classmates have achieved great heights both in our profession and beyond, including one who led a laboratory effort that yielded a major COVID-19 vaccine, another who won a Pulitzer Prize, and a third who became a member of Congress. Five years ago, at our twentieth reunion, one of us was invited to speak about research that has identified persistent gender differences in career experiences and outcomes of physicians. After reconnecting earlier this year, we decided to take a closer look at our own class. How many of our classmates, we wondered, have gone on to achieve traditional forms of success in academic medicine? In particular, as one of the first HMS classes to include more women than men, would our paths over the past twenty-five years reflect differences by gender?

When we arrived at HMS as students, we were welcomed into societies named for great men such as Francis Weld Peabody and Oliver Wendell Holmes. Terms like implicit bias and microaggression had not yet permeated the collective consciousness. We hardly noticed at the time how few of the full professors and leaders in medicine — both at HMS and beyond — were women. To the extent that we did, we rationalized that a dearth of women in senior positions was to be expected when women hadn’t begun entering medical school in meaningful numbers until Title IX passed in 1972. We took for granted that things would be different for us and our classmates.

The two of us were mentored and sponsored by men and women alike and have gone on to have fulfilling careers and to rise to positions still rarely occupied by women. One of us pursued radiation oncology and the other plastic surgery, knowing these were fields in which women were dramatically underrepresented. Today, Christine is among the 12 percent of plastic surgery chiefs or chairs who are women, and nearly half of residents in plastic surgery are women. Reshma is among the 13 percent of radiation oncology chairs who are women, while the percentage of residents in radiation oncology who are women has remained about a third. What would we find when examining our class as a whole? Committed to making this a rigorous effort, we collated publicly available data on grant funding, H-indices, and current professional positions (after confirming that our institutional review board did not consider this to be a human subjects study). What we discovered lends itself to both glass-half-full and glass-half-empty interpretations.

We encourage the HMS community and those at all institutions responsible for medical education to consider the lessons that the experiences of our class suggest.

We found that 89 members of our class were in academic positions (although this can be difficult to determine in some cases, given the corporatization of many community practices), of whom 13 (14.6 percent) held endowed positions, including 6 (14.0 percent) of the women and 7 (15.2 percent) of the men. Another 62 (37.4 percent) were in community practices, 10 (6.0 percent) in industry, and 3 (1.8 percent) in government service. (The class year for an individual alumnus can vary depending on the definition used. We based our analysis on those who self-identify as members of the Class of 1999.)

Of those in academic medicine, 38 (42.7 percent) were full professors, including 21 (45.7 percent) of the men and 17 (39.5 percent) of the women. Another 28 (31.5 percent) were associate professors, including 16 (34.8 percent) of the men and 12 (27.9 percent) of the women. And 19 (21.3 percent) were assistant professors, including 6 (13.0 percent) of the men and 13 (30.2 percent) of the women. The remaining 4 had unknown academic titles or were at the instructor level.

NIH RePORTER lists 37 (22.3 percent) members of our class as having held funding from that prestigious and influential federal funder of biomedical research; over half (54.1 percent) were women. Median NIH funding was $3,070,516 among the women (IQR $486,138–$7,862,376; mean $5,060,816; SD $5,926,409) and $4,889,389 among men (IQR $2,246,660–$9,432,690; mean $46,433,207; SD $151,751,744). The three individuals with the highest NIH funding (each with over $25 million total) were men, whereas all five with under $500,000 in total NIH funding were women, largely driving the differences in means. The median H-index measured by Scopus was 5 for women (range 0-102) and 12 for men (range 0-108).

As we read our reunion report and reconnected with old friends, we were struck by the fact that such statistics miss so many of the more meaningful accomplishments and experiences our class has collectively had. Classmates triumphed over dire illnesses, partly thanks to the miracles of modern medicine and partly thanks to their own mettle. One delivered one of the most memorable lectures of our preclinical years, sharing how when he was born with a diagnosis of cystic fibrosis, doctors had told his parents to abandon hope and expect that he would die as an infant. He went on to a thriving career as a gastroenterologist. Another runs ultramarathons while also grappling with lymphoma, using his experience to help others. Some have achieved great financial success; we have more than one CEO in our group. Many have beautiful families. And those with daughters — men and women alike — told us to share our observations. They noted that although academic success isn’t everything, we should still not be complacent about gender differences in the outcomes we measured.

There are many paths to fulfillment and influence in life, but it is difficult to stomach our findings that a group of particularly promising medical students once so similar in aspirations and opportunities manifested gender differences in academic rank and metrics that are among the most common criteria considered in promotions. We must avoid the narrative that women simply choose to prioritize family life over career — even if, as a recent report from the National Academies of Sciences, Engineering, and Medicine shows, it remains harder for women to have both. The two of us were able to have both, as did many of our male classmates.

Both of us long ago left for other institutions, but we watched with interest as Harvard made changes to many things we had taken for granted while there. As musicians, we had both learned the original lyrics to our school song, “Fair Harvard,” which began, “Thy sons to thy jubilee throng.” More recently, it was revised to “We join in thy jubilee throng.” As our alma mater finds itself at the center of a national controversy, accused of “wokeism,” we worry about the entrenchment of attitudes that have had such a divisive impact more generally.

We encourage the HMS community and those at all institutions responsible for medical education to consider the lessons that the experiences of our class suggest. It is essential to embrace best practices to ensure that all talented individuals have the opportunity to realize their potential. Systems-level interventions, including initiatives to cultivate a respectful work environment; transparent, criterion-based evaluation processes; broad-based sponsorship and career development programs; and leadership term limits are evidence-based strategies that have great promise. Reconsidering whether the sorts of metrics we evaluated should remain the main focus of academic promotions processes may be a more radical but important possibility. Only by recognizing that change will require active interventions to promote equity can we ensure that all members of the medical school classes of 2024 and beyond ultimately reach their fullest potential.

Reshma Jagsi is the Lawrence W. Davis Professor and Chair of the Department of Radiation Oncology at Emory University School of Medicine. Christine Rohde is the Chief of the Division of Plastic Surgery at Columbia University.