When Kathryn Dusenbery was offered the top job in her department at the University of Minnesota in 1990, she had to choose between more time with her children –– then 6, 8 and 11 –– or the job. She chose the job.
But that decision put her in the minority. As head of Therapeutic Radiology, she is now one of three women among 25 department leaders at the University’s Medical School.
Though the percentage of women entering medical schools has nearly doubled since 1975 to the point that the gender gap in enrollment has almost closed, men still dominate the top of the promotion and pay scale in academia.
“We clearly have a problem,” Medical School Executive Vice Dean Mark Paller said.
There are more than 200 full-time male Medical School professors and 50 females. Male professors earned about $3,300 more than their female counterparts in 2010, according to a Minnesota Daily analysis, and most of that disparity is in the upper ranks.
Of the 100 top paid Medical School employees last year, 15 were women.
Conflicts with family life, stress, uncertainty of obtaining external funds and a long-standing social bias all may contribute to women’s decision to leave academia.
Former Medical School Dean Deborah Powell, who held the position from 2002-09, said the school needs to do more to ensure equity.
Powell said administrators need to review how department heads address salary equity, put aside money to address gender disparities and do a formal salary survey to look at gender-based pay disparity.
“You have to do it,” she said. “And you have to do it with the intent of making some corrections.”
In the basement of the Phillips Wangensteen Building, the medical students studying or grabbing lunch are evenly balanced, with women making up about half of the first-year students.
Jump up a few levels in the building, which hosts a variety of departments, and the numbers begin to diverge.
About 39 percent of assistant professors –– the position at the start of the tenure track –– are women, and among full professors, the percentage is whittled down to less than half of that.
Women make up about 35 percent of academic medical professionals nationally, said Stephanie Wragg, the director of Women in Medicine and Science at the Association of American Medical Colleges. An AAMC study found men outnumber women for department chair positions by 6 to 1.
There are “continuing issues” that make it difficult for women to stay in academia or progress though the ranks at the same rate as men, Paller said. But he’s not exactly sure what they are.
“If we really could identify those better than we have, we would try to alleviate that,” he said.
Whatever the problem is, it persists at medical schools across the U.S., Paller said, and “I don’t think all of them are part of a conspiracy of old white men to keep academia as a club.”
But unfair treatment of women could play into retention problems, according to a 2005 survey of University of Minnesota Medical School faculty, which was published in Academic Medicine, the journal of the AAMC.
Few Minnesota faculty reported overt discrimination, however, “more women than men perceived gender discrimination in promotion, salary, space/resources, access to administrative staff and graduate student/fellow assignment,” the study stated.
For full professors, the median salary was $139,300 for men and $135,900 for women.
However, at the second step to professorship, associate professor, the median women’s salary was $8,400 more than the men’s. For assistant professors, the lowest level of the tenure track, it was $9,200 more.
Kristin Hogquist, a professor in immunology, said the current system for salaries is self-policing.
“I’ve never felt that there’s been a very heavy-handed administrative attention to gender balance in salaries,” she said.
Faculty need to look for pay differences and complain, she said, “and the sad thing is, women are not as squeaky [of] wheels.”
To get a raise in academia, professors commonly have to go outside their school and pull in another offer, she said, and when a university sees another school values your work at a higher price, it will often offer a retention package.
A Minnesota native, Hogquist has spent most of her career in the state. A collage of her children, who are 11 and 13, is posted on the glass panel outside her office in the new Wallin Medical Biosciences Building. Her lab is attached to her husband’s.
“If you love where you are and where you live, you have to put that on the line to get a salary increase,” Hogquist said.
Oversight, underlying problems
Department heads or committees make decisions on faculty salaries. There isn’t a common method for evaluating employees’ merit, with differences in criteria like research and publications, making a University-wide policy impossible.
Comparing faculty salaries across Medical School departments is complicated, as some departments have more research-focused faculty while others have more professors doing clinical work.
When department leaders reach pay decisions, some clearly outline the determining factors for the faculty member’s wage and how it stacks up in the department. Others hand down a number –– no explanation, no context.
Salary increases in the Medical School have to be approved by the dean or executive vice dean, Paller said. Last year he did a systematic review of department salaries.
He looked at the different faculty ranks with department heads and compared salaries to Association of American Medical Colleges benchmarks, looking for “glaring abnormalities” and keeping an eye on women and minorities.
“Whenever I noticed someone who seemed to be out of range, I asked why,” he said. Often the response was common, like a phased retirement where the professor was working fewer hours. When there wasn’t an obvious reason, Paller made equity adjustments. They made a “handful” of changes to 2011 wages, Paller said, primarily people who were passed over during salary bumps –– there was no gender trend.
Afterward, he posted salary data by rank and department, without names, to the Medical School website.
“If you’re not afraid ... that there’s favoritism and inequalities that are non-accidental, then you should share the data,” he said.
Budget constraints make things difficult, but it’s a matter of making gender equity a priority, Powell said. When she was dean, she would look over salaries with the chief financial officer annually.
Powell and Chief Financial Officer Pete Mitsch would look at whether departments were in line with AAMC markers. One year, after the provost made some special money available to academic units, they submitted a plan and were able to boost salaries in pediatrics and pharmacology, which were “egregiously out of line” with national pay recommendations, Powell said. Within those departments, women were often on the low end of the pay scale.
Salary data from the University currently shows gender disparities in a number of specialties, including surgery and laboratory medicine and pathology –– the two departments with the most full professors.
The University’s salary data breaks down areas of medicine into small divisions, departments and centers at the school.
In 12 of these 58 categories, including nephrology and pharmacology, the average female full professor earned more than the average male.
The median base salary for male full-time laboratory medicine and pathology professors was almost $17,000 more than females’ –– and the women have worked for the University longer. The median original hire date of female professors in the department is six years earlier.
On top of that base salary, faculty members’ pay often includes “other earnings,” like royalties, grants, bonuses and clinical work. These can make up a large chunk of employees’ total earnings –– they also account for much of the inequity.
For assistant and associate professors University-wide, males made about $3,000 more in other earnings than women in 2010. With full professors, the gap stretched to $10,000.
In laboratory medicine and pathology, men collected about $46,000 in other earnings, compared to $11,000 for women.
In surgery, where there are almost 10 times as many male professors as female, men’s other earnings were $72,200 more.
“The bottom line is how many grants do you have, how many contracts do you have to support your salary and how have you done in terms of patient revenues?” said Chief of General Surgery Gregory Beilman, adding that base salaries are a small part of the pay in surgery.
“So if you are a highly productive member in terms of working hard and taking care of lots of patients, our goal is to make sure that those people are being recognized for that contribution –– regardless of whether you’re male or female,” he said.
Professors face further stress in conducting research and publishing as funding for the National Institutes of Health has declined, cutting down on the number of available grants.
The ‘triple threat’
In obstetrics and gynecology, doctors are constantly on call. Linda Carson, head of the Department of Obstetrics, Gynecology and Women’s Health, said she works about 65 hours per week –– something she’s toned down over the years.
She said women may be drawn to private practice or industry because it doesn’t require them to be the “triple threat.” In academia, people entering the tenure track have to produce the research and publications, teach and do clinical work –– and they usually have nine years to meet the requirements if they want to reach full professor.
Meanwhile, female employees remain the primary caregivers in families. They reported spending an average of 31 hours per week on family and household responsibilities, whereas men spent 19 hours, according to the 2005 study of Medical School faculty.
Carson had children during her medical residency and fellowship in the 1980s. As she was trying to get promoted, she would return home at 8 p.m. and have an hour with her kids before they went to bed, and there was no day off. On the weekends she caught up on research and papers.
“It was a price I was willing to pay,” she said. “I didn’t think it was healthy; I didn’t think it was balanced.”
In the private sector, hours can be balanced with others in the practice, and research and teaching aren’t a requirement.
Now, Carson tries to allow her employees some flexibility in hours. Additionally, University workers receive a 12-week maternity leave. In the ’80s, Carson only got six weeks.
Other changes during her tenure include the implementation of the punch-the-clock initiative –– which allows tenure-track professors to extend their deadline for tenure –– and more balanced salaries for assistant professors.
When Carson started as an assistant professor at the University of Minnesota, she came in at half the base salary of other employees in her department.
“The thought was that you are a woman, your salary is extra. You aren’t, quote-unquote, ‘supporting the family.’ It was a paternalistic idea,” Carson said.
Her salary was increased only after older faculty left.
“We need to make faculty aware, when one is getting a job offer, there are negotiation skills [necessary],” said Stephanie Wragg, the director of Women in Medicine and Science at the AAMC. “Men and women approach money differently … women tend to take the first offer.”
A University problem
The Medical School is not alone in its gender gaps. According to a University-wide study by the Women’s Faculty Cabinet, male full professors’ salaries in 2007 were, on average, 8 percent higher than females. The study did not include the Medical School.
But similar to medicine, it showed less inequity among assistant professors. Their salary gap had shrunk to about 4 percent, close to half of what it was 20 years before.
Nonetheless, a newly recruited female assistant professor will make about $200,000 less than a man over a 25-year career, according to the report.
“I think people have just been concerned and wonder, ‘How can this still be happening?’” said professor Patricia Frazier, who helped lead the cabinet’s study, which was presented to the administration in May 2010.
The study showed the pay gap for tenure and tenure-track faculty has remained “virtually unchanged” over the past 20 years.
The University hired a statistician at the University of Wisconsin to do further analysis, which will likely wrap up in June.
Sally Kohlstedt has watched the shift in gender equity closely over more than 20 years at the University.
“It seems as though things move very slowly, very cautiously and reluctantly in this process and that’s a source of frustration,” she said.
Kohlstedt and members of the Women’s Faculty Cabinet said the data shouldn’t have to come as a revelation. An initial list of solutions presented with the cabinet’s report includes starting a comprehensive salary equity study every three to five years, so discrepancies don’t run unchecked.
A regular review of comparative salary data was expected to start decades ago, following a class-action lawsuit by female University employees that led to widely adjusted salaries and more equitable hiring practices.
The suit began as a discrimination complaint filed in 1973 by Shyamala Rajender, a chemist at the University, and grew to represent all female academic non-student employees.
The University settled the suit, and in 1980 school officials signed the Rajender Consent Decree that established an affirmative action hiring program and a faculty Senate Committee on Equal Employment Opportunity for Women.
After the decree expired in 1991, more than 300 women have sued the University, and 180 received monetary or professional settlements. Another thousand women were granted pay increases in their departments or colleges –– a total of $3 million was distributed to women faculty. But after 1991, some of the decree’s provisions disappeared.
“The promised regular review of comparative salary data did not happen and the still modest increases in faculty hiring in most departments leave open the question of whether significant and fundamental gains have been lost through inattention,” according to a report published in 2004 by College of Science and Engineering faculty.
Kohlstedt, one of the authors of that report, was formerly an associate dean in the college. Every year when wages were being set, she would look at the spreadsheet of salary increases and keep an eye on women and minorities, questioning salaries that looked out of line.
Now, she worries that no one is watching. The commitment to pay equity needs to come from the University’s top administration, Kohlstedt said, but there’s a lack of will to make change a priority.
“I don’t necessarily think it’s diabolical,” Kohlstedt said. “Somehow there hasn’t been leadership that has said, “This is an important thing.’”
In the mid-2000s, when Arlene Carney was the new vice provost for faculty and Academic Affairs, she said there was a push to look at gender inequities.
The Women’s Faculty Cabinet study began shortly after. But to get to “the locus of the problem,” Carney said the study needs to focus on specific departments.
After the outside analysis, if certain departments show issues, the administration would likely make pay adjustments, she said, as well as look at how merit is being evaluated and ask, “Are we making some subtle difference in judgment?”
Faculty members report their activities at the end of the year. Department chairs or committees evaluate those reports and use them when generating salaries.
But there needs to be more transparency about pay decisions, Women’s Faculty Cabinet member Caroline Hayes said, and salaries should be primarily based on data, like the number of articles published, to minimize subjectivity.
A social bias toward men still exists, and can lead to accumulated differences in pay, Hayes said.
Powell said even she is unconsciously biased toward men. She took an online quiz created through Harvard University that mapped her implicit attitudes toward women in science, and was shocked to find her answers predominately favored men as more capable.
An “informal network” can also leech into decisions in academia, said Jasjit Ahluwalia, a Medical School professor and member of the Institute for Diversity, Equity, and Advocacy. He said men traditionally have more male friends in the workforce, and informal interactions like grabbing lunch or playing golf have a powerful effect.
He’s seen his female colleagues stereotyped again and again –– a phenomenon that’s slowly fading, he said, but still exists. He’s seen many patients or hospital staff ask female doctors, “Oh nurse, could you get this for me?” Others ask, “When am I going to see the doctor?”
“And it’s sort of funny I guess,” Ahluwalia said. “But if you’re the woman who’s the trainee or the doctor, it’s obviously not so funny after the third or fourth time.”
Unwilling to sacrifice
In 1965 women made up less than 8 percent of medical schools’ enrollments, according to the AAMC. By 2009, nearly half of students were women.
When Kathryn Dusenbery, head of Therapeutic Radiology, works with residents, she sees a trend: The incoming generation is demanding more balance in their life.
“They aren’t willing to sacrifice everything to be a doctor,” she said.
Anika Ingham grew up with her mom working long hours as a psychologist at a medical clinic. It was her dad who stayed at home and took her to sports practice and music lessons.
Now, the second-year medical student is determined to be better at balancing her time than her mother was. She said it’s a matter of setting boundaries, of leaving her work behind when she returns home.
But in a couple years she’ll begin her residency, a period when, for young doctors, work often becomes home. Residents have an 80-hour average work week restriction.
“I’m dreading it,” Ingham said of the imminent sleep deprivation. “I don’t think people go into medicine for the lifestyle. You have to go into it because you love medicine and are interested in working with people.”
Joan Beckman is about to begin her eighth year as a medical student, and while she knows the difficulties and sees the limited number of women at the top, Beckman plans to enter academia.
She wants to become a full professor and help create an environment that allows women to have families and doesn’t penalize people for taking time off for personal reasons.
“When you’re being pulled in many directions it’s easy to take the path of least resistance” and go into the private sector, Beckman said.
But with women like Powell ascending to top ranks and an equal gender balance entering the field, there is a “changing face of medicine,” Beckman said. “I have optimism.”
Trying to balance
For Dusenbery, becoming a department head as the mother of young children meant additional difficulties and responsibilities.
“I mean the extra hours, and extra –– I think the way I try to lead is by example, and I work as hard if not harder than all of my faculty to be part of the team. So I wasn’t so sure I really I wanted to do it.”
Overall, she said, her field of radiation oncology has “relatively reasonable hours,” one of the aspects that attracted her to the job. In radiation oncology, the hours and the original lack of competition –– something that’s changed over the past two decades –– meant the field hasn’t seen the traditional male dominance prevalent in other specialties, Dusenbery said.
Moving up the University ladder was a matter of being in the right place at the right time, Dusenbery said. She originally got a radiation oncology fellowship at the University in 1985, when the field was “underground” nationally.
She slid into a well-timed job opening at the University in 1990 and nine years later she was senior enough to join the fray when a spot opened a the top of her department. She was selected after a national search.
Shortly after she was appointed head of therapeutic radiology, the only other female department leader stepped down.
Over the past decade, she focused on improving her department, which has grown from one-and-a-half clinics to five.
When she got the job, Dusenbery didn’t feel any sexism, and just tried to do her job well.
“It would only occasionally occur to me that I was the only female in the room."
-Andre Eggert contributed to this report.