Association of Women Surgeons The Climb to Break the Glass Ceiling in Surgery: Trends in Women Progressing from Medical School to Surgical Training and Academic Leadership from 1994 to 2015 Maureen Moore MD, Jonathan Abelson MD, Genevieve Chartrand MD, Tracy-Ann Moo MD, Heather Yeo MD Association of Women Surgeons Scientific Forum Washington, DC 10/15/16

None of the authors have any financial disclosures. Women in Academic Surgery Disclosures None of the authors have any financial disclosures.

Background Since 2005: # women entering medical school = men Women in Academic Surgery Background Since 2005: # women entering medical school = men # and % of women remains low at higher levels Why are women underrepresented? Multiple contributing factors Since 2005, the number of women entering medical school has been nearly equal to that of men—however the number and percent of women in surgical training and academic leadership positions remain low. Over the past thirty years, there have been multiple efforts to increase the number of women in surgery and to evaluate why women continue to be underrepresented in academic leadership positions compared to their male counterparts. Among the many reasons cited for the gender gap, common themes include gender discrimination, lack of visible role models, lack of support and mentorship throughout their careers, difference in salary, and lifestyle concerns. There have been few longitudinal studies, and no reports have included surgical subspecialties in their analysis

Women in Academic Surgery Aims To provide an update of women surgeon representation along each step of the pathway to surgical academia. Assess longitudinal trends of women in subspecialty training. Given this increased focus on gender disparity in surgery, we sought to provide an update of women surgeon representation along each step of the pathway to surgical academia. We also aimed to provide the first detailed analysis of the trends of women in surgical subspecialty training over the same time period

Methods Trainee Data: Faculty Data: Women in Academic Surgery Methods Trainee Data: Faculty Data: FAMOUS (Faculty Administrative Management Online User System) from 1994 to 2015 We complied trainee data using AAMC data for medical students and Graduate Medical Education (GME) reports for general surgery trainees. We included all board ceritfied surgical subspecialties We used the Faculty administrative management online user system for data from 1994-2015

Women in Academic Surgery There is good news! We have noted increased percentages of women medical students From 1994-2014: number of women graduating from medical school increased 43% Currently, women med students account for nearly half of all students. Which has been relatively stable since 2004.

Surgical Trainees Women in Academic Surgery Number of general surgery trainees, as a whole, decreased about 2% over the study period Number of women trainees in general surgery more than doubled from 1,500 to 3,100.

Women in Academic Surgery Currently—women account for about 40% of all general surgery trainees

Surgical Trainees Women in Academic Surgery there were significant increases in the absolute number and proportion of women trainees in a variety of surgical subspecialties.

Surgical Trainees Women in Academic Surgery The highest average increase per year was seen in critical care and the lowest in thoracic surgery Assuming these trends continue, women trainees will reach gender parity the quickest for critical care surgery in 6 years and the longest for thoracic surgery in 34 years

Women in Academic Surgery Despite the good news in regards to women representatives in the medical school and general surgery trainee population, women are poorly represented in academic surgical faculty positions.

Average increase from 1994 to 2015 by academic surgical position Women in Academic Surgery Academic Faculty Average increase from 1994 to 2015 by academic surgical position The number of women who are Assistant Professors of Surgery has significantly increased from 1994 to 2015. Yet, they currently still only represent 25% of all Assistant Professors of Surgery

Average increase from 1994 to 2015 by academic surgical position Women in Academic Surgery Academic Faculty Average increase from 1994 to 2015 by academic surgical position Likewise, the number of women Associate Professors of Surgery did significantly increase during the study period; yet still only account for 19% of Associate Professors of Surgery

Average increase from 1994 to 2015 by academic surgical position Women in Academic Surgery Academic Faculty Average increase from 1994 to 2015 by academic surgical position The number of women who are Full Professors increased the most over the study period The average annual increase was highest for Associate Professors, followed by Assistant Professors, and Full Professors. Assuming each of these rates of increase continues, for half of academic faculty to to be women, it will take 49 years at the assistant professor level, 57 years at the associate professor level, and 121 years for full professors.

Average increase from 1994 to 2015 by tenure track Women in Academic Surgery Academic Faculty Average increase from 1994 to 2015 by tenure track There has also been a significant increase in the number and proportion of women surgeons on the academic tenure track. Although, women surgeons still only comprised 22% of all surgery faculty on tenure track in 2015. Parallel trends were seen for women surgeons who are tenured. For women to represent half of all surgery faculty who are on the tenure track or are tenured, it will take between 43 and 98 years.

Women in Academic Surgery Discussion Women have made enormous strides from 1994-2015 in climbing the ladder to become leaders in academic surgery. General Surgery Trainees: women are on track to represent 50% of population by 2026-2028. Full Professors in Surgery: women are on track to represent 50% by 2136. Overall proportion of women in higher leadership positions remains quite low. WHY?? WHAT CAN WE DO?? Women have made enormous strides from 1994-2015 in climbing the ladder to become leaders in academic surgery However, the overall proportion of women at the higher rungs of the ladder remains quite low Sexton et al, found women general surgery trainees are on track to represent 50% by 2026-2028. However, we found that women are on track to represent 50% of full professors by 2136-a hundred years later. Why is this?? Again, many cited reasons for this gender gap including lifestyle concerns, lack of role models and mentors, and gender discrimination To address this issue of women mentorship in surgery, the AWS, in partnership with the American College of Surgeons (ACS), established the Early Career Women Faculty Mentorship Program in 2005. More work must be done to eliminate gender discrimination such as modeling after successful programs such as the Women in Medicine and Health Science (WIMHS) program at the University of California Davis School of Medicine Another strategy for eliminating gender discrimination is to increase the strength and visibility of existing mentorship programs. For example, the American College of Surgeons Women in Surgery Committee (WiSC) was created to develop and advance women surgeons as leaders. The downstream effects of this program should be huge. Sexton et al. J Surg Educ. 2012;69(1):84-90.

Limitations Multiple different data sources Women in Academic Surgery Limitations Multiple different data sources Lack of data on number of academic leaders in surgical subspecialties

Women in Academic Surgery Conclusions Large increase in the number and proportion of women along the trajectory to become academic surgery leaders. There is hope in that there are currently 16 women chairs in surgery!

Women in Academic Surgery Conclusions Despite the increase in numbers, there is still a huge gender gap. Without a significant change in rate of increase in women who are Full Professors, it will take 121 years to reach gender parity. RENEW EFFORTS!! We continue to call on residency programs and faculty leaders to pay attention to this gap and renew efforts to increase gender equality.

Acknowledgments Department of Surgery Heather Yeo, MD MHS Women in Academic Surgery Acknowledgments Department of Surgery Heather Yeo, MD MHS Fabrizio Michelassi, MD, FACS Jonathan Abelson, MD Genevieve Chartrand, MD Tracy-Ann Moo, MD John Daly, MD, FACS