Phyllis L. Carr

Having the right chemistry: a qualitative study of mentoring in academic medicine.

Purpose To develop a deeper understanding of mentoring by exploring lived experiences of academic medicine faculty members. Mentoring relationships are key to developing productive careers in academic medicine, but such alliances hold a certain “mystery.” Method Using qualitative techniques, between November 1999 and March 2000, the authors conducted individual telephone interviews of 16 faculty members about their experiences with mentoring. Interviews were taped and transcribed and authors identified major themes through multiple readings. A consensus taxonomy for classifying content evolved from comparisons of coding by four reviewers. Themes expressed by participants were studied for patterns of connection and grouped into broader categories. Results Almost 98% of participants identified lack of mentoring as the first (42%) or second (56%) most important factor hindering career progress in academic medicine. Finding a suitable mentor requires effort and persistence. Effective mentoring necessitates a certain chemistry for an appropriate interpersonal match. Prized mentors have “clout,” knowledge, and interest in the mentees, and provide both professional and personal support. In cross-gender mentoring, maintaining clear boundaries is essential for an effective relationship. Same-gender or same-race matches between mentor and mentee were not felt to be essential. Conclusions Having a mentor is critical to having a successful career in academic medicine. Mentees need to be diligent in seeking out these relationships and institutions need to encourage and value the work of mentors. Participants without formalized mentoring relationships should look to peers and colleagues for assistance in navigating the academic system.

Rationing Intensive Care — Physician Responses to a Resource Shortage

To determine how physicians ration limited critical resources, we studied the allocation of intensive-care-unit (ICU) beds during a shortage caused by a lack of nurses. As the bed capacity of the medical ICU decreased from 18 to 8, the percentage of days on which one or more beds were available decreased from 95 to 55 per cent, and monthly admissions decreased from 122 to 95. Physicians responded by restricting ICU admissions to acutely ill patients and reducing the proportion of patients admitted primarily for monitoring. Among patients admitted because of chest pain, the proportion actually sustaining a myocardial infarction increased linearly with the restriction in bed capacity. Although more patients with myocardial infarction were admitted to non-intensive-care areas, there was no increase in mortality. In addition, physicians transferred patients out of the ICU sooner. There was no apparent withdrawal of care from dying patients. Our results suggest that physicians can respond to moderate resource limitations by more efficient use of intensive-care resources.

Comparing the Status of Women and Men in Academic Medicine

Women enter academic medicine from medical school and residency training in slightly higher proportions than their male colleagues [1-3] and are represented in academia in greater proportion than in medicine as a whole. The numbers of women in upper-level academic or administrative positions has remained relatively level for the past decade, prompting a recent position paper by the American College of Physicians [4] that concluded that women have not gained sufficient advancement. However, another recent study [5] at Columbia suggested that this may be changing at least at that institution and perhaps around the country. We analyzed national data on academic faculty in three representative divisions of internal medicine: cardiology, rheumatology, and general internal medicine to shed further light on the status of women in academic medicine. We examined job descriptions including hours of work, allocation of time, self-assessment of skills, self-reported job satisfaction, and measures of academic productivity including research grants as principal investigator, abstracts, and publications in refereed journals. We chose cardiology, rheumatology, and general medicine to obtain a broad spectrum of academic internal medicine, spanning older, more established divisions and newer, more recently added divisions of internal medicine. These three divisions also span differences in procedure orientation, inpatient compared with ambulatory focus, research emphasis, size, and funding. Together they provide a reasonable sample of the diversity of academic internal medicine. Methods This study is based on a 1986 survey of full-time faculty in cardiology, rheumatology, and general internal medicine at the major teaching hospitals of each medical school in the United States. The 1985 to 1986 Directory of American Medical Education from the American Association of Medical Colleges was used to select the list of medical schools, including all 124 member institutions granting 4-year medical degrees. The teaching hospitals affiliated with these medical schools were evaluated using data reported in the 1985 to 1986 Directory of Residency Training Programs. The most important primary teaching hospitals in internal medicine for each medical school up to a total of three were selected using a rating scheme based on the academic status of the chief or chairman of medicine at the hospital, the total number of accredited residency programs sponsored by the hospital, the number of residency positions in the internal medicine program, and the number of hospital beds. The appropriateness of the results of the selection process were verified by telephone interviews with a department of medicine representative at each medical school. A total of 232 primary teaching hospitals were identified. The chief or chairman or other representative of the department of medicine at each hospital was asked to indicate whether divisions of cardiology, rheumatology, and general internal medicine existed at the hospital. Only 61% (142) of these hospitals had all three divisions and thus were eligible to participate in the study. Of the eligible hospitals, 107 (75%) agreed to participate. These institutions were asked to provide lists of the names and mailing addresses of the full-time faculty in each of the three divisions. All hospitals sent lists for cardiology, 90% sent them for rheumatology, and 85% sent them for general internal medicine. A total of 1231 faculty in cardiology, 466 in rheumatology, and 846 in general medicine were identified. Surveys were mailed early in 1986. Potential respondents were not aware that the data would be analyzed by sex. They were only informed that this was a study of academic internal medicine. Each questionnaire contained 55 questions, some with multiple parts, requiring about 45 minutes to complete. The questionnaire included items on demographics, job description, measures of research productivity, academic rank, tenure, job satisfaction, and compensation. The clarity of the questionnaire was evaluated by extensive pretesting. Test respondents who had characteristics similar to the study sample were debriefed question by question after they completed the instrument to determine if they understood the questions and answered them appropriately. The wording of questions was modified accordingly. All initial nonrespondents were contacted by mail and telephone. The final sample included 63% of the eligible cardiology faculty, 73% of rheumatology faculty, and 69% of general internal medicine faculty, including 1428 men (67% of the eligible men) and 265 women (70% of the eligible women). No descriptive data were available from the nonrespondents, except for sex, which was estimated for 99% of the nonrespondents based on their first names. No statistical differences were noted in the distribution of sex between respondents and nonrespondents within the three internal medicine divisions (P > 0.05). Analysis Data were analyzed using SAS software (Statistical Analysis System Inc., Cary, North Carolina). We generated frequency distributions and descriptive statistics for comparisons of responses by sex. For compensation, faculty were asked to report the precise amount of their total compensation; 95% of respondents completed this question. Nonrespondents on that question were omitted from the compensation analysis. Means were recalculated for the sex variable using multivariate methods. Independent variables controlled for in all multivariate models included the following dichotomous variables (Table 1): race, membership in the Alpha Omega Alpha honor society (AOA), fellowship training, faculty rank (associate or full professor or other), division chief, and division type. The intervention effect controlled for in the multivariate analysis was sex by specialty. Nondichotomous variables in the multivariate models were hours of work per week (continuous variable) and year of graduation from medical school (5-year intervals), as a proxy for seniority. The results were unaffected by whether year of graduation was treated as a continuous variable, was dichotomized at the median, or was constructed as a step function with 5-year intervals. Table 1. Characteristics of the Study Group For the outcomes of academic rank, tenure, position of division chief, and compensation, additional variables were included in the models as measures of research productivity, including the number of grants funded as principal investigator and the number of refereed journal publications as first author. For models with annual compensation as the outcome, sex by faculty geographic location was a covariable. The method for classifying locality into nine regions of the United States was taken from the U.S. Census Bureau. The initial analysis consisted of doing either a logistic regression for predicting a dichotomous outcome variable or an ordinary least-squares regression for a continuous outcome. To make the results more interpretable to the readers, we reanalyzed the data using ordinary least-squares regression with forced entry of variables into all models whether the dependent variable was dichotomous or continuous. The adjusted means reported are the main effect of sex comparison controlling for all the other independent variables in the model. Regardless of which multivariate technique was used, the conclusions were identical as to which outcomes differed by sex. Results Demographic Data Women faculty were younger (mean age, 39 compared with 43 years for men; P < 0.001) and graduated from medical school more recently than did their male counterparts (1974 compared with 1969, on average; P < 0.001) (Table 1). Race (white and nonhispanic compared with others) was similarly distributed between male and female faculty (P > 0.20). Men more often than women were members of Alpha Omega Alpha (35% compared with 27%, P = 0.04) and had more often completed fellowship training (87% compared with 71%, P < 0.001). Work Conditions and Skill Self-Assessment On average, women worked fewer hours than did men ( 1.8 hours; 95% CI, 3.5 to 0 hours) but had similar allocations of actual and ideal time devoted to specific professional activities (Table 2). No statistical differences were noted in access to secretaries ( 0.1 full-time equivalent difference; CI, 2.1 to 0.7), and the only difference in self-assessed skills was the lower perception of research skill among women compared with men (Table 3). Table 2. Time Allocation of Female and Male Internal Medicine Faculty* Table 3. Differences with Respect to Support Staff and Self-Assessment of Skills among Female and Male Internal Medicine Faculty* Grants and Publications Table 4 shows that no statistical differences existed in the number of grants submitted or funded or the percentage of grants funded as principal investigator ( 3% difference; CI, 14% to 9%), nor were there differences in the number of publications in refereed journals as first author during an entire career ( 0.5 difference; CI, 2.8 to 1.9), or second or other author, or authorship in refereed journals during the previous 2-year period. Similarly, no statistical differences were noted in abstracts submitted or accepted or membership on the editorial board of a refereed journal. Fewer women (47%) reviewed articles for refereed journals ( 7% difference; CI, 14% to 0%). Table 4. Grants and Publications of Male and Female Internal Medicine Faculty* Academic Rank, Position, Compensation, and Job Satisfaction Fewer women (33%) attained the ranks of full or associate professor compared with men (47%) (a difference of 14%;CI, 20% to 7%)(Table 5). In addition, their adjusted compensation was less than that for men (

Faculty Self-reported Experience with Racial and Ethnic Discrimination in Academic Medicine

6500 difference; CI,

Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine

11 900 to

A study of the relational aspects of the culture of academic medicine

1000). However, no statistical difference for salary was noted for tenured faculty (P = 0.20) or for nontenured faculty (P = 0.08). For cardiology, women earned

Relationships of gender and career motivation to medical faculty members' production of academic publications

9500 less (CI,

Race, Disadvantage and Faculty Experiences in Academic Medicine

15 800 to

Research, academic rank, and compensation of women and men faculty in academic general internal medicine.

3200), and women earned

Evaluation and Management of Vaginitis

7500