Culture change

Hopkins works to smooth the way for women and minorities on the medical faculty. It's not an easy job, as advocates have found out.


Long after he hired Dr. Julie A. Freischlag as director of surgery, the dean of the Johns Hopkins School of Medicine kept her resume on his desk.

That made it easier to rebut the angry critics who challenged the credentials of the first woman to run one of the country's most prestigious surgical programs.

The complaints have dwindled. But nearly three years after Dean Edward D. Miller Jr. stunned Hopkins by selecting her over a popular internal candidate, Freischlag's agenda for making the surgical faculty more hospitable to women continues to make her a symbol of change.

And Hopkins - an institution that owes its success, in part, to a brutally competitive culture that disdains the notion of personal time - is trying to remake itself.

"The way it's set up, all the rules and regulations - they're all wrong," said Freischlag, who argues that academic medicine shouldn't require doctors to live in a work-and-travel frenzy, ignore their children or arrogantly reject medical teamwork that helps patients.

"The only way you can change systems is to be in charge of them," she declared.

With women making up half of its students but just 31 percent of its faculty, Hopkins mirrors the national norm. But it's also among a number of academic medical institutions that are aiming for a better balance.

Women faculty at Penn State and the University of Arizona have received raises to help close a salary gap with men. At Hopkins, efforts on behalf of women are part of a broader attempt to ensure the school is an egalitarian place to work.

One faculty panel has found that women are paid less, promoted more slowly and leave the school of medicine at greater rates than men. A second committee has begun looking at similar problems among minorities.

This introspection was evident at a recent Hopkins School of Medicine conference celebrating the 115 women who have held the title of professor since it was founded 112 years ago. During the same period, there were 817 male professors.

Organizers discussed the findings of the Committee on Faculty Development and Gender and concluded that progress has been made but more needs to be done.

Already, the panel's findings have led to raises aimed at correcting an average 6.3 percent deficit in pay for women. The school also has named a new assistant dean to monitor salaries and promotions. One goal: promotions of women to full professor should no longer take two to three years more than those of similarly situated men.

Efforts to address other diversity issues began in November. Only 3 percent of the medical faculty are underrepresented racial minorities (a figure that doesn't include Asians). That disparity helped spur a recent retreat for about 75 school leaders who closeted themselves at a St. Michael's resort for a seminar devoted to confronting prejudice.

Faculty and administrators accustomed to competitively going it alone got to know each other by playing games such as Cross the Line, in which participants walked to the other side of the room if they would answer "yes" to a question such as "Do you always assume people are heterosexual?"

"This is the first time I'm aware of an entire retreat by the dean that was focused on this one topic," said Dr. Lisa A. Cooper, an associate professor who studies how race affects patient care. "There was nothing else discussed at this retreat other than the importance of diversifying the face of Johns Hopkins."

Demographic pressures are forcing at least some of the efforts to change the culture.

Miller, the medical school dean, said disparate treatment threatens to make Hopkins less competitive for top young doctors, as more women move into careers in medicine. Minorities are also an increasing percentage of patients and potential medical students nationwide.

Hospitable place

As good as it is, Miller said, Hopkins can't afford to be a place where those students and patients don't want to be.

"If you look at Hopkins, it's somewhat diverse, but it certainly doesn't [mirror] the population," Miller said. He also cited evidence that minority patients may get inferior care at institutions that don't embrace diversity.

"Our obligation is to provide the best health care," he said.

Another factor: young medical graduates often expect more time for themselves and their families than previous generations of physicians. Medical training programs are now governed by an accrediting body's rule that limits residents to 80-hour workweeks. Later in life, they expect limited workweeks as well, recruiters say.

Other factors forcing academic medicine to be more hospitable include the small but critical mass of discontented women faculty. They have banded together to press for change at institutions from Hopkins and Penn State to the University of Arizona.

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