1. VANDERBILT SURGERY Women in Academic Surgery: The Pipeline is Busted Sexton, KW; Hocking, K; Wise, E; Osgood, MJ; Cheung-Flynn, J; Komalavilas, P;Campbell, K; Dattilo, JB; Brophy, CM

2. VANDERBILT SURGERY DISCLAIMERS  No Financial Disclosures, unfortunately  Some opinion, mostly data  I am not a woman

3. VANDERBILT SURGERY RATE OF CHANGE TIME Singularity Stone tablets Printing press Internet Watson &Crick Human genome Mendel We are living in the most dynamic epoch of human history. The rate of change is getting faster

4. VANDERBILT SURGERY Diversity Ecosystem stability depends on the ability of a community to contain functional groups with different responses to stressors. McCann KS. The diversity-stability debate. Nature. May 11 2000;405(6783):228-233

5. VANDERBILT SURGERY Elizabeth Blackwell  1821-1910  Bristol, England  Geneva Medical College  1/23/1849 wikipedia.org Roth N. The personalities of two pioneer medical women: Elizabeth Blackwell and Elizabeth Garrett Anderson. Bull N Y Acad Med. Jan 1971;47(1):67-79.

6. VANDERBILT SURGERY N Engl J Med. Feb 10 2000;342(6):399-405.

7. VANDERBILT SURGERY The Pipeline Women in U.S. Academic Medicine: Statistics and Benchmarking Report 1983-2010 Slopes are 0.75 and 0.99 Slope is 0.36

8. VANDERBILT SURGERY The Pipeline The year 50% of surgery residents will be women (R 2 =0.98) The year 50% of professors of surgery will be women (R 2 =0.98) 2028 2096

9. VANDERBILT SURGERY Women in U.S. Academic Medicine: Statistics and Benchmarking Report 1995-2009

10. VANDERBILT SURGERY 30 years of “progress” 1979-2009: Women in Academic Medicine The trend for advancement of women in Academic Surgery is unchanged over the last 30 years. “ On one hand, the numbers of women faculty, department chairs and deans have never been higher. However, this growth has not substantially reduced gender differences in advancement or sufficiently strengthened the pool of women candidates for administrative positions. Thus, the progress achieved over the last 25 years is incomplete and inadequate.” Bickel J, Wara D, Atkinson BF, et al. Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee. Acad Med. Oct 2002;77(10):1043-1061.

11. VANDERBILT SURGERY Slope: 42.79 ± 7.930; R 2 = 0.70 Slope: 11.89 ± 0.9719; R 2 = 0.93 2 Way ANOVA: Gender p<.0001, Year p =.0782

12. VANDERBILT SURGERY Conclusion Women are not advancing to the senior ranks of Academic Surgery, despite increasing numbers of women entering the field.

13. VANDERBILT SURGERY Vanderbilt Dept of Surgery

14. VANDERBILT SURGERY λ = 0.625; p = 0.01 32% response rate

15. VANDERBILT SURGERY Academic Medicine Hierarchy

16. VANDERBILT SURGERY Employee Behavior Determined by structure of an organization and not intrinsic character Kanter RM. Men and Women of the Corporation. New York: Basic Books Inc.; 1977. Perceived access to information, support, opportunity, and resources are related to position in organization. Goddard MB, Laschinger HK. Nurse managers' perceptions of power and opportunity. Can J Nurs Adm. May- Jun 1997;10(2):40-66. Wilson B, Laschinger HK. Staff nurse perception of job empowerment and organizational commitment. A test of Kanter's theory of structural power in organizations. J Nurs Adm. Apr 1994;24(4 Suppl):39-47.

17. VANDERBILT SURGERY Relevance  Job Strain  Work Satisfaction  Organizational Loyalty  Trust in Management Wilson B, Laschinger HK. Staff nurse perception of job empowerment and organizational commitment. A test of Kanter's theory of structural power in organizations. J Nurs Adm. Apr 1994;24(4 Suppl):39-47. Kluska KM, Laschinger HK, Kerr MS. Staff nurse empowerment and effort-reward imbalance. Nurs Leadersh (Tor Ont). Mar 2004;17(1):112-128. Laschinger HKF, J; Shamian, J. Promoting Nurses' Health: Effect of Empowerment on Job Strain and Work Satisfaction. Nursing Economics. 2001;19(2):42-58. Laschinger HKF, J; Shamian, J. The Impact of Wokplace Empowerment, Organizational Trust on Staff Nurses' Work Satisfaction and Organizational Commitment. Health Care Management Review. 2001;26(3):7-23. Laschinger HKF, J; Shamian, J.; Wilk, P. Workplace Empowerment as a Predictor of Nurse Burnout in Restructured Healthcare Settings. Longwoods Review. 2003;1(3):2-11.

18. VANDERBILT SURGERY Solution Average CEO Tenure < 7 years Average Department Chair Tenure 9.6 + 7.8 years 37.5% in position > 10 years What if there were term limits? Kaplan SNM, B. How Has CEO Turnover Changed? Increasingly Performance Sensitive Boards and Increasingly Uneasy CEOs: National Bureau of Economic Research; August, 2006. Kurichi JE, Sonnad SS. Authorship patterns of surgical chairs. Surgery. Feb 2007;141(2):267-271.

19. VANDERBILT SURGERY “We are using imperfect data to perfect perfect-imperfection.” -Mitchell Goldman Resident Work Hours and Improved Safety Tight Glycemic Control Peri-operative Beta Blockade

20. VANDERBILT SURGERY Behavior can change.

21. VANDERBILT SURGERY A Conversation with a Future Professor of Surgery