From the President's Desk

Greetings to all AWN members! This is an exciting time to carry forth our mission as academic leaders at this medical school. Our new 1998-1999 Academic Women's Network board consists of Barbara Zehnbauer, Ph.D., President; Diana Gray, M.D., president-elect; Susan Mallory, M.D., secretary; Alison Goate, Ph.D., treasurer; Marion Peters, M.D. and, Joanne Mortimer M.D., clinical counselors; and Kathleen Hall, Ph.D. and Kathy Sheehan, Ph.D., pre-clinical counselors. The board's summer planning retreat will be August 30th . Our regular monthly meetings will be the first Tuesday of each month at 4 PM. We have several on-going projects that need your involvement and participation.

Marion Peters and Kathleen Hall have organized an impressive roster of speakers for our continuing medical education symposium on Contemporary Women's Health Issues, scheduled for December 11, 1998. A portion of the profits will be contributed to meet the challenge portion of a recently announced gift from Susan Stiritz to establish an endowed chair in Women's Studies at Washington University.

We are again planning a fall dinner to be held jointly with our AWF colleagues from the Hilltop campus. Please send your suggestions for dates, venues, and guest speakers to any AWN board member.

The AWN website is being redesigned and expanded under the direction of Kathy Sheehan. It will include our mission statement, a directory of members, listings of upcoming events, and provide links to key sites for academic faculty development and scientific focus. Suggestions for other features that you think should be included may be forwarded to Kathy or any board member.

Several AWN members are extending the impact of female faculty by participating in faculty recruitment committees. Dean Peck has requested the assistance of AWN members in these efforts. In particular, the medical school is seeking candidates to fill the positions of Chairman of the Department of Internal Medicine and Chairman of the Department of Ophthalmology and Visual Sciences. Please send your suggestions directly to the Dean. You may also forward names for the Chair of Internal Medicine to Penny Shackelford and names for the Chair of Ophthalmology to Barb Cole or Linda Pike. We also continue to provide candidates and suggestions for the Office of Faculty Affairs. An associate dean for this office should be named soon.

We will continue our conversations with Departmental Chairs to ascertain plans for addressing the issues of mentoring, diversity, and professional development of female faculty as identified in the survey of the Task Force on the Status of Women.

I am grateful to the women who have committed their time and energy to the AWN board. We all have many and varied roles to fulfill as busy academic faculty but together we can assure our progress and influence. In addition, we welcome more direct and active participation by our membership in the projects we will sponsor this year. We also want to extend our mentoring to include women post-doctoral fellows and graduate students at Washington University School of Medicine. Your ideas and initiatives will be instrumental in the success of our organization. I am honored to represent this group of talented professional women.

Respectfully,

Barb Zehnbauer

(Excerpted from Women in Higher Education. May 1998)

Female medical faculty at the University of Wisconsin report a much worse climate for women and more obstacles to career advancement than their male counterparts, note early conclusions from a faculty survey.

Of the school's 750 faculty, about 19% are women; 93% of them returned the surveys, compared to only 61% of male faculty. Among their early findings:

--89% of women faculty and 20% of male faculty reported being excluded from informal professional networks.

--42% of women and 14% of men saw gender-specific biases or obstacles.

--13% of women and 4% of men reported witnessing women being denigrated by male colleagues based on gender.

The final report should be out soon, according to the Wisconsin State Journal on March 13, 1998.

(from Women in Higher Education, May 1998)

Treva Rice, Ph.D., Division of Biostatistics was promoted to Research Associate Professor.

Yvette Sheline, M.D. received the NARSAD award for "Affect Induced Activation of the Amygdala in Major Depression".

Word comes from Susan Wood in the Office of Women's Health that a major concern discussed at the recent AIDS conference in Geneva was the rapidly increasing incidence of AIDS in women in developing nations and in the U.S. Many of these women have no access to services and no power in relationships to take measures to prevent them from risk. This includes spouses in marriage.

Legislation has been introduced in Congress that would require insurers to cover contraception in the same way they cover other prescription drugs. If the plan covers prescription drugs, the plan should cover prescription contraceptives. While this legislation is not tied directly to Viagra, it is certainly timely.

A commission to help the government, academic, and private industry recruit and retain women scientists and engineers would be created under legislation (H.R. 3007) approved by two House committees.

The Society for the Advancement of Women's Health Research calls on women's magazines to "stop pushing cancer!" "Women are dying of lung cancer and many women's magazines are not doing enough to stop it." A new analysis of the effects of smoking on women conducted by the Society and presented at a press conference in Washington concludes that the rate of lung cancer is 20 to 70% greater in women than in men and continues to surge. The analysis also determined that the carcinogenic effects of smoking affect women differently than men. In consideration of this compelling evidence of significant gender disparities in lung cancer, the Society is appealing to publishers of all women's magazines to cease accepting tobacco advertising aimed specifically at women. A review of the current issues of 21 of the most widely circulated women's publications at random at Washington area book stores revealed that 17 carried tobacco advertisements."

NIH recently held a conference entitled, "Gender and Pain: A focus on how pain impacts women differently than men." Studies were presented that found differences along gender lines. "Among the important findings were: Estrogen and testosterone may influence pain levels; women have a higher prevalence of chronic pain conditions; during pregnancy and childbirth, women have an increased threshold for pain; women are more sensitive to pain, but have developed more coping mechanisms to manage their discomfort."

The women's community Cancer Project in Cambridge, MA reported that the Physician Insurers Association of America (an organization of physician-owned and physician-directed professional liability companies) agreed to share data on medical malpractice claims brought by women patients for delays in the diagnosis of breast cancer. "The findings were revealing. Although the average age of the claimants was forty-four, a disproportionate share of the total (40%) was under forty. Almost two-thirds of the cases involved women who at the time of their diagnoses were premenopausal. This confirms the difficulty that younger women often have in impressing their physicians with the potential seriousness of their symptoms. Too many doctors still dismiss as unlikely the possibility that a painless breast lump in a woman under forty could in fact be malignant. Even when the idea is not rejected outright, it is not treated with the same sense of urgency that a painless breast lump provokes in a patient ten years older."

Rebecca Dresser comes to Washington University with a joint appointment in the law school and the humanities in medicine program at the medical school. One area of interest is women's issues related to biomedical research in health care. This Fall, she will teach a biomedical research law and policy seminar (stay tuned: this writer plans to audit a class). A Big Welcome to Rebecca Dresser!

A wave of anxiety is sweeping the nation's 125 medical schools. These schools and their affiliated teaching hospitals-the academic health centers where new doctors are minted and where cutting edge biomedical research and medicine is practiced-are being squeezed financially by cost-conscious health maintenance organizations. Managed care providers steer their members who need medical care to nonteaching hospitals where costs are lower or, when their members do see doctors at academic health centers, pay less than private insurers pay.

The ascendancy of managed care is upsetting a relationship that some call a key to the strength of American health care: the cross-subsidization of the teaching and research enterprises from patient care income. Most medical schools have depended on clinical income to support their teaching and research missions because tuition, government research grants, and state funds do not cover the true costs of teaching and research. As clinical revenues to academic health centers decline -or threaten to-medical school administrators find themselves pressured to identify new, reliable sources of funding and to operate their centers more like a business. That has led to cost-cutting and, in some cases, mergers between academic health centers and other hospitals.

The pressure to run academic health centers more like businesses also has led to threats to the tenure system. "Medical schools are seeing a future in which burgeoning growth is not going to happen, and they are making a push to become more efficient enterprises," explains Robert Jones, associate vice president of the Association of American Medical Colleges (AAMC). "With the changing environment, medical schools are trying to adapt. They are rewriting the ground rules of tenure and trying to be responsible fiscal managers. It would be irresponsible to do otherwise."

Uwe Reinhardt, a Princeton University economics professor who specializes in health care, summarized the connection: "When the revenue stream is less certain, medical schools don't want a lot of fixed costs." The medical school administrators interviewed for this article all said that tenure itself was safe. They have seen the results of frontal challenges to tenure. The University of Minnesota is still recovering from its "tenure war,", which started when th e provost of its Academic Health Center, William Brody, asked the board of regents for authority to change tenure for the medical center as part of a way to manage his budget. The regents explored wholesale changes to the tenure code for the entire university, sparking a unionization drive among the faculty that failed by only 26 votes. The regents backed down, the university got a new president, and the faculty accepted some form of post-tenure review. Brody, meanwhile, is now president of Johns Hopkins University.

A 1997 survey of all U.S. medical schools by the AAMC found that only two were actively contemplating eliminating tenure or ceasing to make tenure appointments. Fully half of the schools, however, had changed or were considering changing the way they pay their faculty. Commonly, this has included addressing the issue of what salary guarantee accompanies tenure. That guarantee has almost never been defined explicitly. If asked, as some were by The Scientist, faculty members have said that their entire salary is guaranteed. Administrators, too, often acknowledged that full salary is implicit with tenure.

At Harvard medical School the salary guarantee is absolute, according to Mary Clark, associate dean for faculty affairs. "The commitment at Harvard Medical School is that you will be paid your academic salary until retirement, resignation, or death," she says. Exactly what constitutes "academic salary" is ill-defined, however, and currently under discussion.

The Albert Einstein College of Medicine of Yeshiva University in New York City had no written documents with a definition of tenure, says Curtis F. Brewer, a professor of molecular pharmacology. When the administration tried without faculty approval a few years ago to reduce the commitment of the school to tenure, he says, the faculty countered with New York state common law, arguing that the economic definition of tenure was as it had been practiced for several decades, essentially 100 percent of full salary. The administration abandoned its efforts.

There appears to be widespread unease among faculty members that their tenure rights are in jeopardy. The fundamental issue, states Charles Hill, a professor of biochemistry and molecular biology at Penn State College of Medicine, is "What is the linkage of tenure and salary? Most faculty feel that if there is no linkage, then tenure is a fairly hollow concept. The debate is how much of our salary is protected by tenure."

Based on interviews with administrators and faculty members at several medical schools where this debate is being played out-or recently concluded-the level of faculty involvement from the earliest stages of discussion of faculty compensation strongly correlates with the level of faculty satisfaction in the proposals.

At the University of Southern California, the administration responded to financial difficulties at the medical school by, in part, telling the basic science faculty members they would have 9-month instead of 12-month appointments, effectively cutting their salaries by 25 percent (nonmedical school faculty at USC and many other universities typically have 9-month appointments). Twenty-three tenured basic science faculty sued, alleging breach of contract. Negotiations between the parties have not produced a settlement, according to the attorney for the plaintiffs, so a trial date of November 9 has been set. One of the litigants says the faculty members were not consulted. "The question is whether meetings that are convened to describe the proposal are genuine consultations," he adds.

A proposal to change the financial guarantee of tenure that has been approved by the board of directors of Georgetown University Medical Center in Washington, D.C. is being challenged in an internal grievance process by some faculty members. The plan would define an economic floor of $60,000 for full professors and $50,000 for associate professors, for new hires only. Current tenured or tenure-track faculty would not be grandfathered by the new plan, but would have a more generous guarantee set at the median of what faculty of the same rank in the Northeast make, as measured annually by the AAMC (for full professors, that is currently $103,000).

The proposal was presented to the medical center caucus, a faculty governance body, but was not discussed in depth with the faculty. "The faculty had no opportunity to review the proposed changes," agrees Karen Gale, professor of pharmacology at GUMC. "No written documents were circulated to the full faculty for comment, much less for a vote."

The grievance at Georgetown is based on two aspects of the new tenure and compensation plan. It changes the way compensation is calculated for current faculty, not just new hires; and it changes the meaning of tenure for medical school faculty only, despite the fact that faculty are tenured by the university, not the medical school. "We have one faculty handbook for all faculty in the university, and all faculty are evaluated for tenure by the university rank and tenure committee," Gale explains. "Changing anything about the tenure code at one campus is not a procedure looked upon favorably by the faculty because it is a divide-and-conquer approach."

Although medical school faculty are indeed tenured by the university, Sam Wiesel, executive vice president for health sciences of GUMC says the medical center campus is responsible for its own budget and thus can make changes to compensation independent of the rest of the university. Furthermore, he says, medical center bylaws were followed and no faculty vote was necessary. "I'm not interested in cutting anybody's salary," he says. "I want people to be productive and we have incentives for them. What I don't want to do is pay people with scarce resources who don't do anything." He says administrators will measure productivity by such things as clinical care effort, teaching hours, and grant income and will let each department or institute decide how to pay its members after is has been allotted money based on overall productivity.

Smoother at Vermont, Colorado

By contrast with USC and Georgetown, changes to faculty compensation plans at the Universities of Colorado and Vermont progressed much more smoothly. Faculty and administrators on those campuses worked together to develop compensation plans that defined a guaranteed base salary that was less than full salary for most faculty members. But the plans offered attractive incentives to productive faculty and cushioned the blow to faculty who might lose a grant by reducing salary gradually and giving the faculty member time to find another grant or alter a job description.

At Vermont the plan is new to basic science faculty only, since clinical faculty have long had only the fraction of their salary that comes from the university, as opposed to the practice plans, guaranteed. The base at Vermont, says the executive dean of the College of Medicine, is not to exceed 60 percent of the AAMC median for the same rank.

At Colorado, the base is set according to an internal standard-70 percent of the average salary of a basic sciences faculty member at the same rank-and applies to both basic and clinical faculty (in 1995, the base salary for a full professor was about $68,000). Clinicians at Colorado can still achieve higher salaries by earning higher supplements based on bringing in more patients.

Richard Krugman, dean of the University of Colorado School of Medicine, says that in some way the medical school is a victim of its own success. It used to be a small school with nearly all its income from the state. Even in 1982, the state appropriation accounted for $15 million of a total $40 million in income. By 1997, the budget ballooned to $300 million, but only $26 million came from the state and tuition. The rest was made up by research grants and clinical revenue. During that time, the faculty more than doubled, mostly in the form of nontenurable clinical faculty.

Krugman says the school has an obligation of about $100 million to tenured faculty, but it receives approximately one-quarter of that from tuition and the state. "I felt we were too highly leveraged to assure the long-term success of the school," he explains.

Colorado's reengineering succeeded because two large faculty task forces were involved from the beginning in studying the issue and proposing solutions; Den Krugman met with all departments to discuss the plan; and top faculty could achieve better raises than they were previously getting. The change in the compensation plan, instituting a base plus supplements and incentives, was approved by the faculty senate, 26-4. Colorado also changed its rules on tenure and promotion, including disconnecting tenure from promotion, says Krugman. These changes required a vote of the entire faculty and passed overwhelmingly.

Perhaps the most important factor in winning faculty support was a nod to self-interest: all current faculty were grandfathered in. Boris Draznin, a professor of medicine and chair of one of the faculty committees, says that when colleagues from other institutions call him for advice, "the first thing I say is just exempt existing faculty; then they are happy."

(from The Scientist, May 11, 1998).

AWNings wants to know.

Name ______________________________

Department_________________________

Promotion or Award

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Send to:

Linda Pike

Box 8231 (or pike@biochem.wustl.edu)

Last modified: August 15, 2003