Opening Keynote Address
Carola Eisenberg, M.D.
Lecturer on Social Medicine
Harvard Medical School
SALLY SHAYWITZ, M.D., CHAIR, AXXS STEERING COMMITTEE
One of the pleasures of being here with you today is that I got to know a bit about our keynote speaker. It is a great pleasure to introduce Carola Eisenberg, who is former dean for student affairs and the first woman full dean at Harvard Medical School. Many of you know Dr. Eisenberg for her role in championing human rights as one of the founding members of the Nobel Prize–winning Physicians for Human Rights.
A native of Argentina, Dr. Eisenberg enrolled in the medical faculty of the University of Buenos Aires with an almost exclusively all-male student body. “I didn’t have any role models,” she recalls. “I had never even met a woman physician. The only thing I did know was that I wanted to be a psychiatrist.” After completing training in adult psychiatry, she won a competitive fellowship to study abroad, because there were no programs in child psychiatry in Argentina. In her words, she “came to the States to stay a year, but the year became a lifetime. I met and married a wonderful man with whom I had in short order two children, then and now the light of my life.”
Today, Dr. Eisenberg continues to practice psychiatry, teach, and participate in the international humanitarian efforts. She has mentored countless women through the women’s groups she started at MIT, Harvard, and the National Academy of Sciences. As she has said, “There is still a machismo attitude, particularly within some fields of medicine. It’s changing, but changing slowly.” More efforts should be dedicated to opening doors for women and to following in Dr. Eisenberg’s footsteps. So it’s a real pleasure for me to welcome her today.
HOW FAR WE HAVE COME, HOW FAR WE STILL HAVE TO GO: HOW WOMEN SAVED AMERICAN MEDICINE
It’s a pleasure to be here. It’s a pleasure to see old friends. I’m looking forward to meeting new friends at this workshop.
I am here today in the role of a historian, not a strategist. Strategists will talk tomorrow. If you have read How the Irish Saved Civilization, you will understand the subtitle of my speech, “How Women Saved American Medicine.” As a historian, I will make three points before putting on the hat of a clinician. First, women established high academic standards for medicine. Second, women maintained those standards when men began to default. Third, women led the fight to enhance the quality of life for physicians. When, and not if, we succeed, men will have gender equity for the first time, as well as women.
To my first point, Johns Hopkins University School of Medicine set the standard for American medicine when it admitted its first class in 1893. What you may not know is that the medical school almost did not open. The trustees called a halt when the Hopkins endowment shrunk below the necessary minimum after the stock market crashed. Five Baltimore Quaker women—Carey Thomas, Mary Elizabeth Garrett, Elizabeth King, Julia Rogers, and Mary Gwinn—stepped into the breach. They offered the necessary funds on two conditions. First, women had to be accepted on the same terms as men. Second, a baccalaureate degree and a real knowledge of French and German would be required for admission. Accepting token women was less objectionable than setting high educational standards. Trustees and faculty alike feared pricing themselves out of the applicant market. As Sir William Osler said to Dr. William Henry Welch, “It is likely we’re getting as professors those who would never enter as students.”
But the women were adamant, and Hopkins took the plunge. Carey, Mary, Elizabeth, Julia, and Mary had elevated the intellectual standards of American medicine for the century and the millennium to come. Harvard followed Hopkins’ lead eight years later—that is, in requiring a bachelor’s degree; it took another 50 years to admit women. Abraham Flexner put it succinctly in 1910: “John Hopkins graduates in medicine represent the highest quality this country has produced.”
As for the second point, nearly a century later women came to the rescue of American medicine again. In the mid-1970s, the number of male applicants to medical schools began to decline. Ten years later, there were fewer qualified male applicants than places in the first-year class. By the late 1980s, there were not enough male applicants, qualified or not, to fill a freshman class. How were academic standards maintained in the face of the massive male default? The answer is straightforward: women constituted a third of the admitted class.
What had enabled women applicants to increase five-fold between the 1960s and the 1980s? Had there been a mutation in the M.D. gene or the X chromosome? I have found no support for that hypothesis. Could there have been a
mutation in the admissions process? You bet there was. Was it a random mutation? Not on your life. The mutation was directed by the women’s movement. Each year during the seventies and the eighties, as more women were accepted, more women applied. Success begot success. Women applicants to medical schools numbered 2,800 in 1971 and rose to more than 17,000 last year.
What is the empirical evidence for the directed change in the admissions process? Affirmative action for men had held steady for two centuries until 1970. For each subsequent year, until the end of the 1970s, the percentage of women accepted exceeded the percentage of women in the pool by 2–3 percent. That edge is statistically significant given the large numbers.
Then a funny thing happened. The admissions edge for women disappeared in 1980, and it was replaced by a two to three preferment for men in the 1980s as the male pool got smaller. Without ever announcing it or acknowledging it, medical schools adopted affirmative action for men. Unless my memory fails me, those men were not dismissed as affirmative action admits. It is odd, isn’t it?
Some of you probably object to affirmative action. You will point out that its existence impugns every promotion of a woman by attributing such promotions to affirmative action rather than merit. Yes, some folks do say that. But what about all those men who become professors only because women are not considered? A diverse faculty is a superior faculty, because it is chosen from a larger pool.
My third point is that we are now engaged in a battle for academic norms that acknowledge the importance of family life as a legitimate value. Women physicians with children have been leading fuller lives than most of our male counterparts. Yes, the price has been heavy, but we have not been deterred. We have richer connections with our children and with our parents and, for that matter, with our husbands, when we have them, than men do with their children, their wives, and their parents. We make richer connections with our patients, because we are more in touch with feelings. To the extent we can reduce the endless hours, the competitive atmosphere, and the exclusive focus on personal achievement in academic medicine, we will have created a better world for men as well as for women.
The way scientific research is organized leads to systematic exploitation of trainees. An enormously competitive system forces principal investigators to work themselves and their fellows for long hours. It may surprise you to learn that among postdocs without children, women work more hours than men. Among those with children, women work many fewer. This situation erodes career progression. Citation half-life in the biosciences is short, making it difficult to take time off from work and return to the same career trajectory. Men and women alike need basic reform in the career structure. We need to increase fellowship stipends, to convert lengthy postdoc fellowships into faculty or staff positions, and to provide support for independent research careers at the end of postdoctoral training.
But we must face the fact that women professionals who bear children deal
with problems that have no tidy solutions. Even if an enlightened university provides paid parental leave, it cannot authorize leave from the rapid pace of clinical science. Even if a unit chief is sympathetic to a slower pace of work while the children are small, NIH [National Institutes of Health] study section members could not care less. What has she published lately, they will ask, when your grant is up for renewal.
Some women find returning to work after the birth of a baby acutely painful, whether it occurs at 2 weeks, 2 months, or 12 months. With good child care arrangements, the baby does splendidly. It is the mother who suffers separation anxiety, guilt, and loss, sometimes for months. Symptoms recur as women near 40 and begin to wonder whether they want one more child before time runs out.
So those are the three points. Now I put on my clinical hat. During 50 years at three leading universities—Johns Hopkins, MIT, and Harvard—I have been consulted frequently by female colleagues for a gender-specific clinical disorder: reflex alphanumeric narcolepsy, or RAN, as in she RAN all the time trying to keep up. At Hopkins, RAN was known by the eponym “Carola’s curse.” It is a reflex response precipitated by reading either letters or numbers, thus alphanumeric. The chief complaint is an irresistible closing of the eyes and a rapid descent into slow-wave sleep the moment one sits down in the evening to read a journal.
It strikes on an average day for a doctor who is a mother—that is, on a day that consists of getting up in time to make breakfast for the children, getting them dressed and off to school, rushing to work, seeing patients, leading a seminar, reviewing the NIH pink sheet awarding one a grant score just below the funding level, attending a committee meeting as the token female, squeezing in emergency consultations, rushing home just in time to meet the children returning on the 5:30 school bus, preparing dinner, spending an hour of quality time with the children, getting them to bed, and then trying to read. And suffering, of course, acute narcolepsy. In my view, this was no special day. Neither of the children was sick. There was no call from hubby announcing unexpected dinner guests. Not even a flat tire on the way to work.
My colleagues moan, why can’t I stay awake? What is the matter with me? My husband can read until midnight. Well, it doesn’t take Francis Crick or Sigmund Freud to understand the pathogenesis of reflex alphanumeric narcolepsy. The condition is neither hereditary nor fatal. Therapy begins with the realization that Wonder Woman is or was a comic book character. The solution lies in renegotiating the division of labor at home.
Life demands choices. You cannot be home full time and at work full time. It’s great if your husband takes parental leave from his work. He will be better off for the experience. The children will be grateful to him. I assure you the baby will survive him. But that does not make parting any easier. Many women academics and their children do splendidly with a rapid return to work if partners cooperate, families pitch in, and the couple can afford and find good child care.
As I conclude, I resume my historian’s role to review what has been accomplished since our 1999 meeting. You will recall that Nancy Hopkins had just made history. She had assembled the tenured women in the MIT School of Science to protest the inequity in salaries, research space, and departmental governance. When the administration conducted its own study, its findings validated those claims, and it made them public. President Charles Vest called for comparable scrutiny of gender discrimination in the other MIT faculties and found similar data. The institute also took the initiative of convening a meeting of leading universities on gender inequity.
When I became dean of students at MIT in 1972, I was the first woman to sit on MIT’s Academic Council, its highest internal governing body. It was a heady place to be, but lonely. Today, 36 years later, six women sit on the council. That’s no small progress. Three years ago, not one of us would have imagined that in 2002 four of our leading universities (and this is not the complete list)—Princeton, Michigan, Brown, and Pennsylvania—would have women presidents. At Princeton, President Shirley Tilghman has appointed women to half of Princeton’s top academic jobs. And what women! That is worth celebrating.
However, it’s far from time to declare victory and send the troops home. If we have won the admissions battle, we are making slow headway, at best, in faculty representation. Yes, there are more tenured women at medical schools than there were five years ago. But the percentages remain substantially below the available pool. Success has been greater in pediatrics, public health, and psychiatry; it has been least in the surgical specialties. To quote from the Association of American Medical Colleges [AAMC] report on increasing women’s leadership in academic medicine,
Few schools, hospitals or professional societies have what might be considered a critical mass of women leaders. The pool of women from which to recruit academic leaders remains small. The potential of most women is being wasted at a time when medicine needs all the leadership talent it can develop to address accelerating institutional and societal needs.
Later in this workshop, Janet Bickel, AAMC vice president and the principal author of that report, will tell us what has and has not been accomplished. I invite you to join me in saluting Janet for her outstanding contribution to the achievement of gender equity.
Have we got it made yet? I conclude with a quote from Estelle Ramey, professor of physiology at Georgetown, who pulled no punches. “Don’t tell me we’ve achieved gender equity when a female Einstein becomes a professor. I’ll know we’ve made it when a female schlemiel is as likely to become a professor as a male schlemiel.” I love that quote. My empirical research has identified precious few female professors meeting Ramey’s criteria. We have come a long way, baby, but we have a long way to go. For us, for the sake of patients, for the sake of the profession, even for the sake of man, we cannot afford to stand still.