Racial minorities and women face many barriers to getting promoted to advanced positions at teaching hospitals and in other academic medical jobs when compared with their white peers, found a recent study published in the Journal of the American Medical Association.
The study, “Race and Ethnicity, Gender, and Promotion of Physicians in Academic Medicine,” in fact, reveals persistent inequities in the career advancement of physicians within academic medicine. Disparities were particularly glaring for women and racial and ethnic minority groups.
Academic medicine is a field that combines patient care, teaching, and research generally at a teaching hospitals. Boston, for instance, has many teaching hospitals affiliated with Harvard Medical School as well as other medical schools connected to major universities. Steps in the promotional ladder in an academic setting include: instructor, assistant professor, associate professor, full professor and finally department chair. This study analyzed data from 673,573 graduates of U.S. MD-granting medical schools between 1979 and 2019, shedding light on barriers to promotions and leadership roles that remain entrenched despite efforts to diversify the medical workforce. The team of researchers who wrote the study includes Lauren Clark, and Drs. Elena Shergina and Deepika Polineni, Grace H. Shih. And Robert D. Simari, as well as Kimber P. Richter, who holds a masters in public health.
The study found that Asian men and women, Black women, and white women were more likely than white men to secure entry-level academic positions such as instructor or assistant professor. But white men were significantly more likely to be promoted to upper academic ranks, including associate professors and full professors. This trend persisted across decades, with few signs of improvement in the promotion rates of underrepresented groups. Black women, in particular, faced pronounced disparities. They were 55% less likely to be promoted to associate professor and 41% less likely to reach full professor compared to White men among physicians who graduated before 2000.
While Black men demonstrated a higher likelihood of being appointed as department chairs compared to white men, especially in recent years, their paths to leadership positions were blocked by barriers. Black men were less likely to enter academic medicine and were promoted at lower rates to other academic ranks. The relatively higher likelihood of Black men becoming department chairs does not erase the systemic disadvantages they encountered earlier in their careers. When it comes to promotion from assistant professor to associate professor and promotion from associate professor to full professor, racial and ethnic groups of both female and male gender had lower likelihood of advancement compared with white men with the exception of Asian men.
Compared with the U.S. working population, American Indian, Black, and Hispanic people are underrepresented in the physician workforce. Over a 35-year period, female physicians in the U.S. medical schools are less likely than male physicians to be promoted to associate or full professor or appointed to department chair. These disparities have far-reaching implications for the healthcare system. Academic medical institutions shape the next generation of physicians, and their faculty influence research, education, and policy. A lack of diversity in senior academic ranks limits the ability of institutions to address the healthcare needs of underserved communities. Research has shown that patients experience better outcomes when treated by physicians who share their cultural or racial backgrounds. Ensuring diversity in academic medicine is not only a matter of equity but also a critical factor in reducing healthcare disparities and improving patient care.
Several systemic barriers contribute to these inequities. Faculty promotions in academic medicine often hinge on criteria such as research productivity, the ability to attract grants, and clinical performance. However, these benchmarks are not always applied equitably, and implicit biases may influence decision-making processes. Furthermore, the lack of transparency in promotion criteria exacerbates inequities. Decisions about initial appointments and leadership roles, such as department chair positions, are often made unilaterally, leaving room for subjective judgments that may disadvantage underrepresented groups.
The underrepresentation of racial and ethnic minorities in the physician workforce further compounds these challenges. For example, Black Americans make up 13.6% of the U.S. population but only 6.6% of medical school graduates in 2023. Similar disparities exist for Hispanic Americans. Even if promotion rates were equitable, the small number of minority physicians entering the pipeline means that leadership roles will continue to be dominated by White men unless systemic changes are made.
To address these disparities, the study recommends several reforms. First, academic institutions should adopt transparent and standardized promotion criteria to ensure fairness. Second, implementing performance reviews that incorporate feedback from peers, students, and subordinates could provide a more comprehensive assessment of faculty contributions. Third, institutions should invest in leadership development programs specifically designed to support women and minority faculty members, equipping them with the skills and mentorship needed for career advancement. Fourth, bias training for review committees and decision-makers is essential to mitigate the impact of implicit biases on promotion outcomes. Finally, academic institutions should track and publicly report data on promotions and appointments by race, ethnicity, and gender to hold themselves accountable for progress.
The consequences of inaction are significant. Poor career advancement opportunities are a major reason why physician leave academic medicine. In addition, medical students and residents who do not see themselves represented among faculty may be discouraged from pursuing careers in academia.
The implications extend beyond academia. The United States already lags behind other high-income countries in key health metrics, including life expectancy and chronic disease rates, with significant disparities across racial and ethnic groups. Developing a diverse medical workforce is essential for addressing these disparities and ensuring equitable healthcare delivery.
This study shows that while progress has been made in diversifying the entry-level ranks of academic medicine, significant work remains to ensure equity in career advancement. Women and racial and ethnic minority physicians continue to face systemic barriers to promotion, with far-reaching consequences for the quality and equity of healthcare.
