Demographics of women in biomedical research*:

What is the current reality?

Women in Biomedical Research: Best Practices for Sustaining Career Success

March 4, 2008

Timothy J. Ley, MD Washington University Medical School, St Louis MO

* With emphasis on physician-scientists

The overall message: The physician-scientist

career path is at steady- state.

(wild cards: age and gender)

Num

ber o

f Phy

sici

ans

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000Patient care

Teaching

Research

Num

ber o

f Phy

sici

ans

1980 1982 1985 1988 1990 1993 1995 1997 1999 2001 2003 20050

5,000

10,000

15,000

20,000

25,000Teaching

Research

AMA

Number of physicians has doubled in the past 25 years

Number of physician-scientists has not changed.~1000 new physician-scientists per year required to achieve steady-state

So, what’s the concern?

Sustained trends in the demographics may soon perturb the steady-state

1986 1988 1990 1992 1994 1996 1998 2000 2002 2004

Year

% R

PG A

war

ds, P

I old

er th

an 5

0

NIH funded scientists are getting older

0

5

10

15

20

25

30

35

40

45

50

2006

MDMD-PhDPhD

NIH

Year

% M

edic

al S

tude

nts

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0malefemale

1981 20071983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005

And the gender of medical students has shifted to equality

AAMC

Year

0

30,000

60,000

90,000Male

Female

U.S

. Med

ical

Sch

ool F

acul

ty

1996 1997 20061998 1999 2000 2001 2002 2003 2004 2005

With no change in the proportion offemale medical school faculty

AAMC Faculty Survey

Year

0.0

20.0

50.0

60.0

% f

emal

e

1996 1997 20061998 1999 2000 2001 2002 2003 2004 2005

40.0

30.0

10.0Professor

4,226: 23,419

Asst Professor

17,725: 28,922

Assoc Professor

6,824: 17,945

Student

6,130: 6,235

Instructor

2006Women: Men

AAMC

And very slow increases in the proportion of womenat all career stages, linked to growth at entry

10-15% attrition occurs at every stage of the academic ladder

Projected year of equality (assume no change in trends):

• Instructor: 2005• Assistant Professor: 2023• Associate Professor: 2038• Full Professor: 2058

Key demographic issues:

• Total physician-scientist numbers are currently at steady-state, BUT

• NIH funded biomedical scientists are getting older

• More women entering medicine• Disproportionate career attrition for women

The career path from 30,000 feet:

The database of NIH Research Project Grant

awardees by age, gender, and degree type

Year

Tota

l RPG

Dol

lars

(bill

ions

)

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1994 1996 1998 2000 2002 2004 2006

Funding of Research Progress Grants over the past 15 years

NIH

RPG=Research Project Grants (2/3 of NIH budget)R00, 01, 03, 15, 21, 22, 23, 29, 33, 34, 35, 36, 37, 55, 56

P01, P42, PN1UC1, UC7, U01, U19

DP1, DP2

Female Male

40

45

50

55

1998 2000 2002 2004 2006

MD - applicantsMD-PhD - applicantsPhD - applicants

MD - awardeesMD-PhD - awardeesPhD - awardees

1998 2000 2002 2004 2006

Year

Ave

rage

Age

All RPG applicants and grant holders are getting older:Females are 3-4 years younger than males

Tota

l fun

ded

RPG

s in

200

7

Investigators under 50

0100020003000400050006000700080009000

10000

MD MD-PhD PhD Total

Investigators 50 and older

MD MD-PhD PhD Total0

100020003000400050006000700080009000

10000

Female Male

Progressively fewer female RPG grant holders with age: lowest numbers for physician-scientists

% Decline of female RPG grant holders with age:biggest for MDs (2007 data)

0

5

10

15

20

25

30

35

40

MD MD-PhD PhD Total

Under 50 yearsOver 50 years

0200

400

600800

100012001400

160018002000

Female Male

1998 2000 2002 200620041998 2000 2002 20062004

MD MD/PhD

1998 2000 2002 200620040

1000

2000

3000

4000

5000

6000

7000

8000PhD

Tota

l peo

ple

with

RPG

s

These are longstanding trends, and are not changing

When are women leaving the career path?

An assessment from “cradle to grave”

Are young women entering medicine equally prepared for science careers? • Do matriculating female medical school students

have equal MCATs and GPAs?• Is there growth in female matriculants to MD-

PhD programs?• Does there continue to be interest in research

careers among medical school students?

MCAT verbal

8.0

8.5

9.0

9.5

10.0

10.5

11.0MCAT Physical Sci MCAT Biol Sci

1992 1994 1996 1998 2000 2002 2004 2006

Male

Female

1992 1994 1996 1998 2000 2002 2004 2006 1992 1994 1996 1998 2000 2002 2004 2006

AAMC

Female medical school matriculants score slightlylower* on the MCAT in physical and biological sciences

* Note scale

GPA Overall

1992 1994 1996 1998 2000 2002 2004 2006

GPA Science

3.30

3.40

3.50

3.60

3.70

1992 1994 1996 1998 2000 2002 2004 2006

Total MCAT Score

24.0

25.0

26.0

27.0

28.0

29.0

30.0

31.0

32.0

1992 1994 1996 1998 2000 2002 2004 2006

Male

Female

AAMC

Matriculating female medical students haveslightly lower MCATs, but identical GPAs

0

100

200

300

400

500

600

1990

Md-

PhD

Mat

ricul

ants

, US

1992 1994 1996 1998 2000 2002 2004

Female

Male

Total

Year

700

Recent growth in MD-PhD programs is all from females

AAMC

0

2

4

6

8

10

12

14

16

18

87 90 93 96 99 02

Perc

ent o

f Res

pond

ents

GraduatingMatriculating

Exclusive or Significant Interest in Research

05

Interest in Research & Teaching (graduates)

0

5

78 82 86 90 94 98 02 060

5

10

15

20

25

30

35

78 82 86 90 94 98 02 06

1

2

3

4

Clinical Sciences Basic Sciences

AAMC MSQ and GSQ

Graduating medical students have displayedincreased interest in research careers since 2005

When does career attrition begin?

• Do grant applications and success rates change as careers progress?– Early Fellowship? (LRPs)– Late Fellowship? (K23 for patient-oriented research,

K08 for basic and translational reseach)– First time R01/RPG applicants?– Previously funded R01/RPG applicants?

Year

LRP

App

lican

ts

0

100

200

300

400

500

600

700

800

900

1000

2002 2003 2004 2005 2006 2007

FemaleMale

No Response

The majority of first-time LRP applicants are female

LRP

Success rates are identical:in 2007, 44% for males, 43% for females

Year

LRP

appl

ican

ts

0

100

200

300

400

500

600

2002 2003 2004 2005 2006 2007

MD - female MD - malePhD - female PhD - male

MD-PhD - female MD-PhD - male

Equal numbers of female & male MD applicants:2:1 female PhD applicants

LRP

Female Male

Year

0

50

100

150

200

250

1998 2000 2002 2004 2006

MD-PhD appsPhD apps

MD apps

1998 2000 2002 2004 2006

MD-PhD - awardsPhD - awards

MD - awards

Gender equality for K23 applicants* and awardees

* Decline since 2005 is of concern

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

1998 2000 2002 2004 2006

MD

Succ

ess

Rat

e

MD-PhD PhD

Female Male

Year1998 2000 2002 2004 2006 1998 2000 2002 2004 2006

Equal K23 success rates for both gendersand all degrees

Female Male

Year

0

50

100

150

200

250

1998 2000 2002 2004 2006 1998 2000 2002 2004 2006

MD-PhD - appsPhD - apps

MD - appsMD-PhD - awardsPhD - awards

MD - awards

But the KO8 pool has only half as many female applicants!

MD

KO

8 Su

cces

s R

ate

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%MD-PhD PhD

1998 2000 2002 2004 20061998 2000 2002 2004 20061998 2000 2002 2004 2006

Female Male

Year

And equal success rates for bothgenders and all degrees

0

2000

4000

6000

8000

10000

12000

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Year1998 2000 2002 2004 2006 1998 2000 2002 2004 2006

Female – appsMale – apps

Female - awardsMale - awards

Female Male

Applications and Awards Success Rate

But they have equal success rates

First Time RPG applicants: Only half as many females apply

0

1,000

2,000

3,000

4,000

5,000

1998 2000 2002 2004 2006

MD MD-PhD PhD

Year

1998 2000 2002 2004 2006 1998 2000 2002 2004 2006

Female - apps Male - apps

0

150

300

450

600

750

900

1,050

1,200

1,350

1,500

Male - awardsFemale - awards

0

150

300

450

600

750

900

1,050

1,200

1,350

1,500

First Time R01 applicants: Female physician-scientist applicant ratio is lowest

1998 2000 2002 2004 20061998 2000 2002 2004 20060.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

1998 2000 2002 2004 2006

MD

Succ

ess

Rat

e

MD-PhD PhD

Female Male

Year

But equal success for First Time R01 applicantsregardless of gender or degree

Year

Female – appsMale – apps

Female - awardsMale - awards

0

5000

10000

15000

20000

25000

1998 2000 2002 2004 20060.0%

5.0%

10.0%

15.0%

20.0%25.0%

30.0%

35.0%

40.0%

45.0%

1998 2000 2002 2004 2006

Previously Funded Investigators Success Rate

Female Male

Attrition progresses with experienced investigators:Only ~1/3 as many Previously Funded female RPG applicants

In the Previously Funded R01 pool, progressiveloss of applicants: worst for physician-scientists

1998 2000 2002 2004 2006

MD MD-PhD

Year

Female - apps Male - apps

1998 2000 2002 2004 2006

PhD

1998 2000 2002 2004 20060

1,500

3,000

4,500

6,000

7,500

9,000

10,500

12,000

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Male - awardsFemale - awards

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%MD

Succ

ess

Rat

e

MD-PhD PhD

Female Male

Year1998 2000 2002 2004 20061998 2000 2002 2004 20061998 2000 2002 2004 2006

Despite equal success for all degrees and both genders

Summary 1• The number of US physician-scientists is

currently at steady-state• Changing age and gender demographics are

creating potentially unstable conditions– Aging of the funded investigator pool– Disproportionate career attrition for women

• Equal numbers of men and women enter the career path, but women leave at ~2-3 times the rate

• Attrition is most severe for female physician- scientists

Summary 2

• Female career attrition starts at the late-post doc stage and is progressive

• Females who leave the career path apparently choose to do so, despite the fact that they are equally qualified, and equally successful at obtaining NIH funding at all stages

The undeniable reality in 2008:

• The academic medicine career path was created by men--for men--several generations ago in a highly patriarchal culture

• The basic organization of the career path has not changed since then

• Some experiments designed to change this trend have been initiated at local levels, but no significant change is yet apparent nationally

• A massive shift in the career culture of medical/graduate schools will be required to change these trends

LRP

Kawards

R01s

Acknowledgements• NIH Division of Information Services (Israel

Lederhendler)– Bob Moore, Ernest Stalder, Zhuohong Liu

• AAMC– Gwen Garrison, Jay Youngclaus, Hershel Alexander

• AMA– Derek Smart

• LRP office– Steve Boehler, Peggy Reed

• Rhonda Ries, Marcy Hartstein, Anna Ley (tables and illustrations)

• Lee Rosenberg, Princeton• Barton Hamilton, Wash U. Olin School of Business• Alan and Edith Wolff Chair