When Jessica Lee Mega, M.D., was growing up, annual meetings of the Association of American Medical Colleges took the form of family vacations. Her mother, a child psychiatrist who currently teaches at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, regularly took her young daughter with her to professional conferences. Mega's mother and physician father were her earliest mentors, and when she decided to attend medical school herself, the idea of a career in academic medicine was a natural corollary. This year, Mega, 27, graduated from Yale University School of Medicine and began her residency in internal medicine at Brigham and Women's Hospital in Boston.

"Women who want to pursue careers in academic medicine are very enthusiastic about their plans in medical school," Mega says. "But once you near graduation, people begin to pull you aside and warn you about the stresses inherent in such a lifestyle." While applying for residency, Mega encountered both male and female physicians who urged her to consider her "priorities" as a woman in an intellectually demanding and time-consuming field.

"People weren't malicious, but they would tell me to think about my priorities. I perceived they were scared that if I ended up in academic medicine, it would take up too much of my life, particularly since I'm a woman and may want to have a family," Mega says. "I was warned that I might have to make sacrifices I wouldn't want to make. In many cases, I was asked if I wanted to be a good mother, and if so, was I willing to make difficult compromises? These comments came from both men and women."

Jane Dopkins, M.D., 30, in her 4th year of residency in obstetrics/gynecology at the University of Cincinnati School of Medicine, says that, unlike her, colleagues in her residency, especially those with families, generally perceive academic medicine as a career choice incompatible with the more flexible lifestyles they desire. "My colleagues who are interested in academic medicine tend to be men," Dopkins observes.

Norma E. Wagoner, Ph.D., dean of students at the University of Chicago Pritzker School of Medicine, notes that women are still singled out as having inherent incompatibilities with the rigors of certain medical specialties. "When I inquire whether students are asked about being married or having families during their residency interviews, I find that women are asked these questions in the surgical specialties," she says. "There is still a gender dichotomy; women do still face these issues. Are some of them discouraged? Yes."

Someone to Look Up To

Mega, who is approaching her residency with the belief that women academicians can both pursue successful careers and raise families, says that several mentors have helped her preserve that belief during the course of her medical school career. She stresses that women need to be especially proactive if they wish to find female mentors, given the lack of women in leadership positions on medical school campuses. "We're still at a stage where there are not many women full professors floating around, or even women faculty who are on the advancement track," Mega observes. The woman Mega chose to be her thesis adviser played a significant role in helping shape her career plans. "Just seeing how she leads her life and balances her responsibilities had a big impact on me," she says.

"Mentors are hard to find," Dopkins agrees. She says she has had no significant mentors, male or female, although she is looking forward to the mentorship of a woman physician she will work with during a fellowship next year. "Sometimes the attendings I work with who are in academic medicine are not very positive about their jobs, and they are thus not necessarily the people I would turn to for mentoring," Dopkins observes. "They give the impression of being too burned out by their work."

Like Mega, Maria Savoia, M.D., associate dean for curriculum and student affairs at the University of California at San Diego (UCSD) School of Medicine, followed in her mother's footsteps in pursuing a medical career. A member of the 1937 class of the Columbia University College of Physicians and Surgeons, Savoia's mother joined the two other women in her class to be among the first female medical practitioners in the United States. Savoia says that it is still challenging for aspiring women physicians three generations after her pioneering mother to find positive role models. She laments that there still are not enough women who can serve in that capacity.

"Women need to see other women who are professionally successful and satisfied with their choices. There are very few women who are department chairs or in other positions of major authority to fill that need," Savoia observes. She says that she had the personal good fortune of being under a woman department of medicine chair when she was a resident. The chair, who was also Savoia's mentor, helped her adjust her schedule when she had her first child as a senior resident at UCSD. The experience made Savoia a role model for others. "I was the first person here to have a child while in residency, and people were watching to see how it could be done. The support of my mentor and division made it possible."

Wagoner, who has mentored countless students in the 27 years she has served as a dean, agrees that the number of women in academic medicine serving as mentors is limited, especially in the first 2 years of medical school, when students would benefit enormously from the advice of women scientists who might illuminate their potential. "You hope that in the 3rd year of medical school, when they do have more contact with women clinicians, they might find those relationships," says Wagoner. "But as students expeditiously pass through their 3rd and 4th years to complete their degrees, the time in which real mentoring can take place becomes limited."

'Gendered' Specialties

A member of the next generation of academic clinicians, Mega says that although the numbers of male and female medical students are approaching parity, she observes a persistent "gendering" of specific medical specialties that negatively affects both men and women. "When women enter general surgery, it is emphasized as something special, since few women choose that path," she observes. "But areas such as pediatrics and obstetrics/gynecology are now becoming female dominated, and men attracted to those fields seem intimidated by the prospect of entering them." Referring to her classmates' residency choices, Mega says, "I saw that when individuals crossed into what was considered a differently gendered field, they would be hassled and repeatedly asked if they were doing the right thing."

Although women entering obstetrics/gynecology may now outnumber men, Dopkins says that some older male physicians still operate as if the field were an old boys' club. "I get the feeling that some male physicians resent women's child-rearing responsibilities," says Dopkins.

"For example, last week in the operating room a female colleague of mine who is becoming a partner in an obstetrics/gynecology practice was being discussed, and three men present were joking about her having to postpone childbearing. That's in addition to the traditional sexism that takes the form of obscene jokes and comments about women's bodies," Dopkins continues. Although she says such blatant sexism does not surface often, the casual nature with which such comments are made is disturbing.

While Dopkins indicates that the increasing presence of women in traditionally male-dominated medical specialties is changing such behavior, Wagoner maintains that the "outsider" status many women in medicine occupy can be an asset. "If you have the ambition to achieve your goals in spite of being an outsider, you're not likely to be easily discouraged," she says. "You've never been included in the group, and you don't expect to be. Women who are OK with the sense of their outsider status are the ones who will persevere and achieve senior positions. If you require a sense of belonging and are not sure of yourself, negative messages will carry more weight."

'It's Doable!'

Savoia says that the most important message she can give to women entering academic medicine is that "it's doable." "I have two wonderful children who are very well-adjusted and successful, and I think that it has been good for them to witness my own success. I love what I do. Helping young people succeed and become better doctors is very fulfilling. When I do my job well, people don't perceive me as male or female. They think of me as a person who has done a good job."

Dopkins has no illusions that the path she has chosen will be an easy one. She says she has seen many women in academic medicine struggling with the family side of their lives. "It depends very much on what their husbands do," Dopkins opines. "If a woman has a husband who writes novels from home, it is much easier for her to stay on the tenure track than if she's married to a pathologist." But she remains undaunted. Dopkins intends to marry and have children within the next few years, adding that she has the advantage of a boyfriend who has offered to be a stay-at-home dad.

Mega likewise remains optimistic about her future. "As long as you are realistic about your goals and expectations, I think you, as a woman in this field, can be very fulfilled. I'm looking forward to a great life in academic medicine."

This article originally appeared in the AAMC Reporter, the monthly flagship publication of the Association of American Medical Colleges (AAMC), a nonprofit association founded in 1876 in the interest of medical education reform. The AAMC's members include the 125 accredited U.S. medical schools, the 16 accredited Canadian medical schools, 400 major teaching hospitals and health systems, 95 academic and professional societies representing nearly 100,000 faculty members, and representatives of the nation's medical students and residents. The AAMC works to strengthen the quality of medical education and training, enhance the search for biomedical knowledge, advance research in the health sciences, and integrate education into the provision of effective health care. For more information about the AAMC and its programs, visit www.aamc.org.

Barbara A. Gabriel, M.A., is a staff writer with the AAMC, where she is a regular contributor to the Reporter. She has previously contributed to magazines published by United HealthCare, the American International Health Alliance, and Lifescape.com. Her articles have also appeared in a variety of national human interest and entertainment publications. She resides in northern Virginia and may be reached at bgabriel@aamc.org.