In the 5 years since former president of Harvard University Lawrence Summers made a household name for himself by suggesting that women may lack an "intrinsic aptitude" for science, there's been a heightened sensitivity toward the factors in academic science and medicine that lead so many women to veer from the academic career path. Yet, "so far I haven't found much that's been accomplished," reports Harvard immunologist Laurie Glimcher , who participated in the Harvard Task Force on Women in Science and Engineering  created in the wake of the Summers controversy. That group made a series of recommendations to improve the working conditions for women, and now Glimcher and a colleague are examining the effect of their recommendations. "There's been some child-care improvements but there's really little else, I'm discouraged to say."
Male or female, the biggest factors in academic success are driving ambition and incredible efficiency, Glimcher notes. These qualities are not lacking in the pool of high-achieving, talented M.D.-Ph.D. students--yet the attrition of women from academic medicine continues unabated. "In clinical medicine, we are losing people right and left," Glimcher says. "Sometimes I look around and ask myself, 'Who is the next generation of female immunologists? Who's going to be really wonderful?' They are there, but there are not a lot of them."
Studies tracking academic demographics show that many women in M.D.-Ph.D. programs leave academic medicine. A recent study suggests  that many of them leave during the juncture between postdoctoral training and obtaining an independent academic position. And those who remain in academic medicine progress up the ranks much more slowly than men do (see related article  ). The roadblocks--some documented, others merely speculated--seem to be the same ones women have faced in many scientific fields: family-life and work-life balance and a real or perceived bias that prevents advancement.
But some women leaders say that rather than continuing to document the problems, it's time to focus on solutions. It's time, they say, for women to get on with the business of being successful clinician-researchers.
Glimcher, for one, has little patience for handwringing about the difficulties women face in trying to combine a career in academic medicine with family life. Glimcher, who raised three children while building a stellar academic career, is a doer. She would rather implement tangible programs than start a support group. As president of the American Association of Immunologists , she started a pilot program to provide supplementary funds for postdoctoral fellows who are primary caregivers of dependents. The program was so successful that the National Institute of Allergy and Infectious Diseases  picked it up--but budget woes have left it a mere shell of a program. She says it was a simple, relatively inexpensive program that made a big difference for several women during the postdoctoral years, when demonstrating scientific productivity is essential to making it in academia.
Glimcher also has a policy of providing a full-time technician to postdocs who have primary child-care responsibility. This support proved crucial for Wendy Garrett, a board-certified oncologist, postdoctoral fellow in Glimcher's laboratory, and mother of two children, ages 1 and 5. "Those young family years, it's a wonderful time, but at the same time for some people who are trying to get their careers started as independent clinical or translational investigators, that's a tough enough time as it is, while having other very important [family] responsibilities," Garrett says.
Garrett knew from an early age that she wanted a career in cancer research. Science teachers in middle and high school nurtured her interest in science, and witnessing the ravages of cancer in her own family--her father died of the disease--cemented her career plans. She attended Yale University as an undergraduate and completed her M.D.-Ph.D. there as well. She had her first child while an intern at Harvard's Brigham and Women's Hospital .
Garrett says the staff around her were universally supportive of her during her pregnancy. If anything, she was the one with unrealistic expectations of how quickly she would return to work after giving birth.
"I made the foolish offer--and I didn't know it was foolish at the time, because I didn't have any children--to come back to work a week after giving birth to my first child," she says. "They told me, 'Maybe that's not the best idea.' "
Garrett says the key to balancing her home and family life is being efficient, having a supportive husband and reliable childcare, and--particularly--having technical help in the laboratory. "I think funding for childcare is very important. I think having excellent child-care facilities associated with academic medical centers is very important," she says.
As for the technical help, she advises women physician-scientists to invest time seeking out financial support. She applied for and received a grant from the Burroughs Wellcome Fund  that will provide funding for her final year of postdoctoral research and the first couple of years as an assistant professor. Such awards are specifically designed to assist physician-scientists bridge the critical juncture between a mentored position and academic independence.
The experiences of those who have managed to establish themselves in academic medicine suggest that support from strong role models and mentors is a crucial factor.
Glimcher, whose father, Melvin Glimcher , was her role model and is now her collaborator at Harvard, says she believes the blatant sexism of her early faculty years has abated. "You would cringe if I told you some of the things that people said to me," she says. Now the biggest issue, she believes, is an unconscious bias reinforced by a lack of women in senior administrative roles.
Garrett is clear-eyed about the dearth of women at senior levels in academic medicine. "All you have to do is look around at a grand rounds and see who makes up the room in terms of whether the senior people are women and how many there are of them," she says. In her experience, there aren't many female faces in the crowd. But she will not let those odds deter her. "I'm very happy doing what I'm doing; I love the research that I do. My children are a great source of joy. So I just think being happy in my daily reality keeps me going." Glimcher, she says, is an inspiring role model. "Seeing people around here who have achieved this makes me feel that it is possible."
Yet the fear of speaking out when incidents do occur continues to plague academic medicine. Two women contacted for this article--both physician-scientists--declined to be interviewed by Science Careers, one citing concerns that speaking publicly could get her labeled as a whiner.
It's a reasonable concern, says Nancy Andrews , Dean of Duke University School of Medicine . "It is easy for it to sound like whining," she says, "but [bias] is very subjective stuff that's hard to quantify."
Another problem, Andrews says, is that speaking or writing publicly about the issues facing women physician-scientists, as she has, can get you labeled as an "expert" on women's issues rather than being seen primarily for your scientific or medical work. After she wrote a commentary  published in Nature Medicine in 2002 questioning where all the women physician-scientists have gone, she was asked repeatedly to address the topic at meetings, something she declined to do. "I didn't want to be an activist," she says.
Instead, she prefers to work behind the scenes as a role model and advocate. She says that since arriving at Duke in 2007, she has pushed for equal representation of women on faculty search committees and has sent lists of faculty candidates back to departments because there were no women candidates on the list. These days, she is worried about the near total lack of women in senior administrative positions in academic medicine.
"I think it's easier to see someone as a potential leader if they remind you of yourself," she says. "I think it's harder for women to look like potential leaders when it's a male-dominated leadership above them. I don't think that's anything deliberate on the part of men, I just think it's part of the culture at this point."
For women coming up through the ranks, the obstacles aren't as clear-cut. And the two women just starting their careers in academic medicine that Science Careers spoke with for this article felt that they had been supported equally by men and women.
Garrett says she has both male and female mentors. One of the people she turns to for advice most often is a 90-year-old professor emeritus, who happens to be a man. Lately, she has been seeking advice from peers who have just been through the job-search process. She says it's important to seek out mentors with a broad range of experiences.
Arlene Dent, an assistant professor of pediatric infectious diseases at Rainbow Babies and Children's Hospital  at Case Western Reserve University in Cleveland, Ohio, says there was a time when she actively sought female role models. But after both good and not-so-good experiences with male and female mentors, she says she has greater perspective and realizes that "it's not about male or female. There was a time when I thought I was being treated differently because I'm a female, and you know what, it really isn't. People are people."
But Andrews says she believes younger women coming into academic medicine can still benefit from female mentors who are willing to demystify the unwritten rules of networking that form the "old boys" club.
"In science and in medicine, there are very strong cultures that help determine your success," she says. "For junior women faculty, at least at the institutions I know well, the cohorts are not very large and so it's difficult for the women to come together and learn the culture and the unwritten rules on their own." She says it's important for women to learn what it takes to succeed in their own locale.
Dent acknowledges that her experience may be a little different because she is in pediatrics, a field in which there are generally more women in research and administrative positions. The path may have been smoother for Dent than for a woman in, for example, surgery, which is a field dominated by men.
Running a research laboratory is fulfilling, Dent says, and she has more control over her own time relative to a purely clinical career track. At the same time, she adds, she's grateful for her clinical experiences because it helps her to put things into perspective when nothing is working in the lab. Dent's research deals with understanding acquired immunity to malaria developed in utero, and she spends several months a year at her field site in Kenya, where women are dealing with life-and-death issues.
"The sexism is rampant in Kenya," she says. "So maybe I don't feel it as much in the United States, because I sure feel it in Kenya." She says her fieldwork helps her cope with the everyday hassles of being an overburdened assistant professor. It's on those days, she says, that she tells herself, "No child died," and then she's over it.
Karyn Hede is a freelance writer in Chapel Hill, North Carolina.