Anita Palepu and Carol Herbert are to be commended for their thoughtful analysis of the issues facing women in academic medicine.1 While there is acknowledgement that domestic responsibilities are a major contributor to the career obstacles many women face, there also exists a gender issue at the systems level. Because the academic structure developed at a time when men were its only members, it tends to value stereotypically male characteristics such as autonomy, assertiveness and decisiveness.2,3 In such a structure, “women are perceived as having less leadership ability and less competence, and when women exercise assertiveness or try to assume leadership they have to work harder to get attention and they receive more negative reactions.”2
Perhaps women could develop a different type of organizational structure. A survey of faculty at a single US academic institution found that, relative to their male counterparts, women faculty placed less value on accomplishments such as leadership, scholarship and national recognition and more value on recognition of their work by patients, students and local peers.4
This analysis by no means presumes that men intentionally perpetuate the system, nor does it imply that all men benefit from the current structure.3 New strategies must address ways of changing the academic system to best accommodate the strengths of both women and men, rather than trying to mould women to fit an organizational structure that was never designed for them. This goal can be accomplished by a willingness on the part of academia to understand and root out the cultural biases that lead to discrimination. We would all be well served by institutional approaches that address “discrimination by fixing the organization, not the women who work for it.”3
Rose Hatala Department of Medicine St. Paul's Hospital Vancouver, BC