The National Institutes of Health has announced a plan to enforce 12-year term limits for tenured laboratory and branch chiefs; however, such a limit has yet to be enacted in academic medicine. Authors of an article published in the New England Journal of Medicine argue that lack of term limits on leadership positions at academic institutions has contributed to the underrepresentation of physicians who are female or who belong to racial or ethnic minority groups.
Women account for only 18% of US medical school deans, and underrepresented racial and ethnic minorities account for only 12%. This is surprising, given that the number of physicians who are women or are from racial and ethnic minority groups has been steadily increasing for a number of years, with women physicians constituting nearly 40% of the medical student body for the past quarter century. The authors suggest this stagnation in the demographic breakdown of leadership positions in academic medicine indicates a need for a major policy shift that will facilitate diversity throughout the pipeline of academic medicine. Without this change in policy, they argue, the demographic breakdown of leadership positions is unlikely to shift.
According to the authors, the lack of term limits for senior leadership positions at the university level is a major and modifiable factor that may improve diversity in academic medicine. Currently, senior leadership in this realm is disproportionately white and male. The average term length is 8.7 years among men vs 6.1 years among women. Only 7.3% of 505 US university medical school chair positions with term lengths of ≥12 years are occupied by women, and 9.5% of those are held by physicians who are not white or Asian.
The authors note that academic medicine is supported by leaders with extensive years of experience in their field. However, they argue, this does not necessarily mean that academic institutions would not benefit from these positions being turned over more frequently. Many department chairs or division chiefs rarely leave their position unless they are promoted to higher leadership positions, so the perspectives of physicians holding these positions hold disproportionate sway over time. Allowing these positions to be occupied by new physicians more frequently would allow a more diverse set of views to influence the visions of academic institutions.
Greater diversity in leadership positions may also reduce the risk for harassment and discrimination, as women and underrepresented members of racial and ethnic groups tend to represent mostly junior faculty and trainees. Patients in these underrepresented groups may also report greater improvements in care if they are managed by physician leaders of the same sex or similar cultural backgrounds.
Overall, the use of term limits may “require benchmarking and continuous reevaluation to ensure that the strategy’s potential is realized,” the authors wrote. They also suggest that the expansion of “institution-wide searches for candidates for deanships beyond existing department chairs may also be worthwhile.”
Beeler WH, Mangurian C, Jagsi R. Unplugging the pipeline – A call for term limits in academic medicine. N Engl J Med. 2019;381(16):1508-1511.