Career Advancement Challenges for Women in Tenure Versus Clinical Tracks in Academic Medicine: Cross-Sectional Survey Study

BACKGROUND: Despite gender parity in medical school matriculants, women in academic medicine encounter ongoing challenges in career advancement and promotion. OBJECTIVE: This study aimed to assess the experiences and challenges impacting the career trajectory for women-identifying faculty at the Ohio State University College of Medicine (OSUCOM) in tenure track (TT) and clinical track (CT; nontenure track) academic appointments. METHODS: The OSUCOM Widening Impact in Medicine and Science (WIMS) organization, earlier known as Women in Medicine and Science, conducted a digital online survey in May 2023 distributed to all women-identifying faculty at OSUCOM. We focused on the responses of faculty who reported being on the TT or the CT at the rank of assistant, associate, or full professor. Survey data were compared to ongoing and new career development programming in WIMS that addresses faculty needs across both tracks. RESULTS: Approximately half (639/1292, 49.5%) of all women-identifying OSUCOM faculty responded to the survey, with 565 (88.4%) reporting as TT or CT at the rank of assistant, associate, or full professor. Among these respondents, 23.5% (n=133) were on the TT (assistant professors: n=60, 45.1%; associate professors: n=37, 27.8%; professors: n=36, 27.1%), while 76.5% (n=432) were on the CT (assistant professors: n=245, 56.7%; associate professors: n=129, 29.9%; professors: n=58, 13.4%). Across both appointment tracks, of 492 participants, the two most common challenges impacting career advancement were caregiving responsibilities (n=271, 55.1%) and burnout (n=235, 47.8%). Significantly more CT versus TT faculty identified increased patient load (n=187, 47.8%, vs n=10, 9.9%; P<.001) and clinical productivity requirements (n=150, 38.4%, vs n=19, 18.8%; P=.002) as barriers to career advancement. CT faculty were also more likely to report not currently having a mentor compared to TT faculty (n=202, 48.9%, vs n=37, 31.9%; P=.001). In contrast, significantly more TT faculty reported the impact of COVID-19 (n=50, 49.5%, vs n=75, 19.2%; P<.001) and lack of funding (n=28, 27.7%, vs n=66, 16.9%; P=.014) as barriers to advancement. TT faculty were also significantly more likely to report sponsoring an OSU faculty member in their current position (n=55, 54.5%, vs n=147, 38.0%; P=.003). CONCLUSIONS: Our findings highlight that TT and CT women-identifying faculty experience different career landscapes with distinct track-specific barriers to professional advancement. CT women-identifying faculty are particularly vulnerable in areas such as mentorship and sponsorship, while TT women-identifying faculty experience more challenges related to research productivity. With an increasing number of women hired as CT faculty, it is critical for academic medical centers (AMCs) to maintain and strengthen support for all faculty types by broadening institutional-level strategies and offering targeted career development programming.