Don’t breathe. Not one single breath.

With elbows pressed on the cold stone bench, the fledgling first-year graduate student held perfectly still, a pipette grasped between her delicate hands.

Don’t speak. Not one single word.

The 20-something researcher did her best to preserve the experiment she had worked so hard to prepare — an experiment that had her in the lab on a hot Saturday afternoon because microorganisms don’t know the days of the week. A more senior male colleague hovered too closely behind her, his hands unwanted and ill-placed on her back, her hip, before he laughed and walked away.

She still didn’t breathe.

“It was a much different world back then, and I was a lot more naïve because I didn’t realize they were treating me differently because I was a woman,” says Ann Campbell, PhD, Associate Dean of Student Affairs and Professor of Microbiology and Molecular Cell Biology. “Thankfully, times have changed and women are not only welcome, they are the ones holding open the door.”

As both a research scientist and faculty member, Dr. Campbell has seen the acceptance of women in the lab and in medicine change during her career. She also has seen the number of women entering medical school grow by leaps and bounds. At EVMS, she has seen colleagues and former students rise in rank — some ascending to positions as program and institute directors, department chairs, vice deans and even vice president.

Still, as she heads into retirement this year, she worries that not enough women are considering academic medicine and science for their futures.

Even at just 4-foot-9, Cynthia Romero, MD (MD ’93), can command a room. She’s been called fearless, passionate and powerful. She’s also been called “lady doctor.”

A former Virginia Health Commissioner, an EVMS-Sentara Endowed Chair for Academic Leadership Advancement, Associate Professor of Family and Community Medicine and Director of the M. Foscue Brock Institute for Community and Global Health at EVMS, Dr. Romero is no stranger to championing change — from healthcare access to healthcare bias.

And yes, she says, she does fight like a girl.

“My mom was a physician, and she introduced me to the doctors and organizations where I could step in and step up,” Dr. Romero says. “She was behind me every step of the way, encouraging me to break through every ceiling I could.”

And Dr. Romero did.

She didn’t see herself as the woman in the room. She was a doctor with a seat at the table. She served on boards and committees. She was nominated to local and regional societies. Then she was elected president of the Medical Society of Virginia, representing over 10,000 physicians, residents and medical students.

For a moment, she forgot she was alone.

But during a visit to the society’s headquarters in Richmond, she found herself standing at a wall of portraits. Each frame featured a past president, stoic and proud. Sadly, she was one of only three women to have served in that role since the organization’s founding in the 1820s. Looking down the empty corridor where future portraits will hang, Dr. Romero had a sobering revelation —no female candidates are in the pipeline.

And the problem is even bigger, she says. It’s academic medicine as a whole. Pursuing full professorship had never really been a goal for Dr. Romero. But a few months ago, she changed her mind. She sees it as an obligation.

“I want to prove to other women that it can and should be done,” she says. “I want to look to my left and to my right and see just as many women as men at the table.”

Women are falling out of the pipeline to leadership in alarming numbers. “It’s not a slow and steady flow, it’s gushing in some places,” says Kim Templeton, MD, Professor of Orthopedic Surgery at the University of Kansas in Kansas City and the immediate past President of the American Medical Women’s Association.

“We’ve been successful at drawing women in to traditionally male-dominated fields. It’s getting them to stay and rise into leadership positions where we see the problem.”

Figures from the Association of American Medical Colleges (AAMC) show no shortage of women entering medical school today. In fact, in 1966 women represented only 7 percent of medical school graduates. In 2014, that climbed to almost 48 percent.

In 2017 at EVMS, female students make up half of the entering MD class. Women also are gaining ground in all EVMS residency specialties, including traditionally male-dominated areas like surgery, ophthalmology and radiology.

Over in the School of Health Professions, female students dominate programs like Surgical Assisting, Physician Assistant and Art Therapy and Counseling. Plus, the number of women entering typically male-led fields, like biomedical sciences, is also at all-time highs.

So where is the leak?

At the top, Dr. Templeton says.

A 2014 Women in Medicine and Science survey by the AAMC showed that while the number of women applying to medical school is increasing, only about one-third of full-time academic medical faculty are female with underrepresentation persisting at the ranks of associate and full professor. Even after adjusting for age, years since residency, specialty and measures of research productivity, men were substantially more likely than women to be full professors.

Female faculty were far less likely to be awarded adequate start-up funding for research projects — the kind considered most likely to help launch faculty careers. Men were awarded 67.5 percent more funding than women. And women hold only a small fraction of the department chair and dean positions at LGME-accredited schools nationwide.

Yet even when they do ascend the ranks and earn titles similar to that of their male counterparts, research shows that women in medicine nationwide make nearly $20,000 less a year in salary.

The “pipeline,” Dr. Templeton says, springs a leak somewhere between assistant and associate professor. This is where women’s academic medical and science careers are likely to stall. The numbers at EVMS are reflective of the national trend. Among full-time, part-time, salaried, non-salaried and community faculty, male professors outnumber female professors nearly 2 to 1.

Elza Mylona, PhD, MBA, Vice Dean for Faculty Affairs and Professional Development and Professor of Internal Medicine, says EVMS has placed a strong emphasis on increasing access to opportunities for development and advancement, especially for female faculty. Faculty Affairs is working with department chairs to identify faculty who have been at the same rank — specifically assistant professors — for a long time, to help them develop strategies for promotion.

“I spend a lot of time working with female faculty one-on-one as they prepare their dossiers for promotion, making suggestions of how to present the work they have done so they can receive the credit they deserve,” Dr. Mylona says. “It is difficult at times for them as the underestimate the impact of their work.”

Still, EVMS has boasted a 100 percent success rate on promotions for the past two years.

The institution has also made Professional Enrichment Grants, AAMC seminars for women and minorities and other development activities more readily available. And EVMS officials recently re-established the Women in Medicine and Science (WIMS) group as a way to encourage female faculty to support, mentor and sponsor each other. Recent WIMS workshops have focused on graceful self-promotion, assertiveness, leadership presence and team temperament.

Joining a women’s group, attending workshops, finding a mentor and reaching out to female colleagues are all important ways for women in medicine and science to navigate their way, she says.

“Recruiting and retaining a talented, diverse faculty for academic medicine and science are essential for us to successfully achieve excellence in all mission areas — educational, clinical and research,” Dr. Mylona says. “Strong participation of women will only increase our opportunities to think innovatively about transforming systems of healthcare delivery, discovery and, of course, training.”

Still the roadblocks for women on the path to full professorship are complex and vary from program to program, institution to institution. To seek out promotion, most faculty are required to serve on committees, lecture, write and publish and conduct research. But often times, Dr. Templeton says, female faculty are asked to teach instead of being given the time to pursue those other requirements. And when they are balancing a family and work life, even the times of committee meetings can be an obstacle.

Other factors come into play, too, says Tina Cunningham, PhD.

“Women are often busy at home and at work with their nose to the grindstone and don’t stop to think about or ask for a promotion,” says Dr. Cunningham, Director of the Center for Health Analytics and Discovery, as well as Director of the Master of Healthcare Delivery Science and Master of Healthcare Analytics programs. And women are often reluctant, she says, to speak up about opportunities and advancement the way a man would.

An Associate Professor, Dr. Cunningham says she has been asked by colleagues why she waited so long to seek promotion while her male counterparts were moving up the ladder.

“I just assumed that they would ask me when they thought I was ready, which is silly when you really think about it,” she says. “We as women have to get over that reluctance to advocate for ourselves.”

Mastering the balancing act

Everything about Rebecca Britt, MD, screams no nonsense. For 10 years Dr. Britt (MD ’98, Surgery Residency ’04), an EVMS-Sentara Endowed Chair for Academic Leadership Advancement and the Robert L. Payne Chair in Surgery, was the only full-time female faculty member in EVMS Surgery. Today, she is one of three. Testament, she says, to the change in the way women and men see her specialty.

“Surgery has never been seen as the most family-friendly specialty, but that perception is changing,” Dr. Britt says. “As more women go into the specialty, they are demonstrating that we can do the hours and be moms and have a life outside of work.”

Dr. Britt oversees the EVMS General Surgery Residency Program and a mentoring program through the American College of Surgeons. She is involved with state and national mentoring programs for the Association of Women Surgeons. She also is the mother of three.

“The biggest lesson I learned is that you don’t have to do it all, to be all things,” Dr. Britt says. “It’s OK to ask for help, to build a support system and to let others help you when it’s needed.”

That might mean a sitter to assist with before- and after-school care for your children, a lawn service to mow your grass or a cleaning service to help straighten up the house.

“It’s about finding balance,” she says.

In her role with Student Affairs, Dr. Campbell says she has seen more and more young women like Dr. Britt entering medicine and science with the belief they can do anything they set their minds to.

“I want them to know they can pursue the specialty they love most, that they can have the family and they can become a professor or vice president or a dean,” Dr. Campbell says. “They can even wear the cute shoes. It doesn’t have to be one or the other, all or none.”

For her, the wonder women on campus today are the younger physicians and scientists who seem to balance work, family and everything else so effortlessly. She hopes they will continue to rise in rank and serve as mentors to the still-younger generation of female students preparing to enter the workforce.

“Julie Kerry, Maggie Morris, Jessica Burgess, Becky Britt, Aurora Kerscher, Amy Tang, Elena Galkina, Cynthia Romero, Tina Cunningham, Marissa Galicia-Castillo — I could go on and on,” she says, rattling off names until she runs out of fingers on which to count. “They have families and active lives. They are involved in their communities, and yet they are still publishing, teaching, directing programs and writing NIH grants. These women inspire more wonder than I ever could.”