Academic Skills Workshop

Work/Life Balance

Deborah C. Rubin, M.D.

Washington University School of Medicine

Women in Gastroenterology

• 12-15% of GI physicians are women• Stable since 1980s despite ~50% med students

are women• Why?

– Mentorship needs, especially in academics• Family obligations, performance pressures, gender isolation

– need more female mentors

– Procedural vs. cognitive skills– Excessive hours, emergencies

Foxx-Orenstein Am J Gastro 2004 editorial; Burke et al., Am J Gastro 2005;100:259-264

Women In Science

• New report from The National Academies– (Natl Acad Sci, Natl Acad Eng, Institute of

Med, National Res Council) published 9/06– Women have earned more than half of

bachelor’s degrees awarded in science and engineering.

– Among science and engineers with Ph.Ds, four times more men than women hold full-time faculty positions.

Women in Science

• Women more likely than men to feel colleagues devalued their research

• Fewer opportunities to collaborate

• Constantly “under a microscope”

• Exit interviews from faculty who left “voluntarily” indicate lack of respect a key issue

Women in Science

• Studies have not found significant biological differences between men and women in performing science and math

• Compared with men, women paid less, promoted more slowly, receive fewer honors, hold fewer leadership positions. Not based on productivity, significance of work, or other performance measures

• Measures of success underlying performance-eval systems are often arbitrary and applied in ways that place women at disadvantage

• Structural constraints and expectations built into academic institutions assume substantial “significant other” support. Anyone lacking career and family support traditionally provided by a “wife” is at a serious disadvantage in academe”

• 90% of women’s spouses are employed full time, but only 50% of male spouses.

Women in Academic Medicine

• 2005: 15% full professors, 11% department chairs are women

• Differences in advancement and treatment of women: after 11 years as faculty member, 5% of women c/w 23% men were promoted despite equal numbers of hours worked and articles written (survey 1979-81)

• Women have less lab space, grant support at start of career, receive lower salaries, fewer mentorship relationships

NEJM 355:310-313, 2006

Women in Academic Medicine

• Institutional culture may pose challenges– Time commitment for academic career– Tenure clocks– Meetings outside of traditional working hours– Women with children report greater obstacles to

career advancement and less institutional support. Such differences not observed between male and female faculty members without children.

• Role of Choice

What are the obstacles for dual career or single parent families?

• Balancing family and career– Maximal productivity required during child-

raising years

• Lack of mentorship

• Persistent (albeit less obvious) gender discrimination

Academic Medicine 2004:79:319

Physician-Physician Families

• 22% of male physicians and 44% of female physicians married to doctors

• Compared to male or female MDs not married to M.D.s, they– Earned less money (individually)– Less often felt that their career took precedence over

spouse’s career– More often play a major role in child-rearing– Difference for women bigger than for men

Sobecks et al., Ann Int Med 1999;130:312-319

Physician-Physician Families

• Similar to other physicians in achieving career goals and goals for their children

• Similar to other physicians regarding feeling conflict between professional and family life

• More frequent enjoyment from shared work interests, higher family incomes

What are the obstacles for academic physicians/scientists in either dual career or

single career families?

• Difficulties in combining career with childbearing and family life

• Lack of compelling role models

• Women receive little encouragement

• Perception by women that they will have to be better than their male counterparts to be considered equal.

NC AndrewsNature Medicine 8:439-441, 2002

Women in Academic Medicine

• From Arch Int Med 167:343-345, 2007:• Survey of 31 junior women at MGH with families

– Opportunities lost due to “balancing act”– Approaches to career and work changed as evenings

and weekends much less available for work– Early morning and evening talks “problematic”– Research pace slowed, productivity decreased– “life is extraordinarily challenging, adding a new,

previously unimaginable layer of complexity

Balancing Family and CareerBalancing Family and Career

So what’s the problem?So what’s the problem? So many “hats” to wearSo many “hats” to wear Results are stress, exhaustion and guiltResults are stress, exhaustion and guilt

Family – children, spouse/partner, extended Family – children, spouse/partner, extended familyfamily

Work – highly demanding of time and energyWork – highly demanding of time and energy Home – running the household Home – running the household Community responsibilitiesCommunity responsibilities

Coping “tools” are requiredCoping “tools” are required

Balancing family and careerBalancing family and career

Child CareChild Care Consider carefully what is best for your life style Consider carefully what is best for your life style

and children’s agesand children’s ages Nanny vs. day care Nanny vs. day care

Use available services to help you with hiringUse available services to help you with hiring Background checks, monitoringBackground checks, monitoring

Word of mouth is worth a lotWord of mouth is worth a lot Try to get involved in the communityTry to get involved in the community

Great resources and source of supportGreat resources and source of support Remember that needs change as children get Remember that needs change as children get

olderolder Socialization, driving to activities, drop off and pick up Socialization, driving to activities, drop off and pick up

from school, etcfrom school, etc

How can we deal with the obstacles?

• Personal– Don’t be afraid to seek help– Identify a mentor with experience in this arena– Hone your organizational skills– Simplify your daily life and routines– Use available resources

• At university• Community• National

How can we deal with the obstacles?

• Personal– Don’t be afraid to seek help

• With children• With housework• Share with spouse/significant other• Extended family

• Personal– Identify a mentor with experience in this arena

• Can be separate from your primary academic mentor – the more the merrier

• Seek help from national organizations– American Gastroenterological Association, American

Physiological Society have mentorship programs

• Personal– Hone your organizational skills

• Keep schedules with you at all times• Plan ahead for major stress periods at work (e.g.

grant and other deadlines, presentations. This is difficult to do but critically important

• Set up a good work space at home• Develop a standard routine for creating and

dealing with your “to-do” list

• Personal:– Simplify your daily life and routines

• Can you live close to work? Eliminate long and stressful driving times

• Seek day care with flexible hours• Get help with driving to activities• Use health care professionals with weekend or

evening hours if possible

Family and Career: how to balance?

• Choose the right partner (!)

• Choose your parents with care – High energy, sense of humor, flexibility,

problem solving ability

• Choose the nanny/day care with great care

• Compromise

• CompartmentalizeCJ Kestenbaum J Am Acad Psycho and Dyn Psych 32:117, 2004

More advice

• Susan Lindquist Howard Hughes medical investigator

Member of National Academy SciencesFormer director of the Whitehead Institute MITFrom NY Times April 2007

“Pick a partner who’s going to support (your) work”“Make mindful financial choices” (invest in child care, consider living close to work)“Put resources into things that kept me from falling apart and helped my kids”

How to Balance

• Compromise– Maybe not the best time to serve on lots of

committees– Learn to say no– Limit out of town travel– Focus on what you must accomplish to

succeed. Don’t get side-tracked. Prioritize.

How to Balance

• Compartmentalize:– Divide work time and home time with little

overlap.– Guarantee your children set times when you

will be home; they know what to expect and that their needs are your highest priority

– Give each child some individual time

Arvin, A. Stanford Report 2001CJ Kestenbaum J Am Acad Psycho and Dyn Psych 32:117, 2004

How to Balance

• Avoid guilt– “…employed mothers today seek ways to

maximize time with their children. Within marriages, fathers are spending more time with their children than in the past, thus increasing the total time children spend with a parent even as the mother spends more time away from home.

Bianchi SM Demography 37:404, 2000

How to Balance

• Energy and flexibility

• Level of comfort with a certain degree of chaos and unpredictability

• You can’t be in more than one place at one time

• Family first– Verlander Acad Psych 28:331-336, 2004.

National Efforts

• From National Academies report:– Incorporate the goal of counteracting bias

again women into strategic plans, publicize and account for yearly progress

– Examine evaluation practices– Incorporate flexibility into hiring, tenure and

promotion guidelines – paid parental leave, facilities and subsidies for on-site day care, increase time for tenure and promotion clocks

How to address the inequities: 1. Institutional

• Choose a supportive environment– Presence of other role models– Explore tenure track/promotion guidelines– MIT example – semester’s paid leave from

administrative and teaching duties, delay in tenure decision.

– WUSM example - Tenure track changes passed at WUSM, Gender Equity Committee has been formed and meets regularly, Academic Women’s Network, Office for Faculty Affairs.

– MGH example

MGH example

• Claflin Distinguished Scholar Awards• Financial support for research efforts of women

junior faculty with children – $30,000 per year for two years

• Controversial but effective • Well received, showed institutional commitment,

90% retention of faculty at 10 years, with 22 promotions.

• Grant support received by these women greatly exceeded institutional costs (51 million in direct costs vs. 2 million for start up grants).

Arch Int Med 2007:167:343

Women in Academic Medicine

• Role of choice:– What can be done to support women who

have chosen to have families?• Educate about promotion criteria

– Resulted in an increase from 4 to 20 female associate professors in three years

• Mentorship• Flexible career paths

NEJM 355:310, 2006

How to address the inequities and social pressures

• “View the issues broadly”– “Selectively helping young women will only

serve to reinforce traditional roles if it provides no incentive or opportunity for young men to be involved in parenting. It is not hard to find men who would like to take on an equal share of the responsibility for having and raising children”

» NC Andrews. Nature Medicine 8: 439-441, 2002

How to address the inequities and social pressures

• “Many of the most successful women physician-scientists owe their success, at least in part, to enlightened partners who have made their own unrecognized and unrewarded career sacrifices – but there are few grants or tenure track adjustments for these men. Promotions committees should consider that male faculty members may have assumed an equal or greater amount of the responsibility….

How to address the inequities: 2. National efforts

• Committees on women and gender equity in different specialty and research societies.

• Mentorship programs

• NIH – programs on women’s health research

• Academic success workshops – junior and mid-career run by AAMC

Work/Life Balance

• Progress has been made but much left to be done

• Culture changes required in multiple arenas

• Innovative programs – think “outside the box”

Balancing family and careerBalancing family and career

**A SAMPLE TIMELINE****A SAMPLE TIMELINE** Married after first year of medical schoolMarried after first year of medical school Pregnant with first child during first year Pregnant with first child during first year

of GI fellowship; delivered in August of of GI fellowship; delivered in August of second year of fellowship.second year of fellowship.

Pregnant with second child during fourth Pregnant with second child during fourth year of fellowship (in research lab)year of fellowship (in research lab)

Tenure clock started 6 months before Tenure clock started 6 months before birth of second childbirth of second child

Balancing family and careerBalancing family and career

The beginning:The beginning: When should we start a family? What is When should we start a family? What is

the “best” time?the “best” time?

Balancing family and careerBalancing family and career

There is no “best time” for beginning There is no “best time” for beginning a family – there are pros and cons for a family – there are pros and cons for each possibility:each possibility:

During residency or grad schoolDuring residency or grad school During fellowship or post-docDuring fellowship or post-doc After fellowshipAfter fellowship Probably avoid internship, avoid med schoolProbably avoid internship, avoid med school

Verlander Acad Psych 2004;28:331-336Verlander Acad Psych 2004;28:331-336

Balancing Family and CareerBalancing Family and Career

ResourcesResources http://pathbox.wustl.edu/~awn/awntop/handbohttp://pathbox.wustl.edu/~awn/awntop/handbo

ok.htmlok.html Family Resource HandbookFamily Resource Handbook Table of ContentsTable of Contents Chapter 1: Choosing Child CareChapter 1: Choosing Child Care Section 1 – Overview Page 5 Section 1 – Overview Page 5    Section 2 - Internet Resources Page 5   Section 2 - Internet Resources Page 5    Section 3 - Agencies for In-Home Well and Sick Child Section 3 - Agencies for In-Home Well and Sick Child

Care Page 7Care Page 7 For Profit Nanny Finding Agencies For Profit Nanny Finding Agencies Page 7        Page 7        

  In-Home Child Care Resources Provided by Area College In-Home Child Care Resources Provided by Area College Students Students Page 8  Page 8  

  Section 4- Childcare at Washington University Page 9 Section 4- Childcare at Washington University Page 9      Section 5- Questions to Ask Child Care Centers     Page Section 5- Questions to Ask Child Care Centers     Page

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Balancing Family and Career:Balancing Family and Career:ResourcesResources

Chapter 2: Resources for expectant and Chapter 2: Resources for expectant and new parentsnew parents

Chapter 3: Resources for older childrenChapter 3: Resources for older children Chapter 4: Summer camps and activities for Chapter 4: Summer camps and activities for

childrenchildren Chapter 5: Family fun in St. LouisChapter 5: Family fun in St. Louis Chapter 9: Resources for elderly careChapter 9: Resources for elderly care Chapter 10: Resources for the Washington U Chapter 10: Resources for the Washington U

CommunityCommunity