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D. Rubin: Women in Gastroenterology

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  • 1.
    • Academic Skills Workshop Work/Life Balance
    • Deborah C. Rubin, M.D.
    • Washington University School of Medicine
  • 2. 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
  • 3. 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.
  • 4. 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
  • 5. 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.
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. 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
  • 11. 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 Andrews Nature Medicine 8:439-441, 2002
  • 12. 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
  • 13. Balancing Family and Career
    • So what’s the problem?
      • So many “hats” to wear
      • Results are stress, exhaustion and guilt
        • Family – children, spouse/partner, extended family
        • Work – highly demanding of time and energy
        • Home – running the household
        • Community responsibilities
      • Coping “tools” are required
  • 14. Balancing family and career
    • Child Care
      • Consider carefully what is best for your life style and children’s ages
        • Nanny vs. day care
      • Use available services to help you with hiring
        • Background checks, monitoring
      • Word of mouth is worth a lot
      • Try to get involved in the community
        • Great resources and source of support
      • Remember that needs change as children get older
        • Socialization, driving to activities, drop off and pick up from school, etc
  • 15. 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
  • 16. 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
  • 17.
    • 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
  • 18.
    • 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
  • 19.
    • 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
  • 20. 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
    • Compartmentalize
    CJ Kestenbaum J Am Acad Psycho and Dyn Psych 32:117, 2004
  • 21. More advice
    • Susan Lindquist
    • Howard Hughes medical investigator
    • Member of National Academy Sciences
    • Former director of the Whitehead Institute MIT
    • From 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”
  • 22. 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.
  • 23. 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 2001 CJ Kestenbaum J Am Acad Psycho and Dyn Psych 32:117, 2004
  • 24. 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
  • 25. 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.
  • 26. 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
  • 27. 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
  • 28. 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
  • 29. 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
  • 30. 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
  • 31. 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….
  • 32. 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
  • 33. 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”
  • 34. Balancing family and career
    • Married after first year of medical school
    • Pregnant with first child during first year of GI fellowship; delivered in August of second year of fellowship.
    • Pregnant with second child during fourth year of fellowship (in research lab)
    • Tenure clock started 6 months before birth of second child
  • 35. Balancing family and career
    • The beginning:
      • When should we start a family? What is the “best” time?
  • 36. Balancing family and career
    • There is no “best time” for beginning a family – there are pros and cons for each possibility:
        • During residency or grad school
        • During fellowship or post-doc
        • After fellowship
        • Probably avoid internship, avoid med school
            • Verlander Acad Psych 2004;28:331-336
  • 37. Balancing Family and Career
    • Resources
      • http://pathbox.wustl.edu/~awn/awntop/handbook.html
      • Family Resource Handbook
      • Table of Contents
      • Chapter 1: Choosing Child Care
      • Section 1 – Overview Page 5 
      •   Section 2 - Internet Resources Page 5   
      • Section 3 - Agencies for In-Home Well and Sick Child Care Page 7
      • For Profit Nanny Finding Agencies Page 7        
        •   In-Home Child Care Resources Provided by Area College Students Page 8  
      •   Section 4- Childcare at Washington University Page 9 
      •    Section 5- Questions to Ask Child Care Centers     Page 10
  • 38. Balancing Family and Career: Resources
    • Chapter 2: Resources for expectant and new parents
    • Chapter 3: Resources for older children
    • Chapter 4: Summer camps and activities for children
    • Chapter 5: Family fun in St. Louis
    • Chapter 9: Resources for elderly care
    • Chapter 10: Resources for the Washington U Community