“There are only so many hours in a working day to interface with patients and be a presence at work and also be present physically and emotionally for your child.” This anonymous quote in a 2019 paper in Academic Medicine titled “The Most Valuable Resource Is Time: Insights from a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities” typifies a quandary facing many early-career physician scientists – particularly women: how to balance the extraordinary demands of caregiving just as their careers are taking off.
Too often, the eventual answer is to exit the field: Women, who disproportionately shoulder these responsibilities, report this as one of the principal reasons they leave the academic ladder. Despite high representation in medical schools, outpacing the number of men in the last few years, women have yet to see parity among medical school faculties. So, what can medical schools do to bolster the careers of and better retain these brilliant contributors to their institutions? The before-mentioned article by Dr. Reshma Jagsi and her team takes an early-stage deep dive into evaluating the effectiveness of our Fund to Retain Clinical Scientists, a national program that we first highlighted in a May 2018 article in this column and that aims to address this issue. Run by ten medical schools, the program endeavors to retain promising physician scientists by providing supplemental, flexible funds to outsource time-consuming delegable research tasks that help them carry on their clinical research while contending with substantial caregiving responsibilities.
In this early look at the FRCS program’s effects, Dr. Jagsi and her team used interviews with 28 of the FRCS participants, 23 of whom were women, to determine challenges related to work-life integration. The evaluation team found that time spent caregiving often results in particularly detrimental effects on the careers of female physician scientists, who already manage numerous demands on their time, and illuminated the depth of some of these challenges.
Many FRCS recipients spoke in great detail about these time conflicts, including delivering clinical care, conducting research, executing administrative duties, completing grant applications, writing publications, and so on – all in addition to their duties as a caregiver. “There's never really enough time in the day,” said one interviewee. “The challenge of having a family and a demanding work life is that you never leave anything that's completely done.”
Furthermore, the interviews revealed that these issues seem to be compounded for women who are first-generation academics or members of groups underrepresented in medicine. As one person noted, “Caregiving burden kills people who are the first-generation professionals in their family. It kills their career disproportionately.”
Another offered, “One thing to mention is that there is always the brown tax and, especially … where there are very few minority scientist physician researchers. You get asked to do so much. You’re suddenly the representative at every committee. You are asked to represent your hospital at galas and lunches, you name it! And I think that also takes a huge chunk of time.”
The picture these conversations paint is one of daunting challenges and time in painfully short supply. But the upside is that many of these interviewees expressed that the FRCS program is making a sizeable impact in addressing these issues in their own personal contexts. Repeatedly expressed throughout the paper is the notion that the FRCS program is accomplishing its purpose by helping the program participants meet these incredible burdens for their time. Interviewees consistently noted that the flexible research dollars provided by the FRCS facilitated reclamation and repurposing of time that helped push their important research forward.
The authors of the paper described the program participants’ vivid depictions of how support from FRCS helped maintain their career progress, boost their research productivity, provide flexibility at a critical time in their career trajectory and validate their situation in the institution’s eyes. “This program gives me the opportunity to not have to make any permanent decisions to cut different uses of my skill out,” said one physician scientist participating in the program. “I don't have to cut out research. I don't have to cut out clinical work. I don't have to spend less time with my kids. I can just make use of a broader set of resources. That's what it means to me.”
Another spoke directly to how programs that support clinical researchers with family obligations as FRCS does can help organizations improve gender equity among their faculty: “A lot of the caregiving responsibilities still do fall to women, so I think [the FRCS is] a way for institutions to show they are serious about women advancing in their careers.”
The bottom line is that Dr. Jagsi’s paper confirms there is a genuine need for interventions to relieve a major challenge for physician scientists, which is simply that there are too few hours in the day. Academic health centers should provide more resources that reduce time-related challenges, and FRCS serves as a potentially effective example of one way to do this.
In summary, we are hopeful that the FRCS program is making a real difference. Assessment will continue as the program develops and grows, with the long-term goal of evaluating future retention and success of these researchers in academic medicine. Stay tuned for more!