July 2003

If you are contemplating a career in academic medicine, then it is likely that at some point during your training or junior faculty years, you will begin dealing with family and career issues. These issues will persist for a good part, if not most, of your professional career. After all, once the children arrive, 20+ years of hands-on parenting follow. Although the tenure and biological clocks tick simultaneously, they are not often in synchrony. To further complicate matters, many of us are members of the sandwich generation. We function as caregivers not only for our children but for our parents as well.

Discussions regarding issues of family and career are often treated as "women's topics." Although many men struggle with these conflicts, women are viewed as the primary caregivers in most families. It is not unusual for a man to have a spouse who works full-time at home and keeps the household running. In contrast, most women who work outside the home are married to spouses who also work at outside jobs. As a result, this is not an issue that elicits much open discussion. Both men and women are often reluctant to raise the topic, as if simply mentioning that there is a problem somehow stigmatizes them and brings their dedication and ambition into question. But there clearly is a need to openly discuss these issues.

Although women make up a significant percentage of medical school classes and internal medicine residencies, there is a dramatic drop-off in numbers as one climbs the academic ladder. Across academia, women are more likely to drop out of the sciences during their undergraduate, graduate, and postdoctoral training. They are more likely than men to choose and be in a nontenure-track position versus a tenure-track one. The reasons for this are many, but at least partly due to pressures related to starting and nurturing a family. Either from lack of awareness or sheer inertia, academic institutions have been slow to abandon the traditional, inflexible pathways that lead to tenure and promotion. http://nextwave.sciencemag.org/cgi/content/full/2002/03/18/3

Existing policies related to childbearing and childcare leave are often poorly understood by both administration and current/potential young faculty. Since leave is not automatically granted, women may feel that they are asking for "special consideration" when requesting leave, and may be perceived as being weak in regards to scholarly abilities. These policies may actually penalize women for using them. For instance, at one major academic institution, faculty with primary child care responsibilities may request to continue working (with pay) but with a modification of duties before and up to 12 months following the birth/adoption of a child under the age of 5. If women take childbearing leave, however, this time is deducted from the time available for modified duties/active service while men receive the full benefit.

Parenthood, marriage and career. We want to be successful at all three. But how do we navigate a system that remains distinctly unfriendly towards families? The fact that women remain underrepresented at the top faculty ranks means that there are few role models to emulate. So we must define "success" on our own terms. One theme that I have stressed over and over again in this column is the need to clarify your personal and professional priorities. In order to maximally utilize your time, you must know what you want. Only then can you develop efficient strategies to achieve those goals.

These goals must be individualized according to your and your family's needs and priorities. Everything you choose to do will come at the cost of some other activity. But there are ways to make things work. For instance, I am an associate professor of medicine. I attend on the clinical service, teach and run a research laboratory. Being a pulmonary physician-scientist is part of who I am, and I love my job. But, in terms of absolute priorities, my children's happiness and well-being come first. For the first few months of my children's lives, my schedule revolved around nursing demands. These days, our schedules are school-centered. I try very hard to attend all school performances and participate in at least a couple of school-related trips/activities every month. Sitting down together as a family at dinnertime (even if it means eating leftover takeout) and reading to our children before bedtime are high priorities with both my husband and myself. This means having a great laptop and a work area set up at home so that if I need to, I can work after putting the children to bed.

Remember, you are your own best advocate. By having a clear view of your priorities and setting limits on what you can and are willing to do, you will preserve some semblance of control over your life and thus maintain your sanity and self-respect. What follows in next month's column is a highly personal approach to managing the complex demands of parenthood, marriage and career. I hope that this will serve as a guide, or at the very least, stimulate discussion among those of you thinking about starting, or are about to start, a family.