| | Federation of Pediatric Organizations Task Force on Women in Pediatrics: Considerations for Part-Time Training and Employment for Research-Intensive Fellows and FacultyRecognizing the significant issues and opportunities confronting the pediatric workforce, the Federation of Pediatric Organizations (FOPO) in 2007 appointed the second FOPO Task Force on Women in Pediatrics. The task force selected 4 issues on which to focus its attention in the subsequent 2 years: 1) routinely provide the option to train and work part-time at specific career stages; 2) allow flexibility in the career paths of physician/scientists; 3) draw more women into leadership positions; and 4) address child care issues. At the 2008 Pediatric Academic Societies Meeting, the task force hosted a symposium focusing on the provision of flexibility in the career paths of physician/scientists. This commentary summarizes the portions of the symposium that focused on current funding regulations at the National Institutes of Health (NIH) about part-time and protected research time and changes being considered and experiments conducted in 2 leading institutions that have permitted physician/scientists to work part time. Overview  Although the percent of women in medicine quadrupled in the last 30 years, women represent only 14% of tenured faculty and 12% of full professors1 and approximately 10% of pediatric department chairs.2 This is not a “pipeline issue,” because women represent >50% of matriculating medical students, 70% of pediatricians in training, and 50% of all practicing pediatricians.3, 4, 5 Rather, it may be that academic institutions require women faculty to adjust to organizational structures, policies, and procedures that were established at a time when most faculty were men whose spouses had primary commitment to the household.2 Institutional requirements for physician scientists have remained particularly rigid. In most universities, the physician scientist path is a tenure track position with the traditional restrictions and requirements to attain tenure, including a restricted time frame, explicit requirements for obtaining grant funding and producing publications, prohibitions against part-time appointments, and an inflexible tenure clock.6, 7 These requirements may not be realistic for women faculty because of their multiple roles, such as childbearing and rearing, forcing parents to choose between needs of their families and the demands of their profession in lieu of career advancement.8, 9 NIH Perspective on Part-Time Training and Career Development This topic is best understood in the context of the existing NIH training and career development programs. All NIH training is under National Research Service Award (NRSA) legislation (Fs and Ts; Ks are career development, and not technically training.) NIH has no other authority to support training. NRSA was established by law and requires full-time appointment and research for NRSA fellows. This mechanism is little used by physicians because the stipends are low (approximately $40 000 per annum). Career development grants originated as a mechanism to provide salary support (as distinct from research support) to NIH-funded scientists to free additional time from teaching and patient care to focus on research. During the 1980s, there was concern at the NIH about the decline in the number of physician scientists as NIH grantees. The stipends in the NRSA program were too low to attract physicians, and the 3-year time limit on NRSA training was viewed as too short. The K mechanism was modified to enhance the research capabilities of physicians applying for research support, and provide protected time for research experience under the guidance of a mentor. Two awards (the K11 or the “Individual Physician Scientist Award” and the K12 or the “Physician Scientist Program Award”) were developed to address several of the perceived limitations for physicians of the NRSA grants (Table I; available at www.jpeds.com). The grants have evolved, with the K11 becoming a K08 (non-clinical) or K23 (patient-oriented), and the addition of other K types. Today, NIH annually spends $700 million for Ks, supporting 3700 individual awards and 207 institutional awards (≥3 slots each). The success rate for K applications is 30% to 35%, compared with 20% to 25% for R01s.  | ♦Provide salary of $75K instead of $30-$40K ♦Add $25K for research support ♦Require having a mentor (part of peer review) ♦Provide support as long as 5 years ♦Retain 1-year full-time appointment requirement like NRSA ♦Require 75% research time, not 100%, to allow time for some clinical activity if desired | | | | |
K awards from National Institute of Child Health and Human Development (NICHD) include the Pediatric Scientist Development Program and 20 K12 Child Health Research Career Development Awards to pediatric departments. NICHD has the largest proportion of its budget going to Ks of any institute (6.7%). The rules for K Programs show wide variations in institutes; therefore, it is important to talk to a target institute about specifics (Table II; available at www.jpeds.com). Relevant to the discussion of flexibility in training, the K-awards require a full-time 12-month faculty appointment. The NIH has believed that a full-time appointment is needed to protect the fellow and provide sufficient research time. NIH has been unyielding on this, except to say that the institution decides what full time is (some 35 hours; most 40 hours), and some flexibility exists as to where time is spent (laboratory/clinic versus home). Some of the 75% research time or 25% other time may be spent working at home. The federal government is strongly encouraging “telecommuting,” and arrangements can be made with an institution on an individual level to do this with a full-time appointment. Finally, on a case-by-case basis, an individual K recipient can request from the awarding institute a decrease to 50% full-time employment (FTE) because of illness, family needs, or child or adult care or a leave of absence as long as 1 year. | Require a doctoral degree in research or a health profession (originally excluded PhDs, now modified)♦Must be a US citizen or permanent resident (except new K99/R00 award) ♦No more than 5 years research experience after training ♦Cannot have been a principal investigator on NIH grant (except R03 or R21) ♦Cannot get more than a total of 5 years of K grant support (modified by some institutes) ♦Some rules are of special interest to this discussion■Require full-time 12-month faculty appointment ■Require 75% (some 50%) of time in research ■Leave (sick, maternity) governed by policies of institution ■May retain non-research earnings | | | | |
Although in general a 75% effort is required for the K awards, there are variations about percent effort. The Pediatric Scientist Development Program requires 100% research effort, but some surgical specialties have reduced the effort to 50% to maintain surgical skills. The NIH considers the full-time base to be a 40-hour work week; at 75% effort, 30 hours of research time is required. When the awardee works a 60-hour week, NIH still requires 30 hours of research. There is increased movement toward liberalizing the criteria for allowing <75% effort. Salary levels have been increased in some institutes, to as much as $150 000 per annum. The full-time appointment requirement is being revisited. After the 2006 release of the National Academy of Sciences Report, “Beyond Bias and Barriers: The Future of Women in Academic Science and Engineering,” the NIH director appointed an NIH “Working Group on Women in Biomedical Careers.” One outcome is a committee that has been formed to re-examine the full-time appointment policy for K awards. Finally, the approach of training as a research assistant (with variable FTE) on another investigator's NIH Research Project Grant is a time-honored and viable alternative. Approximately half of NIH research trainees receive their training this way and move on to successful careers. Two Experiments in Flexibility for Physician Scientists In the last decade, Stanford University School of Medicine and Cincinnati Children's Hospital have experimented with policies providing more flexibility to physician/scientists. Stanford University School of Medicine The informational brochure, “Family Matters @Stanford—For Faculty,” highlights Stanford's commitment to faculty with families: from part-time employment options to child care and financial support for child care programs. (http://facultydevelopment.stanford.edu/facultydevelopment.html). Flexible work arrangements are available for both women and men at the school of medicine. In any given year, the school has approved approximately 10 to 15 part-time or reduced FTE faculty appointments (0.5-0.9 FTE). In academic year 2007 to 2008, 6 women and 5 men hold part-time appointments. Other forms of flexible or “family-friendly” work arrangements include: 1) extensions of time in the assistant professor rank for as long as 10 years, either on the basis of pro-ration related to reduced FTE (temporarily or permanently) or leave without salary; 2) a reduction in teaching duties, clinical duties, or both for 1 quarter for new birth or adoptive parents to allow for the care of a newborn or newly adopted child; 3) a 1-year tenure/promotion clock delay and corresponding appointment extension for a faculty member who becomes a parent, by birth or adoption; 4) leaves without salary for as long as 1 year, full- or part-time, for any faculty member who becomes a parent, for the purposes of caring for a child; and 5) with the approval of the provost, appointment extensions, for extenuating circumstances, such as excessive or unanticipated clinical duties or other compromising exigencies. Access and affordability of high-quality child care remains a significant problem that affects faculty with children, particularly women faculty. Stanford, through its Work Life Office (http://worklife.stanford.edu/) offers on-site child care facilities, financial support programs for child care, and an adoption reimbursement program. Stanford offers 6 children's programs on the Stanford campus that can serve approximately 650 children in full-time, part-time, nursery school, or combination schedule. However, Stanford's child care centers are full, with >900 families on waitlists and a wait time that is currently >10 months. The university is planning to open 100 new spaces this fall, and the waiting list for that center is already >200. A significant problem for many faculty members is the need for extended morning or evening hours that are not available at most child care centers. To address concerns, Stanford has established a Child Care Task Force to make recommendations. The task force determined that each year there are at least 340 children of medical school faculty between the ages of newborn and 5 years and 372 children ages 6 to 12 years and estimates that 50 to 60 babies are born to medical school faculty each year. The task force recommended consideration of additional tuition reimbursement to allay the high costs of child care; a new emergency backup program for which faculty pay a small co-pay for in-home or child care center care; consideration of early and late scheduling enhancements at an existing child care center; an in-house nanny assistance (finder's) service; and strategic planning to assess and augment the long-term child care supply. Other action items include the changing of the academic medical community culture from a “hierarchical shame” culture to a more “horizontal supportive” culture, further consideration of greater flexibility in the traditional university procedural time frames (eg, consider widening the window for promotion decisions without incurring inappropriate delays or abuse), and a concerted effort to appoint women leaders throughout the medical center to influence cultural and operational changes favoring a family-friendly environment. Cincinnati Children's Hospital Approximately a decade ago, a task force was formed at Cincinnati Children's Hospital because few women were remaining on the tenure track. The tenure track was an “up or out” system in 7 years (with the tenure proposal occurring at 5.5 years) and generally requiring 2 R01s. Several recommendations were made and implemented. First, initial appointments were made on the clinical or research track, with a switch to the tenure track after a first major independent grant was awarded. Second, the pre-tenure period was extended to 10 years for the clinical pathway tenure track faculty. Third, candidates were permitted a temporary switch to part-time status without relinquishing the tenure track appointment, with tenure extension commensurate with part-time status. (The tenure clock could be extended for 1 year when a candidate was less than full-time status ≤2 years; the clock could be extended for 2 years when a candidate was less than full-time status for ≥2 years.) Finally, a mentoring and internal research support program was established for mid-level women assistant professors. A review of the changes a decade later revealed that the guidelines had applied to a small number of faculty, and the need never arose to invoke the extended clock for tenure considerations. The guidelines appear to have reassured that the option for part-time was there, but did not result in a large number of women transitioning to part-time status. Cincinnati Children's Hospital also established an internal research award program providing discretionary dollars ($50 000/year for 2 years) for women assistant professors who were at least 3 years into their career, on the tenure track or under consideration for a switch to the tenure track, with a record of research success but with a need to boost progress. Selection was based on peer-review of a research proposal, readiness, and need. There were 10 to 15 applications per year (in the 5-year cycle of the grant), with 11 awards being made. Nine of the recipients were promoted to associate professor, and 3 recipeints received tenure. Summary Much work remains to be done about the issues of flexibility in the development of physician scientists, but these reports indicate that progress is being made and serve as examples for other institutions. References available at www.jpeds.com. References 1. 1Bickel J, Wara D, Atkinson BF, Cohen LS, Dunn M, Hostler S, et al. Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee. Acad Med. 2002;77:1043–1061. MEDLINE |
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2. 2AMSPDC Female Chairs (including B. Stanton). Women in pediatrics: recommendations for the future. Pediatrics. 2007;119:1000–1005. 3. 3Magrane D, Lang J, Alexander H. Women in US academic medicine, statistics and medical school benchmarking, 2004-2005. Washington, DC: AAMC; 2005;. 4. 4Althouse LA, Stockman JA. Pediatric Workforce: a look at general pediatrics data from the American Board of Pediatrics. J Pediatr. 2006;148:166–169. Full Text |
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5. 5Shrier DK, Shrier LA, Rich M, Greenberg L. Pediatricians leading the way: integrating a career and a family/personal life over the life cycle. Pediatrics. 2006;117:519–522. 6. 6Kahn JA, Degen SF, Mansour ME, Goodman E, Zeller MH, Laor T, et al. Pediatric faculty members' attitudes about part-time faculty positions and policies to support part-time faculty: a study at one medical center. Acad Med. 2005;80:931–939. MEDLINE |
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7. 7Ward K, Wolf-Wendel L. Fear factor: how safe is it to make time for family?. http://www.aaup.org/publications/Academe/2004/04nd/04ndward.htm. 8. 8Draznin J. The “mommy tenure track.”. Acad Med. 2004;79:289–290. MEDLINE |
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9. 9Hamel MB, Ingelfinger JR, Phimister E, Solomon CG. Women in academic medicine—progress and challenges. N Engl J Med. 2006;355:310–312.
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a National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD b Cincinnati Children's Hospital, Cincinnati, OH c Federation of Pediatric Organizations Task Force on Women in Pediatrics, Dayton, OH d Wright State University, Dayton, OH e Dartmouth Medical School, Hanover, NH f Harvard University, Boston, MA g Wayne State University, Detroit, MI h Stanford University, Stanford, CA  Reprint requests: Theodore C. Sectish, MD, Program Director, Children's Hospital Boston, Associate Professor, Harvard Medical School, Executive Director, Federation of Pediatric Organizations, 300 Longwood Ave, Boston, MA 02115
PII: S0022-3476(08)00697-5 doi:10.1016/j.jpeds.2008.08.010 © 2009 Mosby, Inc. All rights reserved. | |
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