Women in academic medicine - challenges and issues
September 2004
Role models and mentoring
There was overwhelming agreement regarding the importance and value of mentoring and role models for women working in academic medicine. Whilst it was agreed that an effective mentor was valuable for clinical academic women in particular, as they often feel isolated and part of a fragmented group, the gender of the mentor was not an issue, as experiences had shown that both men and women could be effective mentors. There was some debate however, regarding whether mentoring should occur from within the same institution and specialty, from a different institution or a different specialty. Despite this, it was agreed that the key qualities of an effective mentor include being supportive, a sounding board, accessible and inspirational. A need for the mentoring of women in ‘focused’ and ‘assertive’ behaviour was identified, so that they are able to compete more effectively with men in an academic environment. It was also suggested that mentoring itself must be valued more within the academic environment, if it is to be effective.
‘We’ve only got one senior academic woman who’s a recently-appointed university lecturer, and she’s been really brilliant for me, but she’s just looked at what I’ve done and gone 'Why did you do that? That did your career no good. Who told you to do that?', and she just went through, bang bang bang. So there’s nothing wrong with her focus or her ambition or her career-building whatsoever, and she’s empire-building like mad. So she’s an exception, but she’s actually given me confidence... because she’s a woman, if a man had said that I’d have felt really patronised.. Because she is a woman, she’s given me a boost to be an awful lot more assertive so far’.
‘My mentors were actually sometimes not even in my faculty, they were actually outside my faculty. Now, again, there may be a barrier here between the clinician and the non-clinician, but I found those people really helpful, because they see the bigger picture, they see the much bigger picture’.
‘I think at the moment men are in a powerful position in academic medicine and we do need them to actively promote... by not actively promoting they are in essence actively discouraging. We need encouragement, not nothing, not being neutral. Being neutral is as good as discouraging in a way I think’.
‘It (the mentor) doesn’t have to be a female...No, it just has to be someone who will be supportive...And give good advice. And dare I say it, I think sometimes men are more supportive than women actually’.
‘I think the priority is that they have to be interested in mentoring and they have to be interested in you, and that’s actually the fundamental thing and you have to be their priority in terms of helping you’.
The need for a more structured career path into academic medicine was identified. It was suggested that flexible career structures, which encourage doctors from a range of backgrounds, not just those from conventional academic backgrounds, into a career in academic medicine should be promoted. Participants suggest that a structured career path needs to be better defined, with both clinical and academic commitments recognised. As part of the academic component, greater recognition needs to be given to teaching. It is recognised that ‘academic promotion is biased towards research output rather than teaching' (Stewart, P.M. 2002, Academic Medicine: a faltering engine. BMJ 324:437-438). Many focus group participants were heavily involved in teaching, but felt that they were given little or no credit for this aspect of their work. Although this problem affects both men and women, it is suggested that women are more likely to take on teaching and administration responsibilities.
‘We’re told explicitly not to teach if we want to get anywhere, because it won’t do our CV any good’.
‘The reality is that for women there is a stronger possibility that you’re going to have a slightly fragmented career path, for whatever reason, which makes you inherently less competitive, and so if you had a fixed contract, based on merit and relevant merit, then you’re recognising the potential of people and you’re allowing them flexibility to continue with their career path, despite having periods when they’re less competitive because they happen to be women’.
‘The system of RAE is really against people who teach, and teaching is a crucial matter for all health service... for the community, it’s very important, so it’s not as valued as research and the pressure on limited time’.
NHS vs. University
It is recognised that increasingly, doctors are ‘unwilling to choose a career path which promises little in the way of training structure, job security, flexibility or financial reward and are opting instead for the better security, career and pay offered by purely clinical posts' (Goldbeck-Wood, S, 2000, Reviving Academic Medicine in Britain. BMJ 320:591-2).
It is widely perceived among participants that a clinical job in the NHS is more secure and less pressurised than an academic job. The prevalence of short-term contracts inherent in academic research particularly, further impacts upon the insecurity of an academic position. Salaries and remuneration associated with academic medicine are also seen to be significantly less than in the NHS.
‘I get paid a lot less than people I trained with, I’m on about £15,000 less per annum than somebody I went to medical school with, partly because I don’t do on-calls and, if you’re talking about retention, that’s a big one. I know a lot of my colleagues who’ve just said 'I’m not going into it (academic medicine) for more than six months because I can’t afford it because of the big mortgage I have'
‘The question of short term contracts and the restrictions that are placed on people in short term contracts for going for major funding is a real barrier to career progress’.
‘You have a bit of security (in the NHS)...You don’t have pressures on you, as long as you stick to your clinical commitments and don’t kill anybody’.
Job expectations
Many participants suggest that current job expectations of a medical academic position are unrealistic and unreasonable. Whilst expectations of an academic research job are high, this is often combined with the pressures of clinical responsibilities. Whilst high job expectations is not a gender-specific issue, expectations of part-time research are particularly high and this has an impact on women, as they are more likely to be in these part-time positions. The importance of reasonable expectations is highlighted, particularly in relation to RAE, which does little to take into account part-time working.
‘I think that’s absolutely crucial, because we’re coming up to the RAE and everybody’s being looked at and saying 'Where’s your 100%? Here’s what you need to be returnable' and I’ve only done 50% because I’m part-time. It’s completely unreasonable’.
‘So in a way we are failing before we can start, because if we can’t work the 80 hours a week the contract actually does not reflect what’s going on. That’s the point. There’s a big gap, however good the contract is there’s a good gap between what it says and what is required to be deliverable’.
‘There needs to be part-time expectations - but you are judged on grants and publications, it is not a part-time expectation... I think if your commitment is 60% then your RAE commitment should be 60%, that’s two papers a year not three’.