Shruti Jolly, MD; Kent A. Griffith, MS; Rochelle DeCastro, MS; Abigail Stewart, PhD; Peter Ubel, MD; Reshma Jagsi, MD, DPhil
Acknowledgment: The authors thank the K award recipients who took the time to participate in this study.
Grant Support: Dr. Jagsi was supported by the NIH (grant 5 R01 HL101997-04). Dr. Ubel was supported by grants from the NIH and a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0974.
Requests for Single Reprints: Reshma Jagsi, MD, DPhil, Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Jolly and Jagsi: Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010.
Mr. Griffith: Center for Cancer Biostatistics, M2180 SPHII, 1415 Washington Heights, Ann Arbor, MI 48109-2029.
Ms. DeCastro: Center for Bioethics and Social Sciences in Medicine, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800.
Dr. Stewart: Department of Psychology and Women's Studies Program, University of Michigan, 204 South State Street, G277B Lane Hall, Ann Arbor, MI 48109-1290.
Dr. Ubel: Fuqua School of Business, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC 27708.
Author Contributions: Conception and design: S. Jolly, K.A. Griffith, P. Ubel, R. Jagsi.
Analysis and interpretation of the data: S. Jolly, K.A. Griffith, A. Stewart, R. Jagsi.
Drafting of the article: S. Jolly, K.A. Griffith, R. Jagsi.
Critical revision of the article for important intellectual content: S. Jolly, K.A. Griffith, R. DeCastro, P. Ubel, R. Jagsi.
Final approval of the article: S. Jolly, K.A. Griffith, A. Stewart, R. Jagsi.
Provision of study materials or patients: R. Jagsi.
Statistical expertise: K.A. Griffith.
Obtaining of funding: R. Jagsi.
Administrative, technical, or logistic support: R. DeCastro.
Collection and assembly of data: R. DeCastro, R. Jagsi.
Female physician-researchers do not achieve career success at the same rate as men. Differences in nonprofessional responsibilities may partially explain this gap.
To investigate the division of domestic labor by gender in a motivated group of early-career physician-researchers.
Nationwide postal survey between 2010 and 2011.
Physician recipients of National Institutes of Health K08 or K23 awards between 2006 and 2009 with active academic affiliation at the time of the survey.
Time spent on parenting and domestic tasks was determined through self-report. Among married or partnered respondents with children, a linear regression model of time spent on domestic activities was constructed considering age, gender, race, specialty, MD or MD/PhD status, age of youngest child, number of children, work hours, K award type, and spousal employment.
A 74% response rate was achieved, and 1049 respondents were academic physicians. Women were more likely than men to have spouses or domestic partners who were employed full-time (85.6% [95% CI, 82.7% to 89.2%] vs. 44.9% [CI, 40.8% to 49.8%]). Among married or partnered respondents with children, after adjustment for work hours, spousal employment, and other factors, women spent 8.5 more hours per week on domestic activities. In the subgroup with spouses or domestic partners who were employed full-time, women were more likely to take time off during disruptions of usual child care arrangements than men (42.6% [CI, 36.6% to 49.0%] vs. 12.4% [CI, 5.4% to 19.5%]).
Analyses relied on self-reported data. The study design did not enable investigation of the relationship between domestic activities and professional success.
In this sample of career-oriented professionals, gender differences in domestic activities existed among those with children. Most men's spouses or domestic partners were not employed full-time, which contrasted sharply with the experiences of women.
National Institutes of Health.
Appendix Table 1. Multivariable Linear Regression Model to Explain Time Spent on Research
Appendix Table 2. Multivariable Logistic Regression Model to Explain Time Spent on Teaching Greater Than the Median for Married or Partnered Respondents With Children
Appendix Table 3. Frequency and Percentage of Respondents Reporting Teaching Time Greater Than 1 Hour per Week
Appendix Table 4. Multivariable Linear Regression Model to Explain Time Spent on Clinical Duties for Married or Partnered Respondents With Children
Study flow diagram.
Evolution of the analytic sample from the original pool of all 1719 respondents who received new K08 or K23 career development awards from the NIH in 2006–2009, by sex. NIH = National Institutes of Health.* Missing data from respondents.
Table 1. General Characteristics of Respondents*
Median hours per week in domestic and paid labor activities, by sex.
Total hours devoted to paid and domestic labor by the men and women in a sample of respondents to a survey of recipients of National Institutes of Health K08 and K23 career development awards in 2006–2009.* Full-time employment.† “Single” includes those who indicated that they were divorced or widowed.
Table 2. Multivariate Model of Time Spent on Parenting or Domestic Tasks Among Married or Partnered Respondents With Children
Table 3. Percentage of Time Spent on Parenting and Domestic Tasks by the Respondent Versus Other Potential Providers
Table 4. Person Who Stays With Children When They Are Ill or There Are Disruptions in Usual Child Care Arrangements
Dena E. Rifkin MD, MS, Nisha Bansal MD, MAS, Esther K. Choo, MD, MPH
University of California, San Diego, and Veterans' Affairs Hospital, San Diego; University of Washington, Seattle; Brown University
March 20, 2014
"Balance" is not a solution
To the editor:As current NIH career development awardees who are also mothers with employed spouses,we were not shocked to learn that women of our generation continue to bear a disproportionateburden of domestic work in comparison to men, or that the amount of time women with childrendevote to research is lower than that spent by their male counterparts (with a gap that is, notcoincidentally, roughly equal to the extra time doing domestic work).What did shock us were the conclusions drawn by the editorialists. They state that the "true measure of a successful life in academic medicine... may no longer be measured in grants garnered, papers published, or salary attained but rather in the flexibility to balance" other life goals. At our institutions, the sine qua nons of a research-based academic career and promotion from the junior faculty state are grants and papers. To paraphrase Vince Lombardi, grants and papers aren't everything -- they are the only thing. While there are other career trajectories now open in the world of academic medicine, the primarily research-funded academician still needs to produce publications and acquire independent funding to continue in that role and continue to advance up the academic ladder, regardless of gender.We have each benefited from excellent mentors, both male and female, during our careerdevelopment grants. The advice we hear from these mentors is clear: moving from a K grant toan independently funded research career is challenging and needs to be accomplished duringthe five-year K grant timeline. This transition is one where many women researchers falter inthe academic track, either by switching to a different track or by failing to obtain funding. Notcoincidentally, this timeline overlaps with a period in which child-rearing is a distraction, albeit an enjoyable and rewarding one.More radical solutions than a paean to 'balance' are needed to close the gender gap inacademic medicine which continues to include unequal pay and fewer opportunities for promotion among women. Individual women cannot continue to compensate for the inadequacies of systems. Hospitals and universities of the 21st century must consider how best to support women -- and not only women, in truth, but anyone with significant, time-consuming roles of childcare or other major family responsibilities -- so that they can have sustained, productive academic careers.
Ann Danoff MD
New York University School of Medicine & Harbor HealthCare Veterans Administration
March 23, 2014
Sex and the Academy
As a “baby boomer” and former K08 Awardee who leaked out of the academic pipeline (1) long ago, the grim observations by Jolly et. al. (2) regarding ongoing challenges among “Generation X” women to achieve gender equity in academic medical centers and on the home front is disheartening. However, the authors efforts to illuminate these unresolved issues and offer a glimmer of hope that one day we may find creative solutions, so that women who wish to do so are retained as productive and successful investigators, is reassuring.
In contrast, I found the accompanying editorial (3) deeply disturbing. While the editors acknowledge that “continued differences in standards are inexcusable”, they are much too quick to attribute ongoing gender inequity to “preferences” and “choices” made by women aiming to achieve work/life “balance”. As Jolly et. al. demonstrate (2), these so-called “choices” are strongly influenced by work and home environments. To de-emphasize the experience afforded women in academic medical centers (4) or the impact of the “Second Shift” (well described in the 1989 classic by Hochschild) on career decisions does a great disservice to the individual women involved. Examples of not being heard, not being credited for efforts at work, and pay inequity are commonplace among women in medicine, as are descriptions of how her husband “helps” with the childcare, followed in the next breadth by the acknowledgement that it is still her job to keep track of the supermarket list and soccer game schedule, and gently remind her partner to “please pick up the milk”.
I cannot agree more with Cooke and Laine that I have been personally blessed with a rich and varied professional career. However, it was, (arguably), neither by choice nor personal failings that I took this path, but rather, because the deck was stacked against me. It is regrettable that, like the women of my generation, female “Gen-X’ers” must still contend with “accumulated disadvantages” (the converse of “accumulated advantages” described by Malcolm Gladwell in “Outliers”).
It appears we still have an awful lot of work to do. Until all doors are fully opened for each and every one of us (women, men, people of all colors and every sexual orientation), and each of us has equal opportunity for real choice about where on the bus (or in the medical community) we wish to sit, all of us will continue to be short-changed as individuals and as a society.
1. Justice AC. Leaky Pipes, Faustian Dilemmas, and a Room of One’s Own: Can We Build a More Flexible Pipeline to Academic Success? Ann Intern Med. 2009;151:818-819.
2. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender Differences in Time Spent on Parenting and Domestic Responsibilities by High-Achieving Young Physician-Researchers. Ann Intern Med. 2014;160:344-353.
3. Cooke M, and Laine C. A Woman Physician-Researcher's Work Is Never Done. Ann Intern Med. 2014;160:359-360.
4. Levine RB, Lin F, Kern DE, Wright SM, Carrese J. Stories From Early-Career Women Physicians Who Have Left Academic Medicine: A Qualitative Study at a Single Institution. Academic Medicine. 2011; 752-58.
Toni Martin MD
March 24, 2014
Choice in a social context
Perhaps the reason that the authors did not conclude, as the editorialists do, that the observed differences in parenting were due to simple choice, is that women, like men, make choices within a social context. Doris Rubin Bennett, former Chief of Pediatrics at Harvard Community Health Plan, added a postscript to a “lighthearted” career article when it was included in an anthology in 2002. “In 1961, I was the brainwashed product of my culture’s view of woman’s place in society.” At the time, she believed that she was choosing to take primary responsibility at home but looking back, she saw how constrained that choice was by society’s definition of a good wife and mother. The fact that 85% of the spouses of women physicians in the current study were employed full time while only 45% of the spouses of their male colleagues were, underlines the enduring strength of traditional gender roles. Although successful, Dr. Bennett emphatically advocated for her younger colleagues. A woman doctor “… should be able to experience the joys and responsibilities of marriage and parenthood equally with her male colleague—but not more equally.” Bennett, Doris Rubin. Postscript. In: Chin, Eliza Lo, editor. This Side of Doctoring: Reflections From Women in Medicine. Thousand Oaks, CA: Sage Publications;2002. p. 31-32.
Reshma Jagsi, MD
University of Michigan
April 18, 2014
We appreciate the insights shared by these authors and thank them for providing such rich and vivid examples from female physicians’ lived experiences to complement the data we presented. We also appreciate the editors’ decision to publish these letters, which reflects their clear commitment to stimulating the sort of healthy discourse and debate that characterizes the academic enterprise at its best. Although we, like the authors of the letters, believe our findings are a sobering indication of powerful societal constraints on women’s choices even today, we are heartened by growing recognition of these issues and efforts by institutions to support physicians whose careers necessarily develop in this complex social context.
Jolly S, Griffith KA, DeCastro R, et al. Gender Differences in Time Spent on Parenting and Domestic Responsibilities by High-Achieving Young Physician-Researchers. Ann Intern Med. 2014;160:344–353. doi: https://doi.org/10.7326/M13-0974
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Published: Ann Intern Med. 2014;160(5):344-353.
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