Starting an Academic Career and Starting a Family: Challenges and Some Potential Solutions Michelle Mann, MD1, Danielle Goetz, MD2, Daniel H. Leung, MD1, and Drucy Borowitz, MD2


ediatricians are experts at appreciating developmental differences, yet we do not always apply that skill in our academic and personal lives. More women have entered the field of pediatrics.1 More men have chosen to be active participants in their children’s lives.2 Thus, old models of linear academic career paths need reassessment. Although not all pediatricians will have families, in this communication we wish to focus on the developmental stage for faculty members who have very young children. Recognizing that those years contain special stresses that will resolve as children grow can help young faculty to remain in academics. In particular, women tend to be underrepresented in pediatric subspecialties, possibly attributable to concerns about pursuing additional training during prime child-bearing years, as well as issues related to job flexibility.3 Institutional leaders and other faculty members (including those without children) can help maintain the pool of academic faculty and also benefit from changes that accommodate both faculty with young children and others to promote work-life balance and increase career satisfaction. The majority of the challenges that academic faculty with young children encounter arise from the competing, contemporaneous, yet equally powerful, demands of family and career. After many years of training, physicians are excited to begin establishing themselves in their chosen specialty. However, at this point, new faculty often have delayed starting a family during their medical training years because of rigorous call schedules in hopes of reaching a “good” time in their careers to start their families. However, different pressures arise during the first several years as a faculty member, including developing oneself as a new attending, clinician, researcher, and adapting to a new system. New faculty may thus feel the time challenges of trying to “do it all” when there just isn’t enough time. Furthermore, many young faculty members have sizeable debt from their undergraduate and medical education at a time when they need customized, and therefore expensive, child care to accommodate their extended work hours. As a new parent, an academic faculty member also may have to deal with negative feelings in addition to time pressures, such as guilt for not doing either job “fully,” sadness at being separated from his or her children, or worry that the children are being denied “optimal” supervision and upbringing. A common thread might be missing an important moment or event in the child’s life because of patient care or administrative or laboratory schedules that cannot be altered. Trying to help a spouse or child with an illness or even with 430

normal developmental or emotional adjustments may create additional stresses and lead to feelings of guilt, regret, or even depression. As pediatricians we are experts on child health and development. However, giving objective advice and applying it in our own families are 2 different things. Acknowledging that these competing influences are common, perhaps even universal, may be the first step in successfully coping with them. Many stressors exist during these early child-raising years, and we offer some specific solutions by which others have attempted to overcome the aforementioned challenges. Academic faculty often expects perfection from themselves when performing in careers and in the home. Finding a “best alternative to perfection” means recognizing that expectations and roles may need to be adjusted and that “good enough” is, in fact, often good enough. Expect a period of adjustment and realize that sleep deprivation will have substantial effects on efficiency, energy, thinking, and memory. Having realistic expectations up front may make it easier to accept and adapt. Junior faculty should seek appropriate mentors who have experience dealing with these challenges. A network of support and assistance should be developed outside the workplace as well. When available, use outside help with domestic chores such as housekeeping and cooking for the family. It is much easier for parents to leave their children to go to work when trustworthy childcare is in place. When possible, a back-up plan should be in place for unexpected situations, such as when the childcare provider is sick, there is inclement weather, etc. Plugging into a spiritual home, such as a church, synagogue, or temple, also can provide essential support systems. The choice of where to live early in a career can make a difference in the physician’s overall level of contentment. Some families are fortunate enough to live close to extended family and this can provide important support and often provide back-up childcare. Choosing a residence close to the workplace can minimize commute time and maximize precious evening time with family. Alternatively, if a commute is necessary, this time can be used for decompression to enable readiness for family commitments when at home. The travel time without the stress of work or the noise of children can be

From the 1Baylor College of Medicine, Texas Children’s Hospital, Houston, TX; and 2 State University of New York at Buffalo, Women and Children’s Hospital of Buffalo, Buffalo, NY D.B. is supported by the Cystic Fibrosis Foundation (BOROWI03CS0). The authors declare no conflicts of interest. 0022-3476/$ - see front matter. Copyright ª 2014 Elsevier Inc. All rights reserved.

Vol. 165, No. 3  September 2014 cherished by listening to music, books on tape, or enjoying introspective silence. Another strategy for time management is to leave work early enough to be present for one’s children but to use the hours after children go to sleep as time for writing papers or grants or completing charts. It is critical that coworkers are aware of this work at home to prevent being perceived as having a substandard work ethic. Of great importance is having a partner who understands the need for a more equal partnership of childcare and responsibilities for the home4 and your commitment to the career of medicine. For all couples with a physician in the mix, good communication and planning helps to set clear and realistic expectations and avoid some frustration and stress. Some families have found it useful to use a shared calendar whether it is web-based and accessible on all devices or a handy well-used paper one that is regularly updated and edited. Plan in advance when you will be on-call or away at a conference or meeting and inform your family of impending deadlines for grants and papers. Although these times often are stressful, they are a necessity for a successful academic career. Prepare your family for these busy periods. Although you may know what is required of you, ensure that your family understands the importance of these activities so expectations and frame of mind can be recalibrated. It is important that your time commitments are known by the family so that you can accept career-building opportunities that will stretch you in new directions. However, it is equally as important the couple sets aside time to connect. Remember that a strong healthy relationship with your partner sets the foundation for your family. Single parents will need to create a support system for these same issues— sharing the load, communicating time commitments, and making time for personal connection. Leaders in academic pediatric institutions play an integral role in career and personal development of junior faculty and can help to alleviate some of the stressors of the early childrearing years. Knowingly or unknowingly, department and division heads lead by their example of how to find balance between the rigorous demands of career and family. Recognize that by having children, pediatric faculty develop personal insights that can help them become compassionate clinicians who provide developmentally appropriate clinical care to patients. Create a work environment that allows for extended time for maternity or family medical leave to establish bonding with infants. When female faculty return to work, assure an appropriate place is available for pumping to promote nursing infants. Meet regularly with your faculty members to assure that they are establishing a mutually agreed-upon academic niche and to proactively provide career guidance and mentoring. Although not needed for all faculty, implement alternative timetables for promotion within a traditional research-focused tenure track1 or for equal promotion within a clinical or educator track as opposed to the traditional tenure track.

Consider offering part-time positions for faculty. This can be a way both to control cost and optimize output. However, women faculty in particular may choose a part-time position but continue to do the same amount of work outside of typical work hours from home when their children are asleep. Leaders can advocate for creative re-thinking of full-time to mean more flexibility in schedules to allow women to meet family demands, yet also continue to be compensated for the work completed during their off-site time. If possible, curtail early morning and evening/dinner meetings to accommodate family schedules. Consider having division social gatherings that encourage faculty to bring family. This encourages relationships to extend beyond the walls of the hospital or office and can be a source of delight for all in pediatrics. Leaders who are in the position to do so should advocate for on-site child care options and a “sick bay” for employee children. Children are a source of balance and joy in a stressful career. Young faculty members can benefit from recognizing that the years when they have infants and toddlers present challenges that are not insurmountable. Although you can “have it all,” you can’t have it all at the same time. This developmental stage is one in which you will likely have little time for things outside of family, work, and your support system, but that is not all that your life holds. A career extends for many years beyond child-rearing. Impose high but achievable expectations of yourself; seek and accept support. Furthermore, appreciate that there are wonderful benefits to being a child of an academic physician. Over time, your children will be exposed to interesting discussions, see models of compassion, and understand the pleasures of intellectual curiosity and service to others. We encourage academic leaders to recognize that early investment in flexible career support is likely to engender a committed and loyal faculty member. We hope that by focusing on issues and potential solutions for the unique stresses faced by academicians with young children, their careers and their families will flourish and our specialty and subspecialties will develop a strong foundation for the future. n Reprint requests: Drucy Borowitz, MD, Professor of Clinical Pediatrics, State University of New York at Buffalo, Women’s and Children’s Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222. E-mail: [email protected]

References 1. Althouse LA, Stockman JA III. Pediatric workforce: a look at general pediatrics data from the American Board of Pediatrics. J Pediatr 2006;148: 166-9. 2. Gray SF. Women in medicine: doctors of both sexes are seeking balance between life and work. BMJ 2004;329:742-3. 3. Jones MD Jr, Stanton BF. Women in pediatric subspecialties. J Pediatr 2004;144:143-4. 4. Sandberg S. Lean in: Women, work, and the will to lead. New York: Alfred A. Knopf; 2013.


Starting an academic career and starting a family: challenges and some potential solutions.

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