Pediatricians Leading the Way: Integrating a Career and a

42517_7Pediatrics_2006_Shrier_519_22.pdf

COMMENTARY

PediatriciansLeadingthe Way:Integrating aCareer

andaFamily/Personal LifeOverthe LifeCycle

DianeK.Shrier, MD

a,b ,LydiaA. Shrier,MD,MPH c,e ,MichaelRich, MD,MPH c,d,e ,LarrieGreenberg, MD b

Departmentsof

a

PsychiatryandBehavioralSciencesand

b Pediatrics,GeorgeWashingtonUniversityMedicalCenter,Washington,DC; c

DepartmentofPediatrics,Harvard

MedicalSchooland

d

DepartmentofSociety,HumanDevelopment,andHealthandtheCenteronMediaandChildHealth,HarvardSchoolofPublicHealth,Boston,

Massachusetts;

e Adolescent/YoungAdultMedicine,Children'sHospital,Boston,Massachusetts Theauthorshaveindicatedtheyhavenofinancialrelationshipsrelevanttothisarticletodisclose. I

NTEGRATIONOFPERSONAL andprofessionalaspects of

one'slifeover thecourseof thelife cycleisa growing issueforwomen andmenin allprofessions. 1-8

Thisis

especiallysofor individualsat thechronologicalends of thecareerspectrum: thosewhoare intraining orearly career,atime thatoverlapswith thechildbearing and child-rearingyears,and thosewhoare reachingtradi- tionalretirementage, whomight liketocontinue work- ingbutnot atthesame levelof intensity.Individualsat bothendsof thespectrumwould benefitfrom flexible hours,reducedwork schedules,anda widerdiversityof careerchoices.Pediatricians, whospecializein the healthyphysicaland emotionaldevelopment ofchil- dren,shouldlead themedicalprofession inmodeling child-andfamily-sensitive careerpaths.

Inthepast 2generations,the faceof pediatricshas

changeddramatically.As of2002, womencomprised nearly70%of pediatriciansintraining, 9

49.7%ofall

pediatricians, 10 and63%of pediatricianstakingthe AmericanBoardof Pediatricscertifyingexamination for thefirsttime. 11

Inaddition,pediatricians constitutethe

highestpercentageof part-timephysiciansof allspecial- ties. 12

Ofpediatriciansworking part-time,87%are wom-

en. 13

However,withthe exceptionof adolescentmedi-

cine,womenpediatricians areunderrepresentedin subspecialtytraining,academic medicine,and re- search. 11,14

Womenpediatricians'choice ofcareerpath

seemstobe drivenpredominantlyby lifestyleissues and familyconsiderations 15,16 butalsomay beinfluencedby underlyingworkplaceexpectations andstructuresthat makeitmore orlessdifficult tocombine acompetitive careerandfamily/personal life. 4,5

Thefuturepediatric

workforcewillbe stronglyandadversely affectedbya declineofpediatric subspecialistsandphysician-scien- tistsunlessthose inleadershippositions developdiverse andcreativesolutions toaddress thispotentialprob- lem.

7,17,18

Inthefirst 2decadesafter passageofthe 1964Civil

Rightslegislationbanning genderdiscrimination, the majorfocuswas ongenderequity intheworkplace. In manyprofessionsincluding medicine,genderequity has beenlargelyachieved, atleastas faras entryintothe fieldisconcerned, althoughthe"glass ceiling"andsubtle formsofexternal discriminationandinternal sexism continuetoaffect careerdevelopment forwomen. 19 Ear- lierassumptionsthat womencouldnot combinemedi- cinewithmarriage andfamilyhave beenreplaced byan expectationthatboth parents,even ofyoungchildren, willcontinueto workandmanage careerandfamily simultaneously. 20-22

Incontrastwith Europe,however,

theUnitedStates hasnotestablished agovernmental infrastructurethatis supportiveof familiesandwork- familybalance. 23

Manyworkers,including medicalpro-

fessionals,areexperiencing emotionalstressand per- sonalandworkplace difficultiesasthey attemptto juggle marriage,children,a personallife, andacareer. 19 The problemhasbeen particularlyacutefor women,includ- ing75%of womenphysicians, 20 whooftenwork a"dou- bleshift"between workandhome, averaging20 hours Opinionsexpressedinthesecommentariesarethoseoftheauthorsandnotnecessarily thoseoftheAmericanAcademyofPediatricsoritsCommittees. www.pediatrics.org/cgi/doi/10.1542/peds.2005-0868 doi:10.1542/peds.2005-0868

AcceptedforpublicationApr12,2005

AddresscorrespondencetoDianeK.Shrier,MD,161618thStNW,Suite104,Washington,DC20009-

2521.E-mail:diane.shrier.med.64@aya.yale.edu

PEDIATRICS(ISSNNumbers:Print,0031-4005;Online,1098-4275).Copyright©2006bythe

AmericanAcademyofPediatrics

PEDIATRICSVolume117,Number2,February2006519

at Boston University on January 3, 2015pediatrics.aappublications.orgDownloaded from perweekmore thanmenon childcareand household responsibilities. 24

Medicine,awhite-male- dominatedprofessionin

Americasinceat leastthemiddle ofthenineteenth

century, 25
iscurrentlyin atransitional periodasgrowing numbersofwomen entertheprofession. Womenphy- siciansareless likelytobe adequatelymentored andto holdleadershippositions; theyaremore likelytoexpe- riencegender-baseddiscrimination andharassment thantheirmale colleaguesandto havetheir careers adverselyaffectedby marriageandfamily. 17,20

Outdated

assumptionscontinueto predominateamong themed- icalleadership,who viewmedicalcareers asall-consum- ingoftime andenergyat theexpense offamilyand personallife,that ahigh-achieving careerinacademia andinresearch mustbelinear anduninterruptedand thatreducedschedules arereluctantlyacceptable only forwomenwith childrenandshow alack ofcareer commitmentiftaken bymen.

Themajorityof theliterature oncombiningcareer

andfamilyapproaches thesubjectas ifitwere onlya women'sissue.For women,thebiological clockdictates childbearingduringthe yearsthat arethetraditional timeframefor medicalschool,training, andestablishing one'smedicalcareer. Butmen,too, increasinglyregret nothavingsufficient timeforfamily anda personallife. 1

Reducedand/ormore flexibletraining andwork

schedulesduringthe parents'peakchildbearing and child-rearingyearswithout careerpenalties wouldnot onlyseta standardforother professionsandmedical specialtiesbutwould enablepediatriciansto enrichtheir experientialknowledgeand optimizetheir contribution tothefield. Forthosepediatricians inthe traditional retirementyears,it shouldbepossible tocontinueto be activelyinvolvedas longasone's mind,interest,and healthallow;their yearsofclinical experienceshouldbe viewedasa valuableresourceto trainees,colleagues, andthefield ofpediatrics.New modelsof integrating careerandfamily/personal lifemayresult incareers peakingafterchildren leavehome,when experienced cliniciansandresearchers canfocus theirtime,energy, andwisdomto thebenefitof theprofession.Men and women,parentsand nonparentsalike,would been- richedprofessionallyand personallyby morediverse, nonlinear,andcreative careersinpediatrics thatallow forotherinterests andpriorities.

Integratingacareer inpediatrics withapersonal/

familylifeover thelifecycle canbeapproached on individual,institutional,and societallevels.On anindi- vidualbasis,a numberof majorissuesneed tobecon- sidered. 26,27
●Clarifyyourprofessional andpersonal/family goalsin consultationwithyour significantothers.Develop a personalandprofessional missionstatementas a frameworkonwhich tomakedecisions, incorporating yourandyour partner'sprioritiesand revisingit as careerandpersonal commitmentschange.Be aware ofthewide rangeofcareer choiceswithin pediatrics thatmightbe availabletoyou atdifferent timesinthe lifecycle. ●Selectandwork withyourpartner toensurea mutu- allysupportiverelationship andcommitmentto main- tainandnurture yourpartnershipas oneof your priorities. ●Considertheadvantages anddisadvantagesof having childrenatdifferent agesand differentcareerstages. ●Beawareof thespecificneeds ofindividualchildren andfordifferent typesofparenting atvariousstages of development. ●Don'texpectto doeverythingperfectly. Learntodel- egate.Establishtime-management strategies. ●Investinreliable, stable,high-qualitychildcare. Be awareofthe rangeofchildcare optionsindifferent communitiesandworkplaces. Findingand retaining childcarenearwork andhomewill helpyoudeal moreeasilywith inevitable,yet unexpected,crises. ●Identifywhatyou needinthe worksettingand advo- cateforyourself. Becreativeand willingto compro- misewhennecessary, whilecontinuingto workto- wardyourgoals. ●Seekoutsenior colleaguestoserve asmentorsand rolemodelsin careerdevelopmentand personal/ familylife.Meet withsupportive peersregularlyand makeuseof thegrowingliterature oncombiningca- reerandfamily/personal life.Useguidance fromthe

Websitesof theAmericanAcademy ofPediatrics

(www.aap.org)andother professionalsocieties. ●Maintainasense ofhumorand maketimefor pleasure andrelaxation,exercise, andhobbies,even ifitis just gettingawayfor aweek oraweekend severaltimesa year.

Onaninstitutional basis,becomeaware ofthe range

offamily-friendlypolicies andpractices thatbetteren- ableintegrationof careerandfamily. "Achievinggender equityinterms ofcareersand families...requiresa restructuringofthe workplace." 4 ●Identifyexistingfamily-friendly resourceswithin your institutionorpractice. Activelyadvocatefor others, whetheryouare ajunior pediatricianorone ina leadershipcapacity,by drawingon modelsthathave beenimplementedsuccessfully elsewhere. 7 ●Establishpaidfamily medicalleavefor womenand menofat least12weeks fora newchildor careofan elderlyparent. ●Createalternative,gender-neutral careertracks avail- abletoall, withreducedhours andworkload,flex

520SHRIER,etal

at Boston University on January 3, 2015pediatrics.aappublications.orgDownloaded from time,jobsharing forjobsat everylevel, andstopping orslowingdown thetenureclock. ●Exploreoptionsfor careerbreaks, suchasan unpaid sabbaticalwithretraining opportunitiestoassist with reentryforthose whotaketime out(whether for familyorother personalreasons). ●Establishexpectationsand createincentivesand train- ingforeffective mentoringandcareer guidancefor juniorfacultyor practitionersaspart oftheresponsi- bilitiesofdepartment chairs,seniorfaculty, orsenior pediatriciansina practice. ●Scheduleadministrativemeetings andeducational of- feringsattimes thatdonot conflictwithchild care pick-upsandother familyorsignificant personalre- sponsibilities. ●Providehigh-quality,on-site childcareand/orup-to- dateinformationon childcareresources, including school-breakchildcare,summer camps,andemer- gencycarefor sickchildren.Similar resourcematerial shouldbeavailable foreldercare issues,becausein- creasinglythoseat thepeakof theircareersare partof asandwichgeneration thathasresponsibilities for bothchildcareand eldercare. ●Identifyindividualswithin theinstitution orpractice toserveas ombudspersonsorsenior administrators whoareassigned tosupportwork-family/personal-life balance. ●Providetransparencyabout requirementsforpromo- tionandattaining leadershippositions,uniformity in dealingwitheveryone inanequitable fashion,and assistancethroughactive mentoringand otherroutes.

Onasocietal basis,thereare anumberof choicesfor

actionandadvocacy. ●Informyourselfabout organizationsthat advocatefor universalhealthcare, subsidizedqualitychildcare, and othergovernment-supportedbenefits thatwill more easilyenableemployers toallow forpart-time,flexi- ble,anddiverse careerpaths. ●Networkwithcolleagues tostudyand developavari- etyofmodels fordiverseways ofintegratingcareer andafamily andpersonallife atboth endsofthe age spectrum.Educateyourselves aboutcontinuing sex- ismanddiscrimination andthepersistence ofout- datedmodelsfor workand personal/familylife. ●Expectthatchange willbeuneven, frustrating,and slowattimes, butcontinueto pressfor change.Even inSweden,where generousfamilyleave andflexible andreducedschedules wereavailablealong withuni- versalhealthinsurance andother workplacebenefits, ittooka generationformen tousethese family- friendlyoptions. 23
●Implementingchangefor ourselvesand withinour institutionscanresult inbroadersocietal acceptanceof effectivelyintegratingcareer anda personal/family life.

Asphysiciansdealing withchildren,adolescents, and

families,pediatricianscan providemodels fortheirpa- tients'parentswho strugglewithsimilar issues.Pedia- tricianshavethe opportunityto beatthe forefrontofthe medicalprofessionin changingattitudes andoptions thatwillenable womenandmen, parentsandnonpar- ents,tointegrate professionalandpersonal/family lives. Todiversifyand strengthenthe futurepediatricwork- force,theconcerns ofpediatricianswho wishtobe par- entsneedto beaddressedso thattheycan engagein subspecialtytrainingand careersasacademic leadersand researchscientists.The choicesmade bypediatriclead- ershipnowregarding integratingcareerand personal/ familyliveswill determinethe futureofpediatrics.

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DOI: 10.1542/peds.2005-0868

2006;117;519Pediatrics
Diane K. Shrier, Lydia A. Shrier, Michael Rich and Larrie Greenberg

Over the Life Cycle

Pediatricians Leading the Way: Integrating a Career and a Family/Personal Life Services

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DOI: 10.1542/peds.2005-0868

2006;117;519Pediatrics
Diane K. Shrier, Lydia A. Shrier, Michael Rich and Larrie Greenberg

Over the Life Cycle

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