Gender Differences in Time Spent on Parenting and Domestic Responsibilities by High-Achieving Young Physician-Researchers

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 disproportionate
burden of domestic work in comparison to men, or that the amount of time women with children
devote to research is lower than that spent by their male counterparts (with a gap that is, not
coincidentally, 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 career
development grants. The advice we hear from these mentors is clear: moving from a K grant to
an independently funded research career is challenging and needs to be accomplished during
the five-year K grant timeline. This transition is one where many women researchers falter in
the academic track, either by switching to a different track or by failing to obtain funding. Not
coincidentally, 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 in
academic 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.

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.

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.

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.