academic medicine

 

Part-Time Academic Medicine: Understanding Culture to Effect Change

Angela Punnett

Department of Theory and Policy Studies

Ontario Institute for Studies in Education

 

Abstract

P

art-time employment in academia has been increasing in frequency over the past three decades, mirroring global labour force participation trends. In medicine, however, the idea of part-time practice runs counter to the ethos of the profession and has been the subject of much debate. There is a growing body of literature examining the need for and benefits of more flexible work arrangements both in academic and private medical practice. This essay will explore the issue of part-time practice in academic medicine particularly, beginning with a description of the broader sociopolitical context relating to the feminization of the workforce and borrowing from experience in business, the academy and private medical practice. It will end with an argument for culture change for a sustainable and progressive workplace for all of us in the healthcare sector.

 

Introduction

G

lobal labour force participation trends document the increasing number of individuals working part-time, voluntarily and involuntarily, over the past half century.  This is true of individuals working within academia as well and is the subject of much controversy in theory and policy studies of education.  This project seeks to explore part-time employment in academic medicine, where a dramatic change in the demographic of the profession has occurred in recent history.  It will examine the sociopolitical context of the feminization of the workforce and its impact on the academy generally and medicine particularly.  It will query how preferences for working hours have changed in medicine, how such preferences are reflected in practice, and the experience, broadly defined, of physicians working reduced hours.  It will examine aspects of medical culture that facilitate and hinder flexible work arrangements and will return to the larger sociopolitical landscape to question whether culture change for a sustainable and progressive workplace for all domains is indeed possible.

 

In pursuing this project, the author's position is from that of a mother in a dual-earner partnership and former part-time contract, recently turned permanent, academic physician. Although trends in part-time employment across all sectors affect both men and women, the rhetoric and research in the field largely reflect women’s issues.  There are a number of reasons for this, including the increasing number of women entering the professional workforce globally, the traditional role as family caregiver, and the implications this has for the increasing number of dual-earner families.  As the research in medicine shows, it has largely been the work of women and women’s issues committees that has brought forward the need for flexible work arrangements in order to retain and benefit talented individuals of either gender in academic careers (1,2). While both male and female physicians may need to balance career and family, women seem more affected by these issues and are more likely to make a career change based on work-life balance (3).  Unfortunately, the marginalization of part-time faculty is often linked to the high percentage of women in this group (4) and part-time status may be more detrimental to women’s compared with men’s careers (5). It has been argued that the perception of part-time work as solely a women’s issue will need to change and be redefined as an issue of flexibility in any academic physician’s life-course and of pursuing a healthy work-life balance in order for such work to be legitimized (6).  Arguably, improving the working environment across the board is necessary to address the issues arising from the differing life choices and complex responsibilities that constitute the current reality. 

 

The Sociopolitical Context for Part-Time Employment

In order to understand the prevailing sentiments around part-time work it is helpful to begin by examining its social and political antecedents.  This is the approach taken by Rajagopal in her book Hidden Academics, describing the rise and status of part-time faculty in academia (7).  Wages began to decrease in the 1980s along with the growing casualization of the workforce and the deregulation of benefits.  Part-time employment became a practical solution to economic forces (8).  Rajagopal draws on the work of Leah Vosko in referring to the “feminization of employment” and the increase in jobs resembling those meant for secondary breadwinners or “women’s work”.  Vosko notes the change in job structures to accommodate child-rearing, the incorporation of men into “gendered jobs”, and the increasing presence of temporary jobs leading to sex segregation, income disparities and inter/intra gender occupational rifts (9).  Rajagopal quotes the increase in part-time employment among OECD countries from 14.3% in 1999 to 15.8% in 2000 (8) and current Canadian data place the corresponding figure at 18.3% (10).

 

The majority of part-time employees are women.  Currently in Canada, women make up 46.7% of the labour force, of whom 26.8% work part-time, compared with 10.8% of employed men (11).  This part-time work force divides into voluntary (part-time by choice) and involuntary (prefer full-time employment).  Although similar percentages of men and women classify themselves as involuntary part-time workers, significantly more women are employed part-time suggesting unequal opportunity (9).  The research on the part-time workforce is limited and inconsistent with respect to employee attitudes and behaviour, perhaps as a result of local organizational factors (12).  The one common thread in the research is the issue of job autonomy, referring to the ability to independently define schedules and determine the necessary procedures to complete tasks.  Generally, full time employees have greater organizational commitment and job performance than their part-time counterparts.  However, increasing employee autonomy, for example through appropriate training and compensation, appears to mediate the relationship between part-time versus full-time status and these outcomes (13).  This is the notion of reciprocity- an employer invests in the professional development of employees and thereby fosters a greater relational contract, ultimately resulting in greater returns for the employer.  Autonomy is central to the discussion of part-time labour in academia as well.

 

Part-Time Employment in the Academy

H

igher education has also suffered from budget rationalization due to a shift from expansion to contraction of government funding beginning in the 1970s in the face of increasing student numbers, an increase that continues in the present (14).  With a decreasing number of tenure-track positions, part-time or contract faculty have been hired in increasing numbers at universities to maintain acceptable student to faculty ratios for teaching.  These part-time faculty members have been critical to the stability of universities and have allowed ongoing operation within budgetary constraints.  In spite of their contribution to academia, there exists no formal mechanism to gather data related to their numbers and experience; universities are not required to keep data on part-time faculty and Statistics Canada does not follow trends specific to this group.  This paucity of data is not unique to Canada (15). 

 

Rajagopal was the first to perform an extensive survey of Canadian part-time faculty and provides a sobering picture of their experience (7).  Part-time faculty members represented greater than one third of the total faculty numbers in the early 1990s in Canada (14) and closer to one half in the US (4).  Many of these faculty members take on a teaching load equivalent to or greater than that of their full-time counterparts (16,17).  The nature of their work may fairly be described as exploitive.  In Ontario, for example, part-time faculty members currently represent 32.4% of all faculty and provide one fifth of all teaching.  Their salaries amount to approximately 7.6% of those of full-time faculty before accounting for the decreased cost relating to lack of benefits, available support services and professional development opportunities (14).   There is a distinct lack of job security and part-time faculty members are often excluded from participation in administration at the department level and certainly beyond that level, such that they are unable to influence policies related to their employment.  Recent studies confirm that very little has changed for part-time faculty members in any of these areas (18).  Recognizing that part-time faculty positions are the new reality and likely to increase in number, the Canadian Association of University Teachers (CAUT) has recently created an Executive Committee on Contract Academic Staff to address issues contributing to the exploitation of this group of faculty.

 

Part-time academic faculty members are a mixed group.  Overall, 40.8% of these members are women.  Rajagopal describes two main categories: the contemporaries, representing 65% of the members, and the classics, representing the remaining 35%, of who 53% and 32% are women respectively.  The contemporaries are those faculty members whose only job is in the academy.  Most contemporaries hope for full-time status now (60%) or in the future (80% of women raising families) (14).  Gappa and Leslie, in their work on the U.S. part-time academic labour force, refer to these individuals as ‘aspiring academics’ but would include ‘career enders’ (retiring) and ‘freelancers’ (voluntary part-timers) in the contemporary group (19).  The classics are those faculty members who have full-time employment outside of the academy but teach part-time in addition (referred to as specialists by Gappa and Leslie).  The aspiring academics continue to publish at almost the same rate as their full-time faculty counterparts (16) in spite of the little time available after teaching.  Women in particular tend to have more teaching responsibilities and spend more time fulfilling them than men, although the research gap between genders is narrowing (9).  The prevailing attitude of the university administration and those full-time faculty members without previous part-time or contract experience, however, remains that the part-time faculty are hired only for teaching and have questionable academic commitment (20).

 

Rajagopal’s extensive survey results and reported narratives reflect the frustration of the part-time faculty with respect to recognition as a more permanent phenomenon deserving of equitable rewards, particularly related to career advancement and job autonomy.   Rajagopal and Jacobs describe the stratification of the academic workforce into the overworked tenure-track full-time academics and the marginalized yet motivated, highly skilled part-time academics (17, 21).  Both argue that this stratification perpetuates gender inequality in higher education and is harmful to the status of all faculty members in the long-term.

 

Part-Time Practice in Academic Medicine

The issue of part-time practice in academic medicine becomes slightly more complex with the addition of patient care (or, in academic circles, ‘clinical service’) to the teaching, research and administrative responsibilities of the academic.  Medicine began at the bedside and there exist long-established traditions of selfless dedication in training and practice.  More recently, it has been argued that medical education’s humanistic mission is “little more than a screen for the research mission which is the major concern of the institution’s social structure” (22).  Regardless of motivation, the time commitment in academic medicine can be limitless and leads one to question whether part-time work is really an option.

 

The Experience with Part-Time Physicians in Training and Practice

The fact remains that some medical doctors do work part-time with opportunities beginning during training.  Part-time residency/specialty training has been an option in the UK since 1969, although more recent remuneration systems threaten to limit the number of trusts willing to take on flexible trainees and may unintentionally lead to further physician attrition from the NHS (23).  All residency programs in Australia offer a part-time track (1). 

 

The situation for trainees in Canada and the US is less clear.  In a survey of accredited paediatric residency programs in the US, 12% of 156 responding institutions had greater than or equal to one part-time resident during the years 2000-2003, corresponding to 0.7% of residents represented in the survey (compared with 7% of posts in the UK)(24).  As reported in the UK experience as well, the vast majority of part-time residents were women with the most common reason given for part-time status being for the provision of childcare.  In the US, all programs reported prorated salaries, though 71% continued full-time benefits, and 88% used a reduced call schedule.  There are no similar Canadian studies.

 

Physicians in practice also work part-time.  In a large US survey, for example, 13% of respondents worked part-time (22% of women physicians, 9% of men).  Part-time women were more likely to be married and have young children.  The highest proportion of part-time physicians practiced in general paediatrics, representing 20% of those respondents.  This was likely related to the number of women in the field, though men were more likely to be part-time in paediatrics than in family practice (16 vs 7%)(25).  A better picture of the situation may be gained by surveying members of specific medical specialties.  A recent American Academy of Pediatrics survey reported that 15% of pediatricians (28% of all female pediatricians) work part-time (26). Interestingly, 58% of female and 15% of male paediatric residents stated they would be interested in part-time work in the next five years.  These individuals were more commonly married and with less debt.  The most popular reason given for part-time work for both genders related to parenting.  A survey of Queens University family medicine graduates revealed that more recent graduates less frequently entered full-time practice compared to their predecessors immediately after training or within two years of completion of training (27).  In a survey study of radiologists, 10.5% worked part-time (7.4% of male and 30.2% of female radiologists).  Pay was essentially prorated to full-time compensation but there were disproportionately fewer benefits (28).  Men were more likely to be semi-retired and women to be involved in parenting.  In some European countries, the number of part-time physicians in practice is much higher.  For example, in the Netherlands, 32% of physicians work part-time (74% of women and 18% of men).  Again, parenting was the most popular reason given and most of the part-time physicians were non-hospital based (25).  Indeed, part-time physicians are more likely to be in a generalist specialty[1], to spend a greater portion of their time in patient care and less time in research (29).

 

The Experience with Part-Time Academic Medicine: Numbers

The data describing the number of physicians working part-time in academic medicine are difficult to compare across studies because significant differences exist in the job profiles of physicians potentially included in the study samples.  For example, a large number of faculty have university appointments in order to teach medical students but in fact practice privately and teach in the community, never coming into the teaching hospital.  Another group with or without specialty training includes faculty who maintain a private practice but come into the hospital to partake in patient care and teaching on a part-time basis, akin to Rajagopal’s classics.  The last group, and the one most relevant to this discussion, represents those part-time physicians whose professional effort is entirely devoted to the teaching hospital, akin to Rajagopal’s contemporaries.  To further complicate matters, there are a number of academic tracks to which academic physicians may belong to: clinician-teacher, clinician-educator, clinician-scientist, and these titles and their job profiles differ by institution.  Part-time academic faculty may or may not be considered in these tracks depending on the institution.  And finally, the issue of what defines part-time varies.  For most studies, part-time is self-prescribed with average hours worked per week ranging between 27 and 40, not dissimilar to the experience of the contemporaries in higher education as reported by Rajagopal.

 

US survey data suggests 11% of academic medical faculty are part-time and are primarily community-based, academically affiliated practitioners (25).  One study of part-time internal medicine faculty reported that 63% of men and 27% of women work part-time.  The men combined academic and private practice while the women combined academic practice and parenting.  None were involved in research.  Women indicated that they intended to pursue a full-time academic career in the future more frequently than men (30).   Looking across US medical schools and including only those individuals committed to full-time professional effort (FPE), Froom and Bickel report that 13% of clinical faculty and 6% of basic science faculty work part-time in their 1993 survey (31).  Women made up 60% of this group (compared with 24% of full-time faculty), primarily in clinical tracks.  The fact that part-time faculty are more likely to participate in clinical than research tracks has been confirmed in other studies (32).  It can be argued that these numbers have not changed significantly.  In a more recent study at a single institution also aimed at FPE faculty, 10% reported working part-time though three times that number had considered it at some time (33).

 

Is it reasonable to expect that more physicians will or would like to work part-time?  This is a complicated question and must be considered in the context of human health resources, physician preferences, and existing workplace attitudes/experiences.  To begin, the demographics of medical school entrants have changed significantly since the 1970s in conjunction with the rise in the feminist movement and affirmative action in North America and Europe (25,34-36).  Currently in Canada, 57.7% of medical school entrants are women (range 41.1-73.9%)(37).  Survey data has already documented that women more commonly work part-time or want to work part-time at some point during their career.  Men with a desire to work part-time are similarly increasing in numbers (26,38), with both genders seeking a more balanced lifestyle.  This data speaks to the current economic environment of two profession partners and the complex family relationships that require flexibility and tolerance in the work environment.  If interest translates into actual part-time employment, then a significant increase in the part-time workforce is expected in upcoming years.  The preference for part-time work has not been reflected significantly in workforce trends and indeed, the US forecasts only a 3% decrease in full-time equivalents of physicians in the next decade (25).

 

Why has there not been a significant increase in physicians working part-time?  The explanation may relate to the socialization, attitudes and perceptions of physicians and their colleagues.  Women physicians themselves[2] have questioned the benefit of increasing the number of women in the profession, suggesting the sheer numbers have lead to a loss of influence and status in the profession (39).  There has been a feminization of the physician workforce as it were, with the resulting need for fundamental changes in attitudes and policies to accommodate women and men desiring more flexible schedules.

 

The Experience with Part-Time Academic Medicine:  Culture and Outcomes

A number of studies have examined attitudes and perceptions of physicians in regards to part-time work. Academic chairs interviewed for their perceptions of part-time faculty were generally satisfied with the group but did express concern over the academic productivity and commitment of part-time faculty to their respective departments (30,32).  In a survey to assess attitudes about part-time positions of all faculty at a US paediatric institution, Kahn and colleagues found that 59% of faculty reported that part-time faculty were perceived as less committed to their careers and institutions.  In the narrative portion of the survey, a subgroup of respondents expressed concern that part-time faculty are unable to achieve the productivity necessary for a successful research career and suggested limiting numbers of part-time faculty, their job profiles (clinical only) and their eligibility for certain leadership positions (33).   In the Netherlands, where the prevalence of part-time work is high, hospital based specialists were generally less positive toward part-time careers, reporting concerns with continuity of care and communication with colleagues (36).  Similar concerns have been raised in US studies (25) though it has been suggested that as the new reality in medicine is collaborative practice, continuity of care is less of an issue and communication is an issue for all physicians (40).

 

It is of interest that studies of part-time physicians’ clinical productivity and performance have not shown any difference between part-timers and full-time physicians, and indeed often demonstrate superior performance of the part-timers over full-time physicians. Medical residents who complete part-time training had specialty board pass rates equivalent to their full-time peers and received equivalent or better faculty reviews (41-44).   US studies demonstrate that quality of care, patient satisfaction, resource utilization and productivity measures in primary care and inpatient settings are similar between part-time and full-time physicians or actually better for part-time physicians (44-49).  The one area identified in a single study where full-time physicians appeared to outperform part-time physicians was in patient-reported levels of visit based continuity of care.  This applied only to those physicians working greater than 65 hours per week and did not impact global ratings of patient satisfaction.  Those same physicians reported significantly less satisfaction with their work/life balance (45).  Another study found that patients of part-time physicians were more satisfied than patients of full-time physicians (49).  The discrepancy may relate to contextual factors such as booking of appointments.  It has been before argued that having multiple roles may mitigate work stress for physicians (50) and that those more well-rounded physicians with interests outside medicine may provide more humanitarian care with improved communication skills (40).  Regarding the issue of productivity, managed care organizations are interested in examining the work habits of part-time physicians in order to identify potential systems improvements.  It has been hypothesized that part-time physicians may be by nature more efficient and more energetic because they work fewer hours or that do they in fact work longer hours than those for which they are paid thus increasing productivity measures.

 

There are, of course, other potential benefits of employing part-time physicians.  From a human health resource perspective, part-time employment of physicians has been touted as a solution to both the excess of doctors in the US (51) and the shortage of doctors in the NHS in the UK (52).  It is seen as a potential key mechanism in attracting qualified and motivated physicians to under-serviced medical and surgical specialties both by attracting more women and retaining those physicians approaching retirement (25,34).  In academic medicine in particular, part-time or flexible work options are seen as vitally important to increasing diversity within the academy (24) and more specifically to increasing the number of qualified and talented women, both by attracting young graduates and preventing further attrition (33,53).

 

The issue of attrition has been the subject of much recent literature examining the role of women in academic medicine.  In spite of the increased total number of women entering medicine, the number of women in academic medicine, and particularly the number in the more senior ranks of associate and full professor, has remained stagnant in the past two decades (54,55).  In 1999, 27% of full-time medical school faculty were women, but only 15% of tenured faculty, 11% of full professors and 6% of chairs (56,57).  Women are opting out of physician-scientist careers, which has raised an alarm for the future of medical science (58).  Ongoing concerns regarding the gender imbalance in the academy more generally have been raised in Canada and abroad (59).  The recruitment and retention of women faculty has been deemed essential to the long-term success of academic medical centres for individual contributions and in order to maintain the best housestaff and faculty by ensuring appropriate role-modeling and mentoring (60).  In an interview study of clinical department chairs from five faculties designed to examine the barriers for the advancement of women in academic medicine, traditional gender roles, sexism within the academy and lack of effective mentors were the over-riding themes of the responses (56).  Women’s roles in the family were seen to negatively impact the time and energy required to meet tenure and promotion expectations, as well as to limit the geographic mobility often necessary to career advancement.  As one (female) chair noted, “[The problem in medicine] reflects our society as a whole.  We do not value parenting.  We do not value teaching.  We do not value children”. (56) Other studies of single institutions reinforce that the important issue for women is a better work-life balance in academia and thus the call for more flexible work schedules and part-time options (61-64).

 

Studies of the experience of physicians working part-time confirm the benefit of a better work-life balance with reduced work hours.  A large US survey documented that part-time physicians felt more control over their work hours, experienced fewer interruptions, and perceived less competition in their work than their full-time peers.  In addition, they were more satisfied with patient care, administrative issues, and personal time, and their stress levels were significantly lower than their full-time peers.  The comparative Dutch survey in the same study differed only with regard to part-time physicians reporting more difficulty with practice autonomy (25)[3].  Autonomy has been linked with career satisfaction among US women physicians generally (50) and is consistent with the research in business and academia discussed previously.  The results of a large interview study comparing US women physicians working part-time versus full-time reflect this issue of autonomy from a slightly different angle.  The study found that women working part-time tended to have stronger direct relationships between family experiences (marital and parental role quality) and professional outcomes (career satisfaction and intent to leave employment) than their full-time peers.  The researchers suggested that women working part-time may be more concerned about the ways in which they meet their obligations at home and work and could benefit most from flexible work scheduling (65).  Indeed, physicians who work their preferred number of hours report the best balance of work and family outcomes (29).  Not surprisingly, for full-time employed physicians, there is significantly less fit between preferred and actual working hours for women compared to men (36).

 

Although most reduced-hours faculty in academic medicine report high career satisfaction (30), a number of issues for concern have been raised in interview and survey studies of this population.  These include the lack of equitable compensation for actual hours worked, lack of benefits and academic time[4], inability to participate in either key research or administrative activities, limitation of career advancement, and a perception of marginalization by peers (28,30,51).  Women were more likely than men to believe that part-time status adversely affected their colleagues’ impression of their commitment (30,33).  The issue of career advancement is important given the general status of women in academic medicine, and, indeed, in higher education in general.  Part-time women advance more slowly than part-time men in academic medicine (57), although having worked part-time adversely affected academic rank for both genders among one study of academic radiologists (28)[5].

 

It has been noted that universities may have policies that specifically preclude faculty from working part-time or that restrict the participation of part-time faculty in certain academic tracks, including the tenure track (32).  Froom and Bickel conducted a survey of 102 US and Canadian medical schools in the mid 1990s and found that 73% “provided for” FPE faculty though less than half of these had developed specific procedures for such faculty (31).  In a more recent survey study of institutional policies of US medical schools regarding tenure, promotion and benefits for part-time faculty, Socolar and colleagues found that only 27% of medical schools with tenure systems offered tenure-track to part-time faculty working at least 0.5 full time equivalent.  The majority of schools offered all benefits although 40% prorated them to full-time equivalents (6).  Further details on medical school policies are lacking and would be helpful.  For example, in their study of part-time academic radiologists, Chertoff and colleagues found that only half received academic time.  As there was a notable difference between academic rank and history of part-time work, this finding has significant implications for future policies related to faculty development (28).

 

The paucity of information on institutional policies around part-time academic physicians likely reflects that decisions in this regard are in large part guided by the department and not necessarily the faculty at large.  Levinson and colleagues report that two thirds of the women working part-time in academic internal medicine developed the part-time position themselves (30).  A number of letters written to the journal after publication of Levinson’s article describe either individually developed working arrangements or specific policies developed by departments within faculties of medicine for part-time FPEs (66-68).  Individual arrangements create a hiring practice which is not transparent and not equitable.  One could argue that this contributes to attrition, with numerous testimonials in the literature of women leaving academic medicine because of concerns of failing to meet expectations (35).  The source of such concerns may arise from the lack of opportunity to formally and mutually develop and address these expectations from the beginning.

 

The Experience of Part-Time Academic Medicine: Culture Change

What is obvious from the literature is good intent.  For the most part, faculty members at all levels recognize the benefit to the academy of part-time academic physicians and are supportive of policies that will promote equity and enhance the career opportunities of these physicians (33).  The rhetoric in the higher education literature mirrors that of the medical literature; the goal of policies related to part-time employees is a high performance organization and as their numbers increase, part-time academics must be treated as a valuable resource for maximum productivity and equity (17,25).  Policies must be applied uniformly to create widely available options.  Specific recommendations include but are not limited to: availability of permanent part-time positions with prorated pay and benefits, eligibility for primary investigator status on grants, flexible promotion times with transparent expectations, focused mentoring and career development opportunities, provision of administrative support proportional to full-time peers, increasing the representation of part-time faculty within institutional leadership, and improving child care access (28,33,51,54,63,69).  These policies are very similar to those developed by Rajagopal for part-time faculty in higher education (70).

 

Viable flexible work options within medicine reflect a growing support for the so-called life cycles approach (35,36,53) wherein men and women may work part-time hours at different points during their lives depending on home domain determinants or other activities.  Women, for example, have been described to have an M shaped career with decreased hours available during child-rearing but ample opportunity to develop their careers further thereafter (35).  As women are more likely than men to enter specialty careers in medicine a life cycles approach may encourage more women to choose differently and may be more conducive to reduced hours schedules (51), particularly if they have or plan to have children (71).  There is, however, a paucity of information on the motivations of women physicians with respect to their career choices (72).  Are career choices made actively or passively based on perceived opportunities, lifestyle or living constraints?  Showalter suggests that we need to approach the question assuming that women physicians want what their male peers want; a rewarding career and optimal work-life balance (72).  She argues that “one-sided social change” at the level of the institution does not necessarily result in change at the personal level and she echoes Riska’s call for the “deconstruction of medicine and its inherent male values and structures” (73).  In other words, there needs to be a change in attitudes of all physicians with a transformation of the “public, internalized assumptions that link professional leadership to long hours, personal sacrifice, and stereotypes of managerial style (p.73)”.

 

This idea of culture change has arisen from business models.  Duxbury and Higgins have conducted extensive studies into the work-life balance of Canadians for the Public Health Agency of Canada (75).  Organizational culture, specifically ‘hours based’ and ‘work or family based’, was found to be the greatest predictor of role overload, work to family and family to work interference for both genders.  The authors developed extensive recommendations based on their results that are widely applicable.  These include the development of realistic work expectations, increasing employee autonomy, increasing work time flexibility, changing the focus from hours and presence at work to outputs and performance measures, and actively working to create supportive work cultures with modeling by management.  Given the current meritocratic system of career advancement as largely an independent act and rewarding of unrestricted availability to work, many authors and organizations are calling for a change in the culture of academia both within medicine and the academy generally (17,54-56). Barnett describes the required “paradigm shift” to close the gap between rhetoric and practice of policies related to work-life balance (51,76).  Jacobs also calls for a “fundamental alteration” of expectations within the academy and has suggested a change in recruitment tactics to advertise a family-compatible lifestyle and culture while appropriately rewarding teaching, research and service (17).  Beyond the organization, government-lead programs such as a national childcare program and similar programs for other dependents would model a commitment to culture change while alleviating a significant stress for caregivers of either gender.  At the end of their study, Duxbury and Higgins query whether the status quo represents how Canadians want to live their lives now.  It seems that increasingly members of the academy and physicians are doing the same and we need to exercise our agency in redefining our work culture and work-life balance.

 

Concluding Remarks

P

art-time faculty members devoting their career exclusively to higher education or academic medicine are similar and dissimilar in some important ways.  Both groups of aspiring academics are made up primarily though not exclusively of women, with a history dating back three decades to the start of fiscal restraints at the universities and the rise in the number of female medical school entrants respectively.  Part-time contemporaries in higher education are more often involuntary while part-time FPEs in academic medicine are voluntary.  The two groups share challenges related to job autonomy, equity and career advancement within the academy which may be understood within the context of the feminization of the labour market globally.  The recognition of the need for a culture change to address work-life conflict within this larger context has had an impact in the literature relating to the academy and academic medicine.  Further research and assessment of specific interventions to address culture change are required in all domains and for all of us.

 

 

 

 

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9.     Ibid, Chptr 3.

 

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[1]   A generalist specialty refers to family practice, general internal medicine or general paediatrics.

[2]   A particularly interesting series of editorials was precipitated by comments made to this effect by Dr. Carol Black, past president of the Royal College of Physicians in the UK (as referenced).

[3]   The differences with respect to practice autonomy between the US and Dutch cohorts of part-time physicians may be related to the nature of the practice of medicine in the two countries.  For example, the Dutch physicians worked predominantly on salary while the US physicians worked predominantly  fee for service.

[4]   Academic time refers to paid academic release time for professional development.

[5]   The results of this study suggest the cause of the difference in academic rank may be related to waning academic productivity at later career stages for both genders.



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