Results
A total of 78 women participated in the focus groups. The distribution was as follows: 14 fourth year medical students, 12 senior residents, 11 fellows, 22 junior faculty women (two groups, 12 senior faculty, and 7 junior faculty fields having little female representation.
The relative importance of each of the seven attributes is represented in Figure 1. The percentages in Figure 1 reflect the contribution each attribute makes to the career selection decision. The results show that applicants to medical positions value the quality of their personal life above the quality of their work life, their earning potential, organizational rewards, future career impact of being in an academic environment, or stature of the institution in which they were to work. However, the results do not indicate that quality of work life, for instance, is unimportant in making a career choice. In fact we found that of the seven attributes studied, quality of personal and work life together contain about 40% of the information our participants needed to make a career decision (Figure 2).
Overall attribute importance. The satisfaction values from this study are shown in Figure 2.
Degree of influence of each attribute level (of the seven attributes studied) on the participants' choice of a career situation. High values indicate satisfiers, and negative values reflect dissatisfiers. Medical career situations offering high-quality personal and work life offered strong inducements toward a particular career choice, whereas negatively valued levels of these attributes were strong disincentives for a particular medical career path for the women we studied.
Transcripts of the focus group audiotapes provided qualitative information about the climate for academic career development. The purpose of evaluating the transcripts was to hear individual voices and stories and to use that information to more fully describe the work/life environment. By design, this information is less generalizable than questionnaire data, but it is more descriptive. Further, it can be used to articulate concepts that we had not considered in designing our study and that we can explore more fully in subsequent research.
Several common themes emerged and are described, with selected comments. The comments enrich the findings in the conjoint analysis by illustrating the conflict between personal and work life for many women and perhaps help to explain why quality of personal and work life is so important. The comments reflect events that occurred at some point during the woman's training or career. Some occurred at Duke and some at other institutions.
Diversity of career paths. One thread that appeared frequently in the focus group conversations was the idea that the traditional model of academic success cannot adequately accommodate a diversity of approaches to building a career. Participants discussed the conflict that arises when the most visible and valued path to success, namely, a very focused and uninterrupted commitment to career growth, is not feasible and no good alternatives seem apparent. Success in academic medicine appears to grow most easily with singular and unfettered commitment to career growth. The most visibly successful individuals appear to have few obligations outside of work. They may value their family, their community work, or their individual noncareer pursuits very highly, but their life is organized around the core theme of work. Outside obligations, commitments, and passions can be sacrificed or deferred for the sake of work. One woman described the model without admiration as "incredibly competitive, like nothing else matters in the world except your career." Academic medicine is presented as an allornothing proposition.
The paucity of female mentors was noted, and advice from male colleagues was often inadequate. One woman commented that when she decided to specialize in surgery, the advice she received from a senior faculty member could be summed up as, "Well, good luck and get yourself a good wife." Some advice was destructive, as in the case of a young woman who was told, on the occasion of her engagement to another physician, "Great. You'll have kids that grow up to be rapists. You should really find another profession." It was not suggested that her partner find another profession.
Balancing multiple roles. The traditional model of academic success does not work for some of these women because the most intensive years for career building and childbearing occur simultaneously. Currently, the choices these women perceive are to leave academic medicine, opt for a lower pay so that they will not be seen as slacking off, or opting for flex time. In each of the last two options, our participants noted that the actual number of hours may be identical to those worked by colleagues who do not have significant household responsibilities. In essence, they accept less pay to avoid unwarranted criticism.
The lack of workplace flexibility was commented on by one woman, who said, "I just don't think [academic medicine] is prepared to have women in its work force if it can't absorb a 6-week absence of anyone, male or female."
A disturbing theme that arose was that of intense disappointment with the realization that despite their best efforts and past success, the demands of career and personal life were each great enough to extract compromise from the other, and, further, that anticipated support from a partner, the community, and the medical center was inadequate to make it possible to succeed in multiple roles at once. Participants commented that they only realized the toll of balancing multiple roles after several years of career building and after they had had children. They expressed a great deal of personal pain about the choices they needed to make at this point in their career. They expressed physical and mental exhaustion and the common feeling that, "I can't do it anymore." They expressed disappointment that they were letting go of a dream, had wasted effort, and were disappointing their mentors. Rather than seeing several positive and valued choices, the only choice seemed to be to derail their career.
Participants described department chairs as key advisors but related a great deal of variety in willingness for leadership to consider their specific needs, especially where they differed from the dominant paradigm. Participants clearly viewed chairs as extremely important in their development but also expressed a desire for them to provide realistic advice and to help plan for career growth in ways that do not ignore the competing demands of work and life. They also wanted the chair to set the tone in the department for zero tolerance for harassment. Junior faculty in the focus groups believed they would benefit from the guidance of those whose paths to success more closely reflected their own choices and values. In addition, these women felt that they were more likely to be promoted with the support of senior women on appointment, promotion, and tenure committees.
Participants expressed the need to learn specific skills for navigating the academic system. They described limitations to a mentoring system that relies heavily on informal and often inaccessible networks. One participant expressed this by saying, "There's nothing in the medical center that seems to facilitate people getting to know what the tricks are."
Finally, participants observed that many of the issues raised in the groups were not specific to women, but rather reflected the social changes that have taken place over the past several decades. Many women in the focus groups indicated that their male partners tell them privately that they would like it to be acceptable for them to make more of a balanced commitment to work and home. These women thought that if their male partner practiced his commitment to the children, he "would have to take quite a bit of flack about being in the female role, and colleagues would question his commitment to academics." Participants expressed the idea that the desire to build a career that thrives in conjunction with a strong commitment to partner, children, and community and to personal interests is a common concern for both men and women currently making career decisions.
© 2003 Mary Ann Liebert, Inc.
Cite this: Women in Academic Medicine: A Report of Focus Groups and Questionnaires, with Conjoint Analysis - Medscape - Dec 01, 2003.
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