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Shaw, Gina

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How do academic neurology departments measure up when it comes to encouraging neurology academics who seek a balance between work and family life? There has been great progress on this front, young faculty members told Neurology Today in telephone interviews, but there is room for improvement in certain areas.

“We wouldn't have been having this conversation 15 years ago,” said Eva Feldman, MD, PhD, Associate Professor of Neurology at the University of Michigan Medical School and head of the University's ALS Clinic. Her children – who are now 22, 20, and 16 – were infants and toddlers when she first joined the faculty.

“When I was a young faculty member, seeking balance between your work and your family life was viewed as a weakness. Now it's the opposite: we want to encourage them to have more balance. Where we're stuck right now is getting the programs and systems that will facilitate this. But the idea's there, the initial steps are there, and there are some programs. Things are moving forward.”

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After synthesizing a wide range of existing surveys and reports on family-friendly policies in academic medicine, the Families in Neurology Committee of the Association of University Professors of Neurology (AUPN) has issued a series of recommendations that departments and institutions should consider in order to better support young faculty members who want to make time for work and family life.

The effort was spearheaded several years ago by then AUPN President William C. Mobley, MD, PhD – Professor of Neurology and Neurological Sciences at Stanford University. Dr. Mobley felt that academic institutions needed to focus on family problems for men and women.



One of the most important report recommendations, said Donna M. Ferriero, MD, Chief of Child Neurology at the University of San Francisco Children's Hospital and Chair of the AUPN Families in Neurology Committee, is transparency in promotion policy.

“University leaders and department chairs need to provide information to their junior faculty about career path requirements, and the written and unwritten criteria that exist regardless of track,” she said. “Such policies exist at a basic level in universities, but they're often interpreted quite differently in departments. Get your policies out there and define what you want: if you want an investigator to have an R01 – [an NIH grant with one or more investigators] – before they reach associate professor, say that. Don't make success contingent on guessing games.”

Other recommendations from the AUPN include flexible career paths, tenure clock extensions, and well-established mentoring systems. “We also suggest that departments not reward unlimited availability. They should schedule important departmental meetings during work hours, not before 8 a.m. or after 6 p.m.,” said Dr. Ferriero. “We all go home and then do more work at home, that's the reality of our lives, but many people have time clocks dictated by day-care centers.”

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But it is not just day-care that faculty members are seeking to fit in their lives. Columbia University – specifically Timothy A. Pedley, MD, Chair of Neurology – is “incredibly committed and supportive” of faculty members' family priorities, said Melodie R. Winawer, MD, Assistant Professor of Neurology at Columbia. Dr. Winawer, who is five years along the university's seven-year tenure track, conducts research on the genetics of epilepsy at Columbia's Sergievsky Center, teaches medical students, helps direct the neurology residency program, and sees patients at Columbia University Medical Center and Harlem Hospital – all while restoring a brownstone in Brooklyn, with her partner who is 38 weeks pregnant. In her off hours, Dr. Winawer plays cello with a string quartet and teaches about yoga and medicine at a local yoga center.

“Being productive and actively involved in the department is essential, but not at the total expense of family life,” she said. “It's a very intense department, but it's also very human and humorous.”

When she announced that she would be taking six weeks of maternity leave after her partner gives birth, she was greeted with universal congratulations, along with recommendations from male colleagues about which baby books to read and which stroller to buy. “Productivity isn't measured by how much time you spend away from your family,” she said.

Columbia may be an unusually supportive institution, but more academic medical centers are developing – at least on paper – family-friendly policies, ranging from options for temporarily stopping the tenure clock to putting the kibosh on “must-attend” departmental meetings held in early-morning or late-evening hours.

Policies vary widely by institution – and just because a time-out on the tenure clock is available doesn't mean faculty will feel comfortable taking it – but overall, the atmosphere in departments of neurology has changed enormously from just a few years ago.

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Another key issue for many researchers: improved academic recognition of collaborative research. The NIH has recognized the importance of this by re-establishing the “co-principal investigator” classification. For the past 10 years, all NIH-funded research had to have a PI and a “co-investigator.” Unfortunately, being a “co-investigator” did little for a faculty member in terms of promotion, so it just meant more work – and more time away from family – with little contribution to tenure hopes.

“Real research has to be done in a collaborative environment by multiple people, but for promotion in most universities, you have to show how important you are independent of other people,” said Dr. Ferriero. “The NIH is now recognizing that research has to be done by a number of people and allowing for more than one person to be recognized as a lead investigator, and universities and departments need to do the same.”



Other “concrete deliverables” can also help young families – such as moving to make faculty and departmental conferences more time- and user-friendly. At Johns Hopkins School of Medicine, for example, an annual neurology retreat was recently moved from Saturday to a weekday to avoid “stealing” a precious weekend day from faculty members' family time.



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That is already happening at some institutions, like the University of Rochester Medical Center in New York, where there are multiple tenure tracks. “It's possible to get tenure here as a teacher-clinician-scholar: someone who may do primarily clinical work, but also be a scholar and do some writing, but not necessarily a lead investigator,” said Jonathan Mink, MD, Chief of the Division of Pediatric Neurology at the University's Strong Memorial Hospital and the father of two children, ages 10 and seven. “In many universities, yours has to be the first name on a grant to get promoted. Here, there are mechanisms for promotion and tenure without that.”

As a young neurologist at Washington University in St. Louis, Dr. Mink faced the family-work conundrum himself. Part of his strategy was postponing the jump to Assistant Professor. “The tenure clock didn't start until you were an Assistant Professor, so I spent a few years as an instructor, postponing the start of the clock until I got more established,” he said. “It's been a challenge. I do a lot of work after the kids are in bed, and I try very hard not to sacrifice time with them – sometimes successfully and sometimes not. It's a continuous struggle to make sure my priorities are clear.”

So he understands the struggles of the young faculty member for whom, as Division Chief, he must shepherd along their own career paths. “I'm committed to providing them with sufficient protected time and not overwhelming them with clinical responsibilities so that they can get their academic careers established,” he said. “If we need someone from our division to serve on a committee, I'll take on another one myself rather than have it be a distraction for a younger person trying to get established.”

At Rochester, young professors are not given a full clinical load, so that their research time is protected, and departmental leadership strive to help their mentees find grants early on to help pay a significant share of their salaries. And when writing promotion recommendations, Dr. Mink said, he makes sure to attach sufficient importance to being a good and productive collaborator – not just a PI.

“If we're going to attract and retain good academic, research-oriented faculty members, it's going to require increasing flexibility,” said Dr. Mink.

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That is because more young physicians are insisting that they can be good academic neurologists while still spending time with their families, and are choosing institutions and programs that agree. “More than half of the really good applicants to neurology programs now are women,” said Richard O'Brien, MD, Associate Professor of Neurology at Hopkins and a father of two who also serves on the department's residency admissions committee. “The good applicants will go elsewhere if you aren't willing to work with them on this, so there's no not dealing with it anymore.”

Department chairs are beginning to agree with him. “As a chair in an academic department, you want to support productive young people. The market's pretty tight for productive junior faculty, and there are more people looking for them than there are such people out there,” said Frank M. Longo, MD, PhD, who is Chair of the Department of Neurology at the University of North Carolina-Chapel Hill and himself has two children, ages two and four. “When you find productive, highly energetic junior faculty, it's in the best interest of the department to do what it needs to do to hold onto them.”

“We certainly do see more applicants who say they want to balance their careers and their family lives. They're smart enough to recognize that, where not long ago we would have been scared to say it,” said Andrea M. Corse, MD, Assistant Professor of Neurology at Hopkins and mother of two who serves on the admissions committee for the medical school.

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And instead of being a potential negative, those comments are seen as a plus as the department chooses new residents. “Those are the kind of people we want, and the people we think will want to come here because of the advantages we offer,” said Dr. O'Brien. “Hearing that means we'll be in a strong position to attract these candidates.”

That's because at Hopkins, being “family-friendly” is a recruiting feature. The institution recently added a day-care center, which Dr. Corse notes has proved a boon to several people on the neurology faculty already, and has long offered a “family room” in the hospital for nursing mothers who want privacy to breastfeed or pump. During presentations about the residency program, Neurology Chair Jack Griffin, MD, frequently shows a slide photo of the current neurology residents, and notes that up to 70 percent of the group have had children during their residencies.

Another plus: Dr. Griffin's willingness to work with young faculty in need of flexibility. For example, notes Dr. O'Brien, one of the department's three fellows in neuromuscular disease recently negotiated the option to do his fellowship over an extended period, part-time, because his wife had recently given birth. The other two fellows, both women, are also both pregnant, and will likely pursue a similar option. “With Jack, it's not about a time clock, it's about productivity,” said Dr. O'Brien.

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To some extent, Hopkins' neurology department has natural advantages on this score that others may not. With some 45 full-time faculty and as many part-time, it has divisions – like the neuromuscular program – that are larger than entire neurology departments at other institutions. That helps when a faculty member needs coverage in order to take time off.

Even in a relatively large department, highly specialized faculty members may find that no one can fill in for them when they need to take maternity leave or go to a PTA meeting. Christine A. Wijman, MD, Assistant Professor of Neurology at Stanford University School of Medicine, was hired to build the department's neurocritical care program, when she had a newborn and a two-year-old. “Of three neurology faculty members in the stroke center, I found out that I was the only one who had kids,” she said.

Today, she notes, she is one of only two women on Stanford's neurology clinical faculty. “I run a highly specialized program, and then there's our movement disorders clinic, also run by a woman,” Dr. Wijman said. “In those situations, it's almost impossible to find someone to fill in for you, so you're extremely vulnerable, whether you need time off because a child is sick or because you are.”

“I do know of people around the country who dropped out of the field because of these issues,” said Dr. Longo. “They were extremely talented, but it was so much of a struggle for them that it wasn't worth it, and they weren't willing to sacrifice the family part of it.”

Despite institutional, logistical, and historical challenges, many academic neurologists agree that there has been progress toward making a career in the field more compatible with family life. Four babies were born to neurology faculty members at UNC this year, which Dr. Longo takes as an encouraging sign. “Usually we only have one at the most each year, but this year four very productive women faculty members all decided to have kids,” he said. “It took a lot of juggling of schedules, but because they are so productive, people were very supportive.”

Still, said Dr. O'Brien, “There's no doing it all. You have to decide how much of each area in your life you're going to do, and you simply can't do everything. It takes awhile to get used to that idea.”

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  • ✓ Faculty at academic medical institutions discuss the policies of their institutions that support the need for greater balance in their professional and personal lives.
© 2005 American Academy of Neurology