Barriers to Career Flexibility in Academic Medicine: A Qualitative Analysis of Reasons for the Underutilization of Family-Friendly Policies, and Implications for Institutional Change and Department Chair Leadership

Navigating Minority and Gender Discrimination, Substance Use Disorder, Financial Distress, and Workplace Politics: Lessons for Work-Life Wellness in Academic Medicine: Part 2 of 3

In this second of three manuscripts addressing a range of complex work and personal issues, the authors explore case scenarios with characters who work in the fields of general surgery, orthopedic surgery, anesthesiology, neurology, radiology, and otolaryngology. The medical specialty identifiers help inform some baseline understanding of the demands of that particular profession but are less pertinent than the specifics of each case. In this manuscript, the authors dive into the topics of navigating a lawsuit and professional burnout, personal finances, substance use disorder, demands of clinical work and workplace politics, diversity and inclusion, and dealing with major personal illness. The authors provide practical steps to help the readers deal with similar situations and provide insight to support persons on how to improve support structures.

Healthcare Workers' Perceptions of On-Site Childcare

GOAL

Measures taken by healthcare organizations to address COVID-19 highlighted the long-standing lack of childcare infrastructure required to support healthcare workers. This study, designed to provide evidence to support operations at an academic medical center, looked at the influence that in-house and emergency childcare could have on the retention, recruitment, and productivity of healthcare workers. This study also outlined the implications that childcare, or its lack, has for healthcare organizations during and after the COVID-19 pandemic.

METHODS

We conducted a 35-question electronic employee survey (under institutional review board approval) during pandemic-induced public school closures, which included both quantitative and qualitative (write-in) questions.

PRINCIPAL FINDINGS

The survey results showed that weekday on-site childcare was very or extremely important to more than half of survey respondents, the majority of whom were staff members (28%) or physicians (25%), followed by administrators (15%), researchers (12%), others (10%), nurses (5%), educators (2%), and residents (1%). Sixty percent of respondents reported that emergency on-site childcare was extremely important (34%) or very important (26%). Almost half (49%) reported that emergency childcare needs have disrupted their work in the past year, including canceling of clinics or surgical cases. Analysis of qualitative comments via a strategy based on coding and categorization showed that, when asked how childcare influences their work choices, employees responded that childcare availability has limited the hours or times they could work, that lack of childcare has prevented career growth, that they left a previous job or will leave their current job because of childcare needs, or that they stayed at a previous job or have remained in their current job longer because of the availability of childcare.

PRACTICAL APPLICATIONS

Although data from this mixed-methods study support findings in the literature that there is a need for in-house and emergency childcare, the data suggest that current employees at this academic medical center do not currently expect it, likely because such childcare is not generally available at most academic institutions. With increased rates of burnout and healthcare workers leaving the field since COVID-19, offering in-house and emergency childcare provides hospital systems with new opportunities to retain and recruit physicians, nurses, and staff, as well as to improve their well-being and productivity.

Assessment of the Relationship Between an Adverse Impact of Work on Physicians' Personal Relationships and Unsolicited Patient Complaints

OBJECTIVE

To evaluate the relationship between an adverse impact of work on physicians' personal relationships and unsolicited patient complaints about physician behavior - a well-established indicator of patient care quality.

PARTICIPANTS AND METHODS

We paired data from a physician wellness survey collected in April and May 2013 with longitudinal unsolicited patient complaint data collected independently from January 1, 2013, to December 31, 2016. Unsolicited patient complaints were used to calculate the Patient Advocacy Reporting System (PARS) score, an established predictor of clinical outcomes and malpractice suits. The primary outcome was PARS score tercile. Ordinal logistic regression mixed effects models were used to assess the association between the impact of work on a physician's personal relationships and PARS scores.

RESULTS

Of 2384 physicians eligible to participate, 831 (34.9%) returned surveys including 429 (51.6%) who consented for their survey responses to be linked to independent data and had associated PARS scores. In a multivariate model adjusting for gender and specialty category, each 1-point higher impact of work on personal relationships score (0-10 scale; higher score unfavorable) was associated with a 19% greater odds of being in the next higher PARS score tercile of unsolicited patient complaints (odds ratio, 1.19; 95% CI, 1.07-1.33) during the subsequent 4-year study period.

CONCLUSION

An adverse impact of work on physicians' personal relationships is associated with independently assessed, unsolicited patient complaints. Organizational efforts to mitigate an adverse impact of work on physicians' personal relationships are warranted as part of efforts to improve the quality of patient experience and malpractice risk.

Family Supportive Supervisor Behaviors Moderate Associations between Work Stress and Exhaustion: Testing the Job Demands-Resources Model in Academic Staff at an Austrian Medical University

The time-intensive work of publishing in scientific journals is an important indicator of job performance that is given much weight during promotion procedures for academic positions. The current study applied the job demands–resources model and analyzed whether family supportive supervisor behaviors (FSSB) moderated associations between work stress and feelings of exhaustion as a job resource and whether feelings of exhaustion ultimately mediated the link between work stress and academic employees’ publication activity. The current online cross-sectional questionnaire study was conducted in 133 academic employees (65.4% women, 34.6% men; M_age = 41.9, SD = 10.1) at an Austrian medical university and assessed employees’ numbers of publications, H-index, work stress, feelings of exhaustion, FSSB, and work–family services used. Manifest path models revealed that FSSB moderated the link between experiencing high levels of work stress and strong feelings of exhaustion, especially in employees who had at least one child below the age of 18. Part-time employment was most strongly linked with lower numbers of publications and lower H-index levels. The finding that FSSB acted as a job resource mostly for employees with at least one child below 18 underlines the fact that FSSB is different from other forms of supervisor support. The current study supports recommendations to increase the amount of work–family services and to change organizational norms to be supportive of the successful management of family and work obligations.

Meeting expectations: An exploration of academic emergency medicine faculty experiences and preferences in the virtual meeting environment by age, gender and parental status

BACKGROUND

During the COVID-19 pandemic, virtual meetings became the norm in academic emergency medicine (EM) departments. This study explores the experiences of academic EM faculty within this environment.

METHODS

In 2021, authors surveyed a cross-sectional convenience sample of EM faculty using a mixed-methods approach to explore perceptions of the virtual meeting environment. Authors reported data on a five-point Likert scale, summarized as percentages, and calculated differences using Pearson's chi-squared test, where p < 0.05 was significant. Free text responses were analyzed qualitatively.

RESULTS

Two-hundred-fifty-nine responses were collected, (female [55.6%], ≤40 years old, [39.8%]) of which 33.2% had children ≤7 years old. Most respondents felt the total number of virtual meetings had increased and were more likely to happen outside of regular business hours compared to in-person meetings. Most faculty preferred meetings during regular hours and liked the virtual format overall. Younger faculty respondents were more polarized in their preferences of timing of meetings and reported more pressure to accept meetings outside of regular hours. Female respondents with young children were more likely to dislike meetings outside regular hours and to have declined them. Women faculty, younger faculty, and women faculty with young children were significantly more likely to agree that women had been "more impacted by the new virtual work environment." Qualitative themes highlighting the flexibility provided by the virtual work environment and decreased commuting time, though many felt communication was limited in virtual meetings.

CONCLUSIONS

Academic EM faculty mostly preferred keeping meetings during regular business hours and in a virtual format. Experiences varied by age but not by gender overall. Women with young children reported greater challenges than women without. Men did not differ by parental status. The virtual format provided increased flexibility but limited communication and engagement. Academic EM departments may use this data to inform future meeting practices.

Flexibility in Faculty Work-Life Policies at Medical Schools in the Big Ten Conference: A Ten-Year Follow-up Study

Background: Flexible work-life policies for medical school faculty are necessary to support career progress, advancement, retention, and job satisfaction.

Objective: Our objective was to perform a 10-year follow-up descriptive assessment of the availability of flexible work-life policies for faculty in medical schools in the Big Ten Conference.

Design: In this descriptive study, a modified objective scoring system was used to evaluate the flexibility of faculty work-life policies at 13 medical schools in the Big Ten Conference. Policy information was obtained from institutional websites and verified with the human resources offices. Scores from the 2011 study and 2020 were compared.

Results: Michigan State and Ohio State Universities offered the most flexible policies (score 17.75/22) with the Universities of Maryland and Minnesota following (score 16/22). The largest delta scores, indicating more flexible policies in the past decade, were at University of Minnesota (5.25) and University of Michigan (5). Policies for parental leave and part-time faculty varied widely. Most schools earned an additional point in the newly added category of “flexible scheduling and return-to-work policies.” Nearly every institution reported dedicated lactation spaces and improved childcare options.

Limitations: Limitations included missing policy data and interpretation bias in reviewing the policy websites, unavailable baseline data for schools that joined the Big Ten after the 2011 study, and unavailable baseline data for the additional category of return-to-work policies.

Conclusions: While progress has been made, every institution should challenge themselves to review flexibility in work-life policies for faculty. It is important to advance a healthy competition with the goal to achieve more forward-thinking policies that improve retention, recruitment, and advancement of faculty. Big Ten institutions can continue to advance their policies by providing greater ease of access to options, further expansion of parental leave and childcare support, and offering more flexible policies for part-time faculty.

EFFECT OF FAMILY-FRIENDLY PRACTICES ON EMPLOYEES’ INTENTION TO QUIT: THE MEDIATING ROLE OF ORGANIZATIONAL CITIZENSHIP BEHAVIOR

Turnover intention has become one of the most serious issues in organizations around the world. Hence, most organizations encourage family-friendly practices (FFPs) to retain employees and to reduce high turnover risk. A plethora of research has confirmed FFPs as a fruitful predictor of turnover intention. However, what is not yet known is whether FFPs directly influence turnover intention or indirectly through organizational citizenship behavior (OCB). To fill the gap, the present study examined the effect of FFPs on employees’ intention to quit. On top of that, the mediating role of OCB in the purported link was also examined. Data were collected from 338 health sector employees using a structured questionnaire. The results of the structural equation modeling using AMOS indicated a significant negative relationship between FFPs and employees’ intention to quit. Moreover, OCB negatively influences employees’ intention to quit and partially mediates the path between family-friendly practices and intention to quit. Based on theoretical and empirical evidence, this study advances existing knowledge and further understanding of organizational work practices. This study recommends that organizations should encourage FFPs to mitigate turnover rate among employees.

Factors Related to Faculty Work Life Balance as a Reason to Leave a School of Medicine

Mentoring can help promote faculty retention at academic health centers (AHCs). Faculty retention is important to optimize patient care and reduce replacement costs. Nationally "work life balance" (WLB) is identified by faculty as a reason to leave (ARTL) AHCs (Alexander & Lang, 2008). To help mitigate faculty attrition at AHCs, we examined work life balance as a reason to leave (WLB-ARTL) and other associated factors at the University of New Mexico School of Medicine (UNM SOM). Faculty responses from 255 faculty that left UNM SOM between July 2017 and December 2020 were analyzed using logistic regression with the outcome WLB-ARTL. Distributions of each variable were tabulated. Odds ratio associations from logistic regression between WLB-ARTL and each variable were obtained. Multivariate logistic regression modeling was performed with backward selection at p<0.05. Of the 255 faculty who exited the University of New Mexico School of Medicine (UNM SOM), 25% had WLB-ARTL, 48% were women, 72% were physicians, 58% were clinician-educators, and 13% were from racial/ethnic underrepresented minorities (URMs). Multivariate modeling found four factors associated with increased WLB-ARTL: compensation, time for academic pursuits, spousal and family support, and dislike of patient care conditions and environment. Two factors associated with lower WLB-ARTL were better leadership and periodic reviews addressing job satisfaction. Gender, URM, and physician status were not found to be significant. Similar to previous studies (Whittaker et al., n.d.), we found that WLB-ARTL at UNM SOM was associated with specific "work" and "life" factors. Faculty retention efforts should focus on "work" factors such as providing protected time for academic pursuits and improving patient care conditions, and "life" factors such as addressing compensation and supporting families.

Navigating parental leave as a leader in radiology: Commentary on challenges and strategies

Navigating parental leave can be challenging in all fields of medicine, but it can be especially challenging for leaders balancing clinical, research, and administrative duties. As women take on more leadership roles, we have the opportunity to better define the current challenges and identify potential strategies for navigating successful parental leave while balancing the demands of leadership. This manuscript provides a commentary on the challenges and strategies for navigating parental leave in leadership positions in radiology, an important topic for shaping how parental leave is both viewed and valued in the future. Specifically, we highlight challenges and strategies for administrative responsibilities, reporting personnel, emails, microaggressions, research, empowerment, and prioritization.

High Psychosocial Work Demands, Decreased Well-Being, and Perceived Well-Being Needs Within Veterinary Academia During the COVID-19 Pandemic

Higher psychosocial work demands in veterinary and academic professions are associated with decreased occupational, physical, and mental well-being. COVID-19 introduced far-reaching challenges that may have increased the psychosocial work demands for these populations, thereby impacting individual- and institutional-level well-being. Our objective was to investigate the psychosocial work demands, health and well-being, and perceived needs of faculty, staff, residents and interns at the Ontario Veterinary College, in Ontario, Canada, during COVID-19. A total of 157 respondents completed a questionnaire between November 2020 and January 2021, that included the Third Version of the Copenhagen Psychosocial Questionnaire (COPSOQ-III) and open-text questions on perceived needs for well-being. Results showed that COPSOQ-III dimensions of quantitative demands, recognition, sense of community, burnout, stress, and depressive symptoms, were significantly worse in our study population than the Canadian norm. Quantitative and emotional demands, health and well-being (including depressive symptoms, stress, cognitive stress, somatic stress, and burnout), and work-life conflict were also reported to have worsened since the COVID-19 restrictions for most respondents. Females and caregivers had higher odds of experiencing increased work demands, and decreased health and well-being, compared to males and non-caregivers. However, male caregivers experienced worsened supervisor relations, compared to female caregivers. Social capital also worsened for clinical and part-time employees, compared to full-time and non-clinical employees. Respondents identified increased workload support, community-building, recognition of employees' capacities and personal needs, flexible work schedules, and consistent communication, as strategies to increase well-being during COVID-19 and generally. Overall, our findings suggest that COVID-19 has increased occupational demands, work-life conflicts, and decreased well-being in veterinary academia. Institutional-level interventions are discussed and recommended to aid individual and institutional well-being.

Stemming the ‘Leaky Pipeline’: an investigation of the relationship between work–family conflict and women’s career progression in academic medicine

Background

Even though women outnumber men enrolled in medical school, making up 59% of entrants in the UK, they are significantly under-represented in academic medicine and senior positions. In the UK, 28.6% of academics overall are women. In the USA, while 51% of instructors are women, only 20% make it through the ‘leaky pipeline’ to become professors. One attributable factor is work–family conflict. The purpose of this study is to gain a deeper understanding of the relationship between work–family conflict and women’s career progression in academic medicine, and to provide a model to inform and change perceptions and practice in order to improve the ‘leaky pipeline’.

Methods

A systematic literature search was performed to identify qualitative studies which investigated this relationship. Studies were critically appraised, and data were analysed using thematic analysis. Themes identified in the data were used to develop a model to build on the understanding of this issue.

Findings

The findings of this research highlighted two main themes, one related to perceptions of gender (intrinsic or extrinsic), the way it impacts on work–family conflict and its relationship to women’s career progression. The second theme relates to structures which hinder or support women’s ability to have work–life balance. A model was developed that represents the inter-relationship between these factors.

Interpretation

Changes in both organisational culture and individuals’ perception in regard to gender roles, especially of those in leadership, are necessary to create an environment where the best talent in academic medicine is selected regardless of gender.

Workplace Flexibility for Sustainable Career Satisfaction: Case of Handling in the Aviation Sector in North Cyprus

The purpose of this research was to find out how workplace flexibility affects the employees’ flexibility in order to increase their career satisfaction while reducing their workplace stress with the mediating role of goal orientation. Employees need workplace flexibility to develop a better sustainable career. In doing so, the relationship between workplace flexibility and career satisfaction can be affected by two different factors. One of them is job stress, which can be a mediating factor, and the second is goal orientation, which in this study was considered as a moderator between two variables. For this research, a quantitative research method was applied, and a survey was distributed to 216 respondents, namely, everyone working in handling in a single aviation sector of North Cyprus, to obtain better and clearer results from the respondents. A pilot test was completed and data were collected face-to-face in order to observe the reaction of respondents to develop better results and reduce any mistakes that could arise by answering the questionnaire. Moreover, in order to test the reliability of questionnaires, a pilot test was completed with 14% of the respondents and the results were evaluated by examining Cronbach’s alpha. Job stress is a negative term; therefore, surprisingly, there was a positive correlation between workplace flexibility and job stress in the findings. The results were discussed and specifically analyzed with the literature review. Findings of the article clarify that workplace flexibility, along with goal orientation, is expected to positively contribute to the sustainable career satisfaction of employees in the handling sector. This research will make an important contribution to the existing literature pertaining to flexible arrangements in the workplace, sustainable career satisfaction, job stress, and goal orientation, and will contribute to further theories in this field.

Job satisfaction and intention to quit: A bibliometric review of work-family conflict and research agenda

This paper, for the first time, performs a bibliometric review on work-family conflict focusing on job satisfaction and intention to quit since the inception of this concept in 1994. For analysis and graphical presentation, bibliometrix package in R software and VOSviewer software are used. Total 146 documents from Scopus database are examined in this study. The results from the analysis reveal that the number of publications on work-family conflict is recently in an ascending growth that can be characterized by low productivity, low average citations per document and rising collaboration among authors. The growth of work-family conflict literature began to increase from 2003 and the International Journal of Human Resource Management and Journal of Vocational Behaviour played significant roles. Future research areas have been identified from the results of thematic map, trend topics, bibliometric coupling, three-fields plot and co-occurrence network. It is revealed from development of topics in this literature that pay satisfaction, occupational differences, effects of burnout and organizational politics has potential literature gaps. In addition, the examination of highlighted theories and methods used in previous literature contributing in different industries shall be the propitious areas of future research apart from other research agenda as identified in this study.

Factors that Influence Work Family Conflict for Women Faculty

This article was migrated. The article was marked as recommended. Purpose: This study examined the interaction between work role overload, work-to-family conflict, and departmental/division culture conducive to women's academic success. Methods: All women assistant and associate professors eligible for promotion from the Departments of Family Medicine, Internal Medicine, and Pediatrics were invited to complete a validated web-based survey that measured work-to-family conflict, work hours, work role overload, and culture conducive to women's academic success ( Westring et al., 2012). Results: With 88 survey respondents, high work role overload was associated with increased levels of work-to-family conflict while those who reported a higher culture conducive to women's academic success reported less work-to-family conflict. Culture conducive to women's academic success did not moderate the impact of work demand on work-to-family conflict. Conclusions: While departmental/division culture was important, it was not sufficient to completely mitigate work-to-family conflict. Work demand appears to impact work-to-family conflict related to strain, in which women report being too stressed by work to focus on their family and their own health and wellness. Employers can greatly impact work culture by reducing the strain of work demands that interfere with women pursuing promotion, increase burnout, and contribute to women faculty deciding to work part-time.

From Stigma to Validation: A Qualitative Assessment of a Novel National Program to Improve Retention of Physician-Scientists with Caregiving Responsibilities

Background: Research is needed to improve understanding of work-life integration issues in academic medicine and to guide the implementation of the Doris Duke Charitable Foundation's Fund to Retain Clinical Scientists (FRCS), a national initiative offering financial support to physician-scientists facing caregiving challenges. Materials and Methods: In 2018, as part of a prospective program evaluation, the authors conducted a qualitative study to examine FRCS program participants' initial impressions, solicit descriptions of their career and caregiving experiences, and inquire how such factors might influence their professional advancement. The authors invited all 33 awardees who had been granted FRCS funding in the first year of the program to participate in the study, of whom 28 agreed to complete an interview. Analysts evaluated de-identified transcripts and explicated the data using a thematic analysis approach. Results: While participants described aspects of a culture that harbor stigma against caregivers and impede satisfactory work-life integration, they also perceived an optimistic cultural shift taking place as a result of programs like the FRCS. Their comments indicated that the FRCS has the potential to influence culture if institutional leadership simultaneously fosters a community that validates individuals both as caregivers and as scientists. Conclusions: Insights garnered from this qualitative study suggest that there is a pressing need for institutional leaders to implement programs that can foster awareness and normalization of caregiving challenges. In addition to providing funding and other tangible resources, interventions should strive to reinforce a broader culture that affirms the presence of work-life integration challenges and openly embraces solutions.

The Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973-2011

BACKGROUND

To ensure a next generation of female leaders in academia, we need to understand challenges they face and factors that enable fellowship-prepared women to thrive. We surveyed woman graduates of the Robert Wood Johnson Clinical Scholars Program (CSP) from 1976 to 2011 regarding their experiences, insights, and advice to women entering the field.

METHODS

We surveyed every CSP woman graduate through 2012 (n = 360) by email and post. The survey, 12 prompts requiring open text responses, explored current work situation, personal definitions of success, job negotiations, career regrets, feelings about work, and advice for others. Four independent reviewers read overlapping subsets of the de-identified data, iteratively created coding categories, and defined and refined emergent themes.

RESULTS

Of the 360 cohort, 108 (30%) responded. The mean age of respondents was 45 (range 32 to 65), 85% are partnered, and 87% have children (average number of children 2.15, range 1 to 5). We identified 11 major code categories and conducted a thematic analysis. Factors common to very satisfied respondents include personally meaningful work, schedule flexibility, spousal support, and collaborative team research. Managing professional-personal balance depended on career stage, clinical specialty, and children's age. Unique to women who completed the CSP prior to 1995 were descriptions of "atypical" paths with career transitions motivated by discord between work and personal ambitions and the emphasis on the importance of maintaining relevance and remaining open to opportunities in later life.

CONCLUSIONS

Women CSP graduates who stayed in academic medicine are proud to have pursued meaningful work despite challenges and uncertain futures. They thrived by remaining flexible and managing change while remaining true to their values. We likely captured the voices of long-term survivors in academic medicine. Although transferability of these findings is uncertain, these voices add to the national discussion about retaining clinical researchers and keeping women academics productive and engaged.

A Summary Report from the Research Partnership on Women in Science Careers

BACKGROUND

In response to the landmark report "Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering," the NIH Office of Research on Women's Health issued a request for applications that funded 14 R01 grants to investigate causal factors to career success for women in STEM. Following completion of the 4-year grants, the grant PIs formed a grassroots collaborative, the Research Partnership on Women in Science Careers.

OBJECTIVE

To summarize the work of the Research Partnership, which resulted in over 100 publications.

METHODS

We developed six themes to organize the publications, with a "Best Practices" for each theme at the end of each section: Barriers to Career Advancement; Mentoring, Coaching, and Sponsorship; Career Flexibility and Work-Life Balance; Pathways to Leadership; Compensation Equity; and Advocating for Change and Stakeholder Engagement.

RESULTS

Women still contend with sexual harassment, stereotype threat, a disproportionate burden of family responsibilities, a lack of parity in compensation and resource allocation, and implicit bias. Strategies to address these barriers using the Bronfenbrenner ecological model at the individual, interpersonal, institutional, academic community, and policy levels include effective mentoring and coaching, having a strong publication record, addressing prescriptive gender norms, positive counter-stereotype imaging, career development training, networking, and external career programs such as the AAMC Early and Mid-Career Programs and Executive Leadership in Academic Medicine (ELAM).

CONCLUSIONS

Cultural transformation is needed to address the barriers to career advancement for women. Implementing the best practices noted of the work of the Research Partnership can help to achieve this goal.

Organizational factors affecting physician well-being

Purpose of review

Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic.

Recent findings

Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources.

Summary

Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.

Faculty Equity, Diversity, Culture and Climate Change in Academic Medicine: A Longitudinal Study

There is a national call for academic medicine to use evidence-based initiatives to improve its culture and climate. The authors report data-driven policy and programmatic interventions that were associated with increased faculty diversity, equity, respectful behavior and improved faculty climate, at UC San Diego Health Sciences.

METHODS

Based on demographic and survey data, interventions were designed to improve the climate between 2005 and 2015. Interventions included routine measuring and dissemination of demographic data, changes and dissemination of policy and procedures, and new and improved faculty development programming. Impact was measured using demographic data over time, salary equity studies, and school-wide climate surveys in 2005, 2011, and 2015. Specific outcomes included measures of diversity, salary equity, behavior, and climate.

RESULTS

Over the ten-year period, the proportion of women increased from 16% to 23% of tenure/tenure-track faculty and 31%-40% of all faculty. Underrepresented minority faculty increased from less than 1%-7% of tenure/tenure-track faculty and from 5% to 8% of all faculty. While women continued to be paid less than men, the adjusted difference dropped from 23% to 12%. Reports of inappropriate behavior by faculty decreased significantly, while satisfaction and knowledge about institutional mentoring and resources improved.

CONCLUSION

Multiple interventions including new faculty development programs, changes in policy, and measuring demographics/climate supported diverse faculty recruitment, enhanced a culture of respect and improved faculty morale. Cultural changes in policy, periodic faculty data collection with dissemination, and increased faculty development, improve the climate in academic medicine.

Papanicolaou Address: Why the next generation should take this journey and overcome constraint

Cytopathology is experiencing many forces that are changing and constraining current practice, including the need for cost efficiencies, new technologies, expectations for higher quality and faster turnaround time, and a diminishing workforce. Two "hot topics" that will have considerable influence on the changes in the future practice of cytopathology are artificial intelligence and optimization of cervical screening intervals and methods. The future growth and success of the cytopathology subspecialty will require using constraint as a catalyst to achieve transformative solutions, as well as an optimistic "we can if…" entrepreneurial attitude. Success will also require living the field's traditions and values: mentorship, sponsorship, innovation and creativity, a willingness to assume new roles, and the ability to network and support career journeys through active participation in a professional society.