The Scope of Extraprofessional Caregiving Challenges Among Early Career Faculty: Findings From a University Medical Center

Career development in pragmatic clinical trials to improve care for people living with dementia

The growing number of people living with dementia (PLWD) requires a coordinated clinical response to deliver pragmatic, evidence-based interventions in frontline care settings. However, infrastructure to support such a response is lacking. Moreover, there are too few researchers conducting rigorous embedded pragmatic clinical trials (ePCTs) to make the vision of high quality, widely accessible dementia care a reality. National Institute on Aging (NIA) Imbedded Pragmatic Alzheimer's disease and Related Dementias Clinical Trials (IMPACT) Collaboratory seeks to improve the pipeline of early career researchers qualified to lead ePCTs by funding career development awards. Even with support from the Collaboratory, awardees face practical and methodological challenges to success, recently exacerbated by the COVID-19 pandemic. We first describe the training opportunities and support network for the IMPACT CDA recipients. This report then describes the unique career development challenges faced by early-career researchers involved in ePCTs for dementia care. Topics addressed include challenges in establishing a laboratory, academic promotion, mentoring and professional development, and work-life balance. Concrete suggestions to address these challenges are offered for early-career investigators, their mentors, and their supporting institutions. While some of these challenges are faced by researchers in other fields, this report seeks to provide a roadmap for expanding the work of the IMPACT Collaboratory and initiating future efforts to recruit, train, and retain talented early-career researchers involved in ePCTs for dementia care.

Informal Caregiving Among Faculty at a Large Academic Health Sciences University in the United States: an Opportunity for Policy Changes

OBJECTIVE

This article aims to determine the prevalence of caregiving among faculty at a large academic health sciences institution, to examine the effect of gender and other demographic and professional covariates on caregiving status, and to explore caregiver-generated policy recommendations.

METHOD

A cross-sectional, mixed-methods survey was collected from June through August 2018. Participants were faculty within one of the institution's health professional schools (dentistry, medicine, nursing, or pharmacy) receiving at least 50% salary from the institution. In addition to demographic information, we collected academic series and rank, and assessed association between covariates on caregiving status using logistic regression. We analyzed open-ended responses using thematic analysis to identify themes in caregiver barriers and policy suggestions.

RESULTS

Among 657 eligible respondents, 11.4% were informal caregivers. Women were more likely to be caregivers than men (aOR 2.53, 95% CI: 1.40, 4.78), as were older faculty. Caregivers identified unsupportive climate or unrealistic work expectations, concern about career advancement, insufficient information about policies, and concern about colleague burden as barriers to support. Suggestions for workplace support included improved leave policies, increased flexibility, caregiver resource support, improved clarity and dissemination of policy information, and financial support.

CONCLUSIONS

Women faculty are more likely to be informal caregivers, exacerbating disparities within academic medicine for promotion and retention among women faculty. Institutions might include caregiving status in annual burnout surveys to guide the development of structural support and policies for extension of family leave beyond childbearing (or catastrophic leave), flexibility in work hours, and subsidized eldercare services.

Association of publication record and independent NIH funding

Background

Publications may be a modifiable factor toward research project grant (RPG) funding decisions, the objective was to determine the association of publication record with later RPG receipt.

Methods

This was a retrospective cohort study of recipients of K01, K08, or K23 US career development awards (CDAs) starting from 2000–2015. Exposures were CDA awardees’ first-, middle-, and last-author publication counts, and the quartile of awardees’ highest and mean publication impact factors. The independent association of each exposure with time to RPG (R01 or equivalent) was determined using a Cox model, after adjustment for CDA type, awardee change in institution, and institutional CDA count. The proportion of CDA recipients with later independent funding was also determined by publication count.

Results

Among 6744 CDA awardees, 3943 obtained an RPG. The median time to RPG was 5.6 years (interquartile range 4.2–7.5). The number of first-authorships was associated with a shorter time to RPG (1–4 versus 0: hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.10–1.36; 5–9: 1.59, 95% CI 1.40–1.79; 10–24: 1.78, 95% CI 1.54–2.07; 25+: 2.40, 95% CI 1.61–3.56). Last-authorships were associated with a shorter time to RPG (1–4 versus 0: HR 1.99, 95% CI 1.83–2.16; 5–9: 2.72, 95% CI 2.45–3.03; 10–24: 3.17, 95% CI 2.78–3.62; 25+: 3.12, 95% CI 2.17–4.50). Higher maximum impact factor was associated with a shorter time to RPG (Q2 versus lowest: HR 1.28, 95% CI 1.12–1.46; Q3: 1.45, 95% CI 1.24–1.70; Q4: 1.67, 95% CI 1.39–2.02). Mean impact factor and middle-authorships were not associated with time to RPG. Among 687 CDAs with zero associated first- or last-authorships, 158 (23%) achieved later RPG funding. Among those with at least 10 total first- or last-authorships, 1288/1554 (83%) obtained a later RPG.

Conclusions

A higher number and impact of publications was associated with later independent funding.

A lost generation? The impact of the COVID-19 pandemic on early career ASD researchers

The COVID-19 pandemic has disrupted autism research and services. Early career researchers (ECRs) are particularly vulnerable to the impact of the pandemic on job security and career development. The goal of this study was to capture the challenges ECRs are facing during the pandemic and the supports that are needed for career development and research. ECRs were invited to complete an online survey that focused on four major areas; the impact of COVID-19 on their research; changes in productivity due to COVID-19; changes to training due to COVID-19; and current mental health. 150 ECRs were eligible and provided sufficient data for inclusion. All but one ECRs reported their research had been negatively impacted by the pandemic. Reductions in productivity were reported by 85% of ECRs. The biggest impacts included recruitment of participants, increased needs at home and personal mental health. ECRs reported a 3-fold increase in burnout, as well as increased anxiety. ECR supports, such as funding, flexibility, and tenure extensions, are required to ensure ASD research does not suffer from a "lost generation" of researchers. LAY SUMMARY: The COVID-19 pandemic has had negative impacts on research around the world. Loss of productivity impedes autism research discoveries. However, researchers in the earliest phases of their career, specifically postdoctoral fellows through individuals in assistant professor (or equivalent) positions, are particularly vulnerable to long-lasting effects of pandemic-related disruptions which may limit their ability to continue as autism researchers. This survey highlights the needs of this group and identifies mechanisms by which these early career researchers may be supported in this time. This is critical to ensure the next generation of ASD researchers and clinician scientists continue on the path to advancing understanding of autism in the decades to come.

Prevalence of caregiving and high caregiving strain among late-career medical school faculty members: workforce, policy, and faculty development implications

BACKGROUND

Nearly one-third of medical school faculty members are age 55 + . As our population ages, the prevalence of family caregiving is increasing, yet we know very little about the caregiving experiences of aging faculty members in academic medicine. Faculty caregiving responsibilities coupled with projected physician shortages will likely impact the future academic medical workforce. We examined the prevalence of caregiving, concomitant caregiving strain, general well-being, and thoughts about retirement for medical school faculty members age 55 and older.

METHODS

We analyzed data from a survey of 2,126 full-time medical school faculty 55 + years of age conducted in 2017. Chi-square tests of independence and independent samples t-tests were used to examine statistical differences between subgroups.

RESULTS

Of the 5,204 faculty members invited to complete the parent survey, 40.8% participated (N = 2126). Most were male (1425; 67.2%), White (1841; 88.3%), and married/partnered (1803; 85.5%). The mean age was 62.3 years. Of this sample, 19.0% (n = 396) reported providing care on an on-going basis to a family member, friend, or neighbor with a chronic illness or disability, including 22.4% (n = 154) of the female respondents and 17.3% (n = 242) of the male respondents. Among the caregiving faculty members, 90.2% reported experiencing some or a lot of mental or emotional strain from caregiving. Caregivers gave lower ratings of health, social and emotional support, and quality of life, but greater comfort in religion or spirituality than non-caregivers. Both caregiving and non-caregiving faculty members estimated retiring from full-time employment at age 67.8, on average.

CONCLUSION

These data highlight caregiving responsibilities and significant concomitant mental or emotional strain of a significant proportion of U.S. medical schools' rapidly aging workforce. Human resource and faculty development leaders in academia should strategically invest in policies, programs, and resources to meet these growing workforce needs.