Antidotes to Keeping Secrets When the Going Gets Rough
We recognize that things happen to everyone—a health crisis in the family, financial dilemmas, ongoing caregiving needs, or extraordinarily stressful life events. Recent data from a survey of early career faculty document that most face a significant caregiving challenge or stressful event each year. Partners are diagnosed with cancer, parents are in hospice, and children are hospitalized or have chronic debilitating conditions. Our family members and friends have crises, pets die, we experience physical violence or verbal abuse, marital relationships dissolve, and natural disasters shock us.
We are fully human in all its wonderful, messy joy and sorrow. But not at work. At work, faculty avoid disclosing challenges even when they confront crises that could disrupt or redefine their career paths. As part of planning and implementing a site receiving funds from the Doris Duke Charitable Foundation to assist faculty in research-dominant careers in keeping their work on track during extraprofessional caregiving challenges, we’ve had the chance to hear many personal stories, to host focus groups, and to identify these themes underlying why faculty are reticent to disclose to others when the going gets tough.
Striving and Equity: Both mentors and early career faculty note that researchers are accustomed to working hard and pressing on against long odds. We seek to avoid any possible perception of being weak or having poor judgement. We want to reinforce our identities as hard workers who are thriving. Faculty report these views even while acknowledging that crises are not caused by weakness and that seeing crises in such a way is “blaming the victim.” They emphasize that academic scientists “have earned what we have” and “don’t want favors.” The broader theme includes a desire to reject resources to which peers and role models would not have access if those resources existed solely because of life circumstances. “Lots of people have it rough; it could be worse.”
Fear of Pity: Individuals and discussants describe discomfort with receiving empathy or sympathy from others, especially in the work place. As scientists we are aware of the discordance of being in a “caring profession” and rejecting the care of others. Yet we want to avoid a perception of weakness or need and want to avoid favors. But most of all we want to avoid loss of privacy in tandem with “people feeling sorry for them.” We worry we won’t be able to distinguish between ordinary kindness and adaptability from peers, for instance in changing call schedules or trading seminar dates, and people “treating me with kid gloves.”
Another Shoe: This theme is rooted in the belief that “another shoe could drop.” So we “hold on to requests for help in case it gets worse.” Discussants joke about common cultural references like “bad things come in threes” and “this is only the first strike, I’m not out of the game yet.” In reflecting about the thought process during challenging circumstances when problems began to multiply (e.g. recent divorce, followed by hospitalization of a child, or parent in hospice care out of state, followed by partner’s diagnosis of progressive autoimmune disease), many note a sense of dread about what comes next. Counter-intuitively, greater pressures make this instinct to wait to ask for help even stronger.
What antidotes can we pursue as peers, mentors, and institutions?
Normative Data: We need to collect and communicate local and national data that demonstrates that extraprofessional caregiving demands are common. At our institution, we’ve documented that more than half of early career faculty endorsed experienced one or more substantial caregiving challenges in the prior year. This included 23% (35 of 152) having a child or adult in the household hospitalized in the prior year and 24% (36 of 152) being responsible for healthcare needs for a child or adult in the household, or for coordinating elder care, assisted living, or hospice care. Stressful life events also affected the majority at the rate of almost two events per year on average.
These results indicate we should expect the majority of early career faculty researchers, both women and men, will experience substantial caregiving challenges and stressful life events in any given year. These are not rare occurrences. The data also imply that over the course of early career life all faculty will face multiple crises. They need to be aware of this fact to destigmatize being in such a situation and to encourage basic preparation to face unknown forms of challenges that are inevitable. This includes talking with family and friends about how they can marshal support for each other should the need arise, planning with spouse or partner about potential approaches, and building a firm financial foundation to weather the financial pressures that attend most caregiving crises.
Making Faculty Assistance Program Approachable: In the best of worlds, all new faculty would not only hear about faculty assistance resources in a PowerPoint presentation but would be scheduled to visit the program office and meet key personnel as part of their faculty orientation. With proper assurances of confidentiality and attention to voluntary engagement these programs are resource hubs to reduce faculty burnout, provide career coaching, and refer those who could benefit from longer term counseling or support services. In screening our PARTNERs applicants in this setting we achieve multiple ends which include: affirming the power of addressing a need, reducing the concerns reflected in the themes outlined above for confidentiality, and connecting all who present with a broader array of resources. Faculty support services can also be safe ground for providing connections to healthcare concierge resources, legal support referrals, or community services ranging from bonded transportation services during a crises to ratings of eldercare services. As an example, financial distress attendants with crises or causing crises were sufficiently common in our work that faculty assistance now provides access to Smart Money training and coaching to help faculty restore financial stability.
Institutional Financial Supports for Helping Hands: Institutions, including the 10 participating in the Doris Duke Fund for Retaining Physician Researchers, consistently report the value of addressing such needs. Practical supports in the workplace in the form of additional technical support in the lab, research nurse effort to consent study participants, medical editors to polish a grant or buy-out of clinical time are promising options prioritized by awardees. Further assistance with household demands (food delivery, cleaning, transportation, consultants for organization or finances) is also appreciated.
Exclusive of the personal investments in education, training, and delayed gratification that attend faculty life, institutions invest substantial tangible resources in recruitment, space, start-up funding, taking on research positions, and mentoring early career faculty. We select faculty because we recognize their skills, intellectual qualities, and high probability of future contributions to building knowledge and enriching the work of the institution. Nonetheless a single stressful life event dramatically increases consideration of leaving academic life. Our local survey found such an event increased relative risk of “thinking about leaving academics” by 70% (RR: 1.7; 95% CI: 1.2, 2.4). We assume all institutions would like to prevent departures. Small investments in the short term can protect these investments and, more importantly, demonstrate that we are committed to a holistic vision for success of our faculty.
Mentors and Leaders Disclosing Experience: Our highest responsibility is for senior faculty who mentor and lead to share their experiences of caregiving crises and other circumstances that required regrouping to weather a storm. If we always portray smooth sailing and sunny weather in our career presentations and personal conversations we are doing a disservice. Indeed we are perpetuating the lie that those who succeed have everything in control, always. Life will happen, when possible we would do well to disclose what crises felt like, the concerns we worried over, our fear of pity or penalty, and what we wish we had known. Then we must work to assure safeguards are in place to recognize normative data and provide real supports to retain our faculty and maintain or restore their career success. That’s how academic research will flourish. It requires our action.
Additional Insights into the Needs of Academic Research Faculty
Hartmann KE, Sundermann AC, Helton R, Bird H, Wood A. The Scope of Extra-Professional Caregiving Challenges Among Early Career Faculty: Findings From a University Medical Center. Academic Medicine. 2018; Epub ahead of print. PMID: 29596083
Jagsi R, Jones RD, Griffith KA, Brady KT, Brown AJ, Davis RD, Drake AF, Ford D, Fraser VJ, Hartmann KE, Hochman JS, Girdler S, Libby AM, Mangurian C, Regensteiner JG, Yonkers K, Escobar-Alvarez S, Myers ER. An Innovative Program to Support Gender Equity and Success in Academic Medicine: Early Experiences From the Doris Duke Charitable Foundation’s Fund to Retain Clinical Scientists. Ann Intern Med. 2018; Epub ahead of print. PMID: 29554690
Munson M, Weisz O, Masur S. Juggling on the ladder: Institutional awards help faculty overcome early-mid career obstacles.American Society of Cell Biology Newsletter. 2014; 37:9.
Jagsi R, Butterton JR, Starr R, Tarbell NJ. A targeted intervention for the career development of women in academic medicine. Arch Intern Med. 2007;167:343–345.
Beckett L, Nettiksimmons J, Howell LP, Villablanca AC. Do family responsibilities and a clinical versus research faculty position affect satisfaction with career and work-life balance for medical school faculty? J Womens Health. 2015;24:471–480.