Flexible options help balance career, family needs

Medical school leaders are spreading the word that faculty can seek modified schedules

Steve Gladfelter/VAS

Deirdre Lyell checks her e-mail from home while her daughter, Isabella, has a snack. Lyell works 80-percent time and is one of the medical school faculty members who has opted for a shorter workweek to balance family and work needs.

While looking for a job in the early 1990s, Kay Daniels, MD, faced two clear paths: work full time or quit to raise her two young children. Her goal was to keep up her medical practice at half-time hours, but it was tough to find such a position in obstetrics and gynecology, a field with high patient-care demands.

Offered a spot at a hospital residency program, she refused it when the chief insisted she work full time. "They said I'd be a bad role model for my residents if I worked part time," she recalled.

Then she met Maurice Druzin, MD, associate chair of obstetrics and gynecology at the School of Medicine. With his support, she landed a job with reduced hours at the school in 1994, allowing her to spend more time with her two children, then ages 7 and 12. Daniels is now a clinical associate professor who works 80 to 90 percent time, up from 50 percent when her kids were young.

"It's been of benefit to me, but it's also been of benefit to Stanford—now they've got more of a commitment from me," she said.

Medical school leaders point to the ob/gyn program as an example of what they'd like to see in other departments to help more faculty members arrange schedules that fit their work and family needs. Particular emphasis is being placed on faculty in tenure-track (known as the University Tenure Line) and clinician-investigator track (known as the Medical Center Line) positions, who have been far less likely to pursue flexible work arrangements, such as reduced hours, leaves of absence and an extended tenure clock.

Complicated juggling actThe need for such flexibility is clear: A typical academic physician's schedule is packed with seeing patients, teaching students and residents, being on call and, in many cases, pursuing academic research. Given these demands, some struggle to keep up with work and still maintain a family life.

Daniels, like the majority of part-time physicians at the school, falls into a third group: the clinician-educators. These staff members do not gain tenure or "permanent" positions; their jobs are renewed for specified terms. Their key roles are to see patients and to teach. Druzin said that in ob/gyn, there are up to nine part-time clinician-educators who balance their hours as a group—so if one works 30 percent, others cover the rest of the time, and so on, ensuring that patients are taken care of.

Today, about 210 of the school's 400 clinician-educators work reduced hours, although not all such arrangements are related to work-life issues.

While these part-time schedules have caught on among clinician-educators, faculty members with research obligations have been hesitant to change their hours. Fewer than 20 of the school's 784 tenure-track, non-tenure-track or Medical Center Line faculty have less than full-time schedules.

Deirdre Lyell, MD, an assistant professor in obstetrics and gynecology, is one of the handful of MCL faculty members with a shorter workweek. Lyell's 80-percent schedule allows her to take her children—ages 22 months, 4 and 6—to doctor's appointments or on field trips, or to volunteer in their classrooms. "For me, it provides a better work-life balance," she said.

To keep up with her clinical responsibilities, she leaves her pager and phone on during her day off, handling quick questions and reducing the burden on others. Lyell maintains a full research schedule in maternal-fetal medicine, and said she does not feel that her reduced hours will affect any future promotion decision. "I think I'm actually more productive this way—I'm very efficient in my work," she said.

Ticking of the promotion clockBut although Stanford has had flexible work policies on its books for years, many academic physicians are reluctant to downshift, said vice dean and senior associate dean for academic affairs David Stevenson, MD. That is especially true in tenure-line jobs, where faculty can hear the "up-or-out" promotion clock ticking. "It's rare by choice," he said, explaining: "The culture is such that they don't think it will reflect well on them or they think they will get behind."

Senior associate dean for diversity and leadership Hannah Valantine, MD, adds that many medical faculty fear "leaving colleagues in the lurch" if they reduce their hours.

To combat these notions, Stevenson and Valantine have thus far organized four sessions with faculty to educate them about the processes surrounding promotion. "I want to do everything I can to make sure people exercise the flexibility we have in our policies, and that they understand they won't be penalized for that," Stevenson said.

In a recent issue of his newsletter, Dean Philip Pizzo, MD, outlined flexibility options for faculty members and urged departments to "develop a more supportive culture that fosters different trajectories for career development."

Customizing a planWhat steps should be taken by medical school faculty interested in reducing their hours, taking a leave or gaining an extension? Contacting Stevenson's office is a good first step. He can customize a plan to improve work-life balance and work directly with the dean and the provost to gain approval.

"I'm looking for everything I can possibly do to retain bright people. It's a waste of an investment not to try to retain them," said Stevenson.

So far, the primary interest in flexible schedules has come from women with young families who are often at the peak of family responsibilities at the same time they are establishing their careers.

"Young women who are well-trained and who have everything they need to be successful doctors and clinicians find themselves in a no-win situation, where they cannot give due diligence to their family needs by working full time," said Druzin, a professor of gynecology and obstetrics who has been at Stanford since 1991. That dilemma prompted him to offer flexible schedules, taking on Daniels and other part-timers since.

Daniels said she is glad that physicians no longer have to choose between working full-time hours and quitting altogether. Today, when she talks with doctors thinking of leaving their practices while their children are young, she advises them to consider reducing their hours instead.

"Things change really fast" in medicine, she said. "If you can just stay on that treadmill at a slower speed, it really behooves you."

Meredith Alexander Kunz is a freelance writer.