Transitioning to Academic Psychiatry while Maintaining Balance: Working Smarter, Not Harder

“Do not even bother talking to him . . . he just will not get it.” That was the advice given to me by a senior female faculty member when I sought her help finding a mentor—someone to guide me in my transition from private practitioner to academic researcher. This confidante was keenly aware that some faculty members would understand a nontraditional route to academic psychiatry and others would not. Some would welcome the opportunity to mentor me—a senior clinician and educator—in clinical research, while others would view this with as much enthusiasm as buying a “re-tread” (a pejorative term sometimes applied to those of us making midcareer changes). This commentary is primarily a personal account of my career path in psychiatry. From my experiences and interactions with dozens of residents and faculty, a number of insights have emerged regarding how to balance family responsibilities while developing an academic career. I hope that sharing these ideas will help readers with academic interests develop an individualized career-development strategy and provide program directors some suggestions for enhancing career-development opportunities within residency training. I came to academic psychiatry via a nontraditional path, but an interest in research has been evident in my entire medical career. Also, my commitment to raising a family has been equally strong. As a medical student and resident, I had no formal exposure to the topic of career development or work–family balance; however, what I absorbed informally made a significant impression. While in medical school, I worked on an epidemiologic study designed to detect risk factors for congenital cardiac malformations. My mentor was a female physician and full professor who, I noted, had never married or had children. During my psychiatry residency years, I saw more of the same: few female professors and only two married female physician full professors. Why does this disparity exist? Has the representation of women at medical schools changed since I completed residency? How can this gender-gap in academic medicine be further narrowed? How can male and female faculty better balance work and family? The most recent annual report (2007–2008) from the Association of American Medical Colleges (1) answers some of these questions. In its analysis of cohorts from 2002 and 2007, women represented 47% and 49% of enrolled medical students and 38% and 45% of residents and fellows, respectively. (Interestingly, between 1997 and 2007, psychiatry has shown the largest percentagepoint decrease [–3.3%] in female residents of any medical specialty.) As women progress from trainee to faculty status, their representation declines. In 2002 and 2007, 30% and 34% of all medical school faculty members were women. In 2007, women represented 40% of assistant professors, 29% of associate professors, and 17% of full professors. Thus, despite progress, a disproportionate number of female medical students fail to progress to residency, and an even greater number choose not to enter academic medicine. Those who do join a faculty are increasingly underrepresented in seniority. One explanation for this “leaky pipeline” is the continued lack of female role-models in senior academic positions. Another is the longstanding issue of balancing work and family (2). According to the American Association of University Professors, the ideal academic worker is one with few personal obligations (3). This model puts at a disadvantage those individuals who are unable to spend as Received October 7, 2009; revised December 10, 2009; accepted February 2, 2010. Dr. Chisolm is affiliated with the Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, Baltimore, M.D., Address correspondence to Dr. Margaret Chisolm, Johns Hopkins University School of Medicine, Department of Psychiatry & Behavioral Sciences, 5300 Alpha Commons Dr., Alpha Commons Building, 4th Floor, Baltimore, MD 21224. Mchisol1@jhmi.edu (e-mail). Copyright © 2011 Academic Psychiatry