When I was a medical student, I did not for one second imagine I would pursue a career in academic medicine – I hated research! However, following an intercalated BSc, I caught the bug.

I spent the first few years as a junior doctor focusing on gaining clinical competencies and obtaining MRCP, before embarking on a PhD as an MRC Clinical Research Training Fellow. I’m currently an academic clinical lecturer (ACL), spending 50% of my time in specialty training, and 50% protected for research.

A BALANCING ACT

I love my job, and I believe the ability to combine research and clinical training is far more rewarding and satisfying than a purely clinical post. It can, however, be quite challenging. It is difficult to juggle the demands of two institutions – the NHS and the university – whilst trying to fulfil the requirements needed to gain a certificate of completion of training. The addition of protected research prolongs specialty training; combined with two periods of maternity leave, I am a perpetual trainee!

Those who work less than full time (LTFT) find their years of specialty training heading into double figures. I am in a fortunate position to be able to work full time, as my husband and I have the financial means to afford a great nursery, and also benefit from supportive grandparents. Not everyone is so lucky – periods of maternity leave, coupled with LTFT working and childcare responsibilities, contribute to a gender pay gap among UK doctors of, on average, £10,000.¹ Given that women make up more than half of the workforce in medical specialties (including endocrinology), this is pretty shocking.

WEIGHING UP THE PROS AND CONS

Although balancing a career in academic medicine with the pressures of parenthood can be tricky, there are many benefits. I am fortunate to be working in a specialty I am passionate about, and to be able to concentrate on my research interests. Having no fixed clinical commitments (during research blocks) offers flexibility with childcare and frees up precious weekends. There are also options to work from home when writing grant applications or manuscripts (although the chances of getting any work done with small children around are slim!).

There are some downsides. You never truly switch off from research, and very frequently have to work during your ‘free’ evenings and weekends. Opportunities to spend time in other labs (particularly abroad) – often viewed as essential to success in academia – are also diminished, due to the logistics of arranging childcare, taking children out of school, etc.

THE FEMALE ‘DROP OFF’

I’m working towards applying for clinician scientist awards. Whilst women make up a little over half of clinical predoctoral fellowship awardees, there is a decline in the proportion of female fellowship holders at later career stages. This is particularly the case at the stage of establishing research independence and in more senior roles (37% of intermediate fellowships and just 12% of senior fellowships were awarded to females).² Data from the National Institute for Health Research (NIHR) reveal approximately 50% of predoctoral academic clinical fellows are female, dropping to 34% for ACLs.³

So why is there such a drop off? For clinicians, the academic route is often a risky one, with fixed term contracts and the constant need to secure funding. The lure of a substantive NHS consultant post, with its job security, is often too strong. A recent report highlighting barriers to academic career progression found female participants were more likely to cite family commitments as a barrier to advancement.⁴

TRAVERSING THE HURDLES

There are other hurdles faced by (predominantly) women when pursuing a clinical academic career. For example, doctors training in academic medicine often cannot transfer benefits that are dependent upon a minimum duration of service within either NHS or university employers – the most obvious benefit being parental leave. Consequently, many people suffer a financial penalty for working between the two institutions.

Thankfully, my employer changed its maternity entitlement policy just before my maternity leave. It is, however, one of only a few universities in the country to recognise previous NHS employment. Conversely, some NHS Trusts don’t recognise previous university employment. As the majority of parental leave is taken by women, this constitutes a form of gender discrimination.

Another issue frequently faced by female academics is that research often grinds to a halt during maternity leave. There may not be anyone to carry out experiments in your absence and, whilst extensions may be granted by funding bodies, funds are often in abeyance for the duration of leave, including essential costs such as animal maintenance and publication fees (researchers still publish during maternity leave!). Certain research (such as clinical trials) cannot be halted, leaving some researchers no alternative but to work during leave.

My research pretty much came to a standstill during maternity leave. And, as researchers know, a lot can happen in a few months! Whilst most funding body review panels take into account career breaks or flexible working, can I be as competitive as someone who hasn’t had any career gaps?

LOOKING TO THE FUTURE

The future is beginning to look positive for women in academic medicine. Efforts are in place to advance gender equality within academia, such as implementation of the Athena SWAN Charter in Higher Education Institutions. The Academy of Medical Sciences’ SUSTAIN programme provides training and support to female researchers in developing career potential.

Within endocrinology, we have a great number of inspirational female clinical academic role models. We should be as confident and assertive as our male counterparts in pursuing a career in academic medicine, as the benefits far outweigh the challenges!

Rachel Jennings, NIHR Academic Clinical Lecturer in Endocrinology and Diabetes, University of Manchester, and Manchester University NHS Foundation Trust

REFERENCES

1. Financial Times 2018 https://www.ft.com/content/29fb6794-6035-11e8-9334-2218e7146b04.
2. Medical Research Council 2017 UK-Wide Survey of Clinical and Health Research Fellowships https://mrc.ukri.org/publications/browse/clinical-and-health-research-fellowships-survey-2017.
3. National Institute for Health Research 2017 Ten Years On: Adapting and Evolving to New Challenges in Developing Tomorrow’s Health Research Leaders www.nihr.ac.uk/our-research-community/documents/TCC-NIHR-Strategic-Review-of-Training-2017.pdf.
4. Medical Research Council 2015 A Cross-Funder Review of Early-Career Clinical Academics: Enablers and Barriers to Progression www.mrc.ukri.org/documents/pdf/review-of-early-career-clinical-academics.