In December 2020, almost a year into the COVID-19 pandemic, the United States lost 140,000 jobs, and all of them were held by women. The COVID-19 pandemic has brought unrivaled and unprecedented challenges, and the damage done to gender equity in the workplace has been pervasive, and physicians and other health care workers have not been spared.
The pandemic has dramatically reshaped physicians’ workloads and priorities, time utilization, and responsibilities both at and outside of work. Physicians have had to create and cobble together ways to care for their families while also keeping them safe. And like the rest of the country, this public health crisis has also added additional stress on home life due to virtual schooling for children, constrained resources for childcare, and other risk mitigation strategies. As the pandemic continues to rage and we enter a new calendar year, physicians and other health care workers continue to face exhaustion, burnout, and ongoing disruptions to careers and personal lives.
Early data showed that the pandemic was disproportionately negatively affecting working mothers, including women physicians. Some tangible and objective disparities became obvious early on, including (but not limited to) a decrease in publications and more at-home responsibilities, including home-schooling responsibilities. As the pandemic continues, women are disproportionately affected by its economic impact, professional disruptions, and ongoing at-home responsibilities.
Even prior to the pandemic, women faced an uphill struggle, including paying the “mommy tax” in academic medicine. Women were 24 percent less likely to be promoted than their male counterparts. Structural sexism already existed in medicine, and the challenges of the pandemic raise concerns about the exacerbation of gender-based inequities in medicine, delays in progress towards gender equity in medicine, and the potential for “a lost generation of women falling off the path” as well as reduce work hours or leave medicine altogether.
As women in academic medicine, we know first hand what it is like to balance clinical responsibilities, non-clinical responsibilities such as leadership roles, academic productivity expectations, and personal lives, including families with young children before the onset of the COVID-19 pandemic. In order to ensure the “she-cession” is prevented in academic medicine, it is essential to be intentional in creative and novel strategies to account for the barriers faced due to the ongoing pandemic.
In two recent articles published in the Proceedings of the National Academy of Sciences and the Journal of Hospital Medicine, the three of us, along with two male allies, propose one such solution for academic medicine: ensure that pivots, novel contributions, and academic disruptions be captured on the professional CV. The CV is the currency used for promotion and tenure in our academic health centers. However, the CV is often constrained by a linear trajectory to explain one’s academic achievements through the limited lens of a chronological list of publications, grants, or leadership opportunities. Unfortunately, this strategy may not work for pandemic time, when many academic physicians have been redeployed, changed roles, or had to step back for a variety of reasons. Instead of being punished for not being on a linear trajectory, the “COVID-19 Curriculum Vitae Matrix” enables novel contributions during the pandemic to be accounted for, while also providing an opportunity for disclosure of any academic disruptions.
The matrix’s value extends far beyond gender binary women in medicine. In addition to the “mommy tax,” the “minority tax” is pervasive in medicine. The matrix adds to our ability to support minority colleagues in medicine who have faced the “second pandemic” of structural racism.
Additionally, faculty with more clinical time (compared to research/academic time) were more likely to be disparaged in the promotion process. Those spending more time on the clinical frontlines before the pandemic might be more likely to spend more time on the clinical frontlines during the pandemic, and the matrix facilitates recognition of clinical work during the pandemic.
In order to be successful, the matrix requires institutional buy-in. For decades, publication volume and quality, often as measured by the number of subsequent citations, serve as the bastion of promotion and tenure pathways in academia. Prior to the pandemic, there were signs that promotion benchmarks were being reconsidered and reimagined, for example, with the expanded acceptance of alternative research metrics and social media use for professional purposes. This pandemic must result in additional conversation about what defines meaningful and relevant retention and promotion criteria. While the matrix was created to promote equity, it serves a greater purpose of opening a dialogue for intentional changes needed to ensure a more equitable future in the health care space.
Many colleagues in medicine already talk about medicine never going back to its state pre-COVID-19 – be it telehealth for patients, new flexibility to work/life scheduling, or a new acceptance of telecommuting outside of direct patient care. There has been too much suffering as a result of the COVID-19 pandemic and stressors of 2020 to progress through 2021 and beyond without lessons learned. New recognition of the need to broaden the definition of what “counts” in careers, be it in health care or beyond, along with a means to articulate that, must be a lasting outcome of our nation’s response to the pandemic if we want to avoid losing more of our best and brightest in these fields.
Avital O’Glasser is an internal medicine physician and can be reached on Twitter @aoglasser. Vineet Arora is an internal medicine physician and can be reached on Twitter @FutureDocs. Shikha Jain is a hematology-oncology physician and can be reached on Twitter @ShikhaJainMD.
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