The Many Facets of Career Flexibility in Academic Medicine: What Does It Mean to You?

work life balance

By: Lydia Pleotis Howell, MD, professor and chair, Department of Pathology and Laboratory Medicine, University of California, Davis Health, Sacramento, California.

What does “career flexibility” and “work-life balance” or “work-life integration” mean to you? When I bring these up to department chairs or academic health leaders at my (or other) school(s), I often get openly unenthusiastic responses such as “Don’t you know that we can’t afford to have faculty working less? We need more productivity than ever before!” This is despite the majority of medical schools—including those ranked in U.S. News and World Report’s top ten—all having adopted career flexibility policies to improve recruitment and retention by helping faculty better meet their work and family/personal responsibilities.1

But career flexibility does not mean working less. Flexibility, as defined by the Sloan Center for Work and Aging at Boston College, involves “making changes to when, where and how a person will work to better meet individual and business needs…. Flexibility should be mutually beneficial to both the employer and employee and result in superior outcomes [italics added].”2 Shared responsibility and accountability are therefore requirements—in other words, no entitlement.

The University of California Davis has had career flexibility policies (such as childbearing and family leaves, active service-modified duties, and “stop the tenure clock”) since 1988, but in our NIH-funded survey, we found only 6.7% of women and 0.0% of men in the School of Medicine officially used these policies.3 Faculty appear to self-censor their use, as one-third under age 50 reported wanting to use the policies but choosing not to make the request.4 Highest among the many reported barriers to use was concern about burdening colleagues and others’ (including department chairs’ or division chiefs’) perceptions that the policy user was not committed to his/her career or team. These barriers are more frequently reported by women, but increased for both genders after an educational intervention, indicating that raising awareness of policies also raises concern about “flexibility stigma.”4,5

The qualitative analysis of written comments from our survey provides unique and valuable insights into institutional culture and norms that depress use of flexibility policies and inhibit growth of a culture of flexibility.6 We identified several themes, including misinformation and myths about using these policies and a perception of an unsupportive local culture, as faculty expressed concern that using the policies could be damaging to their career, despite all faculty generations and genders anticipating the need to use them in the future and considering them to be important for career growth, recruitment, and retention. Another theme we identified was a rigid, inflexible professional/academic culture, as faculty reported an inability to diminish their pace or take family-related leave due to fears of falling behind or limiting future opportunities.5 Many of the concerns identified in these themes reflect “face-time bias” (a form of unconscious bias related to physically seeing/not seeing colleagues in the workplace) and a culture of “over-work” creating conflict between professional and personal identities, which also reflects conflict with gender-specific roles since gender differences in the reported barriers and comments were observed.5,6

Having worked part-time for 16 years of my academic career while raising my children, I can personally confirm these concerns are significant and real. I made every effort to make my 80% faculty appointment “invisible” to others, so I wouldn’t be perceived as being on the “mommy track” and not serious about my career. I took on extra duties, including some considered onerous by others to minimize any bias to having a “part-timer” on the faculty. The upside is I was able to be flexible about my time, create a buffer in my life, and minimize the stress associated with being a working mother, while still rising through the ranks to professor and serving in leadership roles.

Keeping talented faculty in academic medicine and nurturing them so they can succeed and give back is exactly why career flexibility policies exist. How can we help more faculty overcome barriers and conflicts related to accessing career flexibility policies so more can achieve career success in academic medicine? Increasing awareness through published studies3–6 is an important and effective approach to culture change. Identifying and raising the visibility of successful faculty who have used flexibility policies or had alternative work schedules or places is also important to normalize flexible career approaches and paths. Finally, revealing faculty struggles and the consequences of an inflexible culture6 to school leaders is important to change the flexibility stigma and reshape the next generation of physicians and scientists into a happier, healthier, and more resilient workforce.



  1. Bristol MN, Abbuhl S, Cappola AR, Sonnad SS. Work-life policies for faculty at the top ten medical schools. J Womens Health (Larchmt). 2008;17:1311–1320.
  2. Sloan Center for Work and Aging at Boston College. What Is Workplace Flexibility? Accessed July 13, 2017.
  3. Villablanca AC, Beckett L, Nettiksimmons J, Howell LP. Attitudes, awareness and use of family-friendly policies for career flexibility: An NIH-OWHR funded study to enhance women’s careers in biomedical science. J Womens Health (Larchmt). 2011; 20:1485–1496.
  4. Howell LP, Beckett LA, Nettiksimmons J, Villablanca AC. Generational and gender perspectives on career flexibility: Ensuring the faculty workforce of the future. Am J Med. 2012;125:719–728.
  5. Howell LP, Beckett LA, Villablanca AC. Expectations of the ideal worker and its influence on professional identity in academic medicine: Perspectives from a career flexibility educational intervention [published online ahead of print June 15, 2017]. Am J Med. doi:10.1016/j.amjmed.2017.06.002.
  6. Shauman K, Howell LP, Paterniti DA, Beckett LA, Villablanca AC. Barriers to career flexibility in academic medicine: A qualitative analysis of reasons for the underutilization of family-friendly policies, and implications for institutional change and department chair leadership [published online ahead of print August 22, 2017]. Acad Med. doi:10.1097/ACM.0000000000001877.

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