Flexible Policies, Unchanged Practice

More medical schools offer better-balanced work-life policies to faculty, new study finds, but few actually use them.
February 25, 2011

The number of medical schools that have adopted longer pre-tenure probationary periods for new faculty doubled over the previous decade, but -- even at institutions with flexible, family-friendly policies -- just a handful of faculty members actually took advantage, according to research to be published in the April edition of Academic Medicine, the journal of the Association of American Medical Colleges.

The findings of the report, “Evolving Workplace Flexibility for U.S. Medical School Tenure-Track Faculty,” were based on responses from 126 medical colleges -- nearly all of the 133 such institutions in the U.S. that the association identifies as accredited -- to a 2008 survey.

The authors -- Sarah A. Bunton and April M. Corrice, who are, respectively, research director and research analyst for the association -- note a pattern of progress among medical schools in adopting policies that acknowledge the changing nature of the academic work place, particularly for clinical and research staff at medical schools. These policies add flexibility that, ideally, allows faculty members to be productive while balancing work, life and family obligations.

The findings have implications both at medical schools, where 35 percent of all full-time faculty are women, and in other sectors of higher education. While medical schools still have ample room for improvement, the report notes, they also tend to be at the forefront in crafting family-friendly policies. In recent years, the American Council on Education and the American Association of University Professors have also produced reports on the need for universities in general to adopt more flexible and family-friendly policies.

The authors of the AAMC study focused on three such policies: extending pre-tenure probationary periods, which they defined as eight years or longer; allowing faculty members to stop the tenure clock so they can take leave (typically for child rearing) without being penalized; and letting them work less than full time while still being on the tenure track.

The number of colleges with longer probationary periods doubled between 1983 and 2008. In 1983, 26 institutions with basic science faculty had probationary periods of eight years or longer. By 2008, 53 of them did. For clinical faculty, 25 institutions had pre-tenure periods of eight years or more in 1983; in 2008, 55 did. About one in 10 medical schools also said they were considering making changes along those lines.

Lengthening the probationary period before tenure is something that higher education faculty members, in general, have decidedly mixed feelings about, due to fears that tenure-track faculty will be left to dangle without a clear commitment from their college.

But such extensions are often welcomed by medical school faculty members, who have a unique set of demands. Medical school professors say that research has become more interdisciplinary in nature; funding has become more competitive; and the pressure to generate revenue and to manage clinical practice has grown more acute since 1940, when the AAUP recommended capping the probationary period at seven years. "Some faculty face extreme service and education demands," the authors wrote. "All of these factors contribute to a much different work environment than what was in place almost 70 years ago."

The notion that pre-tenure periods ought to be extended has been considered elsewhere in higher education recently, with differing results. Brown University's faculty approved extending its pre-tenure probation from seven to eight years, while the University of Michigan's faculty senate rejected plans -- which were depicted largely as a way to help medical school faculty -- that would have pushed the probationary period from 8 to 10 years.

While the number and share of medical schools with extended pre-tenure periods grew markedly over the five-year period studied, the share of the other family-friendly policies identified by the authors remained relatively flat -- though still higher than the average for colleges and universities.

Nearly 8 in 10 medical schools surveyed had tenure clock-stopping policies, which allow those who are eligible for tenure to temporarily -- and without penalty -- pause the period (be it seven years or eight) in which a candidate must prove him- or herself worthy of tenure, in order to cope with other life issues or priorities. Typically, clock-stopping is used for child care, followed by medical disability, and caring for a sick family member. By comparison, 65 percent of universities had similar provisions, according to a 2009 study by the Center for the Education of Women, at the University of Michigan.

Over the past several years, the number of institutions allowing faculty members who are not employed full time (defined as 0.75 or less of a full-time equivalent) to remain eligible for tenure has dropped slightly, from 40 percent in 2002 to 35 percent in 2008.

While such practices -- particularly clock-stopping -- are very prevalent, they are seldom used by medical school faculty, the authors note. For example, in three-quarters of the medical schools that offer a clock-stopping policy to faculty members, fewer than five people actually used it in 2007-8. The authors speculate that the lack of acceptance of this practice in the culture of academe may prevent some faculty members from using it for fear of retribution. "Many institutions may have developed flexible policies, but implicitly or explicitly discourage faculty members from using them," they wrote. "There may be a disconnect between the existence of the policy and faculty knowledge about or willingness to use it, which may reflect lingering employment norms."

That such norms persist does not surprise Jean Waltman, senior associate for special projects and initiatives at the Center for the Education of Women. “Enacting the policy is easy,” she said. “The hard part is changing the mindset of the people who work in those departments.” Waltman added that other research has suggested that those who run departments may not be aware of the existence of family-friendly policies, even in places where they have long been in place. And prevailing norms hold that taking leave for child-rearing is somehow "scamming the system," she said.

The end result, she said, is that women -- if they don't stop the clock -- leave academe or wait until they get tenure before having children. She recalled one respondent to the center's research who said she had waited and finally been granted tenure, but then found that too much time had passed and she could not have children. "Nobody should have to make that choice," she said.


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