Achieving gender equity in academic psychiatry – barriers to involvement and solutions for success

Abstract

Objective

Women face considerable barriers in pursuing careers in academic psychiatry.

Methods

A group of Australian and New Zealand academic women psychiatrists convened in September 2022 to identify and propose solutions to increase opportunities for women in academic psychiatry.

Results

Limiting factors were identified in pathways to academia including financial support, engagement and coordination between academia and clinical services, and flexible working conditions. Gender biases and the risk of burnout were additional and fundamental barriers. Potential solutions include offering advanced training certificates to enable trainees to commence a PhD and Fellowship contemporaneously; improved financial support; expanding opportunities for research involvement; establishing mentoring opportunities and communities of practice; and strategies to enhance safety at work and redress gender bias and imbalance in academia.

Conclusions

Support for women in research careers will decrease gender disparity in academic psychiatry and may decrease problematic gender bias in research. Fellows and trainees, the RANZCP, universities, research institutes, governments, industry and health services should collaborate to develop and implement policies supporting changes in working conditions and training. Facilitating the entry and retention of women to careers in academic psychiatry requires mentoring and development of a community of practice to provide and enable support, role modelling, and inspiration.

Introduction

Almost ten years ago, Why academic psychiatry is endangered was published, highlighting barriers to academic psychiatry in Australia and New Zealand (ANZ). ¹ Of the 21 authors, only one was a woman. Ten years on, four out of five senior leadership roles in academic psychiatry across ANZ are held by men, despite admission to Fellowship in psychiatry reaching close to parity since 2014.^2,3 So, why are there still so few women academic psychiatrists in ANZ, and what are the barriers to their involvement? In September 2022, the inaugural meeting of the Australian and New Zealand Women in Academic Psychiatry (ANZWAP) group was held in Melbourne, Australia. All women in academic roles in psychiatry were welcome; emails were sent to Heads of Department for Psychiatry and Deans of Medical Schools asking them to forward invitations to their women academics. Other potential participants were identified by word of mouth. This group comprised women at different stages of their academic career and invitations were to all those who identified as women and in academic roles to attend. Of the 27 that attended the meeting, 26 agreed to co-author. Overall, there were 49 women invited to the ANZWAP meeting and of these 5 were from New Zealand, 15 each from Victoria and from NSW, 9 from Queensland, 1 South Australia, 1 Tasmania and 3 from Western Australia. The women attending ranged from PhD students, Early Career Researchers through to Professors. There was diverse representation of women in both ethnicity, as well as the type of research employment - from predominantly clinical, through to education focused roles, through to predominantly academic research roles, as well as composite roles. The purpose was to discuss barriers and solutions to women psychiatrists participating in academic psychiatry in ANZ.

Psychiatry as a profession in Australia

In 2020 there were 3,769 psychiatrists employed in Australia. ⁴ The majority were male (58.4%). ⁴ Despite this imbalance, the number of female psychiatrists has increased at more than double the average annual rate compared to males (6.1% vs 2.3%). Given two in five Australians will experience a mental disorder in their lifetime, ⁵ the modest increases in medical psychiatric workforce (of approximately 4% per year) means there is significant pressure on psychiatrists, particularly as the number of psychiatrists per capita in Australia and New Zealand is lower than many other developed nations. ⁶ Some have gone as far as to say the country’s psychiatric workforce is in ‘crisis’ and unable to meet the needs of Australians. ⁷

Added to this, is the steady reduction in the proportion of academic roles in psychiatry that are employed in a tenured position, and furthermore women are underrepresented in senior academic roles, despite making up half of the academic workforce. ⁸ Women are also more likely to be employed in teaching roles that are fixed term and less senior roles, further exacerbating the commonly reported and documented seniority and pay gap for women academics. As academic salaries are usually lower than clinical salaries, the further gap for women in more junior academic roles increases any gender pay gap.

Benefits of academia

While there are many challenges for a clinical academic career, it equally can provide a varied career across teaching, research, and clinical care as well as the potential for leadership roles either in universities or health services, making this an attractive long term career path. There can also be increased workplace flexibility than in a fully clinical role and for many women this may be an important consideration. As well it may bring the rewarding experience of training a new generation and discovery and expanding knowledge through research to complement the rewards of a clinical career.

Barriers to women entering research careers

A 2022 paper highlighted the difficulties in ensuring adequate academic psychiatrists in the future. ⁹ Indeed, the National Health and Medical Research Council (NHMRC) has recommended promoting the role of clinician researchers and professional pathways for clinical researchers across health and medical research. ¹⁰ The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has been addressing this lack of academic psychiatrists with advocacy and initiatives to increase exposure to research and provide tangible support through grants, scholarship and award programs. ANZWAP considers the ongoing underrepresentation of women in academic psychiatry to be a disservice to the communities we serve, including influencing the focus of research undertaken, with research on areas of importance for women's mental health less likely to be prioritised. Increasing gender parity in academic psychiatry is likely to expand the focus of research. In any endeavour to increase women in academic psychiatry it was raised that there is a risk for those women of the burden of representation, where the few women in academia are asked to be members of multiple committees and working groups, detracting from other academic activities. The concept of intersectionality for many members in the discussion was also raised. This can be in particular for women of colour, women with disabilities, indigenous women, and LGBTQIA+ women, who may face ‘double’ discrimination as an additional barrier to an academic career in psychiatry. There is also the emerging issue of increased work for these women, with the burden in time and additional tasks often requested referred to as a ‘minority tax’, increasing the risk of burnout for women in academic roles. ² Finally, it was discussed there is not a mechanism for fully renumerating the additional time and burden frequently faced by women through this burden of representation.

The identified barriers for women psychiatrists pursuing academic careers were numerous. First and foremost, clear pathways to academic psychiatry are lacking. Those that do exist are facilitated by the NHMRC ¹⁰ and state-funded mental health services. However, a strong culture of undervaluing research in clinical services continues to be perceived by women pursuing academic careers. This lack of value is not specific to women; however, the lack of support has a disproportionate impact on the recruitment and retention of women in academic psychiatry. ¹¹

By the time women psychiatrists complete their Fellowship, and their clinical career is established, often they are also starting a family. Managing a career, children and home is already challenging, without adding the complexities of a PhD and developing a competitive research track record. For those choosing to have children, returning to work can be difficult, as flexible well-paid academic positions are lacking, and work schedules can be unpredictable.^12,13

Further, clinically focused roles can be more lucrative for psychiatrists, compared with the relatively poorer paid academic roles. Added to this, are the increasing expanding flexible work options for psychiatry clinical work, for example, telepsychiatry, second opinions and the rapidly expanding areas of diagnostic clinics that all take psychiatrists away from academia and are particularly attractive to some women with caring responsibilities due to their more defined working hours.

Impediments to continuing academic careers

An academic career may involve research or teaching, or a combination. Research roles and promotions rather than teaching performance are often linked to a successful research track record. ¹⁴ Female academics continue to be underrepresented in senior academic positions, with the number of women achieving senior lecturer or professorial level roles proportionally lower than their male counterparts. ¹⁵ This ‘holding pattern’ has been attributed to women having to juggle other responsibilities, ¹⁶ limiting networking opportunities, including the ability to attend and contribute to academic forums as well as to research activities. This is a particular limitation for early career female researchers, for whom such exposure is critical.

Regardless of gender, building an academic career and a research track record requires an investment in time to write publications, attend conferences, deliver keynote speeches and write grants. Academia is a challenging career path, more so for women, whose contributions to science has been an issue for more than a decade. ¹⁷ Women academics, who typically have greater family, carer and domestic responsibilities,^18,19 experience further pressure on their family and leisure time. The cognitive load is significant, with burnout a real issue.^2,20,21 This was highlighted during the COVID-19 pandemic where the impact on productivity for academics was more notable in women than in men. ²²

There remains a disparity between men and women with the proportions of publications as first, second or last authors in top tier medical journals being lower for women. ²³ There needs to be a stronger effort to improve adjustments for relative opportunity and career interruption, such as in the scoring of grant/other funding. Strategies, such as imposing gender parity on grants and funding (e.g. NHMRC Investigator Grants); ¹¹ and grant and fellowship opportunities open only to women (e.g. the ‘Grant for Outstanding Women’ from the Melbourne Medical School at the University of Melbourne) may help to address this.

Finally, personal safety is a barrier for women psychiatrists, ²⁴ and a concern which is echoed across women in academia. Regardless of gender, there is a real tension between the very public persona required of an academic psychiatrist, and the need for privacy for the clinician – especially considering women are more likely to experience vulnerability or adverse outcomes from breaches of privacy. Women academic psychiatrists have often experienced exclusion, unwanted attention or inappropriate behaviour. ²⁵ Power dynamics must be shifted such that women feel safe and supported as they embark on and continue academic careers.

Gender diversity in academia

There are many benefits to society for women undertaking careers in academic psychiatry, not the least being a different research lens ²⁶ and gaining the benefit of the full breadth of human academic talent. Women may also be more likely to undertake collaborative work.

Supporting female-led research will increase the potential for scientific discovery, as women are more likely to develop new programs related to women’s, children’s and family health. ²⁷

Solutions for improving equity

Systemic changes, including cultural and structural transformation, are urgently needed to address problems faced by women in academic psychiatry. ²⁸ ANZWAP recognises that the following recommendations require performance reporting and engagement across individual, clinical and academic institutions to ensure that real progress is made. In order for more women to take up the challenge, ANZWAP developed the following recommendations using an informal consensus approach:

Promote an academic career at the earliest possible opportunity for trainees and new psychiatrists, and target women

(a) Provide financial support for women undertaking academic careers; including government funded rotations in academic psychiatry for junior medical officers; and grant or scholarship opportunities unique to women.

(b) Promote women’s attendance and participation in conferences and academic forums.

Promote clear career pathways for clinical research and teaching through collaboration between universities, funding bodies and mental health services and

(a) Increase the visibility of women pursuing careers in academic psychiatry.

(b) Improve relative opportunity and career interruption reporting and consideration.

Support, recruit and promote female academic psychiatrists

(a) Offer flexible working conditions for all roles (e.g. part-time work, part-time training or job sharing) to improve opportunities for participation. ²⁰

(b) Establish formalised mentoring, developed within a broader community of practice, and serving the specific needs of female academic psychiatrists.

(c) Promote the NHMRC Gender Equity Strategy 2022-2025 and support the implementation and targets set.

(d) Eliminate gender discrimination and sexual harassment in the workplace in universities and health services. ²⁰ This includes through supporting education and empowerment initiatives such as being undertaken by RANZCP as part the new Gender Equity Action Plan as well as specific institutional and legislative initiatives for organisations.

ANZWAP calls on the RANZCP and male colleagues to support women in academia, including by supporting increased scrutiny and audit of the proportion of women as first and senior authors, editorial writers, keynote presenters and grant recipients.

Future directions

The ANZWAP met initially in September 2022, and have plans to continue the development of a community of (academic) practice and is working on strategies to increase the participation of women in academic psychiatry. As part of this we must regularly measure and report the number of women in senior academic positions as a proportion of all academics, the number of papers where female academics are the lead author, and finally we must determine the number of grants awarded to female academics as a proportion of all grants. By measuring these over time, we can see the impact of any solutions to improve equity that have been implemented.

Conclusion

There are many benefits to a career in academic psychiatry, including creating a legacy of improving mental health, professional growth, capacity building, and tremendous personal satisfaction. There is a need to continue to support women to become academic psychiatrists, not only to bolster the numbers of academic psychiatrists more generally, but to incentivise inclusion of diverse perspectives within the academic psychiatry research lens. Mentoring and development of a community of practice can provide support and inspiration for women, to encourage and facilitate their pursuit of careers in academic psychiatry. The inclusion of more women in academic psychiatry will ultimately benefit the whole community.