Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System

Arthur H. Rubenstein, MBBCh 

The COVID-19 pandemic has laid bare what we already knew about societal inequities in academic medicine. This world-wide disaster is having a disproportionate impact on women, underrepresented ethnic and racial minorities, LGBT scientists, people with disabilities, and those from a myriad of non-traditional backgrounds. As co-authors of a recent 

 commentary, “Pandemic-related barriers to the success of women in research: a framework for action,” we believe it is of upmost importance that those of us in clinical research leadership positions acknowledge this issue and provide a constructive framework for meaningful action. We believe that the timing of this action is now, if we are to successfully prevent more women from leaving the biomedical workforce altogether.

As we detailed in our paper, the data is more than worrisome. Since the onset of the pandemic, significantly more faculty in academic medicine report that they are considering leaving their faculty positions or reducing their hours. Our data has shown that childcare responsibilities are a significant contribution to the attrition of women from science. For example, women with children were more than three times as likely to decline leadership opportunities as women without children. During the pandemic submissions of scholarly papers authored by women to the medical journals decreased, whereas submissions authored by men increased. One department of internal medicine found while that the number of research grants submissions by male scientists to funding agencies increased during the first 12 months of the pandemic, a similar increase in grant submissions by female scientists was not evident. Notably, of the grants submitted by women, lower dollar amounts were requested in these applications. Data from one funding agency, the NIH, shows that while women continue to submit entry level grants in greater numbers, they are not submitting career-advancing higher-level applications. When we think of the clinical research enterprise, inclusive of clinical trials, we know that women are disproportionality represented. Thus, the evident impact of attrition is likely to disproportionally affect clinical research.

While we have documented the problem, the efforts now must be focused on implementing solutions. The solutions are a shared responsibility that will require the buy-in from and engagement of academic institutions, research foundations, government funders, and professional organizations, including Clinical Research Forum. One of several solutions proposed in our commentary centers on providing additional short-term flexible funding for investigators who have care responsibilities and the associated competing demands on their time. For example, the provision of $50,000 to $75,000 per year for junior faculty heavily impacted by caregiving responsibilities would afford opportunities for women to hire additional staff as a way to share the workload and/or may provide funds to offset the cost of childcare and elder care.

Existing programs that provide this type of financial support have been very successful. One such program that existed prior to pandemic, the Claflin Distinguished Scholar Awards at Massachusetts General Hospital, provided $50,000 per year for two years to maintain research productivity during the child-rearing years. The program is competitive, and data indicate that scientists selected had a higher retention rate at their institution (90% vs. 60%) when compared to those who applied but were not selected for the program. Of note, it was a wise investment with a total of $2.1 million provided over an eight-year period, which resulted in the people supported by the program successfully submitting research grants that ended up reaping $51 million in subsequent grant funding—in essence reflecting a 24-fold return on the initial investment.

We exhort more academic institutions to replicate this investment in their basic scientists and clinical investigators—including clinical trialists. While several other similar strategies are funded by foundations, such as the Doris Duke Charitable Foundation and the Rita Allen Foundation, they are not sufficient to address the need. One discrete call to action is for additional organizations to fund similar programs.

Although the COVID crises has highlighted the challenges women face recently in their academic medicine careers, the difficulties women have in being appointed to leadership positions goes back several decades. In fact, the data from the Association of American Medical Colleges indicates a very small increase of only a few percent over the past three decades in women chairs of departments, vice deans, vice presidents, and deans and presidents of medical schools and their teaching hospitals. This is all the more disappointing, considering that women now constitute 50% of the medical student body and junior faculty ranks, and the importance of women role models as leaders and mentors is critical for their career progression. In this regard, it is encouraging that six organizations have recently banded together to form the Gender Equity in Academic Medicine and Science (GEMS) Alliance with the goal of providing specific and practical support for women to advance and be successful in their leadership positions.

As members of the board of directors for Clinical Research Forum, a non-profit professional organization devoted to providing leadership in the clinical and translational research enterprise, we are committed to advocacy efforts that will continue to elevate the importance of the clinical research enterprise and the preservation of a diverse and inclusive workforce. This particular challenge did not just happen overnight, and its solution will take time. The steps we detail are critical right now.

Our hope is that clinical research leaders will commit to financial, operational, and cultural changes to attract and retain women and other underrepresented populations in clinical research. Only by all of us participating can we meet the health and scientific challenges we are facing to improve the public health of our nation and our globe.

, MD, Professor, Medicine and Pharmacology; Vice Dean and Chief Clinical Research Officer; Senior Associate Vice Provost for Human Research; Director, Translational Research Education, Perelman School of Medicine, University of Pennsylvania, and 

, MBBCh, Professor of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System

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