Overcoming barriers to career progression for mid-career female physician-scientists: Insights and solutions

Participant recruitment

This research was conducted at a Dutch medical center (University Medical Center Groninen (UMCG)) and approved by the local medical ethics review board of the UMCG (IRB number: 11009, approval date and number 17/10/2022, and approval number METc 2022/498). Based on the hospital's administrative records, a sampling frame was constructed comprising all female mid-career medical specialists who fulfilled the inclusion criteria of being a physician, holding a PhD degree, and supervising at least one PhD student. A purposive sampling method was employed, aiming for a balanced representation of assistant professors, associate professors, post-docs, various medical specialties, and residency program leaders. Initially, the response rate in the first round of data collection was not sufficient. As a result, in the second round, one of the inclusion criteria, the requirement of supervising at least one PhD student, was removed. The overall response rate was 73% (19 participants out of 26 approached physicians). Each potential participant received an invitation letter containing information about the study. Subsequently, they were contacted by phone and invited to participate. Upon agreement, interviews were scheduled. The interviews were conducted by four experienced and trained interviewers from the hospital's Human Resources department, consisting of one male and three females. Prior to the interviews, all participants provided verbal consent. In total, 19 interviews were conducted. For qualitative health research, a minimum sample size of 9-17 interviews is recommended to achieve data saturation.^19,20 The interviews had an average duration of 54 minutes, with a range of 38-72 minutes.

Interview procedure

The interview guide, developed by the research team, covered four topics derived from the literature^5–7: 1. The significance of work in life, 2. Expectations and needs regarding career development, 3. Current support and encouragement for career development, including formal policies, and 4. Opportunities for career development. Each topic included open-ended questions and follow-up probes to encourage detailed responses. Interviews were held between November 2022 and March 2023.

Data analysis

All 19 audio recordings were automatically transcribed using Amberscript (www.amberscript.com), and subsequently, the transcripts underwent manual correction by three coders (Second author, fourth author, and one research-master student trained in qualitative coding), marking the initiation of the data familiarization process. During this process, all identifying information was removed from the transcripts to ensure privacy. To address our research question, a thematic analysis was employed.^11–12 The coding process was facilitated by the use of ATLAS.ti version 23 for Windows.²⁰ To commence the coding process, all three coders inductively coded an identical interview keeping the deductive themes in mind. The double-coded interview was subsequently compared and discussed among the three coders. The coders also together reflected on their own subjectivity and positionality to be aware of possible bias while coding the data. This discussion led to the final set of codes. A codebook was developed based on these codes for structuring the analysis process. The coding process continued as each coder individually applied the codes from the codebook and incorporated new inductive codes as needed while coding a set of interviews. On two occasions, the coded interviews were merged in ATLAS.ti to discuss the ungoing coding process and to assess data saturation. Data saturation was achieved after coding 16 interviews. To ensure the robustness of our findings, interviews 17-19 were also conducted and coded. No new information emerged from these additional interviews, increasing the likelihood of data saturation. Finally, the codes were utilized to construct themes that reflected the needs and barriers to talent development in the career paths of the interviewed women.

Participant characteristics

Interviews were conducted with a diverse group of women: 3 associate professors, 6 assistant professors, 4 postdocs, and 6 residency program leaders. The mean number of years working at the hospital was 14 with a range of 5-23. The specialities of the participants were: pathology (2), nuclear medicine, oncology (2), gastroenterology, clinical genetics, interventional cardiology, pediatrics (3), pulmonology, radiology (3), rheumatology, psychiatry, anaesthesiology, and gynaecology.

Thematic analysis

Four main themes were constructed in the data: 1. Horizontal and vertical ambitions, 2. Evaluation of talent, 3. Career path needs, and 4. Receiving support.

Horizontal and vertical ambitions

Within this theme, participants displayed two types of ambitions: horizontal (knowledge expansion) and vertical (career progression).²¹ Focusing on horizontal ambition, participants indicated they work at an academic hospital because they want to increase and innovate their knowledge and skills. Learning is a process that is ongoing and never finished. Participant 9 phrased it as follows: “I think that you are constantly learning, right? That was also the reason why I wanted to work in an academic setting. It's a constant learning process, you have to teach others what you know”. Talent development is often intrinsically motivated. Participants explicitly mentioned they enjoy self-development and the choice for knowledge expansion does not have to be related to higher academic positions. Not only self-development but also contributing to a higher cause and improving clinical skills to become better medical specialists is important for the interviewed women.

Vertical ambitions refer to aspiring specific positions such as assistant-, associate- and full professor and other leadership roles. Many participants already took management and leadership courses, some specifically aimed at being a female leader. This indicates that these women want to advance their skills on this front and see themselves in these leadership positions. For example, one participant strived to be the chairwoman of her professional association and another participant had the ambition to become residency program leader. The female physicians are aware of their position at the department and some anticipate on possible chances that will appear in the future, like participant 8: “I do have plans for the next five years. There will definitely be some changes happening in our team, so I would like to be involved or jump in, so to speak”. The women that are already in associate professor positions have the ambition to become full professor, mostly because it is part of the academic process and reaching the professor position feels as if the process is completed.

Though for those in other positions than associate professor (i.e., post-doc, assistant-professor) vertical ambitions were expressed with some hesitations. The participants mentioned that it is very time-consuming to climb the hierarchical academic ladder and that promotion depends on many different aspects which makes it hard to become an associate or full professor. Participant 6 expressed her feelings about the academic positions as follows: “Yes, so I did want to become a good specialist. But, apart from that, well, I didn't really have ambitions to reach the highest levels of academia. I did want to do some research, perhaps conduct my own studies, but not necessarily become a professor. I didn't see myself in that role because I thought, well, everything is already so busy, and that would make it even busier.”

Evaluation of talent

This theme addresses women's perceptions of the hospital's promotion regulations, crucial in evaluating talent for career advancement. The hospital outlines specific criteria in a policy document for academic positions, such as supervising PhD students, research conceptualization, scientific impact, acquiring grants, publications, international recognition, outreach, and educational contributions. Moreover, Dutch knowledge institutes and funding bodies seek to modernize the recognition of researchers.²² They emphasize evaluating quality beyond publication numbers and impact factors, aiming to recognize teaching, societal impact, leadership, patient care, open science practices, and team collaboration.

Participants prioritizing horizontal growth or feeling their research did not align with academic standards often did not review the hospital's policy document. They believed that lacking a robust research background made pursuing academic positions unrealistic, as talent is predominantly assessed based on research achievements. They also sensed that the absence of early career research could significantly impact their academic trajectory, participant 4 described this as follows: “In my opinion, if you miss out on that initial grant, then you can forget about the rest. That's how it feels, I think. If you haven't immediately jumped on that train, then you'll be playing catch-up for the rest of your career”.

Women who did read the policy document and who were working towards a higher academic position had mixed feelings about the hospital’s policy. On the one hand, they find the policy clear and transparent and like that the rules are the same for everyone. On the other hand, participants thought the policy encourages box-checking. They disliked policies’ uniformity and believed more tailored rules should be applied because in some fields it is more challenging to secure funding or achieve certain milestones. Participants did not see the new Dutch policy, valuing skills beyond research, reflected in the hospital's policy or embraced by their department chairs (DCs). They seek assurance that diverging from the promotion policy will not hinder academic progression, emphasizing the need for recognizing and rewarding teaching and clinical contributions more consistently.

Career path needs

In this theme, we explore the vital career needs constructed from women's perspectives. They express a desire to influence hospital policies and shape the work environment, believing it would aid their career growth. Specifically, they advocate for a more balanced workload distribution and increased staffing to facilitate dedicated time for professional development in which balancing personal demands and professional wishes should be possible as well. Despite encouragement for self-development, participants find themselves investing personal time in talent growth. Additionally, they seek peer discussions—collaborations with colleagues at similar career stages, albeit not necessarily from the same department. These conversations encompass a range of topics from career decisions to specific tasks, exemplified by participant 7 discussing grant writing: “I really miss having a meeting or a structure or maybe a mentor, but also a discussion with, let's say, peers or colleagues because I've heard of groups that have that, for example within the [department], where they gather together to write a proposal, for instance”.

Not all women were certain about their career aspirations and specific needs. They were unsure about the appropriate steps to take or the most advantageous direction for their talent development. This suggests that the participants require additional or different support in order to advance their careers. Participant 1 mentioned the challenges she faced during the annual performance review when discussing her needs with her DC: “It's always a question during the annual performance review of what you will do next year and what you want then. But it's always… Well, I think it's a mutual interaction because I'm not particularly outspoken about it and I don't really know myself what I want”.

Receiving support

One of the potential needs that was explicitly discussed with the women during the interviews pertained to the availability of career support in their work life. This theme explores whether the women receive support and, if so, their feelings about it.

Generally, women held positive views about their annual performance reviews with their DC or clinical director. These sessions facilitated discussions on department satisfaction and skill enhancement through recommended courses or training. However, many felt responsible for navigating their career advancement independently. While their DC directed them to the hospital's policy document, participants desired a more proactive approach, seeking personalized conversations about the promotion process aligned with their unique strengths. Moreover, participants noted a lack of ample recognition beyond research and insufficient discussions on leveraging these talents for career growth. For instance, participant 5 stated: “Yeah, what I really miss and what I need is indeed that at some point it is also expressed like, hey, we see in you this or that talent or that particular potential. And how can we help you get there? And that's not there. That's really unfortunate because you, you simply can't do it alone, it's as simple as that”.

The participants voiced a need for a dedicated confidant to discuss their careers, offer reflective feedback, and aid in expanding their professional network—a role where feeling safe to address job-related matters was paramount. They highlighted challenges when their mentors changed positions or relationships shifted with their DC, impacting confidentiality. Participants noted the limitations of their DC as a sponsor due to potential conflicts of interest and expressed a desire to choose their own sponsor from a list of potential candidates. They stressed the importance of a compatible match between the employee and this confidant, emphasizing shared career paths and personalities. This sparring partner should empower the employee, respecting their aspirations, be they focused on horizontal, vertical advancement, or both.

Ethical considerations

This research was conducted at a Dutch medical center and approved by the local institutional review board (IRB number: 11009). Verbal informed consent was obtained from all participants. Based on the documents reviewed, the medical ethics review committee of the UMCG determined that this study did not constitute clinical research with human subjects as defined under the Medical Research Involving Human Subjects Act (WMO). Given the low-risk and non-invasive nature of the research, verbal informed consent was deemed appropriate. All participants were comprehensively briefed on the study's objectives, procedures, and potential implications, and their verbal consent was obtained prior to their participation, ensuring they were fully aware and agreeable to the terms of the study.