gms | German Medical Science

The issues of reconciliation of work/study and family and work-life balance in the field of higher education have gained considerable momentum. This applies in particular to medical studies with its rather strict study framework, high presence phases and practice units.

The purpose of university is to develop strategic concepts and adequate measures which go beyond individual solutions. It should be noted that a holistic approach to structural reform is at the forefront in order to meet the complex challenges described. It is essentially about bringing about a paradigm shift so the situation of students with family obligations is improved, as to date young doctors have mainly had to rely on individual strategies to ensure the compatibility of studies or careers with family life, mostly on their own. The decision to pursue a career in family-friendly neighbouring countries is all the easier when offer child care services to enable and actively support people to ensure the compatibility of studies and family life.

Institutions should therefore develop a holistic concept that encompasses the following three dimensions in order to achieve gender equality and family friendliness:

• Improve employment loyalty and long-term safeguarding of existing human resources in the medical faculties
• Identify the need for action in relation to the design of the transition phase from university to a scientific career and continuing medical education as this phase has a major impact on future career development,
• Strategic orientation of the faculty and university administration towards gender/family/work-life balance at the university and linked to it, the development, implementation and control of adequate measures.

These development processes in the dimensions listed have consequences for the organizational structures of medical schools. These must be changed in order to succeed in the competition with others for the best brains and talents in medical studies, accompany them in their career and retain them.

The message of this article is therefore that the issue of gender, family and work-life balance must be at the very top of the agenda of leaders in higher education to promote gender equality and family friendliness in order to future-proof themselves as scientific institutions.

The brochure published by the Federal Chamber in 2010 under the title “Family-friendly Workplace Handbook for Doctors” emphasises the following aspects in the introduction:

“Medicine is facing unusual challenges. One hundred years after women everywhere in Germany finally gained the right to study medicine in 1909, at the beginning of the 21st century they are see as the future prospect for the maintenance of comprehensive and good medical care for the population” (Bühren) [1].

Due to demographic developments, the number of people in employment in Germany will fall significantly in coming decades. As a labour market counter-policy, in addition to increasing the retirement age, targeted promotion of female participation and strategic considerations on the reconciliation of family and studies are being taken into consideration. At German universities, some 7% of students are studying with children.

The question of the compatibility of medical school and family is also relevant because of the high proportion of women in this subject. The proportion of women recorded in medical school has been steadily increasing and has been over 60% for some years. Prospective doctors in particular begin considering issues of balancing work and family during their time at university. It is therefore necessary to create conditions that allow and encourage family foundation during their time at university already.

The issues of reconciliation of work/study and family and the work-life balance have become increasingly important recently in higher education policy development as higher education institutions in the competition for the best minds are already forced to tackle these issues, some of which are still novel to them, as they are faced with demographic change. High dropout rates among students with children, increasing shortages of physicians and the continuing underrepresentation of women in the next generation of scientists are also issues that need addressing urgently. Then there is the fear that conditions at university are compounding increasingly high sector emigration abroad. University reform must also counter the high levels of childlessness among graduates. This article proposes that a gender and family-oriented higher education strategy can (successfully) address the identified problem areas. The relevant levels and drivers of the reform process aside, the key players are also stated. To make the link to real-life scenarios, selected examples from universities where the implementation process has already succeeded in practice are given.

There are three guiding dimensions in the implementation:

• Recruitment and retention of young scientists at the university,
• Managing the transition from student to specialist training or a scientific career,
• Implementation of family-friendly services and establishing family and gender policies at the university.

The following section outlines the requirements and approaches to finding solutions.

How can medical faculties, clinics and (teaching) hospitals achieve a family-oriented profile? Which key players and areas of higher education management are relevant to the management and decision-making structures? What exemplary measures for designing family-friendly medical studies and work places offer success?

This applies in particular to medical studies with its rather strict study framework, high presence phases and practice units is in urgent need for action regarding the compatibility of study, academic career paths and family. Today’s medical students – tomorrow’s doctors – will influence future roles and role models in medicine. So far students must find individual solutions for reconciling family, studies and careers. This is a great burden for those affected and in times of increasing shortages of doctors - currently about 5,000 positions nationwide are vacant – a waste of skills from a socio-political and economic point of view.

Medical schools, clinics and (teaching) hospitals could instead, in cooperation with students and employees, develop their own sustainable projects, introduce and expand measures proven in other areas. Faculties, clinics and hospitals – this seems to be a prerequisite – must view themselves as a modern educational institutions and employers and derive practical consequences from this. This applies both to the organization of studies and work, personnel management and in particularly culture of higher education and work which are in need of an overhaul as regards the work-life balance.

Family-friendliness thus is not only an issue of equal opportunities in a field of study where the proportion of women has grown rapidly in recent decades but it also entails a compelling need for the restructuring of entire study and work areas.

In addition to adequate measures to promote family-friendliness, the question arises what organizational structures medical schools in particular have to demonstrate in order to succeed in the competition with others for the best brains and talents in medical studies and to accompany and retain them throughout their career.

And above all, what aspects of higher education policy must be recognized and developed as a strategic leadership roles?

One factor for success, amongst others, is than in the wake of gender mainstreaming men are also encouraged to be active in parenting. This in turn means that more spaces could be developed to facilitate the reconciliation of family and work/study better. However, here too the emphasis is somewhat different compared to women, as freeing up men successfully in a more family oriented environment can create good preconditions for their female partners to pursue their career paths more easily.

Against this backdrop, there are three main areas medical faculties and departments – not only in Baden-Württemberg – must address in particular:

• On the one hand, existing human resources in the faculties must be “tied” more tightly and thereby securing them for the long-term. In addition to attractive offers of competing scientific and research institutions and in spite of all existing measures and support services, the still lacking balance between family, studies and career leads to a skills drain (study dropouts, emigration of physicians).
• Awareness of the strategically important transitional phase from university to scientific career paths and medical specialisation should receive greater attention.
• Furthermore, strategic planning and operational implementation should subscribe to gender mainstreaming and family-friendliness through a comprehensive science strategy, creating attractive propositions for students and doctors. Secondly, support for families itself is becoming more of an independent issue, away from the central theme of gender equality. So it is also an issue of family support and in particular increased family-friendliness in all study, work and scientific areas (especially teaching, research, administration and management, service and advice).

Solutions are therefore needed aim for the implementation of sustainable goals in the short, medium and long term. However much individual projects and measures are justified, it nevertheless is essential to develop a holistic concept which has clear strategic goals and perspectives.

In the following section, successful examples are presented that demonstrate a holistic approach.

Yale University is an example of the need to focus measures through a strategy. In addition to an office for work-life balance measures, the university offers comprehensive support to its employees and students and thus ties its employees to the university. This makes the university the only university in addition to the 100 largest companies in the US which received an award for a family-friendly environment by the Association of Working Mothers. This also facilitated an increase in the proportion of women taking up posts. So a family-friendly atmosphere can be associated with supporting a higher proportion of women in leadership positions. [http://working.yale.edu/features/yale-best-company-work-working-mother-magazine-believes-so].

German medical schools also focus on the issue of family friendliness.

In 2009 the Goethe University in Frankfurt am Main introduced the model project Part-time Medical Studies, funded by the State of Hesse. It included the implementation of a counselling service for students in special circumstances, in particular for students with children. The day care centre of the hospital provides childcare. The use of advice sessions on returning to study or work for mothers has proven effective in supporting mothers seeking to return following maternity leave.

Appropriate childcare measures were designed and developed both for students and doctors working at the Medical University Hannover (MUH).

The rationale for these measures is seen to be the recruitment of young scientists as the view is that a medical faculty which wishes to recruit the best young talent for research, teaching and patient care cannot afford to restrict the choice of candidates in advance by not giving people a chance who are planning on having a family. Furthermore, the university acknowledges the issue of multiple responsibilities which according to female doctors active in science is extremely high (patient care, teaching duties, research, writing publications, preparation and holding lectures, etc.) [2].

The following conditions are in need of reform to make universities more family-friendly.

Create more stable employment for the mid-level faculty staff [3]

Secure sustainable living and working conditions have an influence on parents’ decisions about having a family. But young researchers of today mostly are in temporary employment. To strengthen mid-level faculty staff and to create secure employment prospects below the level of professor too, new permanent jobs must be created. In addition, compulsory tenure-track options should be offered for junior professors and pure teaching professorships should be introduced. All these measures would help universities in their efforts to improve the quality of teaching in the Bologna Process and to secure well qualified and highly motivated academic staff.

Introduce uniform wage agreement to science

The collective wage agreement TV-L and TVöD for employees of scientific institutions leaves little scope creativity for HR manager. The different wage agreements – with their classifications (themselves handled very differently) into experience-based wage increases and rarely used performance-based bonuses – hamper performance-oriented personnel development planning and mobility. In practice, switching employment from one institution to another frequent results in financial losses. In addition, there are currently different groups of employees, one group being those who enjoy unlimited privileges after their transition into the new wage agreement, such as special allowances for married couples and children, and on the other hand the increasingly large group of newly employed staff for which these regulations no longer apply. A standardised scientific wage agreement would facilitate the recognition of professional experience, comparability and remuneration of special contributions, career and life planning and the often demanded mobility.

Abolish detrimental age limits

Entry to and advancement in the science system is regulated by a series of very narrow time windows. Strict age limits for awarding scholarships and professorships leave very little room for young scientists to have children. This has greatly hindered female scientists in particular in advancing their professional careers. To promote the compatibility of science and parenthood, it would make sense to abolish the existing age limits and also to allow the awarding of professorship positions in-house in principle.

Make parental leave attractive for both parents

Employers assume that female scientists will be of limited availability as they might become mothers. As such, they are often excluded from interesting job and career prospects. This could be tackled through greater incentives for fathers to take the parental allowance, for example by increasing the so-called Paternal Months. Increasing the flexibility of the parental allowance should be coupled with supportive measures towards awareness and culture change amongst both employers and employees regarding the role of fathers in society.

Cover shortages due to parental leave through funding and job pools

Temporary externally funded projects and small university units are reliant on their ability to carry their work quickly and on time. It can be a problem for them if employees are temporarily absent due to parental leave and care responsibilities. One solution is the establishment of funding and an additional job pool. This would, for example, enable the funding and organisation for covering parents on leave. The German Research Foundation (DFG) with their funding project “Cover for maternity and parental leave” are the market leaders in this aspect. They enable project management to finance cover if parents take pregnancy and parental leave or stop working temporarily. In this context, the DFG also supports part-time work in its projects. Funds for covering an employee on leave can also be applied for [http:// www.dfg.de/dfg_im_profil/aufgaben/ chancengleichheit/massnahmen_details/ausgleich.html].

Make the limitation arrangements for parents binding

The Temporary Scientific Employment Act (2007) contains a family-policy component in the interests of extended temporary employment opportunities for parents. § 2 Para 1 Sentence 3 WissZeitVG provides that the allowable limitation period while a parent is in training is extended by two years per child for each child care is being provided to under the age of 18. This is open to both parents independently. The children being cared for do not have to be one’s biological children but must live in the household of the applicant. However, the family-policy component only introduces the option to extend the contract and therefore requires the agreement of the employer. In practice, the family-policy component is being used far too infrequently. In the interest of the parents, this is in need of improving.

Establish more appropriate childcare offers

Children of academics in most universities are not visible. Their care usually takes place far away from the workplace of the parent, often causing considerable additional effort. One measure to respond to the actual needs of parents and children is the establishment of nurseries at the university itself. It would be helpful if care services could be made much more flexible and be adapted to the normal academic working hours. This includes extended opening hours (until 8pm), weekend services and service offers during the school holidays or when parents are at conferences. Another option is to set up a generational network for childcare of school children and homework help or a babysitter pools for short-term care of infants and school children. Small changes to the infrastructure, such as installing changing and nursing rooms and child-friendly chairs in the canteens are also supportive. To ensure the quality of childcare facilities, the establishment of a national coordinating body would also be useful offer best practice standards in quality for all universities.

Taking into account recent analyses [4] and national (for example the audits on family-friendliness and diversity management) [5] and international experience to date currently allows us to identify the following areas as necessary for a holistic approach:

1.

Organisational Structures

2.

Study Organisation

3.

Communication and Advice for Women/Families

4.

HR Development and Labour Organisation

5.

Monitoring of Families

6.

Optimal Infrastructure for Families/Women

7.

Faculty Culture and General Conditions

In the following we will list examples for each sphere of activity:

1. Organisational Structures

• Responsibility of senior management at the medical faculty level
• Networking and establishment of annual interview dates of medical faculties of universities, possibly also with participation of the Ministry
• The creation and expansion of staff positions dealing with gender mainstreaming and family in the faculty management, clinics and hospitals (similar to the work-life balance offices at American universities in personnel/HR (for example, Stanford or Yale))
• Establishment of a gender-balanced Commission for Family-friendliness (cf Finland, Norway, Sweden, Iceland (see Husu 2007))
• Motivating people to use the university’s own resources for the implementation of family-friendly policies and measures, networking and cooperation with municipalities, associations, organisations, businesses, development of sponsorship and fundraising projects (cf Stanford where three positions in the Work-Life Office were created (for approximately 15,000 students and 1,800 employees))
• Considering the special situation of carers and parents

2. Study Organisation

• Review of study formats, regulations and examination regulations in relation to their family-friendliness. For example, blended and e-learning, unpenalised withdrawal from examinations due to pregnancy and maternity leave, counting failed examinations during maternity as unsat; counting an attested illness of a child as an illness of the exam candidate in modularized and stepped degree courses
• Adapting the curricula to a family-friendly format
• Part-time studies
• Making the timing of lecturing hours more flexible, such as flexible choice of courses within each of the pre-clinical and clinical study sections, offering courses with the same content at different times, offering special courses for students with children, additional course days to compensate for missed course days
• Special mentoring services on studying with a child
• Gender-specific career guidance for university students: low-threshold offers which allow students crystallize their diffuse career plans and ask questions about the compatibility issue; talks about role models in the field of medicine
• Bringing infants to courses, which don’t involve dangerous substances (if required)
• Enabling students to get leave with a minimum of bureaucracy and the opportunity to take examinations during this time; more flexible arrangements of interrupting the Practical Year and the transferability of work credits when taking a break

3. Communication and Advice for Women/Families

• Optimising web-based information by the faculty on family-friendliness
• Embedding advice services into the facilities, for example by the setting up work-life offices in the HR area in order to ensure comprehensive and competent advice to students and staff (parent service offices, welcoming facilities)
• Establishment a shared internet portal for family-friendliness of the medical faculties, a central drop-in centre at the faculty, clinic or hospital
• Introductory and information events (every semester) for students and employees with children
• Regular exchange of experiences with students with children regarding their undergraduate studies, the Practical Year etc.

4. HR Development and Labour Organisation

• Making life phase-related work and sabbaticals more flexible, such as longer-term adjustment of working hours to different life circumstances, for example by introducing paid (through saving schemes) or unpaid time off work
• Job sharing for qualification positions, i.e. creation of qualification positions by splitting a professorship, better distribution of workloads
• Support active fatherhood; faculties, hospitals and clinics could promote a positive image of paternity leave for example by promoting positive role models; the provision of information directly addressing fathers would be beneficial; supportive stance of supervisor
• Planning and support of parental leave (task for line managers, topic for management CPD; bearing in mind the different phases of parental leave/family-friendliness (including caring for family members) which require targeted information and planning such as measures to maintain contact and supporting re-entry (childcare, innovations at the workplace, qualification requirements, feedback interviews require))
• Requirements and satisfaction surveys of employees (especially the young scientists with regard to family-friendliness and work-life balance)
• Staff meetings, ward rounds and CPD during guaranteed childcare hours
• Holiday care for school-age children
• Part-time work also for fathers; in traditional gender roles, the desire for part-time work to enable spending more time with the family is almost exclusively interpreted as a “feminine” concern, while managers with conservative views tend not to mention such issues, seen to be somewhat “unmanly,” to male colleagues in employment and qualification interviews’ meaning that systematic sensitisation of leadership is required

5. Monitoring of Families

• A faculty-specific, followed by a nationwide survey of the measures taken towards making medical schools more family-friendly
• Developing and editing of a checklist on family-friendliness with a definition of minimum standards

6. Optimal Infrastructure for Families/Women

• Expansion and flexibilisation of childcare times; nurseries/crèches/after school care with maximum flexibility but at least better coordination between work and study times on the one hand and care times on the other hand
• Embedding emergency care and procurement of day care
• Parent-child rooms, breastfeeding rooms; family-friendly canteens (equipment, furniture)
• Special laboratories for pregnant mothers or appropriate support programs

7. Faculty Culture and General Conditions

• Development of an explicitly family-friendly medical mission statement
• Raise awareness amongst managers regarding the issue of family-friendliness; any professor in addition to their function as teachers and researchers also have role as leaders; therefore deconstructing the image of the role model of the “selfless, altruistic physicians”
• Role model function of the management level (chief physicians, medical directors through acceptance of family careers and leading by example)
• Considering social and family skills in the selection of leaders; this requires the development of guidelines for recruitment; in addition, applicants should be asked specifically to identify their strengths in family-friendliness when presenting their social and leadership skills
• Informing the applicant/candidates during staffing and appointment procedures about family-friendly services offered by the faculty or university

It primarily requires a change in attitude regarding the need for family-friendly degree courses and work organization in medical schools, clinics and (teaching) hospitals. Modern HR management, which seeks to employ all opportunities, already implies viewing employees as individuals in different life phases but equally anyone in under an postgraduate courses and CPD. This means that in the medium and long term, such institutions must not only introduce and expand family-friendly measures but also that the culture of higher education and work must be fundamentally changed. This is also the strategic responsibility of faculty and hospital management which broaches the issue of work-life balance in medicine by developing a modern, family-friendly vision an links this to other issues of equality, ringing in a change in thinking regarding compatibility and gender issues.

In future there must be an expectation that leaders, be that hospital management or professors in medical schools, are expected to show social skills and that they not only accept the strategic goal of family-friendliness but also that they have accepted it and work towards implementation and that they reflect on their own leadership roles and experiences. In reality this means that management and leaders must be open to the problems of combining study, work and family and should be willing to create a balance of interests. They are expected to show a lot of courage for change in making decisions that will achieve a balance of interests and accordingly, that they will intervene in and manage team processes that are in conflict. In the spirit of lifelong learning, therefore, information and training for managers and their employees must top the agenda for family-friendliness.

In this diversity of tasks, however, it is also clear that science policy, insurers and associations must show moral and financial support to facilitate targeted, resource-based development of structures.

Because only if being a parent, pregnancy and care of relatives are seen as a natural events in life and not classed as disturbances in clinical processes, if the needs of medical students and physicians are acknowledge and integrated into family-friendly concepts, if they need not fear loss of career any more, structural adjustment measures can achieve the goal of winning the most talented minds amongst the next generation of doctors and permanently bound, while at the same time slowing their migration to other (European) countries which have far more family-friendly work and study conditions.

On a structural level, this includes the modification of the Maternity Protection Act at the federal and state level. Similarly, a shift away from male-dominated careers and working hours can be perceived as the desire for part-time employment increases. This departure was also noted in terms of career paths in academia. As a consequence, this requires universities to meet the demand for structural change that will enable conditions for balancing studies/career development and family life through the introduction of part-time models in under and post-graduate studies or the temporal restructuring of the clinical curriculum using part-time models (currently in blocks or all day or late afternoon).

A reform of maternity provision would certainly also be helpful.

One gets the impression that the need for a paradigm shift is necessary and desired, as the recommendations and requests presented here show. It is important that such a re-orientation is based on a holistic concept as family-friendliness is a comprehensive approach addressing both students and staff. The slogan “Dare to be more family-friendly” is easy to understand but the consequences and implications, however, are complex.

The author declares that she has no competing interests.