TIME FOR SOME REPAIRS

This year’s ECCMID in Vienna was another great success, with record-breaking attendance and interesting, relevant sessions. But there was one statistic that remains disappointing, and it’s hard to blame it on ECCMID organizers. Their job is to promote good science wherever and in whatever form they find it. They should well be blind to that form. They draw from the landscape as it is.

Yes, I’m talking about the male-female split among speakers at ECCMID. The ratio remains flat this year at around 65% to 35%. Why, you may ask, are women always whining about speaker opportunities? First, these are not vanity activities. Many institutions include invitations to speak at international conferences in their valuation models for employees’ career advancement. Like academic authorship, speakership becomes a sort of monetary currency on the road to career independence.

Second, the male:female ratio at these conferences is a window into something more consequential than an annual meeting. It is a bellwether, indicating slow—or flat—progress overall. Want examples? In one prominent university medical center of a capital city in Southern Europe, there are currently 64 full professors. Two are women. In a celebrated Swiss university hospital known for its progressive, outside-of-the-box approaches, here is what we have, going from the lowest rung of the ladder to the highest:

The landscape in hospitals elsewhere in Europe is not wildly different; you can get a sense of it by looking at the Parity Commission’s first international survey on the matter. Frankly with numbers like these, we might even want to congratulate the ECCMID organizers for finding the 35% they did.

But “whining” and disappointment alone produce nothing. They must be followed by a plan. We have one. We know the landscape—we live in it, after all. But we’re also figuring out what is propping up the scaffolding that keeps these skewed demographics in place even in 2017, decades since medical schools started turning out >50% female medical graduates.

There are a few people in my microcosm that I call my favorite feminists. At the top of that list is my husband, followed closely by one of my bosses here in Geneva, Laurent Kaiser, who is trying to right our local scaffolding as efficiently as he can. Yet another is Eli Perencevich, a great communicator whose infection control blog we probably all know. At an earlier ECCMID, Eli told me that he knew a secret to repairing a major defect in the scaffolding. And since then, a few women physicians and microbiologists have written to me to point out the same defect. Even I was scratching at it in a recent blog post, when I shared one seemingly minor email exchange that could have had enormous ramifications for the woman who was its subject.

The “defect” Eli identifies is our institutions’ one-size-fits-all age limits to young-investigator awards, career-development awards, research prizes, and so on. Indeed, as British colleague Trupti Patel pointed out to me, even the ECCMID registration fee essentially discriminates against mothers or fathers who took career breaks, or worked part-time, to assume the majority of child rearing. She wrote:

I have had an abstract accepted to this year’s ECCMID conference and would obviously like to attend.

Having had children and worked part-time for the majority of my training has meant that I have become a new Consultant in Infection at the age of 41 years. Had I not had children, I would have qualified for the ‘young physician’ rate of €175 for ESCMID.

There are many in my position who cannot afford to pay the full registration fees of an ESCMID member of €510 compared to the much lower sum above, notwithstanding the additional travel and accommodation costs.

 Attending an international conference is not a vanity activity, either. These conferences are vital for displaying and explaining your research and therewith planting the seeds for future collaborative research with those outside your institution.

So, problem identified. Where to begin? The Parity Commission will tackle the problem formally as its 2018 project, with the goal of effecting concrete changes in these limits. Luckily, we have an extremely supportive and sympathetic ESCMID Executive Committee. Chantal Britt and Henri Saenz at the Executive Office have already done an initial “reconnaissance mission”: they have found the few organizations that have already implemented more flexible age limits to these kinds of awards. (It’s not many, but they should be celebrated: the Wellcome Trust and the European Council.) We will learn from these organizations’ work.  I, in the meantime, find no meaningful policies in place in some of the most powerful medical societies and institutions (but please contact me if you know that I am wrong).

Yes, the NIH never states an explicit age limit, and even allows a request for extension of the “Early Stage Investigator” status for new parents and those with other family responsibilities. Wonderful. But look more carefully:

It seems that the parental leave itself—still often just a matter of weeks in the US—is what is really considered here. But delivering the baby is the easy part. What about the five to ten years of part-time work that some of us do to ensure our presence in our children’s early lives? The “opportunity cost” is enormous and goes unheeded here.

And the IDSA’s Young Investigator Award is tricky indeed. You need to be “assured of a faculty position” AND you need to have finished your infectious disease fellowship within the last four years. But many women put off having children specifically during the grueling years of training and fellowship; biologically speaking, they can’t put it off much more than that. For many, those post-fellowship years are the last call for healthy reproduction. And for whoever takes on the brunt of the child-rearing thereafter, anything less than 100% at work means fewer projects assigned, less visibility, a thinner CV: in those four years, perhaps there will be no faculty position and certainly there will be less to show for on your award application.

So here we go. We are dedicated to making this change—and to making the change stick, not just within ESCMID but within other organizations that also understand the need for it. But it will take some time. Along the way, please feel free to contact me if you have advice and ideas. I’m glad Eli did.

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