How Can STEMM Do A Better Job of Caring for Its Caregivers?
Caregiving is a nearly universal human experience, but it’s not often thought of as an issue with implications for our nation’s science, technology, engineering, mathematics, and medicine (STEMM) enterprise. A new report from the National Academies of Sciences, Engineering, and Medicine, Supporting Family Caregivers in STEMM: A Call to Action, seeks to change that. In some academic STEMM environments, devoting time to care for family members is still seen as a taboo subject because it clashes with the idealized notion of scientists who focus exclusively on their work. The lack of legal and institutional support for caregivers drives many people to leave STEMM fields altogether. What can be done to change this inequity?
On this episode, Issues editor Sara Frueh talks to Elena Fuentes-Afflick, chair of the report committee and a professor of pediatrics and vice dean for the School of Medicine at Zuckerberg San Francisco General Hospital at the University of California San Francisco. Fuentes-Afflick talks about the pressures of balancing caregiving with a STEMM career; how complex and poorly implemented policies are hurting workers and the economy; and steps that the government, universities, and others could take to make a difference.
Resources
- Read the Supporting Family Caregivers in STEMM: A Call to Action report and find more resources.
- Learn more about federal policies and practices to support STEMM caregivers by reading the National Science and Technology Council’s report.
- Find more of Elena Fuentes-Afflick’s work on her website.
Transcript
Sara Frueh: Welcome to The Ongoing Transformation, a podcast from Issues in Science and Technology. Issues is a quarterly journal published by the National Academy of Sciences and by Arizona State University.
Have you ever had to miss work to care for a loved one? Caregiving is a nearly universal human experience, but it’s not often thought of as an issue with implications for a nation’s STEMM enterprise. A new National Academy’s report titled, Supporting Family Caregivers in STEMM: A Call to Action, seeks to change that.
I’m Sara Frueh, an editor at Issues. I’m joined by Dr. Elena Fuentes-Afflick, chair of the report committee, and a professor of pediatrics and vice dean for the School of Medicine at Zuckerberg San Francisco General Hospital at the University of California San Francisco. Elena talks to us about the pressures of balancing caregiving with a career in academic STEMM; the impact that’s having on workers and on science overall; and steps that the government, universities, and others can take to make a difference.
Elena, welcome. Thank you for joining us.
Elena Fuentes-Afflick: Thank you, Sara, I’m glad to join you.
Frueh: I’d like to start talking today about what your study found in terms of the problems and barriers that caregivers in academic STEMM are facing now. In terms of laws and existing supports for caregivers or lack of supports, what does the current landscape look like?
Fuentes-Afflick: The committee considered the current landscape of legislative and other policies related to caregiving, and what we found was that while there are many supports and protections for caregiving, current policies are incomplete and fragmented, and this lack of cohesion creates confusion and it makes it difficult for institutions to comply with the current laws. So we recommend a number of corrections or suggestions for these entities, but we were pleasantly surprised to find the scope and the type of supports that are in place. But we note that the communication is often difficult to find, the resources are hard to localize, and it’s difficult both for institutions as well as individuals to find information when they need it.
Frueh: Your report notes—I found this interesting—that there’s a high degree of non-compliance with the law across institutions. What types of laws aren’t they complying with and what’s driving that? Is it just the complicatedness of all the different laws and rules or what’s behind that?
That’s part of what we mean by the fragmentation, that there isn’t a cohesive set of rules that applies to all people in academic STEMM.
Fuentes-Afflick: Part of the issue is that the applicable laws and policies depend in part on which constituent group we are referring to. So our focus was in academic STEMM and even within that community, we are talking about faculty; we’re talking about staff, students, postgraduate trainees; and in the case of medicine, residents and fellows. Each of those groups has slightly different policies and rules which apply and so it takes a very sophisticated level of knowledge and coordination to understand which policies apply and how to navigate them. So that’s part of what we mean by the fragmentation, that there isn’t a cohesive set of rules that applies to all people in academic STEMM. And we recommend that universities and other entities have a centralized resource with a specific person or office who can be a confidential resource when people have questions, and that that person be fully versed in the laws and policies to provide accurate and timely advice.
Frueh: Now, your report points to another problem, which is cultural. You point out that in some STEMM environments, it’s taboo to even bring up caregiving responsibilities and you talk about there being this ideal worker norm and expectation. I’m wondering if you can say more about what that ideal worker norm looks like on the ground for caregivers and how it affects them.
Fuentes-Afflick: The ideal worker norm is deeply embedded in the fields of STEMM. The ideal worker norm is the prototype of someone who can be completely dedicated to their work in a STEMM field, who is available for round-the-clock work, who has no or minimal outside obligations. And clearly this prototype is difficult to achieve, but for someone who has caregiving responsibilities, there’s a direct conflict with requesting time or juggling caregiving responsibilities with the expectation of round-the-clock non-stop availability and productivity. So while we recognize that this is a deeply embedded cultural norm, we also recognize that changing culture is very difficult and we have a number of suggestions for how institutions and individuals in leadership roles in particular can begin to identify it and try to change the culture to make it less reliant on an ideal worker norm as the ideal and more balancing caregiving and other responsibilities with one’s professional obligations.
Frueh: I’m wondering if during your career in academic medicine you’ve run into some of these issues? Did anything while you and the committee were exploring this issue and writing the report, were there particular things that resonated with you or made you think about your own experiences?
Fuentes-Afflick: As an academic physician, I’ve juggled with caregiving responsibilities throughout my career as a faculty member. I have two children and when they were born, our policies were not as generous as they are now. And so I’ve always been cognizant of balancing personal responsibilities with work. And often—although we identified the ideal worker norm as a concept and we discuss it in the report—it’s often much more subtle in the way that it plays out. And I would say I was conscious, I didn’t have the term “ideal worker norm,” but I was conscious of a high expectation of availability to either do clinical work or other research responsibilities. And it’s always been a struggle. I’m very glad that now we have better terminology. We have better policies so that we can talk about caregiving responsibilities without violating laws. We can talk about how we can adapt our expectations, how can we adapt our schedules to be more accommodating by focusing on the work that needs to be done, but being more realistic about the other responsibilities that people bring to their work.
Frueh: I kind of want to go a little bit deeper into what this looks like in the real world for people who are trying to do a good job, progress in their career and they run into these types of barriers. What effects is it having on them and their careers?
The birth of a first child is a moment of great vulnerability and a high proportion of both women and men in STEMM fields leave the field entirely at that time.
Fuentes-Afflick: What we know—both from research as well as the interviews that we conducted as part of this study—is that people experience a great deal of stress. We also know that from the published research that the birth of a first child is a moment of great vulnerability and a high proportion of both women and men in STEMM fields leave the field entirely at that time. We don’t know all the reasons why people leave the field, but one might speculate given the timing that it is that challenge of integrating a new set of caregiving responsibilities with the professional responsibilities that becomes either untenable, too stressful, unaffordable or somehow doesn’t work anymore, and people leave the field. So that’s a real challenge for our profession when we want to encourage people to pursue careers in STEMM, and we want to make the workplace inviting and receptive and accommodating to their needs.
So we know that there are major challenges, some of which people are even reluctant to share with their supervisor. So it’s sad to think about someone leaving the field without ever really asking for help or accommodation, but sometimes people don’t know who to ask, they receive incorrect information or they just make assumptions that no one will be accommodating and I just will leave. So we have a lot to do, but we also identified in our report and through our committee process that there are institutions that are undertaking innovative pilot programs. And these include programs such as team-based science or team-based teaching, so that the responsibilities don’t only fall to one person. There are programs called time banking where you can receive kind of an in-kind support if you are helping out another colleague, if you step to the plate and you help a colleague, you can perhaps get a benefit in a different form. There are re-entry programs for people who take time away for caregiving responsibilities and then need a bit of a refresher or retooling, so that’s a way to retain people in the workforce.
And then we recognize, as you said in your question, that the STEMM workplace has high expectations. We expect people to be innovating, to be creating new knowledge, disseminating that, and that can be very stressful without caregiving responsibilities, but that our tenure process is often very rigid, very unforgiving, and some institutions have developed ways of adapting their tenure review and advancement review process to take more consideration of those who have caregiving responsibilities. So those are examples of innovative practices that we recommend institutions consider.
Frueh: I want to go back to something you said before about this affecting both women and men. And I know the report notes that these issues disproportionately affect women, and I’m wondering if you can talk a little bit about that, like the impact that caregiving and stresses around caregiving have on women’s ability to participate in the STEMM workforce?
Fuentes-Afflick: We know that women are very interested in STEMM fields. When we look at survey results of children or adolescents interest in STEMM fields, there’s a widespread interest. And you look at college along the continuum. There’s a great deal of interest among women and men, but we note that there is attrition as one proceeds along that professional pathway. Part of that we believe is caregiving, and these are societal norms that place a disproportionate burden on women, particularly women of color.
Society has a norm that places a disproportionate burden on women. But in our committee deliberations, we noted that these also have disproportionate impact for women of color and for both ethnic minority and LGBTQ communities.
And our committee took a very expansive interpretation of what caregiving means. It is caregiving in the perhaps traditional sense, but it also involves transportation, it involves financial management. It does not just involve children. There are elder care aspects to it. And it’s not just one’s nuclear family, there are other forms of caregiving for people outside the nuclear family. So we considered all those dimensions of caregiving. And again, society has a norm that places a disproportionate burden on women. But in our committee deliberations, we noted that these also have disproportionate impact for women of color and for both ethnic minority and LGBTQ communities, the definition of family or the scope of caregiving is often broader than it is in a majority population. So it’s an important issue, but it doesn’t apply equally to different groups and it’s very important from our committee perspective to take what we call an intersectional lens to look at the way that different identities such as race, ethnicity, and gender affect caregiving expectations and caregiving experience.
Frueh: It’s clear that this is affecting individuals and individuals in some groups disproportionately. I’m wondering if you can talk a little bit about the impact this lack of support for caregiving has on the workforce and the nation’s scientific capabilities? What’s at stake here for the rest of the country?
Fuentes-Afflick: The committee strongly believes that supporting caregiving represents a strategic investment in the labor force and is an important aspect to addressing and advancing equity. So we see caregiving as a major national priority. And that is based on our finding that lack of support for caregiving results in labor force issues like reduced participation in the labor force, reduced earnings and retirement savings for those who either cut back their labor force participation or drop out completely. And for those who remain and are juggling either the ideal worker norm or other pressures, they may experience reduced career opportunities or career growth. So each of these dimensions has a negative impact on individuals’ career trajectory. And when you consider the fact that caregiving as an experience is extraordinarily widespread in our society, you can understand that collectively there is a major impact.
Frueh: We’ve talked a little bit about the problem and its impacts, and I kind of want to switch to speaking a little bit more about solutions to this. And you noted that the committee really is encouraging innovative solutions and gave some great examples of that. And in addition to trying to think creatively and come up with other solutions, are there things that all academic institutions should be doing as a baseline to support caregivers?
Fuentes-Afflick: Our committee made some global recommendations and then some specific for colleges and universities. So what we made as a global recommendation is the development of a centralized resource to which people can turn. That includes clear and easily accessible written communication about policies and procedures. We recommend that these be universal so that they apply to the faculty, to the staff, students, the various constituencies. And we recommend that they be opt-out rather than opt-in. Opt-in requires an affirmative choice that you want to participate in some of these flexibility or programs, whereas opt-out means the expectation is you will participate, you have to actively disenroll from that.
We recommend that very strong protections be placed to protect against discrimination and bias, which we heard about in our interviews that people are sometimes very afraid to bring forward even a request for caregiving accommodation because of retribution. And we recommend that affordability and access be directly addressed by institutions because the cost of caregiving services is often high and puts it out of reach, particularly for some of the earlier career groups.
For colleges and universities specifically, we made some recommendations and these include ensuring compliance with legal requirements. We spoke earlier about the fragmented and the piecemeal nature of laws and policies, and so colleges and universities should be sure that they are complying with everything that is required of them. We also recommend that they provide 12 weeks of paid caregiving leave for all employees and leave for students that allows them to maintain their student status. Sometimes students are given accommodations, but they have to step away from their role as students to accept them and then that puts them behind in their educational progress. So we are encouraging colleges and universities to ensure that their policies continue to support students in their student role.
Colleges and institutions are their own labs, if you will, and they can implement policies and see who takes advantage of them and what impact do they have.
We recommend that colleges and universities institutionalize opportunities for flexibility in the location, time, and work intensity associated with employment. We didn’t focus specifically on the pandemic, but we know that the pandemic has encouraged us to be more flexible in our thinking about how and where and when we work. So we recommend institutionalizing opportunities for flexibility. We recommend providing centralized resources to support caregiving needs. We recognize that colleges and universities are major employers and they have opportunities as large employers to create resources. We recommend that they collect and analyze data on caregivers and on the impact of the policies that they institute. Colleges and institutions are their own labs, if you will, and they can implement policies and see who takes advantage of them and what impact do they have. And then we encourage them to take a scholarly approach and pilot innovative practices and evaluate them to understand their impact.
Frueh: I’m wondering about the culture change piece. With topics such as sexual harassment in academia and diversity and inclusion, one thing that often comes up is that culture change is both really important and really hard, and I’m wondering if you can talk about that in the context of caregiving. How can schools and individuals who are part of this system start to shift to a more supportive culture for caregivers? Who needs to start that and who needs to be involved in it?
Fuentes-Afflick: This is a really important area and one on which we did not find a great deal of research. So it comes more in the category of sharing practices and sharing experiences around the committee table. What we discussed was that the leader’s example can be very powerful. So if a major leader at a university says that they are taking caregiving leave either for the birth of a child, for example, or an elder care issue, and if they share their experience that they are stepping away, that can be a very powerful example to the remainder of the community.
I encourage leaders to the extent that they feel comfortable talking about their own personal experience with it.
Now, one can’t force that, it has to be authentic. But I will say that from my own experience, when my kids were young and I was a junior faculty member, I often felt that I had to be a little on the down-low about any kind of leaving early or taking them to a pediatric appointment or whatever because we didn’t have a vocabulary for that. And I’m very proud that although our culture still needs to change, I believe that it is changing and that we will continue to change. So I encourage leaders to the extent that they feel comfortable talking about their own personal experience with it. We believe that that is one important way to begin to change culture. But clearly understanding and following the policies and laws is another important way to shift some of those cultural expectations.
Frueh: What about other parts of the STEMM ecosystem? Are there things that policymakers and research funders should be doing to make sure that caregivers in STEMM are better supported?
Fuentes-Afflick: Our committee considered these various entities because we recognize that the educational institutions are one part of the STEMM ecosystem, but as you know, there are many others that have an important role in either the policies that we follow or the way that we can implement flexibility. So we see a role for the federal government, and we recommend that the federal government enact legislation that mandates 12 weeks of paid comprehensive caregiving leave. We believe that would be a major advancement for our country. We also were inspired by the recent CHIPS and Science Act which requires that institutions applying for funding under that act must provide on-site childcare. That we see as a very innovative practice, and we recommend that the federal government consider adopting that requirement for other federal opportunities.
It was hard for me, when we were reviewing the interviews that were conducted, to hear people speak so painfully about their fears of requesting accommodation, their fears of retaliation, their fears of discrimination.
For funders more generally, private and public, we recommend that they support flexibility in some of their deadlines. For example, they may define a junior faculty award and they may define it very narrowly, for example, the first three years of a faculty career. Well, what happens if you’ve taken a caregiving leave during that period? We recommend that funders consider a bit of flexibility if there has been a caregiving issue that has disrupted that zero to three year requirement. So we recommend some flexibility on the part of funders, and we recommend that funders provide support for caregiving when that comes under the granting period. We recommend that funders also assist in developing reentry programs for grantees, and we recommend that they fund innovative scholarship on family caregiving, whether it is the policies that support reentry programs. There are a number of important research topics that remain in need of additional study.
Frueh: While you were conducting this study, thinking about both the problem and solutions and examining both parts of that, did you run into anything that surprised you?
Fuentes-Afflick: I would say that nothing really was a surprise, but I will say it was hard for me, when we were reviewing the interviews that were conducted, to hear people speak so painfully about their fears of requesting accommodation, their fears of retaliation, their fears of discrimination. We talked in our committee about the maternal wall bias, biases that assume that professional mothers are less committed to their work or less committed to being a good employee if they are juggling caregiving responsibilities. These are norms and biases that I’m familiar with, but I guess I had hoped that in 20 or 30 years they might be less prevalent. So it was sad for me to realize that these are ongoing timely issues even now, and so we need to focus on this and acknowledge it and try to develop policies and programs to address it.
Frueh: So given that it has been a problem that’s been so persistent and things haven’t entirely changed in the last 20 years, how optimistic are you or aren’t you that this can really change in the near future and that the STEMM community, policymakers, everyone can start to see this for the important issue that it is an act like it? And if you are hopeful, where does it lie?
Fuentes-Afflick: I am very hopeful about making meaningful progress on these issues. First of all, I think we have strong data, and while we need further research, we have a good amount of true data that we can use to identify challenges as well as best practices and innovative programs. So we need to continue to build on that. We also, I believe, understand more clearly the economic impact that it has on individuals, institutions, and also our whole country. We have significant problems in STEMM that we need to address and we need everyone to engage in that. We need them to participate to create solutions. We can’t afford to lose people. So I hope that the policy imperative is clear.
We have significant problems in STEMM that we need to address and we need everyone to engage in that. We need them to participate to create solutions. We can’t afford to lose people.
I also am very encouraged in my own field of medicine, and as I work with junior faculty and trainees, they bring an urgency around these issues. They speak up, they talk about what they need. They may be reluctant to a certain extent about fears of discrimination or retaliation, but they still speak up and they push us to be better. And so I’m encouraged by that bravery that they often show. And so I’m optimistic that we are creating momentum for change and that we will see meaningful improvement.
Frueh: Is there anything that you think is really important about this report that we haven’t covered so far that you want listeners to know about?
Fuentes-Afflick: What I want to be sure to convey is that caregiving we consider a universal phenomenon. Certainly when we were little, we needed caregiving. If you become a parent, you get firsthand experience. If you have parents for whom you are caring, you understand that. Sometimes you’re caring for a spouse, sometimes it’s a sibling or a neighbor or some other person. So caregiving is really an equalizing experience over our lives. So it is really important. But also, even if one is not a direct caregiver, the caregiving experience impacts families and couples and communities. It is truly an issue that should matter to all of us in our professional and in our personal lives, and we can all speak up and advocate for policies, for individuals, for being innovators. I think it truly touches everyone, and I hope that everyone will be engaged in the effort.
Frueh: Thank you. That was so helpful. I appreciate your delving into this issue, and that is all the time we have. So I just want to thank you for joining us, Elena.
Fuentes-Afflick: Thank you so much for the invitation.
Frueh: Check out our show notes to find links to the report, Supporting Family Caregivers in STEMM: A Call to Action, and other Resources. And if you’re listening to this, you’re probably passionate about science policy. Please visit issues.org/survey to participate in our survey of the science policy community.
Please subscribe to The Ongoing Transformation wherever you get your podcasts. Thanks to our podcast producer, Kimberly Quach, and our audio engineer Shannon Lynch. I’m Sara Frueh, an editor at Issues in Science and Technology. Thank you for listening.