The COVID-19 pandemic has struck at the very fabric of academic medicine, causing career uncertainty for many, with a disproportionate impact on underrepresented minorities, LGBT+ scientists, people with disabilities, and those from myriad non-traditional backgrounds. The challenges of the pandemic have been amplified for women, especially due to the additional burden of home caregiver responsibilities. Many women are at risk of dropping out of academic research altogether, unless urgent action is taken.

Credit: Diana Johanna Velasquez / Alamy Stock Vector

An increased burden

The immediate burden of COVID-19 on academic medicine has been the delivery of high-quality clinical care, but there will also be a major long-term negative effect on research1, which will most heavily affect women investigators. Surveys of academics showed that the strongest predictors of time lost from research were female sex and the presence of young dependents1. Women have dropped out of the US workforce in far greater numbers than men have and are not coming back at the same rate2, including in academic medicine3.

Considerably more faculty in academic medicine report that they are considering leaving their positions or reducing hours during the pandemic than before, especially female faculty with children. Moreover, women with children were more than three times as likely to decline leadership opportunities as were women without children4. Submissions of scholarly papers to the medical literature by women decreased, whereas for men, they increased5,6. One department of internal medicine found that the number of grant submissions during the first 12 months of the pandemic increased for male faculty but not for female faculty, and that female faculty were requesting lower dollar amounts in these applications7. Other data, from, for example, the US National Institutes of Health (NIH), indicate that overall, the proportion of women submitting grant applications has not changed much in the pandemic8. The NIH data show that women continue to submit entry-level grants in greater numbers, but not career-advancing higher-level applications, such as program project or center grants (‘P series’) or large collaborative ‘U series’ grants8.

Clinical research has been especially hard hit by the infection-control requirements of the pandemic, and the delay imposed on clinical studies may be hard to overcome. Because grant funding was commonly not suspended (a real institutional asset during the crisis), it now may not extend sufficiently to cover the delay in study completion. Because women are disproportionally overrepresented in clinical research, according to Michael Lauer, Deputy Director for Extramural Research at the NIH, the impact on women will probably be greater.

There is a risk that junior women academics will not be able to meet expectations for tenure or promotion, even if their grants are extended, as they have not been able to publish enough in 2020 and 2021. Indeed, tenure-clock extensions granted during the pandemic, although well intentioned, may inadvertently benefit male faculty, who tend to use them for academic purposes, unlike female faculty, who tend to use them for caregiving responsibilities9. There is also a risk that early-career women academics will elect to pursue careers outside of academic medicine or leave the workforce completely, further exacerbating the challenge for women to achieve leadership positions.

Unacceptable baseline status of women

Women are appropriately represented, or very nearly so, among residents, fellows and assistant professors in academia, but the presence of women diminishes substantially at the level of associate professor, full professor and department chair. Representation of women at these higher ranks has not advanced in the past 35 years10. This is despite the efforts of many groups, such as Executive Leadership in Academic Medicine at Drexel University or the mentoring program initiated by the Center for Women in Academic Medicine and Science, to train women for leadership roles and provide mentorship and sponsorship for women, as well as an insistence by many institutions that searches for upper-level positions include diverse candidate pools.

Women are paid less than men in comparable positions are11,12, receive lower startup funds for laboratory research, and take longer to be promoted10. Women as a group may have fewer of the conventional markers of achievement in academia than do men, including fewer principal-investigator positions on large NIH grants such as P or U series awards (ref. 8 and M. Lauer, personal communication), fewer grant applications and grant renewals13, lower funding amounts for initial grants14, fewer papers for which they are first or last author15, and fewer citations of their papers (including papers authored by women in prestigious journals)16,17.

Funds for caregiving responsibilities

Several existing programs offer valuable solutions to prevent the loss of women from academia. The Claflin Distinguished Scholar Awards at Massachusetts General Hospital provide US$50,000 per year for two years to maintain research productivity during the child-rearing years. The program is competitive, and data indicate that those who were selected had a higher retention rate at their institution (90%, versus 60% for those who applied but were not selected for the program). Of note, the program invested $2.1 million over an eight-year period and garnered a very substantial return on investment, with $51 million in direct costs in grants being awarded to the recipients18.

The Doris Duke Charitable Foundation developed the Fund to Retain Clinical Scientists, through which support is awarded at the institutional level and is targeted to early-career faculty conducting clinical research who need supplemental resources because of caregiving responsibilities19,20. Providing laboratory support allows women to devote their time to other academic activities. Institutional matching funds, although not required as a condition of grant funding, were often provided to pay for child or elder care. The Doris Duke Charitable Foundation reissued this grant offering in 2021 and has formed an alliance with other foundations, including the American Heart Association, the Burroughs Wellcome Fund, the Rita Allen Foundation and the Walder Foundation. The NIH now offers $2,500 to support childcare to recipients of National Research Service Awards, but this has not been extendedto other awards. In late 2019, the NIH launched supplements to “promote the continuity of the research project...during a period [of] critical life events” by purchasing extra technical assistance for faculty ‘K award’ recipients and holders of early stage R01 grants21,22.

A framework for retaining women in academic research

We provide here a ‘menu’ of possible interventions to reduce the attrition of women from academia (Table 1). Both financial investment and commitment to cultural and operational changes are important to pursue at the institutional level, and there is room for creativity and flexibility beyond these recommendations23,24. Among stakeholders such as foundations, government funders, and professional organizations, there are already important examples of programs designed to mitigate the impact of COVID-19 on research by women. Expansion of such programs and investment in other innovative measures will be needed to prevent considerable loss of talent at early-career levels. Finally, and perhaps most importantly, substantial national and global efforts to change societal norms that position women as the default responsible caregivers are critical to allow women to succeed in the workforce, including in academic research careers.

Table 1 Recommendations to retain women in the biomedical work force
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