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The Director of the Office of Research on Women’s Health on the Benefits of Diversity in Medicine

The long-time physician and researcher discusses the setbacks women face and the institutions and initiatives bringing about gender parity in medicine.

Janine Austin Clayton, M.D.

Director, Office of Research on Women’s Health (ORWH), National Institutes of Health (NIH)

Why did you decide to pursue a career in the medical field?

My father was my inspiration to get into the field of medicine. His name is Dr. Kenneth Austin and he practiced rheumatology at Howard University Hospital in Washington, D.C. Being a physician was the only job I ever thought about as a child.

What inspired you to go into research on women’s health?

My first role was as an ophthalmology attending physician at the National Institutes of Health (NIH) National Eye Institute, or NEI.I treated children and adults with autoimmune eye diseases and trained other doctors. I designed studies to test experimental medications to improve treatment of these conditions.I was really disturbed when I learned that, worldwide, about two-thirds of those who are blind or visually impaired are women. That wasn’t something that could be explained by our best knowledge or our most advanced research. Eight years ago, I had the chance to spend what’s called a detail, a temporary placement, in the NIH Office of Research on Women’s Health (ORWH). I’ve been here ever since and have been fortunate enough to be appointed as the director.

Tell us a little bit about your typical daily routine. What does your role as the director consist of?

One of the exciting aspects of my role is that no two days are alike. I chair and co-chair a number of NIH committees and working groups, so I attend many meetings with representatives from the NIH Institutes, Centers, and Offices (ICOs), as well as other meetings sponsored or co-sponsored by ORWH. I also meet individually with the directors of each IC to collaborate with them as they address compelling clinical questions about the health of women. ORWH co-funds and manages a number of grant programs, so I interact regularly with the staff members who oversee these efforts. We also produce a number of publications and reports, which I oversee and review before they’re released to a wider audience. I’m often asked to speak at professional society meetings and national or international conferences, which requires the preparation of speeches and travel. I do quite a few media interviews on topics related to women’s health, both by phone and in person. Of course, I need to stay up-to-date with the latest research, so I regularly read a number of journals. One of the most enjoyable aspects of my job is interacting with the dedicated staff at ORWH, hearing about the progress of their programs and their innovative ideas.

When conducting research, are their specific areas of women’s health that interest you the most?  

ORWH is the first Public Health Service office dedicated specifically to women’s health and it’s the focal point for women’s health research at NIH. The ORWH director has a leadership role that was mandated by congress. It includes the responsibility for strengthening and enhancing research related to diseases, disorders, and conditions that affect women; ensuring that research conducted and supported by NIH adequately addresses issues regarding women’s health; ensuring that women are appropriately represented in biomedical and biobehavioral research studies supported by NIH; and developing opportunities and support for recruitment, retention, reentry, and advancement of women in biomedical careers.

I am also the architect of a recent policy that requires investigators to study both male and female animals in basic laboratory research unless there is a valid reason to study only one sex. Now scientists applying for NIH funding must account for sex (that is, being male or female) as a biological variable (or SABV) in their research studies with animals and humans. This new approach has the power to transform how science is done and can help propel medicine into the realm where it works for both women and men. 

Why do you think it’s important to create more support and inclusiveness for women in medicine? 

First, I should note that recruitment, reentry, retention, and advancement of women in biomedical careers are longstanding, congressionally-mandated elements of the ORWH mission.

Across the globe, women represent only about 29 percent of the world’s scientists working in research and development, and only 13 percent are in senior-level positions. The women who do have successful careers in science, technology, engineering, math, and medicine (STEMM) earn less money than their male peers. In addition, as women advance in their careers, the conflicting priorities of family and career can decrease career satisfaction and predict career departure. Institutional support for these women is important in lowering the attrition rate, as is helping women reenter the workforce after taking leave to attend to family responsibilities. 

Some of the programs and activities we have at NIH/ORWH to support women in biomedical careers are listed below.

ORWH/NIH co-sponsored a National Academies study with the National Science Foundation and L’Oréalfor spring 2020publication to address many barriers that result in underrepresentation of women in STEMM. Unfortunately, progress toward gender equity in STEMM has stalled. Women are underrepresented at full faculty and senior leadership levels, despite extensive research on the value of gender diversity and numerous policy changes designed to help women. This study presented an opportunityto help the STEMM community realize that an evidence-based body of knowledge exists on the contributions of women. It also increases understanding of what works and what doesn’t work in different career stages and by varying race and ethnicity.

The NIH Working Group on Women in Biomedical Careersis led by Dr. Francis Collins, the Director of NIH; and myself. It was created in response to the fact that women in the biomedical sciences face institutional and environmental barriers to advancement at all career stages. The Working Group is comprised of individuals in leadership positions at NIH. It sponsors national workshops on mentoring and other career topics of importance to women. 

In 2008, the Working Group issued a Request for Applications (RFA) for research on causal factors and interventions to support women in biomedical and behavioral science and engineering. The Causal Factors RFA has been the most significant effort by NIH in the 21stcentury to support women in STEMM.A large number of research grants that were supported across the NIH ICOs investigated obstacles faced by women at all stages of the career pipeline.

The Causal Factors and Interventions Research initiative also resulted in a vibrant research partnership for women in biomedical careers that continues to publish. The members sit on advisory committees, study sections, study committees, search committees, and are in leadership positions. They’re influencing the way we think about the barriers to women in biomedical careers and the approaches we can use to accelerate institutional and cultural change. The initiative conducts workshops and presentations, as well as producing publications, including two special journal issues in “Academic Medicine”(2016) and the “Journal of Women’s Health”(2017). 

Journal article topics have included the power of unconscious bias, stereotype threat, the stigma of institutional flexibility policies, the importance of strong publication records for women, the effectiveness of mentor networks, and the importance of a socio-ecological approach for effective interventions. 

Other achievements by the Working Group on Women in Biomedical Careers include: 

  • Policies for intramural scientists at NIH that include extended paid parental leave for NIH trainees for up to 8 weeks.
  • A leave bank program for NIH employeesso they can attend to family responsibilities.
  • A program to provide back-up care for children, elders, and adult dependents.
  • The “Keep the Thread” program that offers flexible schedule options and part-time work options.
  • The Women of Color Research Network (WoCRN); a social media effort that provides women of color and others with information about the NIH grants process, career development advice, and a forum for networking and information-sharing.It includes a LinkedIn site.

Working Groupsubcommittees include: (1) Women of Color (WOC) in Biomedical Careers, and (2) Advancement of Women in Independent Positions (for research or research-related positions).

Do you think mentorship is beneficial to helping women advance their professional careers? 

Yes, mentoring is one of the most important ways to develop young talent. Unfortunately, women can be reluctant to seek out mentoring relationships for fear of being perceived as inadequate — and they often have smaller professional networks. Research tells us that mentorship requests from scientists from underrepresented groups, including women, are more likely to be ignored than those from white men. In addition, scientists from underrepresented groups typically receive less mentoring than their well-represented peers. A lack of or failed mentorship can result in career attrition or can limit advancement. Mentoring is more likely to be successful when there’s strong support from leadership at the institution, when mentor and mentee training is provided, and when there is ongoing monitoring of mentor-mentee relationships. Positive effects from good mentoring include a sense of belonging and self-efficacy that can lead to increased persistence, research productivity, and career satisfaction. This can enhance an institution’s ability to attract scientists from underrepresented groups.

Through one of our grant mechanisms, NIH/ORWH created a successful mentored career development program to increase the number of women’s health researchers, called “Building Interdisciplinary Research Careers in Women’s Health (BIRCWH).”It connects junior faculty, known as BIRCWH Scholars, to senior faculty with shared research interest in women’s health and sex-differences research. Applicants can be either men or women, although the vast majority of BIRCWH Scholars have been women. Applicants must be pursuing interdisciplinary research on women and girls and the study of sex and gender differences.Since 2000, there have been approximately 700 BIRCWH Scholars from 46 research institutions. The program demonstrates the effectiveness of a mentored career development approach. 

The ORWH website provides inspirational videos in which prominent women in science and medicine share wisdom on advancing in the biomedical field. Called “Pearls of Wisdom,”each interview offers a unique perspective for women on overcoming barriers to success. We provide biographies that describe the journeys of each speaker. The women profiled have had successful careers in fields such as ophthalmology, gynecologic surgery,obstetrics and gynecology and gynecologic oncology, family medicine, and orthopedic surgery. 

From your perspective, why do you think diversity among medical professionals and within organizations is so valuable?

Diversity brings a wider array of perspectives, insights, and creative problem-solving that are critical in scientific research and other endeavors. In the work we do at NIH, it broadens the scope of biomedical inquiry, fosters research addressing health disparities, and promotes innovation and excellence in biomedical research to benefit our diverse Nation. The NIH Office of Scientific Workforce Diversity offers a toolkit[1]on promoting diversity in the workplace at the junior and senior levels. Some of the topics addressed are reducing implicit bias, conducing unbiased talent searches, outreach, networking, and mentoring.

Not surprisingly, women in STEMM and other disciplines generally experience greater challenges in their professional careers than their male teammates, which hinders their success. A recent study found that women of color are particularly underrepresented across the career spectrum and especially at higher organizational levels.Minority women in science face a double bind because of the barriers that exist for both women and minorities.Scientists from underrepresented groups include African Americans, Hispanics, Native Americans/Alaska Natives, Pacific Islanders, and those who are multiracial.

In 2017, NIH/ORWH began the U3grant program, which stands for Understudied, Underrepresented, and Underreportedpopulations. Grant funding is awarded for research that looks at issues of relevance for U3 populations of women, which can result from factors such as race and ethnicity, socioeconomic status, gender identity, and urban-rural living. The initiative also promotes growth for medical practitioners and clinician-researchers who work with U3 populations.

What is one piece of advice you would offer to prospective women looking to have a career in healthcare?

My advice for women is to follow your dreams no matter what it takes, and don’t let anything or anyone persuade you otherwise. Hold true to your principles. Each of us has her own path to take. Honor those who came before and always remember their legacy. They blazed the trail and made it much easier for me and many others to follow. Women have incredible strength and are so important to the health and well-being of our communities and society. Be there for each other. Each one can teach one and each one can reach one. 

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