Pulled in Too Many Directions: The Causes and Consequences of Work-Work Conflict

Abstract

Previous research has documented the influence of overwork and inflexible hours on work-life conflict for working professionals. In this paper, we build on this literature and explore the novel theoretical concept of work-work conflict, a form of inter-role conflict analogous to work-life conflict. Drawing on 48 in-depth interviews with 42 physicians and survey data of 60 faculty at a prominent west-coast academic medical center, we find that work-work conflict is fueled by institutional structural characteristics. Institutional incentives, the extent of recognition for various work activities, and financial rewards are misaligned, causing physicians to experience competing demands across multiple organizational missions (research, teaching, clinical care, and administration/service). Other industries may face similar conditions leading to work-work conflict. We conclude that work-life interventions are necessary but not sufficient to increase employee satisfaction, and that mechanisms to alleviate work-work conflict must be incorporated in practical solutions to address burnout.

Keywords

organizations occupations work medical sociology qualitative methods

Scholars have written extensively about the poignant and substantial conflict between work and personal life. Due to increasingly demanding expectations at work and at home, employees manage an inordinate amount of conflict between work and family (Allen et al. 2000; Glavin, Schieman, and Reid 2011; Ilies et al. 2007; Jacobs and Gerson 2004; Milkie et al. 2004; Schieman, Milkie, and Glavin 2009; Schieman, Whitestone, and Van Gundy 2006; Williams 2000). However, work-life conflict is not the only type of time conflict workers experience. In this paper, we introduce a new theoretical construct, work-work conflict, to describe time conflicts between various work activities, the strain they exert on workers, and resulting outcomes. Comparable with work-life conflict, we posit that work-work conflict can produce similar outcomes of burnout, stress, and low satisfaction.

Although different types of role conflicts and time strain have been studied by scholars (Biddle 1986; Blair-Loy and Cech 2017; Kahn et al. 1964; Milkie et al. 2004; Nomaguchi, Milkie, and Bianchi 2005; J. R. Rizzo, House, and Lirtzman 1970; Turner 1962), conflicts between roles within the same job and work sphere, and the toll these conflicts take on employees, have not been examined. Research on work-life conflict has typically viewed work and home as distinct spheres in conflict with one another (e.g., Coser 1974; Greenhaus and Beutell 1985); however, conflicts within each domain remain relatively unexplored. In this paper, we examine conflicts between distinct work roles within a single employment context. In addition to having inadequate time, participants in our sample struggle to allocate their time between competing work roles within the same job. We find work-work conflict arises from a number of sources, including competing institutional priorities, ambiguity and lack of transparency about work expectations, lack of recognition for certain work activities, and compensation structures misaligned with the full set of job responsibilities. These work features create a context in which employees must perform multiple distinct roles to be successful at work, leading to significant conflict for employees.

The field of academic medicine provides an exemplifying case for developing the theoretical concept of work-work conflict. We conducted 48 in-depth interviews with 42 faculty members at a prominent west-coast academic medical center (AMC; referred to hereafter as the School of Medicine, or SoM), and we collected survey data from 60 faculty participants. While scholars and practitioners have expressed significant concern about overwork and burnout in the medical field (Aiken et al. 2002; Avgar, Givan, and Liu 2011; Halbesleben and Rathert 2008; Kellogg 2011), research has primarily focused on the problem of long hours. Our research identifies conflict between work roles as an additional contributing factor to stress and dissatisfaction among physician faculty, which can ultimately affect the health and safety of broader patient communities. Previous research has noted that faculty make tradeoffs in allocating their time between different activities (Massé and Hogan 2010; Misra et al. 2012; Misra et al. 2011). We extend this work by characterizing the conflicts these tradeoffs create and identifying the sources and consequences of such conflicts in a medical school context. In addition to the typical faculty expectations of research, teaching, and administration, most medical school faculty members have extensive clinical duties, which exacerbate work-work conflict by tying faculty to different institutional expectations and roles.

The realms of work and family have often been termed greedy institutions (Coser 1974; Franzway 2000). Here, we suggest domains within work can be similarly greedy, demanding complete devotion and extensive time commitment on more than a single mission, none of which can reasonably be met. Scholars examining work-life conflict can benefit from considering not just the conflict between work and home spheres but also conflicts within the work context. By examining “time conflicts” more generally, we can better identify the sources of conflict and design more effective policies and structures to address these conflicts. In addition, although academic medicine has many unique qualities, these findings likely apply to other industries with similar structural characteristics requiring that employees take on competing roles at work.

Background: Work-Life Conflict and Work-Work Conflict

Previous research has thoroughly documented sources and consequences of work-life conflict. Ideal worker expectations require workers to demonstrate intense devotion through protracted time commitment at work (Albiston 2010; Jacobs and Gerson 2004; Williams 2000). Due to this ideal worker norm, work hours have lengthened over the past few decades, particularly in high-status jobs, and technology has enabled companies to expect nearly constant availability from employees (Cha 2013; Glavin et al. 2011; Jacobs and Gerson 2004; Perlow 2012; Schieman et al. 2006). Meanwhile, expectations for “good” parenting have also become more extensive and demanding (Hays 1996; K. M. Rizzo, Schiffrin, and Liss 2013). Combined with the increasing prevalence of dual-earner and single-parent households, workers face severe challenges to conform to competing expectations at work and at home (Allen et al. 2000; Benko and Anderson, 2010). These expectations particularly disadvantage women, who remain primarily responsible for housework and childcare responsibilities, and face gendered penalties in workplace structures that prioritize a stereotypically masculine ideal worker (Acker 1990; Gerson 2010; Roth 2004; Williams 2000).

Scholars have identified three primary dimensions of work-life conflict: time, strain, and behaviors. Work-life conflict is created when time devoted to one role, strain from participation in one role, or specific behaviors required by one role make fulfilling requirements of the other role difficult (Carlson, Kacmar, and Williams 2000; Greenhaus and Beutell 1985; Greenhaus and Powell 2003). According to the conservation of resources model, individuals must allocate their finite amount of time and energy between various activities—essentially dividing their available resources between the two disparate domains of work and family (Grandey and Cropanzano 1999; Hobfoll 1989).

However, work expectations do not all necessarily align into one neatly contained category; workers can also experience conflicts within work (or within family). We thus use the definition of work-life conflict in defining a parallel concept: work-work conflict. We define work-work conflict as a form of inter-role conflict in which conflicting job roles are mutually incompatible so that participation in one role is made more difficult by participation in another role (Greenhaus and Beutell 1985; Work and Family Researchers Network 2014). In line with the findings of Misra and colleagues (Misra et al. 2012, Misra et al. 2011), we propose conflicts can arise between various work activities, as individuals struggle to allocate their time and energy between different roles within the broad umbrella of paid work. We draw more broadly from role theory, which posits that individuals occupy roles containing embedded expectations for behavior and social interactions (Biddle 1986; Turner 1962). In organizational settings, roles can conflict with one another and create ambiguity about employees’ work expectations (Kahn et al. 1964). Work-work conflict is a type of role conflict where fundamentally different work roles are encapsulated within a single job, and workers are expected to adequately fulfill each conflicting role. While role ambiguity has been explored by existing research (Kahn et al. 1964; J. R. Rizzo et al. 1970), we extend this research by examining not just when roles are ambiguous but also when discrete work roles are incompatible. The ambiguity of roles certainly contributes to work-work conflict, but even if work roles were perfectly clear and transparent, they could still theoretically compete with one another. What happens when participation in one required work role makes participation in the required other work roles within the same job more difficult?

Furthermore, work-work conflict extends existing research on work overload, time adequacy, and time strain (Blair-Loy and Cech 2017; Milkie et al. 2004; Moen, Kelly, and Lam 2013; Nomaguchi et al. 2005). Competing work roles not only put employees in a position of having insufficient time to devote to each required work task, in absolute amounts, but also create tensions that essentially split a worker into pieces. The overall amount of work is not the only problem employees face; the conflict between work roles, identities, and tasks may create additional tensions for employees. In particular, Mary Blair-Loy and Erin A. Cech (2017) examine work overload, which they define as the desire to cut hours, feeling pushed to exhaustion, and the sense of being overloaded by all of one’s roles. We extend their theoretical concept by focusing on the conflicts employees experience between roles within the same work sphere or job, creating tensions for workers above and beyond the long hours. Particularly in a field like academic medicine, where employees report to more than one institution and execute disparate sets of tasks, work-work conflict is an important theoretical construct that encapsulates employees’ day-to-day experiences.

Academic medicine provides one example of an industry rife with work-work conflicts. Research has documented the difficulties clinical faculty face when attempting to navigate their varied work responsibilities (Arana and McCurdy 1995; Barchi and Lowery 2000; Fleming et al. 2005). Clinicians are expected to successfully embody a “triple threat,” substantively contributing to clinical service, research, and teaching missions, or even “quadruple threat,” with increasing demands for service/administration activities (Arana and McCurdy 1995; Fleming et al. 2005). Different institutions—the hospital and the university—demand employees’ time and divide the responsibility for incentives such as pay and promotion, leading to time conflicts between clinical care and research (Barchi and Lowery 2000). The competing demands of the varied tripartite mission areas and administration/service activities lead many faculty members to feel unable to meet any mission area adequately as they struggle to do all simultaneously. Furthermore, although faculty are expected to succeed in all areas, not all areas provide equal reward or recognition; teaching and administrative/service duties tend to be devalued in the larger institutional culture, despite their importance to the institution’s missions (Fincher et al. 2000; Fleming et al. 2005; Massé and Hogan 2010; Pololi et al. 2009; Reiser 1995). Similarly, clinical duties often take a backseat to research in terms of perceived value in research-intensive institutions.

AMCs have begun to recognize these conflicting roles, and several have instituted multiple faculty lines or tracks, which generally include (1) clinician-scientists (expected to perform clinical duties and excel in innovative research); (2) clinician-educators (expected to spend more time in the clinic and primarily serve as a teacher to medical students and other clinical trainees, with less time on research); and (3) basic scientists (most similar to a traditional university professor, with research and teaching responsibilities and no clinical responsibilities). Clinician-scientists and clinician-educators are often in a particularly challenging situation, where clinical expectations create significant conflict (Buckley et al. 2000; Levinson, Branch, and Kroenke 1998; Levinson and Rubenstein 2000; Thomas et al. 2004). These difficulties faced by academic physicians have been described and detailed in medical journals (Aiken et al. 2002; Arana and McCurdy 1995; Avgar et al. 2011; Barchi and Lowery 2000; Fleming et al. 2005; Halbesleben and Rathert 2008), but such accounts have typically remained unconnected to the work-life literature more broadly.

An academic physician’s career success depends on fulfilling different roles effectively, and each role carries the weight of underlying institutional incentives and expectations. Faculty members are expected to embody successful physicians, researchers, and educators while contributing to the overall administration and service activities of the institution. Participation in each role makes participation in the other roles more difficult (Greenhaus and Beutell 1985). Work-work conflict often coincides with overwork, and the two concepts can exacerbate one another, but they are theoretically distinct. For example, work roles could conflict even if an individual does not experience overwork. In addition, work-work conflict also encapsulates competing ideal worker norms: The ideal clinician demonstrates complete devotion to her patients, the ideal scientist is completely devoted to her research, and the ideal teacher volunteers extra hours and supplies to support her students (Blair-Loy 2001). Thus, academic medicine represents an extreme research site, where overwork and work-work conflict exist simultaneously.

A number of factors may conceivably cause work-work conflict, and we identify a subset of potential mechanisms in this paper. First, different institutions (e.g., School and Hospital) can create competing incentive structures that pull employees in multiple directions. In addition, ambiguity and lack of transparency surrounding administrative and service expectations can cause conflict by leaving employees without a clear sense of where to devote their time. Finally, compensation structures can cause work conflicts by failing to incentivize particular work activities, although they are necessary to the function of the institution.

As with work-life conflict, work-work conflict likely has significant negative consequences. Work-life conflict has been linked to high turnover in companies, low employee satisfaction, reduced health and well-being, stress, and burnout (Aiken et al. 2002; Allen et al. 2000; Kossek and Ozeki 1998; Moen, Fan, and Kelly 2013; Moen, Kelly, and Hill 2011; Moen, Kelly, and Lam 2013; Moen et al. 2011; Pearlin 1983; Schieman, McBrier, and Van Gundy 2003). Burnout is an important theoretical concept that has been examined by existing research, and it includes the loss of enthusiasm for work, emotional exhaustion, feelings of cynicism and depersonalization, and a low sense of accomplishment (Shanafelt et al. 2012). In the medical context, work-life conflict and physician burnout can also contribute to worsened patient outcomes (Aiken et al. 2002; Avgar et al. 2011; Halbesleben and Rathert 2008). We expect work-work conflict may have similar psychological and organizational outcomes by constraining an individual’s time in meaningful ways and creating zero-sum situations where employees must choose between competing priorities.

Furthermore, akin to work-life conflict, work-work conflict may also have gendered dimensions. In much the same way the ideal worker norm systematically disadvantages women, experiences of work-work conflict may be exacerbated by disproportionate home responsibilities (Gerson 2010), service work (Misra et al. 2011), and experiences of workplace discrimination or barriers to advancement (Eagly and Carli 2007). Workplace processes and structures that impede women more generally may combine with the drivers of work-work conflict to produce worse outcomes for women.

Research Site, Data, and Method

AMCs and their affiliated teaching hospitals account for 5 percent of U.S. hospitals; however, they provide the majority of care to vulnerable patients and operate most regional specialized services (e.g., Level 1 trauma and burn centers, pediatric intensive care, psychiatric emergency services) (Grover, Slavin, and Willson 2014). In addition, research activities at AMCs have accounted for many of the most innovative advances of the twentieth and twenty-first centuries (Grover et al. 2014). Because of the requirements necessary to be a contributing employee to an AMC, this provided the ideal research setting for the present study.

In this study, we analyzed the presence of work-work conflict at a prominent west-coast AMC, SoM. SoM has just under 2,000 faculty: 94 percent (more than 1,800 physicians) in clinical departments. Faculty in the basic science departments generally report only to the school and are in positions more similar to traditional faculty appointments. Unlike clinicians, these basic scientists do not face conflicting responsibilities toward both the hospital and the school, although they do manage conflicts between teaching, research, and service/administration.

Faculty in three clinical divisions and two basic science departments were asked to complete a survey and interview. While the initial survey of 60 respondents conducted in 2012 and 2013 revealed a widespread feeling of competing priorities, the survey results could not convey the extent to which these competing priorities create work-work conflict for SoM physician faculty. Thus, we also conducted interviews to examine these processes in more depth.

Interviews were conducted with 42 participants: 22 (52 percent) male, 20 (48 percent) female; 22 (52 percent) junior faculty (instructors and assistant professors), 19 (45 percent) senior faculty (Associate and Full professors), and one nonfaculty staff participant. Twenty-nine (69 percent) interviewees were White, seven (17 percent) were Asian, and six (14 percent) were another race or did not report race. Interviews lasted approximately 90 minutes each. Six interviewees were interviewed twice over a year apart, by two different interviewers, to fully flesh out and understand their experiences over time, for a total of 48 interviews. Participants were asked about their reasons for choosing SoM, career progression and advancement, work allocation, family situation, use of flexible work arrangements, organizational and team culture, job satisfaction, and future career plans. We analyzed interview data using a modified grounded theory approach, allowing themes to emerge inductively and relating those themes to existing interpretations. The concept of work-work conflict emerged organically from the interviews; when asked about work-life balance and their allocation of time between various work tasks, participants brought up the conflicts and tensions they feel between their different work roles (e.g., clinician vs. researcher) and the institutions to which they report. In later interviews, we probed more about these conflicts directly, asking questions about what it means to report both to the hospital and to the university, how participants feel about the different expectations placed on them, and the tensions they experience. Each interview was transcribed verbatim and coded using Dedoose software for qualitative and mixed methods research. We conducted two rounds of coding: open coding to understand the various ways participants conceptualize work-life issues, and focused coding to capture theoretically relevant patterns across interviews. To protect participants’ privacy, we use pseudonyms in our discussion.

Findings

Physicians come to SoM for many reasons. For example, they enjoy the teaching opportunities, the community of their colleagues, and the geographical location. However, despite these benefits, physicians struggle with high levels of work-work conflict; in other words, the different missions of their job—clinical, research, teaching, and service/administration—often conflict with one another and create tensions. These physicians feel torn between competing missions and exercise little control over how they spend their time.

Work-work conflict in this case is generated by a number of institutional factors: competing incentives at the hospital, university, and team (e.g., department/division) levels, lack of recognition and transparency about work expectations, and incentives provided through the compensation structure. We detail each of these factors as revealed in our interviews.

Why Choose This Job?

A variety of unique characteristics differentiate academic medicine from other job opportunities available to candidates—other opportunities that would often result in higher compensation. For example, in our interviews, many respondents highlighted the ability to teach. “What I really liked about academics was that teaching aspect,” said one associate professor, Emily. “To me, teaching and taking care of patients, that’s a great combination.” Similarly, Assistant Professor Kevin told us,

One of the things I like about here, it is good to be working with residents. . . . It’s nice to feel like you have an impact as they’re going through, ’cause when I look back and reflect on my medical school—my undergrad and my medical school and residency—I definitely can name people who had a big impact on me, who were sort of mentors, role models. I like being able to do that.

Ruya, another assistant professor, agreed, “I just love to teach. I love to teach and be part of creating good, new doctors.” One physician even went so far as to negate the motivating influence of compensation: “I don’t really care how much money I’m making here,” said Instructor Brian. “I like working with the residents. . . . That’s why I stuck around here.”

In addition to teaching, interviewees discussed the benefits of working among energetic, knowledgeable, and inspiring colleagues. For example, Associate Professor Hiro said,

I think [SoM] is a very unique environment in that . . . the whole energy and the grouping of all the thoughts and things, and all the progressive kinds of initiatives around here are really satisfying. . . . It drives all of the interest and searching for different horizons.

Instructor Priya also added, “When I come to work I love seeing my colleagues and talking about what they’re doing, and we build off each other, and we help each other.”

Clinicians also often have personal reasons to remain in the area. For example, numerous respondents talked about their spouses or families also located in the area. One physician told us, “I’m here because my wife’s here.” Another physician described his children as “[West coast] kids.”

While physicians have diverse reasons for choosing and remaining in academic medicine, they often have trouble celebrating the benefits due to work-work conflict. Academic physicians drawn to academia for love of teaching must find balance between teaching and heavy clinical and research responsibilities. Academic physicians excited about research opportunities must secure sufficient funds to compensate for lost clinical hours. In the following sections, we detail how these activities stem from contradictory incentive structures at the institutional level.

Introducing the Concept of Work-Work Conflict

In addition to splitting their time between work and personal commitments, academic physicians must alternate between competing work responsibilities. The survey of 60 respondents conducted in 2012 and 2013 revealed high levels of work-related dissatisfaction among faculty. For example, 43 (72 percent) reported that they did not have adequate resources to meet the demands of research, teaching, service, clinical, and administration. Forty-seven (78 percent) reported that they did not have enough time for their research in particular. Furthermore, 38 (63 percent) respondents reported that most of their time at work was not spent on the things that matter most to their career goals, and 41 (68 percent) reported that most of their time was not spent on things they are uniquely qualified to do. Below is a graphic that depicts the extent to which respondents desired a change in their allocation of time spent on clinical, research, teaching, and other responsibilities.

Figure 1 reveals that a large percentage of physician faculty want to decrease clinical time and increase research time. While it is likely that many types of faculty experience similar frustrations with the lack of time to devote to various tasks, these tensions are particularly acute for academic physicians, who must balance the faculty role with their clinical duties.

Figure 1.

Time allocation preferences of faculty (N = 60).

Along with these survey data, our interviews delved into the lived experience of respondents. According to Emily, an Associate Professor, “To me, it’s not just . . . the home and work. It’s really, to me the bigger problem is the work conflicts.” Emily describes these “work conflicts” in the context of detailing the extra work created by her teaching responsibilities; when teaching residents, her clinical shifts become slower, and she is unable to see as many patients. Emily further explains,

People excel at different things. An academic institution needs all those different parts to work well. If you have an excellent clinician, and you have an excellent teacher, and you have an excellent researcher, you need all of those things, but there’s no way that one person can do all of it.

Mark, an assistant professor, adds, “It’s always the tension between the academic role and the clinical role.” Academic physicians often feel as if they have two (or more) full-time jobs demanding their attention and are thus unable to perform at a high caliber at both.

Competing Institutions

Academic physicians face divergent incentive structures stemming in part from separate institutions; the hospital rewards employees for clinical productivity, whereas the university determines advancement and promotion outcomes, based in large part on research. Take-home pay is determined by the hospital based on clinical shifts worked, whereas tenure and advancement decisions go through the university and often rely on research accomplishments. Amy, an Instructor, explains, “I think what’s hard, too . . . is that it seems like there’s the clinical and then there’s also the academic, which are really different and not related.” Similarly Greg, an assistant professor, views these responsibilities as separate and conflicting:

[You have] this choice between being a clinician and being a [professor]. Every time people said to me, “You can’t be both,” I just kept saying “I’m going to do both.” But, you know, you pay the price because now you have two jobs.

Kevin, an assistant professor, explains, “That’s where I feel like right now, being spread out over the different things has its pluses, but one of the challenges to me is that I feel like I’m always disappointing someone.”

While faculty in all tracks complained about this tension, it seems particularly acute for those in the clinician-educator track. The clinician-educator role is primarily intended to support the hospital clinically, even though the university prizes research. Because clinician-educators have no protected research time unless they are able to secure outside grants independently, they especially struggle to balance clinical responsibilities with research expectations. Steve, an Emergency Medicine Associate Professor, explains,

[Clinician-educators] can’t do research. They can’t do research. They’re not on the right track. They can’t even hold grants. They’re not even considered for research positions. I’m doing faculty searches now. I can’t bring anybody in a [clinician-educator] line that holds a grant.

This particularly pessimistic perspective indicates the difficulties clinician-educators face when trying to engage in research. Technically, clinician-educators can hold grants through a principal investigator waiver, but faculty members feel the rules are restrictive. Melissa, an assistant professor in the clinician-educator track, explains this tension between the written and unwritten rules:

I would say that one thing that’s not written in the [clinician-educator] faculty manual but I understand from speaking with other people at [this university] is that despite there being no publication requirement for promotion, it’s expected that we still publish. That’s—[laughs]—over time, that’s gonna be difficult, I think. Especially if I have no protected time to do research. I’m able to collaborate and get on some papers. I would say not as the primary author right now because of how busy I am clinically. If that’s a real expectation, I think that will be difficult for me to fulfill that unwritten requirement.

Amy, a clinician-educator instructor, similarly describes her experiences trying to secure dedicated research time:

I told [my supervisor]—and this is a conversation we have every time—I want to be working 75 percent time, but I want 25 percent of it to be academic work, that I can move my career forward, that I can actually be working on the things that I’m in an academic institution to work for. I’m gonna stay at 50 percent time knowing that this is a personal financial hit that I’m taking and knowing that—but it’s so that I can move forward. I am so naïve. That doesn’t work, right?

Here, Amy explains that she reduced her hours from 75 percent to 50 percent in an attempt to secure additional research time; however, this “personal financial hit” has not enabled her to do more research as intended. George, an associate professor in the clinician-educator line, similarly says,

One of the problems of the [clinician-educators] is that they all want to get paid. . . . They all want to get paid for educational things that don’t pay. But yet, that’s part of their mission. Do you see the Catch 22?

He goes on to explain, “The division is benefitting from [their educational activities]. The division is benefitting from that, but not directly. It’s very indirect.” Thus, while certain educational activities benefit the division, those activities are not necessarily rewarded explicitly by the hospital or the university.

Mana, a clinician-scientist associate professor, discusses service activities that help the hospital but do not contribute to her promotion evaluations at the university level:

Sometimes I get really overwhelmed, and it’s really cutting into my personal time more and more, and I’ll think, “Okay, what should I drop?” Even my boss thinks, I think, I’m probably overextended. I think of all the things that I probably—if I could—if I wanted to drop, I should probably drop is the [service activity], because that unfortunately does nothing for my promotion. It’s really a service thing I’m doing. It’s really—it’s a good skillset and it’s definitely helped me network and get to know a lot of people, but it definitely—and I recognize it’s not doing anything for my promotion track, although the [people involved with the activity] go, “Oh yeah, yeah. Sure it’ll help you one day.” I don’t think it’s really—I don’t think this gets any kind of recognition for—because this is a hospital thing. It’s not a university thing. I think it definitely helps the [hospital]. It helps us run smoothly, but it doesn’t do anything academically.

Examples like Mana’s demonstrate how activities that aid one institution may conflict with incentives of another institution. Clinical faculty experience these conflicts acutely as they make daily decisions about how to allocate their time.

Lack of Recognition for Service, Administration, and Teaching

As Mana’s quote indicates, certain activities receive little reward or recognition even when those activities benefit the hospital, university, and/or department/division. Mark, an assistant professor, explains,

I would actually like to be a little bit more involved [in teaching]. But it’s pretty clear . . . that in terms of the priorities, it’s establishing a research program and publishing. And so education falls kind of low on that list.

Emily, an associate professor, calls this prioritization a “research chip on the shoulder” and claims, “There’s no way the clinical and the service side and the teaching—I just can’t see that ever becoming equal.” Because research is prioritized so heavily in the academic culture, other activities become denigrated—even when those activities are necessary and critical to the success of academic medicine.

Clinical faculty also have intensive administrative responsibilities that can become overwhelming. Yuan, an assistant professor, laments the glut of paperwork:

We are responsible for all the notes being signed off on. You see everybody, but the paperwork just starts to build up, and that can get hard . . . And the next day starts, and like 34 patients are seen, and your inbox just piles up with responsible notes that you have to just sign. Even though you’re done, it’s just the documentation.

These additional responsibilities create conflicts between various work roles for academic physicians. They also feel obliged to participate in institutional service activities that are often not rewarded, such as department meetings and conferences. Despite the cultural emphasis on the need to engage in service activities, faculty members report that these activities are not formally rewarded in tenure and advancement decisions.

This devaluation of nonresearch activities makes it difficult for academic physicians to successfully fulfill their competing work roles. By engaging in teaching, they risk shortchanging their research. Likewise, engaging in service or administrative responsibilities—essential activities for the hospital and university—also takes time away from potential research and clinical productivity.

Lack of Transparency

Interviewees also discussed the lack of transparency regarding expectations about work allocation and advancement criteria. When work expectations are not clearly defined, conflict between work roles can become even more acute. For example, when asked about promotion expectations, Ramit, an associate professor, replies, “I’ll be honest here, it’s really nebulous. There’s no defined targets. You get conflicting information. . . . I think it’s really nebulous how that promotion decision gets made.” Yuan, an assistant professor, also finds the promotion process unclear for clinician-scientists:

Not very [clear]. I think they are making an effort now to make it more clear because the line that I’m in, the [clinician-scientist] line, is very heterogeneous. It has very different kinds of people with different backgrounds that all have a—they say they all have a clinical base. But what the expectation is research-wise or other activities in the mix they say is hard to define. When you say that, then do you know you’re okay? Are you not really okay? . . . You feel very nervous about the whole process to begin with.

Amy, a clinician-educator, feels the process is similarly unclear for clinician-educators as well:

I feel like when I was hired, I was told—I mean, I think our department really lacks transparency. It is very unclear, A, how you get promoted, B, how you actually are within the department. I mean, there’s so many different lines. We don’t know who’s doing what. Some people show up to a faculty meeting, but you never see them in the clinical sphere, or you see them once a month in the clinical sphere, and that’s what makes the department money. I was told if I want to not work clinically, I have to bring in grants or I have to teach. If I can’t bring in grants, then all I can do is work clinically, and then why would I just work for [the university] for free, which is what it feels like [the university] asked me to do, like to actually have an academic career.

In addition to highlighting the lack of transparency, Amy mentions the different incentives behind clinical work and research. Hospitals need these various tasks to be fulfilled, but universities often struggle to incorporate clinical faculty into the research-heavy university context. As such, AMCs are unable to provide clear guidance on where and how physicians should be dividing their time. Similarly, according to Priya, a clinician-educator instructor,

I don’t think we are clear on what—I don’t know if other people felt that they were clear, or—I feel like I’ve talked to all the other faculty and no one really knows. I think it’s a little more clear for the [clinician-scientist] line . . . Because they are told, I guess if you’re employed by the university, that you do need X amount of publications. Certain authorships. And when I’ve talked to [my supervisor], he said that I don’t need research for promotion, or you don’t need publications. It helps, but that’s not in my clinical line. My clinical line is to teach.

Here, Priya expresses ambivalence about the extent to which research will feature in her evaluations. Technically, clinician-educators are not given protected time to do research; yet in Priya’s words, “it helps.” She goes on to say that the promotion timeline is unclear; she does not know how long it should take to progress from instructor to assistant professor. While the university does offer training on expectations for clinician-educators, academic promotions (as well as promotions in other employment contexts) often rely on subjective rather than formal criteria; clinician-educators worry they will not fulfill tacit research expectations that often underlie promotion decisions.

For Greg, an assistant professor originally hired into the basic science/research track, his promotion process varied considerably from what he expected. Although the basic science/research track is typically expected to do more research than the other tracks, Greg was hired with the expectation that he would focus on his clinical work:

I had been hired. I said, “I really want to be a clinician. Why are you making me be a [researcher] where it’s 85 percent grant support, and you’re allowing me a 10 percent clinical effort?” . . . That was always my plan. I can show you the job talk, and I literally said, “I’m going to develop these [technologies], I’m going to do these clinical trials.” And people said “That’s great.” But then when it came up in three years, they said, you know, “You’re not generating enough papers. You’re not really going to write a Nature medicine paper out of this type of work.”

Greg did not end up earning a promotion in the basic science/research tracks, and he was instead transferred to the clinician-scientist track. Although his case has many particularities, it resembles other professors’ experiences in that the expectations for advancement were not clear to him at the outset. Operating under unclear advancement expectations, physicians feel particularly conflicted about how to allocate their time between their different work roles.

In addition to the lack of transparency around advancement criteria, AMCs can also lack transparency regarding the distribution of service and work allocation. According to Bahir, a clinician-educator associate professor, “There are lots of people who carve out their little sweet deals, where they’re workin’ one, two, four shifts a month. They aren’t actually—and you know, it’s not clear exactly how that’s being funded.” Similarly, Amy complains about the lack of clarity around what constitutes fulltime clinical hours:

I think for me it would be really helpful to even know—I mean, I wish they could just even lay out for us, at 50 percent of time—I was told you’re just working clinical shifts and you’re not expected to do anything else, even though there’s a culture within our department that says you should go into faculty meeting, you should be going to conference, you should be doing all of these other things. The culture is there.

Here, Amy claims the tacit cultural expectations obfuscate the alleged formal criteria and add responsibilities to faculty’s time. She continues,

I’m getting mixed messages. The Chief and the Associate Chief [division leaders] are telling me different things. Even just transparency on what is expected. I’ve been talking—when I found out that our FTE is based on 21.67 shifts a month, I have talked to some of my close friends that are colleagues, and they [said], “No, it’s not.” . . . None of us know this. We don’t even know what our fulltime is based on. It’s so weird. I was like, “How did I sign a contract?” It wasn’t outlined in my contract that FTE is 21.67 shifts. I think that needs to be [laughs] really explicit. I mean, I don’t even—we don’t even know what we’re working for. . . . Make it explicit, but tell us what it is, right?

Amy laments the lack of transparency around clinical expectations. She goes on to say that this lack of transparency breeds discontent among faculty:

Because otherwise I feel like it’s manipulative and it feels really badly [sic], right? Because you’re told you’re not doing enough, and they can always tell you you’re not doing enough, and it’s expected of you because ostensibly 20 percent of our thing is academics and admin, right? They can always tell you, no, that’s for your admin. You need to do it.

Because clinical activities require additional work on top of time spent in clinic, and research time requirements ebb and flow, varying tremendously, it is difficult for universities, hospitals, and faculty members to clearly anticipate the time various activities will require. Academic physicians tend to be motivated, driven people dedicated to fulfilling job expectations, so the ambiguity causes acute anxiety and the perception that their efforts are never good enough.

Compensation

Work-work conflict is also exacerbated by the compensation structure. According to Priya, an Emergency Medicine clinician-educator instructor,

My fiancé . . . doesn’t understand this at all. . . . He’s like, “So you work twice as much at [the university] and you get paid half as much? I don’t understand that.” I don’t know. It’s just the way I’ve been doing it. I like it. I like the work. But now you start thinking about, okay, we do want to buy a house, have a family. I probably at some point need to look at making money, right? We’d like to do this, I’d like to say, “Yeah, I just do it and have fun,” but realistically you have to live. And here is the highest cost of living. And we are the lowest paid. I talk to all my friends I went to med school with anywhere else. They’re all getting—they laugh at how much I make. You know? It’s, I don’t know if the idea is you have [the university’s] name so you feel honored to work here? Is what I’ve been told, and that’s why you get paid so little. But that’s not—it’s almost abusive, I feel.

Compensation for physicians outside of academic medicine often significantly surpasses an academic salary; yet the workload in academic medicine often exceeds that of other jobs, because academic physicians have considerable administrative responsibilities, plus teaching and research, in addition to clinical duties. Priya, along with many interviewees, also expresses the difficulty living on the West Coast in an expensive area on a university salary. Similarly, George, an associate professor clinician-educator, compares academic compensation to other institutions outside of academia:

I know the amount you get paid here is dramatically different than private practice in emergency medicine. I don’t know if that’s true in other fields as much, but it’s very significant. The salary is the same, but the workload is three times—it can be up to three times as many hours a month. It’s just a lot different.

Although George stipulates he is not in a position of hiring people, other interviewees who do hire new employees agree with his claims. For example, associate professor Steve explains,

I have coordinators that I hire for my research. I lose them over compensation all the time. That’s a huge friction cost for me. Then when I train new coordinators, I’ve got to be on call with them all the time. They come in, they stay for a year if I’m lucky, and they go, they take higher paying jobs. . . . It just—it’s really frustrating.

To supplement their compensation, many doctors work part-time at other nonacademic hospitals in the area, particularly in a shift-based service like emergency medicine. However, this can increase work-work conflict by introducing another set of responsibilities and another employer into the time allocation model. For example, according to Robert, an associate professor in emergency medicine, “We have a lot of emergency doctors who come to us just for the fact that, ‘I can work at [the university] with residents.’ The real money they make is somewhere else.” Doctors add on responsibilities outside of their academic job to increase their total compensation.

Academic physicians also note the excessive amount of uncompensated responsibilities. According to Jessica, a clinician-educator instructor, “Every shift that I work at SoM, I expect that I’m gonna be here for hours after the shift.” In addition to all the administrative work, faculty members complain that the day-to-day work allocation hardly ever adheres to agreed-upon limits. For example, Lien, an instructor who moved from the clinician-educator to the physician-scientist track, explains,

75 percent [of my allocation] is research, but the reality is—I’m sure you’ve heard this before as well—it’s never 25 percent [clinical]. The reality is more like 50–50. The reality is really 50–50, because . . . to start a [clinical] service and maintain a service and also the teaching, the preparation of lectures, taking care of your fellows and also taking care of your patients off-line: the reading, the checking up on their charts, following up, it really ends up—dictation, communication with other providers—hopefully you’ve heard this before—it’s more like 50–50.

Daniel, an assistant professor in the clinician-educator track, agrees, “Right now, I work much more than 100 percent. Much more—way, way more. I don’t wanna calculate my hours. . . . They haven’t really changed from residency.”

Some interviewees indicated these uncompensated tasks often arise out of cultural expectations. Amy officially works on a 50 percent part-time schedule, but her hours usually total more like 80 % according to her, “I feel like there’s always additional expectations of you.” These additional expectations create conflict because professors are pressured to work more than their scheduled allocation.

Compensation for certain activities can conflict with other incentives. For example, according to Melissa, a clinician-educator assistant professor,

I would say that our bonuses are completely based on RVU [Relative Value Units] right now. That means direct patient care, much more heavily geared towards procedures and seeing patients in the hospital and billing for ICU consults, that kind of thing. That work is very heavily rewarded in regards to pay. . . . Then, other activities that are also important for patient care and education are not rewarded financially. Fellow education, all the lectures that I get invited to speak, those are not given credits right now for bonuses and have nothing to do with the financial piece at all. They definitely have to do with promotion because in the [clinician-educator] track, I also have to give excellent clinical education. That’s a nice, obviously, work product of doing that, but right now, that’s not tied to any financial compensation at all. Then, activity work or being a good citizen is also not financially rewarded. . . . None of that is compensated for. I also, as we all do, all the faculty, we attend meetings, participate in work groups, come up with clinical protocols for things. Over time, I’ve learned to say no. Even though I think some of the work is interesting and important, I just don’t have time to do it. It’s not compensated for. The committee work is also really not part of the promotions picture. There’s really no incentive to do committee work, but it has to be done. It’s important for patient care. It’s important for quality patient care, so I don’t really know how to resolve that conflict except to say no [laughs].

Melissa contrasts the paid activities (clinical) with the unpaid activities (teaching, service) that are necessary for the functioning of the medical school but are not clearly incentivized or rewarded financially. In these ways, the compensation structure exacerbates employees’ perceptions of work-work conflict by highlighting the tension between their relatively low pay for clinical shifts and additional unpaid service and administrative responsibilities.

Work-Work Conflict and Satisfaction Outcomes

Respondents in our sample expressed concern and stress about how they allocate their time, and the survey data demonstrate that these concerns are linked to key outcomes. We used the survey findings to examine some preliminary patterns and connections between certain drivers of work-work conflict and important outcomes, such as work-life satisfaction, job satisfaction, and turnover intentions. While the qualitative data provide an in-depth window into the nuances of work-work conflict, the survey questions examine only pieces or particular operationalizations of work-work conflict; still, they give us some leverage in assessing whether work-work conflict is related to other important outcomes.

To examine work-work conflict, we use six related survey questions: (1) I have appropriate resources to meet the combined demands of clinical care, research, teaching, administration, and service work. (2) Most of my time at work is spent on the things that matter most to my career goals. (3) I have control over how I allocate my time. (4) I understand the requirements for promotion to the next level. (5) I understand the career opportunities available to me. (6) Service and leadership activities are valued by [this AMC]. Although these questions do not represent the concept of work-work conflict in its entirety, they can show how specific aspects of work-work conflict serve as mechanisms affecting faculty satisfaction and intentions to leave.

The dependent variables we study include: (1) I am satisfied with my current career-life fit. (2) I intend to stay employed at [this AMC] for the foreseeable future. (3) Overall, at this time, how satisfied are you with being a faculty member at [this AMC]?

Answer choices ranged from 1 (strongly disagree) to 5 (strongly agree).

Table 1 depicts ordinary least squares (OLS) regressions using each of the work-work conflict variables to predict each of the dependent variables. The survey question about having the appropriate resources to meet the combined demands of various work roles is at the heart of work-work conflict: the difficulty of meeting all the demands of each separate, consuming work role required of academic clinicians. We find this difficulty is significantly related to career-life satisfaction (p < .001), job satisfaction (p < .05), and intentions to stay employed at this institution (p < .05). Feeling that one’s time at work is largely spent in service of “things that matter” to career goals is also significantly related to the three satisfaction and turnover intention outcomes (all p < .01), as is feeling a sense of control over time allocation (all p < .01), understanding requirements for promotion (all p < .05), and understanding the career opportunities available (all p < .01). Using our qualitative data, we found that in the context of work-work conflict, where employees feel beholden to different institutions governing compensation and promotion outcomes, ambiguity around promotion expectations is common. Here, we find this ambiguity is significantly related to critical work outcomes.

Table 1.

OLS Regression Coefficients Predicting Satisfaction and Turnover Outcomes (N = 60).

Variables	Career-life satisfaction	Job satisfaction	Turnover intentions
Resources to meet combined demands	.563*** (.093)	.294* (.110)	.228* (.088)
Time spent on things that matter to career goals	.424** (.119)	.426*** (.115)	.286** (.095)
Control over time allocation	.509*** (.094)	.350*** (.103)	.313*** (.080)
Understand requirements for promotion	.299* (.117)	.275* (.110)	.304** (.085)
Understand career opportunities	.326** (.114)	.407*** (.105)	.310** (.086)
Service and leadership are valued	.117 (.136)	.391** (.119)	.357*** (.093)

Source. Work-Life Program Baseline Survey, 2012–2013. Standard errors are in parentheses.

Note. Each coefficient represents the result of a separate regression. OLS = ordinary least squares.

p < .05. **p < .01. ***p < .001.

In addition, believing that service and leadership activities are valued by this institution is significantly related to job satisfaction (p < .01) and turnover intentions (p < .001). Overall, while 90 percent of participants agree that research is valued by this institution, only 55 percent of respondents agree that service and leadership activities are valued. As discussed earlier, the expectation to engage in service and administration activities—coupled with devaluation of those activities—also contribute to work-work conflict. The survey findings reveal that this perception of devaluation is also correlated with job satisfaction and intentions to remain employed with this institution.

Thus, in summary, we find that work-work conflict factors are significantly related to important satisfaction and turnover intention outcomes. It is important to note that causality is impossible to determine here; work-work conflict variables could predict our dependent variables, and/or it is possible the dependent variables cause work-work conflict. Either way, clear relationships exist between drivers of work-work conflict and key outcomes such as work-life satisfaction, job satisfaction, and turnover intentions.

Analyses by Gender

We used the survey data to examine patterns by gender. (There was not enough variation to complete analyses by race.) While men and women were largely consistent in their experiences of work-work conflict and work outcomes, there were some notable differences.

When asked whether they have appropriate resources to meet the combined demands of clinical care, research, teaching, administration, and service work, only 19 percent of women agreed or strongly agreed, whereas 39 percent of men agreed or strongly agreed (p < .10). Thus, women are significantly less likely than men to believe they have the resources to meet the demands of conflicting work roles (although this difference is only marginally significant). In response to the statement, “I have control over how I allocate my time,” 42 percent of women respondents agreed, whereas 69 percent of men agreed (p < .04), matching findings in a national survey of physicians (Linzer et al. 2001). Women were also less likely than men to believe they understand the requirements for promotion to the next level (p < .06) and less likely to believe work is distributed in a transparent way in their division (p < .05).

These gender differences are not altogether surprising given existing research on women’s harsher experiences of work-life conflict (Gerson 2010; Jacobs and Gerson 2004) and difficulties advancing in the workplace (Eagly and Carli 2007). Existing research shows women continue to do more household labor than men (Gerson 2010), and in AMCs, women continue to do more service and administrative work that tends not to contribute to promotion outcomes (Misra et al. 2011). Accordingly, when asked, “I am confident that I can make my future career-life fit work for me at [this institution],” only 23 percent of women in our sample agreed, whereas 45 percent of men agreed (p < .07).

In SoM, women are also more likely than men to work as clinician-educators. In 2013, 29 percent of non-clinician-educator faculty members were women, whereas 57 percent of clinician-educators were women. Because research is so highly prized at this institution, the clinician-educator role is often seen by participants as less valued. This fits existing research finding that women in academia tend to have lower-status roles than men (Benderly 2014; Conner et al. 2014; Massé and Hogan 2010; Misra et al. 2011). Thus, the difficulties clinician-educators face also have a gendered dimension; women are more likely than men to be found in these roles and are, thus, more likely to experience certain difficulties related to work-work conflict. That said, the causality is impossible to determine: Do clinician-educators face these additional difficulties because of their faculty line, their gender, or some combination of both? Future research would be needed to examine these dimensions more fully.

Discussion

Our findings reveal that work-life conflict is not the only type of time conflict that hampers employees; they also experience conflicts between competing work roles. The context of academic medicine provides a useful site in which we can observe such work-work conflict and identify some of the causal mechanisms at the institutional level. Through the demands of competing institutional missions, the misaligned financial rewards and other incentives, the unrecognized role of service/administration, and the lack of transparency about work expectations, the environment of academic medicine generates work-work conflict as academic physicians struggle to allocate their time between incompatible priorities. This conflict creates considerable strain for employees, akin to the deleterious effects of work-life conflict, and our findings indicate that work-work conflict may produce similar outcomes of stress, low satisfaction, and potential burnout.

Although academic medicine has many particularities, we posit that work-work conflict affects other industries as well. For example, employees working for nonprofit organizations may experience work-work conflict as they struggle to meet the altruistic mission of the organization while simultaneously fundraising enough to stay afloat. Matrixed organizations and subcontractors may face work-work conflicts as well. Lawyers, consultants, and other client service professionals may feel tension between the demands of different clients, and between serving the best interests of the client and doing what is best for the company. However, even though such professionals serve various clients, pay and promotion decisions are typically made consistently by their superiors in the firm, unlike the faculty members in our sample, who report to both the hospital and the university; thus, the experiences between the two populations might differ on that basis. In addition, low-wage workers employed in multiple part-time jobs may feel a type of work-work conflict, although the specific operationalization may look quite different than our sample of elite employees. In sum, the theoretical construct of work-work conflict we identified may well apply to a large variety of work settings, and future research can explore variations in work-work conflict across different industries.

Future research can also study the etiology of work-work conflict in more detail. For example, is work-work conflict primarily generated by the conflict of professional identities within a single job? Or is it fueled mainly by conflicting sets of tasks, differing occupational norms, serving both salaried and billable roles, the pressure to please different superiors, and/or being embedded in different institutions? In the case of medical faculty, these types of conflict all coincide, producing acute tensions and creating a useful setting in which to study work-work conflict. Future studies can tease apart the various mechanisms we identify to determine which are most detrimental to employee satisfaction and well-being.

Our study expands existing theory in a number of ways. First, it identifies organizational contextual and structural factors that exacerbate role conflicts among employees. Elements of the institutional environment—such as competing incentive structures, compensation structures misaligned with the multiple job functions required to meet institutional needs, and lack of transparency about work expectations—influence the conflicts employees experience when attempting to manage their time. Second, we study employees within the larger context of their careers. To advance and earn promotions, employees struggle to meet the demands placed on them in their competing work roles, and this ever-present concern about their advancement shapes the way they make decisions about where to devote their time. Finally, this paper broadens the concept of work-life conflict to “time conflicts” more generally, or conflicts allocating one’s time between different priorities and activities, both personal and professional. Employees can experience conflicting roles (with corresponding demands on their time) both within and outside the two domains of “work” and “personal life.” We introduce a novel concept, work-work conflict, to describe the tensions workers experience when work roles compete, making participation in one role more difficult by participation in another role. Future research can expand from this foundation by exploring the ways in which domains within work and within the personal sphere contain conflicting roles that put unique strains on individuals.

The burden of work-work conflict for employees has important policy implications. Our findings suggest that for workers experiencing high levels of work-work conflict, programs designed to increase work-life fit and flexibility will experience limited success if they do not alter the structural features of work itself. In other words, organizations cannot solve the broad problem of conflicting demands on an employee’s time by addressing work-life conflict without also addressing work-work conflict. Interventions such as part-time work, flexible scheduling, and childcare have made significant inroads in improving employee life (Moen, Kelly, and Lam 2013); however, organizations must also incorporate policies designed to alleviate conflicts between competing work roles. For example, institutions could work together to ensure job roles are clearly defined and structured in a way that enables employees to succeed without compromising fulfillment of each role; in the case of medical faculty, the hospital and university could collaborate to ensure physicians can meet clinical demands without sacrificing research achievements, and to create a unified incentive structure. In addition, organizations could increase transparency around job and role expectations and the drivers of pay and promotion decisions. Work-work conflict, and the corollary, family-family conflict, contributes to existing theory by broadening the discussion of various time conflicts people experience, and policy makers can benefit from a more comprehensive evaluation of these conflicts.

Footnotes

Acknowledgements

We would like to thank the members of the social psychology workshop at Stanford University and the participants of the Work and Family Researchers Network and American Sociological Association conference presentations for their helpful comments and suggestions. In addition, we are grateful for the suggestions of the anonymous reviewers and the editor of Sociological Perspectives.

Authors’ Note

Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation or other funders.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the American Council on Education (ACE) in partnership with the Alfred P. Sloan Foundation, through the ACE-Sloan Projects on Faculty Flexibility: Award 2012-5-45 Career Flexibility Award (CFA); Stanford University School of Medicine; and Stanford University Office of the Vice Provost. This material is also based on work supported by the National Science Foundation Graduate Research Fellowship.

Author Biographies

Alison T. Wynn is the Diversity & Inclusion Postdoctoral Fellow with the Clayman Institute for Gender Research at Stanford University. Her research examines organizational policies and practices that may inadvertently create or reinforce inequality, particularly in elite industries such as technology, management consulting, and academic medicine.

Magali Fassiotto is Assistant Dean for Faculty Development and Diversity at Stanford University School of Medicine. Her research focuses on the functioning of organizations and work teams as well as the role of diversity in organizational processes.

Caroline Simard is Senior Director of Research at the Stanford University Clayman Institute for Gender Research. Previously, she served as Associate Director of Diversity and Leadership at the Stanford School of Medicine. She holds a PhD from Stanford University and a Master’s degree from Rutgers University.

Jennifer L. Raymond is a Professor of Neurobiology at the Stanford University School of Medicine. Her neuroscience laboratory investigates the neural mechanisms of learning and memory. Her efforts to increase diversity in science and academia have been reported in national and international news media as well as scholarly journals.

Hannah Valantine is Chief Officer for Scientific Workforce Diversity and Training at the National Institutes of Health, where she focuses on diversity across biomedicine. She is also a senior investigator in heart transplantation at the National Heart, Lung, and Blood Institute.

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