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Table 4 Career barriers

From: Academic career in medicine – requirements and conditions for successful advancement in Switzerland

Category Examples
1. Lack of structured residency programs 1. Job planning for further training is not very transparent in many specialist fields and hospitals. It is a nuisance having to apply for a job 2 years in advance. Often you do not even get an offer for the whole period of further training. There are still too few further training associations for individual specialist fields.
   2. There are hardly any structured further training programs for physicians with academic and clinical interests.
   3. In further training you have to be very flexible about where you live and work. I tend to be the social type who wants to stay near family and friends. I would certainly have progressed faster if I didn't mind where I worked.
2. Interference between clinical training and research activities 4. It is difficult to carry on further clinical training and research in parallel. You need to work at least 50% of the time for specialist training, otherwise it is not recognized. There are very few jobs split between 50% research and 50% further clinical training. It is easier to split a job after becoming a specialist.
   5. It is tremendously difficult to be good at research AND in hospital. I don't know whether I will manage it. It is a great strain, you have to find a way with which you yourself are happy. Clearly a hospital provides services and so you have to be a clinician first and foremost. If I were asked which was more important, a patient or a research project, there would be no question about it being the patient.
   6. If you aspire to an academic career you still have to do the clinical work. You are relied upon to work in your free time.
3. Insufficient research coaching 7. It is difficult to find anyone to initiate you into project planning and research methodology. You always have to keep asking.
   8. It is not easy to find a research group with a good atmosphere where you are respected but where you also know what you have to achieve, what the targets are.
   9. Far too little support is given in working out projects for a Swiss National Science Foundation grant and for all the preparation and administrative aspects of a stay abroad.
   10. Whether a paper is accepted for a journal depends not only on scientific quality, a part is often played by connections and inside contacts.
4. Demotivating rivalry 11. I have been thwarted by superiors on many occasions. If you are young and successful and achieve recognition from outside you are sometimes perceived as a potential competitor by your superiors. Consequently they do not let you operate. But you are absolutely dependent on this as a surgeon, without operations you cannot become a surgeon; this knocks your motivation.
   12. Although a lot of senior staff assert that they give us junior academics long-term support, they are often more interested in being listed as co-authors in publications even though they have had hardly any involvement in the projects. But you can't have it out with people because later on you might want to do something in the research line and need a job. As soon as you scare someone off you can say goodbye to further clinical training.
5. Financial short-comings 13. I earn very little in research (CHF 3,500 per month). At 32 it is not pleasant to have to rely on financial support from your parents. It is off-putting when, with all the skills you have acquired to date (technical, intellectual etc.), you have to start at the bottom again. My colleagues who are medics are generally already in senior physician posts and colleagues who work in industry all earn a great deal more than I do.
6. Personality related barriers 14. Tolerance to frustration and staying power are very important factors in the academic field. Sometimes you can't make any headway for 6 months but still have to motivate yourself to carry on; then you generally make a breakthrough some time afterwards.
   15. Your own doubt can be the worst hurdle. You begin to wonder whether you are on the right track, whether you are capable enough or good enough.
   16. There are difficulties and hurdles everywhere. I see the whole thing as a sporting challenge.
7. Gender related barriers 17. Women approach things differently, they are less self-assertive and aggressive than men, are more hesitant about aspiring to an academic career at all, and wonder whether it is worth all the effort.
   18. Not many senior staff believe that women can make a career in surgery. It is hard work convincing them.
   19. It never occurs to senior staff that a woman could habilitate, this happens a lot faster for a young, ambitious man.
   20. The most important thing is self-confidence. You are always hearing that a woman cannot have an academic career and a family at the same time.
8. Work-family Imbalance 21. It is quite difficult to introduce part-time working to many specialist fields, for example intensive-care units. It is often thwarted by management. This is a great career obstacle for assistants who have children and aspire to a challenging career.
   22. Balancing career planning and family planning is a big problem. It also depends on the partner's attitude. Many women tend to put their career plans on hold to give themselves more time to attend to family chores and leave the man free to pursue his career. If you are a woman aspiring to an academic career you will not start a family until relatively late in life, so you have to expect to be an "old" mother and be fairly certain of not just having a half-time job.