Compelled by the growing recognition of the burden and harm perpetrated by sustained inequality and explicit and implicit biases on our patients, trainees, and colleagues, the Society for Pediatric Research’s (SPR) Justice, Equity, Diversity, and Inclusion (JEDI) Committee was tasked by the society leadership to develop an actionable framework and iterative toolkit comprising a set of scholarly resources, including readily implementable actions at the individual, department, school, and national organizational levels to promote JEDI principles within the pediatric scientific faculty workforce.1–3 SPR created the Diversity, Equity, and Inclusion Committee in 2016. The committee’s initial purpose was to increase the diversity of SPR membership. In 2021, the committee changed its name to JEDI to reflect the underlying need for justice to bolster diversity, inclusion, and equity. The committee has worked to enhance the diversity of the pediatric research workforce, improve the inclusivity and acculturation of underrepresented groups, and promote equity and justice within academia and at the SPR organizational level. We recognize inequities within academia experienced broadly by faculty and trainees by gender, by those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more), and/or have a background that is historically excluded and underrepresented in medicine (URiM) and more so by those at the intersections (ie, individuals who identify with >1 underrepresented group).4–7 We use the National Institutes of Health’s (NIH) definition of groups underrepresented in the scientific workforce which includes standards for race, ethnicity, sex, primary language, and disability, as well as criteria for individuals from disadvantaged backgrounds (NOT-OD-20-031). Although this is a US-based definition, we hope our recommendations can be broadly used internationally and can also be applied beyond pediatrics. Other groups have similarly commented on the challenges faced by women, URiM, and research-focused faculty; however, fewer data exist on the effects of intersectionality within academic medicine.8–15 Our recommendations are specific to the additional unique challenges faced by academic pediatric faculty researchers, which we broadly define as MD, DO, MD/PhD, PhD, biomedical scientists, clinical investigators, and health policy experts performing research in child health across the entire discovery spectrum.
The diminishing pathway of physician-scientists is a major concern to the future of medical research.16 In the first pediatric-focused data reported during the fiscal years 2012 to 2017, 15 institutions in the United States accounted for 63% (1561/2471) of R01-equivalent grants in pediatrics.17 More than 60% of awardees were men appointed at the academic rank of professor, with only 15% (379/2471) of R01-equivalent grants awarded to early and midcareer physician-scientists. The number of researchers identifying as LGBTQ+ and/or URiM is unknown. Data reported by the Association of American Medical Colleges indicate that the percentage of physicians who are Black is only modestly different than it was in the 1970s, with data surrounding physician-scientists completely lacking.18
Beyond any moral imperative and contrary to the notion of being politically correct or driven by societal politics, academic institutions need diversity and inclusion within their scientific workforce because diverse teams make excellent teams.10 Empirical evidence reveals that diverse teams perform better with higher metrics of innovation and scientific impact.19–21 Despite these findings, Ginther et al have reported that URiM applicants for NIH funding awards are less likely to obtain funding, and in 2000, Fang et al published data revealing barriers to promotion for URiM and ethnically diverse faculty.22–24 Twenty years later, Bennett et al demonstrated that although there have been some significant increases in the rates of women faculty, particularly among Black and Latina women, the majority of academic faculty remain White men.25 A recent cross-sectional analysis of NIH investigators from 1991 to 2020 with >1 project grant award revealed growing gaps with regard to both gender and race. Demonstrating the impact of intersectionality on this highly esteemed metric, White men were most likely to be designated as a “super primary investigator,” whereas Black women were the least likely.26 Perhaps even more concerning, although studies reveal that underrepresented groups produce highly innovative and impactful research, their findings are less likely to be adopted into the mainstream and are often discounted.27 Racism and social inequities have also been tied to poor health outcomes of our pediatric patients, including infant mortality, type 1 diabetes, and mental health, whereas racial concordance between physicians and patients improves the perceived quality of care.28,29
In recognition of the growing crisis in JEDI for the pediatric scientific workforce, this call to action is focused on layered recommendations at the individual, local institutional, and national organizational levels, specifically focusing on US-based faculty seeking career development (K award) followed by independent (R-level or equivalent) research funding. We recognize that a predominance of these faculty is physician-scientists with MDs, DOs (or equivalent degrees), or MD-PhDs, with higher salary expectations, and commensurate expectations to generate clinical revenue. A smaller but important set of faculty members hold PhDs or other nonclinical doctoral degrees and may have different salary expectations and variability in teaching expectations depending on the degree of affiliation to the local medical school. Although the onus remains on individual faculty members to define their own career goals, develop their research and leadership skills, seek out and lead their mentoring relationships, and optimize career opportunities, the purpose of this Call to Action paper is to delineate strategies for allies within academics and emphasizes the foundational and supportive infrastructure that local institutions and national organizations should provide faculty to deliver transparent and equitable support to these individuals throughout their faculty lifespan (Fig 1).30
Institutional support and allyship to empower justice, equity, diversity, and inclusion in academic pediatrics (created with BioRender.com).
Institutional support and allyship to empower justice, equity, diversity, and inclusion in academic pediatrics (created with BioRender.com).
With these stakeholders in mind, we have focused on 3 specific domains: (1) equitable distribution of institutional resources, (2) equitable and transparent salary structures, and (3) increased support and allyship for pediatric scientists belonging to URiM and LGBTQ+. We have selected these domains because they have been identified as strategic targets to improve diversity, inclusion, and retention in the physician-scientist workforce and the pathway for pediatric researchers.8,9,13,31–33 Importantly, these domains focus on actions within the realm of responsibility and sphere of influence of our academic departments, medical schools, and national organizations. Herein, we provide a brief outline of our recommendations.
Equitable Distribution of Resources
Providing clear guidance for available institutional resources ensures fairness and equity and guards against implicit or explicit biases. Types of institutional resources that we address include expectations of externally and nonexternally funded research time, allocation of research resources (ie, space, staff, funds), salary equity, and support and allyship.34 Early disparities in resources can compound significantly over the course of pediatric faculty researchers’ careers. A transparent blueprint also enables career planning for early, middle, and advanced career stages, and facilitates open discussion between faculty and their section/division leaders around these expectations and the resources needed for success. Transparent policies help to eliminate politics, favoritism, and either real or perceived implicit biases from key resource distribution. However, these blueprints should also be open to the unique individual needs of the participating faculty. URiM and LGBTQ+ faculty, and faculty with family needs (new parents, elder care, medical issues) may benefit from a more individualized approach. Such guardrails can aid in the early identification of faculty who may be experiencing difficulty advancing their research careers and may help mitigate attrition and foster success through targeted resource allocation.35 Transparent and fair processes, described in our online SPR JEDI Toolbox (https://www.societyforpediatricresearch.org/jedi-toolbox/), may reasonably be expected to aid in retention and possibly recruitment as younger generations seem to have higher expectations regarding equity, and thereby serve to further strengthen participating departments.
Equitable and Transparent Salary Structures
Pay inequities persist with respect to gender, URiM, LGBTQ+, and intersectionality.36 We advocate for schools/universities to set clear and transparent guidelines for remuneration throughout their departments, ideally tied to national standards, such as data reported by the Association of Administrators in Academic Pediatrics and the Association of American Medical Colleges. In the absence of guidelines, it is incumbent on pediatric departments that include pediatric researchers to ensure such guidelines are generated and implemented. We favor a holistic approach to valuing the contribution of individual faculty members’ efforts toward the mission of clinical care, advocacy, research innovation, and medical education.35 Therefore, we favor pay equity between clinical and research tracks. Review of pay equity, controlling for rank and time at rank, should be performed routinely, and discrepancies noted regarding gender, URiM, LGBTQ+, and intersectionality should be corrected.37
Challenges exist in implementing such policies. Foremost, each department exists in a unique environment, with varying resources and faculty needs. In addition, the NIH salary cap can create a discrepancy between the allocated effort and the grant dollars provided to support this effort; institutions are, therefore, required to allocate funds to address this “cap gap.” The “cap gap” discrepancy can be notable for more highly compensated specialties (ie, proceduralists/surgeons), and the necessity of institutional subsidization of research to “fill the cap gap” can disincentivize research, particularly in the more highly compensated specialties. In a similar fashion, for those at an earlier career stage, the mandated protected time for career development awards can further disincentivize research as it competes with opportunities to generate revenue for the institution. These costs are somewhat offset at the institutional level by the indirect costs generated by federal awards, as well as the prestige generated by the conduct of high-quality research. Institutional leadership is needed to overcome these challenges and ensure salary equity for pediatric scientists.
Increased Support and Allyship
Apart from direct research and salary support, local institutions need to recognize the importance of career development, leadership training, and optimizing mentor/mentee relationships for pediatric faculty researchers, as with all other faculty.38 Faculty members should be encouraged to participate in campus seminars, workshops, and short courses on topics such as mentor/mentee relationships, communication styles, conflict resolution, leading a research laboratory, hiring and managing personnel, and managing research and personal finances. Participation should be subsidized. Some courses are targeted toward specific groups who may be underrepresented. National organizations and campus-wide initiatives also foster interdepartmental collaborations and peer mentoring.
Medical schools and departments must also be able to respond to scenarios that impede successful career development. The coronavirus disease 2019 pandemic is one example in which many faculty members have experienced new barriers to success. The impact of the pandemic has been more severe for faculty with caregiving responsibilities, which has disproportionately affected junior faculty and women. A temporary increase in additional resources and support, (ie, subsidized child/elder care) may help mitigate attrition. Institutions have a financial incentive to invest in faculty retention because of the high cost of recruitment and replacement.39
The burden of education is on the individual on how to become an ally. As our field becomes woman-dominated, women, White women in particular, need to play a larger role in the culture of mentorship, allyship, and sponsorship for any meaningful transformation to occur. Allyship applies across all academic ranks and tracks and includes self-reflection, self-education, and speaking up (Table 1). Allyship also includes mentoring new and junior faculty on the policies within your department and advocating for additional resources not explicitly guaranteed by a standard policy. Allies should also use their collective power to advocate for and hold institutions accountable to systemic reporting and review of inequitable allocation of resources.
Self-Reflection for Allies
| Questions to promote self-reflection |
| Who helped me along the way? |
| What do I wish I had known earlier in my career? |
| When should I have said no? |
| When should I have said yes? |
| What can I do to help others? |
| How would intersectionality have potentially affected me? |
| How can I use my lived experience to help and advocate for others? |
| Questions to promote self-reflection |
| Who helped me along the way? |
| What do I wish I had known earlier in my career? |
| When should I have said no? |
| When should I have said yes? |
| What can I do to help others? |
| How would intersectionality have potentially affected me? |
| How can I use my lived experience to help and advocate for others? |
An additional consideration is needed to bolster the pathway for URiM pediatric scientists. Although beyond the scope of this Call to Action, the attrition of URiM and LGBTQ+ students from the science, technology, engineering, and medicine pathway is a major upstream issue that results in a lack of diversity at the faculty level. Science, technology, engineering, and medicine enrichment programs for undergraduates have revealed the importance of science identity as well as racial phenotype on graduate school matriculation.40–42 Once at the faculty level, URiM and LGBTQ+ groups disproportionately experience the “minority tax,” and are routinely asked to make contributions specifically because of their underrepresented status, and women faculty experience a “citizenship tax” such that women from underrepresented groups may endure additional burdensome tasks and responsibilities that take time away from their academic pursuits (eg, research endeavors).43,44 Conversely, White men who are faculty benefit from a tax subsidy because they do not experience these citizenship and minority taxes to the same extent.45 Awareness of and efforts to mitigate the impacts of both the “minority tax” and “citizenship tax” on academic advancement is needed at all levels.46 Secondly, institutions need to approach the recruitment of new faculty with intention and seek to refine the numbers of URiM and LGBTQ+ in the research workforce. Institutional policies on search committee composition and implicit bias training are needed. Finally, once recruited, some URiM and LGBTQ+ faculty may experience social isolation, and efforts are needed at the institutional and national level to address and overcome the loneliness and isolation from resources such as mentors, sponsors, funding opportunities, ideas for research, and collaboration, that pediatric faculty researchers may feel.47 Schools can implement programs that affirm JEDI principles and integrate diverse faculty within the workforce.48–52
The data, although imperfect, are still clear; there is a significant problem within academic pediatrics with respect to JEDI.53,54 Rather than await more perfect data, we urge strong consensus action to foster JEDI principles within our field and among our ranks. The powerful and detrimental effect(s) of systemic racism on the health and wellness of our patients and communities has been well-described.55 Others have described the persistent structural and systemic racism within academic medicine and made a call for system-wide change at the national and institutional levels.56,57 Although other groups have made similar recommendations, ours are specifically geared toward the pediatric research workforce and include concrete specific recommendations for actions that both systems and individuals can make to foster significant and lasting improvements.58–60
Our full policy recommendations for each of the 3 domains introduced herein can be found online on the SPR JEDI Toolbox (https://www.societyforpediatricresearch.org/jedi-toolbox/). We expect these resources to be iterative, providing practical solutions and examples such that individuals and institutions alike can use them as roadmaps for improving the JEDI of our pediatric research community, and highlighting best practice recommendations as they evolve. We also invite individuals and institutions to share their new ideas and successes within these realms. We feel urgent action is needed at the individual, local, and national levels to mitigate the harm perpetrated by sustained inequality and explicit and implicit biases on our patients, trainees, and colleagues, and to promote JEDI principles within the pediatric research workforce.
This Call to Action is for bold, sustained, iterative work to be performed at the local, departmental/school, and national organizational levels to support URiM, LGBTQ+, and those faculty with intersectional identities performing pediatric research. As the diversity of our population increases, meaningful support for the diversity of our pediatric research workforce is an investment for the future of our field, in which our future academic leaders will reflect our patient population. Pediatricians have a long and proud history of advocating for policies to improve the health and wellbeing of children, and advocacy is deeply embedded in our culture. Now let us come together to advocate for our colleagues and trainees, and in doing so, empower and sustain the Justice, Equity, Diversity, and Inclusion of our pediatric scientific workforce.
Acknowledgments
Additional members of the Justice, Equity, Diversity, and Inclusion Committee for the Society for Pediatric Research include Drs Kikelomo Babata, Catherine Bendel, Heather Brumberg, Luca Brunelli, Alyna Chien, Keisha Gibson, Monika Goyal, James Guevara, Erica Kaye, Ashwini Lakshmanan, Tamorah Lewis, Nathalie Maitre, Sagori Mukhopadhyay, Lisa Robinson, Prachi Shah, Maureen Su, Elise Tremblay, Patricia Vugui, and Shilpa Vyas-Read. We also wish to acknowledge the contributions of Stephan J. Nemeth IV to this work.
Dr Soranno wrote the original draft of the manuscript and responded to reviewers’ critiques; Dr Simon participated in data curation and project administration of the Web pages, referenced and completed original drafts of the Web pages, reviewed and edited the manuscript, and referenced and responded to reviewers’ critiques; Drs Bora and Lohr completed original drafts of the Web pages referenced, reviewed and edited the manuscript, and participated in data curation and project administration of the Web pages referenced; Ms Sedano participated in data curation and project administration of the Web pages referenced; Drs Bagga, Carroll, Daniels, and White completed the original drafts of the Web pages referenced; Dr Spector reviewed and edited the manuscript; Drs Davis, Fernandez y Garcia, Orange, and Tarini provided resources and supervision; and all authors participated in the Justice, Equity, Diversity, and Inclusion (JEDI) project’s conceptualization, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.
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