Professor of medicine. PhD in human factors engineering. Living with type 1 diabetes. Infrequent blogger.


Reflections on being awarded tenure as a woman with kids and a disability / chronic illness

Short version

There is no universal experience. In my individual experience, a good partner can make the ‘with kids’ part much easier but the ‘and a disability / chronic illness’ part remains tough. Support helps, but no one else can ever do the daily, relentless work of keeping myself alive in a world and career that isn’t always well-structured for staying healthy. The things that have worked well for me have been: (1) being flexible geographically, even at a cost to my family, (2) being extra disciplined about working hard whenever I can to balance out the times when I can’t, (3) using a calendar, not a To Do list, for planning my work, (4) writing constantly, and (5) having full drafts of grants ready 6-8 weeks ahead of deadline for rounds of pre-submission review. It also gives me hope for the future of science and research to (6) use my position to work to improve the system so that research and researchers don’t continue to be held back by barriers that have nothing to do with the quality of one’s work. This effort may or may not help me, but I am determined that it will help others. I am glad not to be alone in these efforts, and I invite anyone who isn’t already involved in such efforts to join in. Especially if you are an academic in Canada, please read this book.

Much, much longer version (fair warning: it’s really long)

In November, my application for tenure and promotion was approved. June 1, my rank went from Assistant Professor (professeure adjointe at my French-speaking institution) to Associate Professor (professeure agrégée), a bigger deal than I ever understood before I became a professor. This means that the university at which I am a professor has more of a commitment to me, and I to it. I will still be reviewed annually and need to continue to work hard, especially if I want to continue doing work that is funded by competitive grants, but this provides a higher level of job security than I had before. It means, essentially, that I cannot be fired without cause.

It has been a long road to get here, and the road doesn’t end here. My colleague Dr. Brian Zikmund-Fisher once told me, “Getting tenure is like winning a pie-eating contest in which the prize is more pie.” I have already found this to be true. But it’s a good time to take stock.

“Getting tenure is like winning a pie-eating contest in which the prize is more pie.”

I originally started writing this for myself. I write for myself a lot. It is how I sort through my thoughts. In this case, those thoughts were about how I got here, what has gone well for me that I should keep doing, what has gone less well for me that I should stop doing, and what else I can do to help improve the system. I read something recently that really resonated with me and so I decided to share this post in case any of what I’ve written might be helpful to others, especially any others like me. (Those others will have to be people who can make it through many, many paragraphs. Scroll down towards the bottom if you just want my list of things that have helped me.)

I have two kids and have spent nearly all my life living with type 1 diabetes, a time-consuming autoimmune chronic illness classed as a disability. My kids are 10 and 5 years old. My diabetes is 34 years old. It took me quite a few of those 34 years to identify as disabled, a period of time I now recognize as being marked by my own internalized ableism that took some time to address, a growing awareness of how much I still have to learn about other forms of disability, and fear. When I say internalized ableism, put plainly, I mean that didn’t want to identify as disabled because I saw it as a negative attribute rather than just an attribute. It took me a while to deal with that. My fear comes from being afraid of having my ability to do my work impeded by ableism. I’m having a very successful career so far. I’m thrilled to be able to do research that I hope will help many people. I love doing the work I do. I love solving problems, answering research questions, and being able to support trainees in their paths toward their career goals. I don’t want that to stop for any reason, but I especially don’t want it to stop because people who have power over my career may be prejudiced.

My fears are well-founded. Academia is a competitive, reputation-based business, reputation is determined by people, people shape and are shaped by fundamentally unequal social structures, and many people also have individual biases. Individual biases may be conscious or unconscious, against groups of others or against groups of which we are members. There are many randomized controlled trials and well-analyzed observational studies in which the data support what people from underrepresented groups have long said: when you are a member of one of these groups, you have to be extra good to get an even chance. (For those who are curious, here is an excellent annotated bibliography on gender bias and other biases in academia. I also linked to a number of studies in this editorial and you may also wish to use search engines and academic databases just like you would for any other academic topic.)

The effects of four such biases in academic research in Canada are most easily apparent in statistics for the Canada Research Chairs program, a prestigious salary award program that was required to set targets for equity after a court settlement. Canada Research Chairs pay whole salaries or portions of salaries of professors and thus, are used as recruiting tools and/or budget line adjustment tools by universities. It’s up to each university to nominate people for the chairs they have been allocated. They may nominate professors already appointed or they may recruit new professors.

The idea of having these targets is to help ensure that known biases in academia don’t prevent qualified candidates from being nominated. These targets are achievable, not aspirational. They reflect realistic, even low, proportions within the available pool of candidates in academia. All of the targets are well under than the associated proportions in the general population. In Canada, including Indigenous nations, women represent 50% of the population, visible minorities (a Canadian term for people of colour) represent 22%, Indigenous peoples represent 4.6%, and disabled people represent about 14% of the population aged 15 years or older. For context, in the US, 19% of the population have a disability. In Australia the figure is 18%. In France, the statistic is 18%, with 80% of those being invisible. In the UK, 16% of working aged adults are disabled. Countries don’t all have the exact same definitions of disability but it’s clear that in all countries, there are a lot of people who face different kinds of barriers.

The fact that the Canada Research Chairs program isn’t achieving easy targets suggests strongly that the nominations processes as a whole are unfortunately biased, most likely in subtle ways that may be hard to identify in any single decision. This means we, as a group, are likely failing to hire and/or nominate excellent candidates. Data below are from the Canada Research Chairs’ Program Statistics, using their nomenclature. They only report single categories, no combinations. In other words, as Dr. Malinda Smith notes, there is no intersectional presentation. In statistical terms, this is like looking at main effects but not interactions, even though you know that interactions are likely to matter.

Canadian universities have had trouble with all four targets but they failed most spectacularly in nominating disabled people, so much so that the target was lowered. Among the people I know in academia in Canada who advocate for leveling the playing field for everyone, they often bring up issues of sexism, sometimes racism, sometimes colonialism, but rarely ableism. (There are also other dimensions that get less attention in academia; e.g., gender identity, sexual orientation, socio-economic background, and others.)

2009 2012-2014 2015-2017 [1]
Women achieved / target 24% / 25% 26% / 28% 26-28% / 31%
Visible minorities achieved / target 12% / 11% 13% / 15% 15-16% / 15%
Persons with a disability achieved / target 1% / 5% 2% / 4% 1% / 4%
Aboriginal peoples achieved / target 0.4% / 0.7% 1% / 1% 1% / 1%

[1] 2015-2017 data represents chairs reported only for large and medium universities. These two groups represent the majority of chairs.

(Full disclosure: I cannot claim to be an unbiased observer of this issue. I’ve been short-listed twice for a chair, but I have not yet been selected by my institution to be nominated. This has been disappointing for me, of course, but I am lucky to work at an institution with a lot of excellent researchers, so it’s very possible that I just wasn’t the best choice available. Choosing academia means choosing a career with a lot of rejection, and I don’t take these things personally. My point here is about the system as a whole, not my individual case. However, although I think the data speak for themselves, I do recognize that I have a stake in this issue that might cloud my judgment.)

In addition to diabetes, I live with some related issues that are common among people who have had diabetes as long as I have. One of these is that I have a hard time detecting low blood sugar, or hypoglycemia. A little after two decades living with type 1 diabetes, my usual hypoglycemia symptoms disappeared and the ones I now have (a vague tiredness, being distracted) are not easy to notice in a life in which I have more tasks than time. Especially when I am thinking about something else or asleep, I don’t always notice when my blood sugar is low or falling. As a result, I can suddenly lack enough glucose to my brain. When I’m awake, this can cause me to lose the ability to think or speak coherently. Everyone else just carries on, and I do my best to pull myself together and catch up. Being unable to press pause and have others wait for me has hurt me. For example, once, an unnoticed hypo complicated by a pregnancy I wasn’t yet disclosing left me unable to articulately answer questions during a critical portion of a campus interview. More recently, I had a hypo during an important teleconference when I was arguing my point and trying very hard to convince a number of people who weren’t yet on my side. As my blood sugar fell, I started to lose my usual ability to formulate my points quickly, and I lost an argument that I think I might have won had my brain had enough fuel.

As frustrating as these occasional hypos are when I’m awake, they’re most concerning when I’m asleep, because there is a chance that I could die. I use a continuous glucose monitor and it helps a lot, but because it measures interstitial glucose, not blood glucose, there’s a 15-20 minute lag in its readings. That matters. Also, because I pay a major portion out of pocket and sensors are $85 each, I stretch my sensors as long as possible. They are rated to last 7 days but mine last longer. They are known to last longer if you don’t have a lot of high blood sugars, and there’s also an element of luck here in how your body responds to the sensor and vice versa. I typically keep them in 2.5-3.5 weeks until they stop being accurate enough or the itching bothers me so much I have to pull them out. Usually, this means that the last 3-4 days out of every 18-24 days, I’ve got less reliable data. When I travel, I have to be extra disciplined. I use a range of techniques, including some do-it-yourself technology that, when it works, allows my husband to see readouts of my continuous glucose monitor on his phone. We also have lower-tech backup routines. If I don’t call or text by a predetermined time in the morning, he calls the hotel and gets them to call 911, if necessary. We have developed routines for making sure he has the phone number and my room number to hand, just in case.

I can run my blood sugar higher to better avoid hypos, but that isn’t fail-safe, either. It could cause complications of diabetes, like blindness, kidney disease, amputation, heart attacks, and so on. In the short term, it makes me feel awful, and I don’t think as clearly. One of my personal symptoms of high sugar is that I start thinking in circles, looping around and not getting anywhere. Occasionally, my husband asks me when I’m working on something and it’s taking longer than it ought to, “You look like you’re stuck. How’s your sugar?” Keeping my blood sugar within my target range is not only important for my health, it’s also important for my productivity.

I also have Hashimoto’s disease and Raynaud’s syndrome. Hashimoto’s disease is an autoimmune thyroid disease that, like celiac disease and rheumatoid arthritis, is associated with type 1 diabetes. When you have one of those in your family, the chances of having the others are higher. For me, Hashimoto’s disease requires nothing more than taking thyroid medication daily, monitoring, and adjusting my dose as needed, such as when I start to feel cold all the time again. Raynaud’s syndrome is very common in long-term diabetes. So far, my case means that I easily lose feeling in my fingertips, most commonly my left middle finger, and occasionally my toes. I always carry gloves because it’s a pain–literally and figuratively–to get feeling back after my fingertips lose all colour. Among other difficulties, I can’t type, use a touchpad, or touchscreen. This issue mostly arises when I ride my bicycle to and from work in cold weather, so I do my best to keep my hands protected if I might be manipulating anything small like electrodes first thing in the morning. My new office is lovely but absurdly cold, so I often wear mittens to help keep my hands warm enough and I regularly take breaks to do jumping jacks. (Many thanks to a colleague at another institution with undisclosed lupus and Raynaud’s who gave me the jumping jacks tip years ago.) Regular exercise also helps me manage both my diabetes and Raynaud’s. When it happens that I’m in such a busy period that I stop exercising regularly, I especially notice the differences in my mood, my blood sugars, and the pain in my hands.

What all these things mean is that I have to be constantly vigilant. Part of my mind is constantly attending to my health. The best analogy I’ve come up with so far is that, for me, living and working with type 1 diabetes and its related challenges is sort of like constantly having a 3-year-old with me. Every day is take-your-3-year-old-to-work day! (Psst. Most workplaces are not very well set-up for constantly having a 3-year-old with you.) A 3-year-old can be kept reasonably quiet most of the time with careful, diligent, daily, never-ending preparation, checking in regularly, preparing and packing healthy snacks, and maintaining constant vigilance with part of your mind monitoring and anticipating your 3-year-old’s needs at all times. Still, despite your my efforts, sometimes you need to care for your 3-year-old at an inopportune time. Worse, the 3-year-old will occasionally have a tantrum for no reason. And then people will look at you as if to say, “What is wrong with your child?” Except they are really looking at you as if to say, “What is wrong with you? Why can’t you hold it all together?”

Every day is take-your-3-year-old-to-work day! (Psst. Most workplaces are not very well set-up for constantly having a 3-year-old with you.)

Sometimes, thoughtful people ask me what I will need and I can’t answer with certainty. I don’t always know what I need until the moment I need it. I cannot give you a list of things that will avoid me having problems because, unfortunately, I might have problems anyway, and then I feel terrible for being a disruption and I worry that you will think I’m incompetent for being unable to provide you with a complete, fail-proof list. Sometimes, I optimistically provide a list anyway. Please take breaks at the time scheduled. Please have something other than pastries and sandwiches to eat. Cheese and vegetables are much appreciated. Please ask whoever is making the food if they can provide carb counts, or at least a list of what’s in things. Please book the transportation so I have at least 2 hours at each airport. It occasionally takes me a long time to get through security with my medical equipment, and I can’t predict when those delays will happen.

My health has affected my career in ways I didn’t always see until I looked back. I was sicker in my undergraduate degree than I even realized at the time. I missed classes and, once, a midterm exam because I wasn’t well. Once, I got myself a diet soda from the drink machine in the cafeteria, only to realize in the ensuing hours, as my tongue turned to sandpaper and ketones washed their sticky nausea over me, that either I made a mistake or the cafeteria staff switched the vats by mistake, because it sure wasn’t sugar-free. I spent the next 24 hours in bed, getting up every hour or so to take another shot of insulin, drink water, and pee. I should have gone to the hospital, but I didn’t know any better. I still didn’t know any better a year later when I got sick, thought mistakenly that since I wasn’t eating anything, I shouldn’t take any insulin, and landed in the emergency department of Kingston General with a blood glucose of 36 mmol/L (650 mg/dl), in acute diabetic ketoacidosis. I am lucky and grateful to still be alive.

I didn’t even realize this all at the time. I hadn’t the faintest idea how sick I was until later when I started to feel well more of the time. My transcript from those years was not stellar. I was able to mostly compensate for my erratic health by being a very quick learner and working intensely whenever I needed to and could. I wasn’t worried about doing more than mostly compensating because as long as I could graduate with decent grades, I could probably get a job. (In this respect, the 90s were possibly a better time to be young than now.)

I had never planned on going on to graduate school. I didn’t know anything about it and I didn’t really see the point when I could get a job with an undergraduate degree. I chose to do my undergrad in engineering because I was very good at math and science, I liked them, and they seemed hard for other people. I thought engineering would give me my best shot of getting a job with a stable income so I wouldn’t have to worry between paycheques. If I ever had kids, despite doubts voiced by doctors to my mom as if I weren’t sitting right there–doubts that were later reinforced by Steel Magnolias–my kids wouldn’t have to depend on their part-time, minimum wage jobs to buy groceries or to get the home phone turned back on.

When I graduated, I got a job in an engineering department in Toronto, at a company where I’d previously worked two summers in the quality department. I was the first woman engineer the engineering department had ever hired. Meetings were a few dozen men plus me and the department secretary. Our boss assigned a senior engineer with a PhD to mentor me. He taught me about research and development. I’d had no idea how creative and fun it was. We tackled problems like designing and then building a mechanism that would move the handle of a large switch more like a human arm so that we could test and certify the switches more accurately without putting any humans in danger. We worked to understand the behaviour of metals on impact, with the goal of developing a mathematical model and informing parameters for use in modeling software to better represent what we actually observed in circuit breakers. For that one, our company paid for each of us to get research reader cards at the University of Toronto so that we could pore over books and papers. We wrote a conference paper to help other users of the software who didn’t have time to do all that digging. That was my first exposure to any sort of scientific writing beyond a technical report.

I loved the research part of my job and I knew I needed additional training and letters after my name to be able to do more of it. My mentor had transferred to a job in the US, so I set up meetings with graduate studies chairs at the University of Toronto, who very kindly agreed to meet with a young woman who was cold-calling them, trying to find out how the heck graduate school worked and how she could go about maybe getting a Master’s degree. I couldn’t get into the math graduate program because my math and engineering undergraduate degree had some holes that needed filling for me to be prepared for graduate work in math. I could get graduate course fees covered by my work, but not undergrad. At the Department of Mechanical and Industrial Engineering, they were weren’t too impressed with my undergrad transcript, heavy with B’s, but the graduate chair at the time–who met with me personally, a kindness that I recognize now in retrospect–happened to do research related to the conference paper I had co-authored. I asked a couple of questions about his work that he seemed to think were interesting, and he decided to give me a chance. I had to take four graduate courses as a test run. I took 1 or 2 at a time while also working full time, which was not easy but was far more feasible since improved insulins had improved my quality of life and ability to maintain stable blood sugar. (Though it was not the best choice on my part to take two courses while one of my product lines was moving from one factory to another.)

After doing well in those courses, I was admitted to the graduate program. I had been auditing a methods course in human factors because I had maxed out my four courses but was interested in the topic. I had always had a thing for linear algebra, so multivariable statistics were stats in a language I enjoyed. I ate up the course. The professor of the course once wandered into the common space of his lab to find me meeting with two students on a Friday night to do problem sets. He paused, and asked me, “Aren’t you auditing this course?” His tone added, “Why are you doing problems sets on a Friday night when you don’t have to?” When I was admitted to do full time studies, he agreed to serve as my advisor and found some funding for me to get started until I was able to get some fellowships with his support and that of my co-advisor. I would not have been able to go to graduate school without funding, so their support made my current career possible. I am immensely grateful.

In grad school, better healthcare access helped me a lot. I finally had something like a family doctor again by always seeing the same physician at student health services. A mentor connected me with an endocrinologist who was accepting new patients. She helped me get my first insulin pump. (And a dozen years later, long after she was no longer my health care provider, that same endocrinologist shared a copy of her successful grant with me when I was looking for ideas of how to structure mine better. Helpful people just keep on helping.) The insulin pump allowed me to tune my basal insulin to my body’s apparently nonstandard basal insulin needs, and it was an incredible change. I told my partner, “If this is what people without diabetes feel like all the time, they should be doing more with their lives!” I had spent decades learning to perform as best as I could even though I often wasn’t well. I had developed habits of working intensely whenever I felt well, because I couldn’t count on that feeling being there later. Suddenly, as long as I put in the time and effort to use the technology well, I felt fine much of the time and could work intensely more often.

And yet, feeling better most of the time is never all of the time. I can never count on it. On the first day of my postdoc, I was nervous and my blood sugar was acting up accordingly. I was low when someone (I still don’t know who) introduced me to an important person (don’t know who that was either). The entire interaction was a blur. I spent the entire postdoc wondering who I met but couldn’t remember. I was too embarrassed to say anything. Some months later, I uncharacteristically failed to show up to a morning meeting with my postdoc mentor. She called 911; people from emergency medical services brought me back to consciousness. It was after that that I was able to get my first continuous glucose monitor, which helps me optimize the way I manage my diabetes and detect low blood sugar, though always with that 15-20 minute lag.

In my second year as faculty, I had a proposal accepted at a selective conference at Harvard. I almost didn’t make it to present my talk because my youngest was sick with croup. My child turned the corner just in time for me to leave to get to the meeting. I had a wonderful conference, and afterward, the research center’s director approached me to tell me about a junior faculty position they had open. He emailed me afterward to encourage me to apply. I wasn’t sure what to do. I liked my job and had just earned a non-portable career development award, but I was flattered and curious. I knew that if I were to get that position, the name Harvard would open doors for my work that might not otherwise open. I asked my local and non-local mentors for advice, talked to my chair, took a couple of days to reflect, and started drafting an application. But before I could finish and submit it, weeks of caring for a sick, croupy child and then traveling caught up with me. I came down with my toddler’s bug and landed in the hospital. By the time I was well again, the position’s announcement indicated that it had closed early. I honestly have no idea if I would have gotten the position, but I was frustrated that my health interfered with me learning the answer to that question. I lied to my mentors and told them that I had decided not to apply, because my fear of ableism meant that I was scared of even my best supporters seeing that example of how my health can interfere with my plans.

I never know when I’m going to experience the frustration that comes from that kind of interference with what I would otherwise do. I have long stretches when all the extra work I do to stay alive and healthy yields the desired results, so I’m fine and extremely productive. But some days, an out-of-nowhere blood sugar roller-coaster takes its toll on my focus. Some days, I have to call a pump company and wait on hold and then argue with them about why they need to refund me the $4000 they are holding, because I sent the pump that wasn’t working for me back 2 months ago, and I don’t have a spare $4000 to be out for that long. Some days, I’m dealing with the fact that my university has changed insurers for our extended health benefits and I have to re-initiate all my systems to get my supplies. Some days, I’m waiting on hold to order sensors. Some days, I am busy jumping through hoops to qualify for very expensive private life insurance. Because of my diabetes, no matter how well-controlled it is, the only life insurance I can get through work is one year’s salary, and as the primary earner for a family of four, that isn’t enough. Some days, I ride my bicycle back an hour across town from a meeting because exercise is good for me, and because it makes me happy to cycle from place to place, but I have such a bad hypo that I hallucinate and my evening plans to work for a couple of hours are shot. Some days, one of the few other women with type 1 in academic health research I know kills herself, and I find it tough to think about anything else. Some days, I’m trying to network at an evening event at a conference but there’s no decent food, too much alcohol, a bizarre bro culture of staying out late drinking, and it’s a bunch of diabetes researchers, for goodness’ sake, who really ought to know better. Some days, I pack for a 3-day meeting and pull the wrong bottle of insulin from the fridge to put in my kit, bringing one that was nearly empty instead of the one I’d recently opened. (Fortunately, a meeting full of physicians is a very convenient place to suddenly realize your pump is empty and you don’t have enough insulin to refill it.) Some days, I have to cancel my attendance at an international, invitational meeting that I was excited to attend because I need specific tests over several days and the only time I can get an appointment interferes with the meeting. All of these days, I feel embarrassed and frustrated by my inability to keep diabetes from interfering with the rest of my life. Then I feel angry at myself for having internalized such an unrealistic, ableist expectation.

Academia is just not well-structured for lives that sometimes require more care. In Canada, we have to use the Canadian Common CV (CCV) to apply for most grants. The CCV has many documented problems that affect everyone. On top of this, if you have any reason why your career progression may be different, too bad for you. There is a section, often ignored by reviewers, to explain interruptions like parental leave and their impact–limited 900 characters total, a problem to discuss another time–but there’s no way to account for having a bad year publication-wise because that year you had fewer spoons that year. I’ve been fortunate to be able to hit or exceed productivity expectations despite barriers (see below for what’s worked for me to do this) but I suspect that the CCV’s design, with its structured inability to account for the realities of human existence, has hurt good researchers.

With all that said, here are my best lessons learned for how to make it in academia–to tenure, at least–with kids and a disability.

Things that have worked for me so far

Caveat 1: None of this works perfectly. I still have times when I feel overwhelmed and like I am failing at everything. It’s easier to write the things below than it is to apply them 100% of the time. But the further I go, the better I get at these things. A common statement in the diabetes community is, “It doesn’t get easier, but you get better at it.” In my experience, that applies broadly.

Caveat 2: There are no guarantees in this career. I tell my trainees that you have to work hard and put yourself in a position to get lucky but you also have to get lucky. Just because something worked for me doesn’t mean it’s the right thing for everyone to do. Also, you may be further ahead of the game than I was and these things may be totally obvious to you. I had to learn many of them, so I am offering them to others who may not already know these things. Take what works for you, leave the rest.

1. Family

1.1 Timing. There is no good time to take a break from a career clearly not designed to accommodate them. Nonetheless, I’m glad I had both of my kids before I started my faculty position. I had my first in grad school after I had finished my coursework, and my second between my postdoc and faculty position. It was easier to press pause during those times. Note, however, that: (1) I had supportive mentors. This is not guaranteed. Other people have had a much harder time having kids in grad school. (2) This is common timing in my field. In fact, nearly every academic parent I know at my level had one or all of their children before starting their position. This may not be the case in other fields. (3) The timing meant that I had zero paid leave with either child. I did some part-time paid work during both of my maternity leaves. My husband had some partially-paid leave with both, which helped us be more equal parents because I went back to full-time work earlier and he stayed home for a few months. (4) Because I had another career first, I am a little older than other people at my career stage, so there was more impetus to have kids early rather than wait until post-tenure. (5) I lost a tenure-track job when I was pregnant with my second. I had a verbal offer, had verbally accepted, and it was time to talk start date. I disclosed my (unplanned) pregnancy. They wanted me to start when the baby would be 2.5-3 months old. I further disclosed that due to complications I had after my first was born, I couldn’t guarantee I’d be raring to go by then, and I’d rather commit to a later date when I could be confident I’d be ready to tackle exciting new challenges. They declined to extend a written offer. That was the only offer I had at that time, so that was that. When I applied for more jobs after my baby was born, two more of my first author papers had been accepted, including one for which I did the bulk of the revisions while in labour and finished them up postpartum, in bed, on a laptop balanced next to my sleeping newborn, when I couldn’t even sit yet (see: academia is not well-structured for lives). I ended up choosing between three offers, so it all worked out in the end, but I would not recommend being pregnant and on the market if it’s possible to avoid that timing.

1.2 Geographic flexibility. Being flexible about where you can live is a major asset if you want an academic career. There are reasons for this. There is value in moving around. You expand your network, you learn new ways of doing things, and if or when you come back, you bring new ideas. This is why geographic mobility is valued on CVs and it is one of the ways some groups get advantaged over others in the current system. People who are willing and able to live almost anywhere have an advantage. Those people may be less likely to have family responsibilities, health needs, or concerns about themselves or their families being welcomed and treated well in the local environment. Because my family was on board to come with me, I was willing and able to go anywhere in Canada for a tenure-track faculty position. I had more constraints about going to other countries due to health system constraints, for me and for extended family. Being willing and able does not mean it’s easy, it just means it’s possible. Quebec City is a beautiful place to live and we are very happy here, but we are far from all our family, my partner didn’t initially speak the language at all, I already spoke but had never worked in French, and it is a tough place to break in because almost everyone else is from here and has a family network around. It was a big cultural change, too. In Toronto, over half of the residents were born outside Canada. In Quebec City, I was once asked to appear in a video about diversity because I’m anglophone. It’s been a big change, bigger than I knew before we moved. But we were, at least, able to move. Not everyone has that geographic flexibility. I know brilliant people who left academia because they were not willing or able to leave the area in which they lived.

1.3 Sacrificing family time. I spent a lot of time away from my family to do my postdoc. Because I am Canadian and my career goal was to end up back in Canada, I knew that leaving the country for my postdoc was a good idea. I did my postdoc in Ann Arbor, Michigan; my family stayed in Toronto. I went back and forth. It’s typically a 5-hour drive, longer if you have to stop to check your blood sugar regularly, if there’s bad weather, or if there is a long line at the border. It’s about an 8-hour trip if you take the train from Toronto to Windsor and then rent a car or get someone to pick up up and drive you back to Ann Arbor. I tried all of those methods over the two years of my postdoc. I kept going back and forth because my partner had a good job in Toronto and would have been unable to work in the US, both for visa reasons (unlike me, he was not eligible for a TN visa) and because it was just after the 2008 recession that hit the Michigan economy especially hard. There were few new jobs available, period, let alone jobs for which it could be proven that the position couldn’t be filled by an American. At that time, we had one child, who was 3 when I started my postdoc. I wasn’t even gone all the time, and it was still hard. I committed to be in Ann Arbor minimum one week a month. I was there a little more when running lab studies, a little less two months when I had meetings and conferences elsewhere. In total, I had 30 trips in 2 years. When not physically present, I spent a lot of time on Skype with my colleagues. The group does a lot of online studies so it was feasible but definitely not ideal. It was hard on my family and I know I missed out on things in both places by not being physically present all the time. When I was in Ann Arbor, I said goodnight to my family in video calls. My travel impacted weekends on either side of every trip because I had to leave on Sunday to arrive for Monday morning meetings and most the time I didn’t get home until late Friday night, too late to go anywhere. We barely visited family during those years because I was so overwhelmed and so rarely home. It was an amazing two years with people who remain some of my favourite colleagues. It was a great decision for my career. I learned everything I went there to learn and more, and I will always be grateful that the group accommodated my family circumstances that inconvenienced us all. But it was really, really hard. Note that this kind of situation is not uncommon. Many students are in long-distance relationships, and that reality doesn’t necessarily end when your degree does. I have a friend from grad school who did a postdoc in Washington DC and had a situation similar to mine except she took her child with her while her partner stayed behind in Toronto. I have a colleague who took her kids with her to another province for a postdoc, leaving her partner in Quebec City. I have a dear friend who did two postdocs in two different European countries and finally moved back to Canada with her two kids while her partner remained in his postdoc in Germany. I was recently heading to the airport in Toronto with a colleague who has a position in Ontario and who was catching a flight to spend the weekend with their partner (also an academic) and children in Alberta. I know many couples and families who live apart most of the time. I do not recommend any of this, but it is important for people considering an academic path to know that this is a reality of many academic lives. Many people are willing and able to suck it up, so if you aren’t or can’t, you may be disadvantaged in the current system.

1.4 Lowering expectations. We make explicit choices about things that matter to our family, and I try to let other expectations go. Things that matter to me: Family suppers most nights. Reading to my kids most nights. Playing board games together. Volunteering at my kids’ school for one activity a year. Doing things outdoors. Snuggling my kids to sleep (admittedly often while multitasking on my phone by reading papers or Twitter).

1.5 Reducing the need for coordination. My partner and I have specific things we each manage for the family. For example, I do the all timetabling, activity planning, French homework help, and most of the interaction with people and systems (e.g., meetings with teachers, talking with parents of my kids friends, figuring out how school works in this province which has a system unlike other provinces, signing kids up for summer activities, etc.) My husband does the laundry, shopping, and the majority of the drop-offs and pick-ups. I typically do the cooking; he typically does the grocery shopping. This means that we are more efficient and don’t need to discuss or coordinate who will do what. The downside is that we are each ill-equipped to handle the other’s tasks. In our second year in a new city, I went to pick some things up at the grocery store, and I needed a map to find the grocery store in the first place, and once there, I had to phone my husband so he could help me find some things in the store.

1.6 Streamlining routine tasks. In addition to the ‘who does what’ streamlining described above, I also find it helpful to streamline what gets done. Examples of this include avoiding clothes that require ironing, having routines and checklists for activities (e.g., we used to have checklists at our front door for what needed to be in a child’s backpack for a school day, an outdoor activity, or an indoor activity) and meal planning in advance. In my twenties, I cooked for a living on a charter sailboat in the Bahamas, so if I had unlimited time I would spend a lot more time cooking. That doesn’t fit in reality so instead, I make weekly meal plans that fit in with our schedules. Both my husband and I were vegetarian for a long time so we are big fans of beans and legumes. Planning for a week at a time is more efficient. For example, I’ll make black beans from dried on Monday, then make black bean soup on Tuesday and black bean fajitas on Friday. The following week I’ll make chickpeas on the weekend, make a batch of hummus, and then have chickpeas, pasta and garlic in oil Monday and a chickpea curry on Thursday. Whatever we’re eating that week, having a plan posted on the fridge makes it go more smoothly. When I get stuck in an end-of-day meeting, my husband starts supper from the list.

1.7 Shared family calendar. We use a shared online calendar and everything goes on there. My flight or train leaves this day at this time, children’s lessons and activities with exact start times & confirmation codes as needed, drop child X at birthday party at address Y, family member Z’s flight arrives at this time, babysitter arrives at this time, and so on. Most of the time, as the planner, I make sure that where everyone needs to be is on there, and then my partner, the doer, gets them there.

1.8 Two kids, max. I know successful academics who are mothers and who have more than two kids, but I could not personally handle more than two. (See also: diabetes is basically my third child who is constantly with me.)

1.9 Purchasing time when we can afford it. When we are able to fit things like a cleaning service or lawn cutting service into our budget, it is a huge help to our quality of life. It is truly wonderful. If you can afford to do this, I highly recommend it. Other ways to purchase time if it’s affordable include buying rather than making gifts and costumes, paying a more advanced student to help your kid with spelling, buying your kids’ lunches at school rather than making them, and using pre-prepped food when needed, including pre-cut frozen vegetables. I had a hard time coming to terms with the idea of spending money on things we could do ourselves. Thinking of it as purchasing time was important for me to deal with the idea.

1.10 Limited kids’ activities. This is partly for us and partly for them. I know other families whose kids are involved in multiple activities but even if we wanted to do that, we couldn’t manage it. We allow one activity per week, preferably the same activity for both children at the same time. This limits the extra trips, saves money, and allows them to have more unstructured time at home to be bored. It helps that they can do some activities through their schools, so if they really want to, there’s an option there.

1.11 A partner who is all in. My husband grew up on a commune, birth to age 21. Good grief the man knows how to pitch in. (The downside is that he’s really most comfortable working in a team, so our divide and conquer approach often puts him out of his preferred mode. Sorry, love.) There is no way I could work the way I do if it weren’t for his active, instrumental support and the way he picks up the slack at home whenever slack needs picking up. So I recommend commune-raised partners for their ability to be part of a team but since that background is not common, in my experience, early signs of support include being flexible when you need to cancel plans due to a pressing academic concern, expressing and maintaining interest in your work, and pitching in with whatever needs doing, no complaints. Note: I am woman and wound up marrying a man, so those are the gender roles we negotiate. In addition to being commune-raised, my husband has worked in academia in a support role as a medical librarian and therefore understands academia. These signs may or may not apply as well in other relationships.

2. Disability and Health

A lot of my best diabetes-related lessons learned are here. (I also wrote more about my experiences living with diabetes here.) This section will vary a lot depending on the barriers a person faces. In reality, there isn’t much we can do as individuals aside from finding our own best way through or around the barriers. I hope for and continue to work towards a time in which this is less and less of an issue. (See section Changing the System, below.)

2.1 Disciplined, strategic spoon use. In my experience, to make it through, it’s critical to be extra disciplined and extra strategic about maximizing my productivity. I don’t have as much slack, and academia is not a system in which allowances are easily made. Deadlines don’t wait. I never know if my health or my kids will interfere with my plans to work later, so I work extra hard now, just in case. I do my very best to maximize the quantity of time I’m feeling energetic and the amount of work I get done during those times. I have great stretches when everything is ticking along diabetes-wise, and I am very productive. This isn’t entirely within my control, so I keep that in mind. Whenever I have time to work, I jump on it, because that capacity might not be there later. Also, because I never know if I will have all the time I need to squeeze in one more thing, I’m cautious about taking on too much at once. If I can’t figure out where on my calendar I will fit in the work, I try not to take on the task. I am not perfect at this and still find myself overwhelmed sometimes when I get too optimistic about timelines, but the further I go, the better I get at this. This is also why I try to be disciplined about doing things that keep me feeling well and energetic. Staying healthy has never been optional for me. When I let things slide too much, a cold turns into bronchitis, or pneumonia, and I’m set back weeks, if not months. I get regular reminders that I am not invincible. I’ve come way too close to dead-in-bed syndrome. I had a (false positive) diagnosis of kidney damage and spent weeks believing my life was going to be radically shortened. A family friend with type 1 diabetes died of a heart attack a few years back, leaving a wife and two children. Because I am all too acutely aware that my time here may be limited, I am driven to extend it as well as I can and also to make the best possible use of it while I have it.

2.2 Making use of strengths. Having to overcome barriers sucks in a lot of ways. It would be nice if the world were organized such that most of those barriers weren’t there (see Changing the System below). However, working within current reality, I make the most of my strengths I have developed. There are three main strengths that I use regularly. First, I have been forced to develop a capacity for relentless work at managing a disease that never gives me a day off. Whether I feel like it or not, the work required to keep myself alive is not optional. This means that, well before I came to academia, I had already developed an ability to be disciplined in ways that most people don’t need to be. This is a huge strength in a research career. Second, I apply my understanding of life as a patient to inform the research questions I ask, and how I approach them. I was a patient for nearly 3 decades before I got a PhD, which offers me a perspective that not everyone has. Third, I’ve already had to accept that I can do everything by the book and still have blood sugars off target. So I came into academia already having accepted that there are no guarantees. All I can do is work my tail off in the hopes that some of my efforts will have the intended result.

2.3 Making use of waiting time. When I am up late at night to deal with a child or my blood sugar, I often have to wait for a while for them to go back to sleep or to make sure I’m back in range, so I often make use of that time to get a bit of pleasant work done–a bit of reading, some poking away on a paper, etc. This habit served me extremely well when I had non-sleeping kids.

2.4 Exercise. Exercise helps me minimize the interference of both type 1 diabetes and Raynaud’s in the rest of my life. I’ve never noticed a difference with Hashimoto’s but there’s a big difference for T1D and Raynaud’s. It’s also really important for my overall sense of well-being. Sometimes I find myself working too much and not sleeping or exercising enough. It’s a really bad cycle for me. Exercising is just not optional for me. When we moved here, among the places we could afford to live, we deliberately chose to live a half-hour walk from my primary office. That way, even when my work schedule makes it difficult to fit in exercise to the extent I would like, walking or biking to and from work every day helps gives me a base. I’m a much happier person when I’m going beyond a base. Since starting my faculty position, I haven’t been able to figure out how to fit in field sports the way I used to, so I do other things. We do a lot of family activities like hiking in warm weather, cross-country and downhill skiing in winter, and for my regular activity, I run. I don’t run races. I’m not at all interested in adding yet another element of competition to my life in which I would have to surmount extra obstacles not faced by most others. I just do it for myself and my well-being. It’s the most time-efficient way I’ve found to meet physical activity guidelines (minimum 150 minutes per week of moderate intensity or 75 minutes of vigorous intensity). I am not a morning person but mornings are the only time I can consistently fit in a run without messing with my schedule or my blood sugars, so that’s when I do it. In the past, I would run outdoors but since I now live in a place where mornings in the winter are pitch dark and covered in drifts of snow (Quebec City gets an average of 3 metres / 10 feet of snow per year) in our second year here, we spent some of our budget on a treadmill. I was really worried about spending the money but it has been a fantastic investment. It allows me to run in the dark early morning and I don’t have to pack my diabetes gear with me because I’m not actually going anywhere, which significantly cuts down the time required. It’s an amazing luxury.

2.5 Old-school routine. Most workdays, I fall back on the old-school diabetes methods with which I grew up. I eat the same or similar breakfasts and lunches on a regimented schedule. Breakfast is plain yogurt with nuts, seeds, and a handful of berries when I can get them, or raisins when I can’t. This means that I either travel with plain yogurt or I have to find some when I arrive. The security staff at my small local airport have started to recognize me when I arrive in line as, “la madame avec le yogourt!” (hey, it’s the lady with the yogurt!) (I think they also got to know me because I kept showing up with different colours of hair.) Hotels will usually provide a fridge if you have diabetes but plain yogurt also keeps a day or so without refrigeration if you put it in a jug of ice or up against a cold window.

2.6 Packing extras, stashing supplies everywhere. I cannot count the number of times that packing extra supplies in my daily bag has come in handy. I always carry a ziploc with spare infusion set, cartridge, battery, bottle of test strips, lancet, swabs, low treatment, and a backup bottle of insulin with dregs and an old school needle just in case. I have had to use the needle three times in my 13 years with an insulin pump, and every single one of those times, I’ve been incredibly relieved to have the option. When I travel, I always carry a loaner pump, and ever since I once somehow forgot to pack my test meter, my diabetes travel kit also has a backup meter. I also keep a backup test meter in my office and a stash of juice boxes. I will always remember the time I had an unusually difficult low blood sugar in a meeting. I pretended to receive an urgent message that I needed to attend to, excused myself, went to my office, closed the door, sucked down two juice boxes from my stash, vomited into my waste paper bin (thank you plastic bag liners) and spent the next hour laying on the floor waiting for the dizziness and shakiness to pass. (As unpleasant as that was, I’m aware that not everyone will always have the option of keeping events like that private. It probably wasn’t such a great idea for me to keep it private but that’s how decision making works sometimes when my brain doesn’t have enough fuel.)

2.7 Using work to distract me. The fact that I am busy and have a lot of engrossing work to do can be a positive thing when I need to avoid thinking about my own health issues. I finished two manuscripts last time I was waiting for scary test results. I also got a lot of work done at the end of my second pregnancy when I was having Braxton-Hicks all the time.

2.8 Being open about my reality. In my experience, there is no perfectly comfortable way to manage disclosure. I have chosen to be more open than others I know, as evidenced by this incredibly long blog post. I also make a point to deliberately share my reasons for making specific choices or specific requests. (“What flight are you taking?” “Flight XYZ. I’m leaving earlier than you because I sometimes need more time at security due to my medical equipment.”) I do this on purpose because I know that others may not feel they are in a position to be able to acknowledge barriers they face. Colleagues have told me that they never thought about these things, so I hope that by being open about the barriers I face, I may be helping to open some minds–including my own–about other possible barriers. As I wrote above, I did lose a job offer after disclosing aspects of my health. I landed in a tenure-track position and am now tenured, so it’s easier for me to be writing this on this side of that experience. If I hadn’t found an academic job, I might have a different view. Having said that, I spoke on a set of career panels recently, including one for an audience of trainees. One trainee shared that they had a major health issue during their studies. The trainee is now applying for jobs. They are struggling with the lack of publications on their CV when they’re just happy to have made it through their program and to still be alive. There is no easy way to deal with this and I think everyone has to find the balance that is most comfortable for them. But I think it’s worth considering the option of disclosure. They were planning to simply not mention it and I suggested they reflect on what they might lose or gain from disclosure. When applying for jobs, one of the advantages of being open is that it gives you some insight into how they respond to that and allows you to better explore whether or not it’s a place you want to work.

2.9 Good comments folder. Some days, I need to remind myself that I can do this. I have a folder on my computer in which I keep copies of letters of recommendation, awards notifications, good peer reviews, etc. for the days when I need them.

2.10 Speaking out because I can. I also think it’s important for those of us who have some job security to speak out, because there are a lot of people struggling who can’t necessarily do so. The more I learn about the barriers that others face, the more effectively I can advocate for a system that is free of bias, one that is inclusive and thus producing the maximum amount of good research. (See also Changing the System below.)

3. Productivity

3.1 Recognizing that I am lucky to do this work. I am intensely grateful to have the job I have and to get to do what I do. There are times that are intense and long, but it is meaningful, interesting, and I have a lot of agency. I love research, and I love being able to work on ways to help people get good health care and make difficult health decisions. From my teen years on, I worked at minimum wage jobs, sometimes less than minimum wage under the table. My least favourite was doing telephone surveys. It wasn’t physically difficult, but it was the job that drained me the most. I found it hard to get yelled at, get sworn at, have my personhood questioned, and get hung up on for hours on end when I politely asked people if I might please ask them about their chewing gum preferences. For a long time I was the only academic in my family (I now have a cousin-in-law who is doing a fellowship at Sick Kids in Toronto–we’ve doubled our numbers!) and I have a lot of family in construction, seasonal jobs, freelance work, and who hustle from contract to contract. So I am keenly aware that while I work very hard at my job, so do lots of people in lots of fields. Academics are not unique in that we have to work hard, and we are often working hard with public funds. Those public funds could pay for a lot of other things. So with that in mind, my view on the productivity requirements of academia is that they are pretty reasonable. I think our incentive structure is problematic and the current funding environment is really tough, but the basic idea of needing to propose work that you will do (write grants), report back (write papers), and have it all reviewed by peers who may or may not see things the same way I do is all very fair. The things that work for me to meet those requirements are as follows.

3.2 Writing constantly. Writing manuscripts is the one thing I can do that doesn’t depend on forces outside my control. Making progress on a manuscript makes me feel like I have at least some say over my fate in a career in which there are a lot of forces outside my control. Any amount of progress on any manuscript improves my mood. Even if I haven’t blocked time for writing on a given day, I often squeeze in 10 minutes just to keep a manuscript moving. A big help for this is that I’ve moved to drafting in such a way that I can poke away on a paper on my phone, meaning that I can work anywhere. I always have at least one manuscript on the go, more often two or three.

3.3 Writing in an organized way. One of my postdoc mentors, Dr. Peter Ubel, taught me to start from the middle of a paper. This helped me speed up my manuscript writing. I prepare tables/figures first, then methods, results, intro, discussion, abstract. As I started to have more and more manuscripts to write, I developed a template for my lab’s papers, which streamlines things and helps maintain some consistency. Also, when I’m drafting something, I keep a To Do list at the top of the document with notes to myself about what I was working on and what I need to do next, and I put “come back here” wherever I was working. That way, if for some reason I don’t touch it for a couple of weeks, when I do get back to it, I don’t waste time reminding myself where I was and what I was doing. I open the file, read my list, and search for the text “come back here”.

3.4 Maintaining an attitude that writing is just part of the job. As noted above, I see writing as part of my work, and not something to agonize over. This comic about publish or perish really resonated with me, as did this quote in Mama, PhD by Dr. Angelica Duran:

My working-class roots are evident in my response to colleagues’ puzzled question, “How in the world do you get your work done and find time for your family?!” I’d answer, “A bus driver doesn’t get ‘driver’s block,’ a janitor doesn’t get ‘cleaner’s block,’ and I don’t get, ‘writer’s block.’ When it’s time for me to work, I work.

I strongly agree with the idea that when it’s time to do a job, you do it. Academic writing is a process of putting words down and then editing them. I don’t need to be James Baldwin. I just need to get words out and arrange or rearrange them in a clear structure. It is part of the job, and it’s a heck of a lot easier and more enjoyable than the tough parts of a lot of other jobs. I’d way rather work on a paper or grant than clean toilets or wire a building in -20C or phone people for hours and hours to ask the same eighteen questions over and over regarding their opinions about chewing gum. It took me a while to get the hang of finishing and submitting academic papers because I found it very intimidating and I would really prefer to just keep polishing this manuscript forever and ever, thank you very much. (Did you know that if no one ever sees it, no one will ever know that it might not be perfect?) It was hard for me to learn to finish them, and then let them go. But once I got the hang of it, I really got going. I organize my life digitally for the most part but I keep a physical bulletin board in my office with columns: waiting to be written, in prep, waiting for someone else, submitted and waiting, revise, and accepted. I scribble the manuscript name on an index card and move it along the columns. I get very anxious when a card stays in the first three columns for too long.

3.5 Working with people I like on topics I care about. Thanks to Dr. Angie Fagerlin for this tip. This is easy to do in our field, which is full of brilliant, kind people. (That may be partly due to the fact that no one goes into this field for fame. There will never be a Nobel prize in health services research. The field “is more about hitting singles, day after day.”) Whatever the reason, I’ve found this to be excellent advice that is easy to take. When it comes time for long hours and intense periods of work, it’s so much more fun when the people alongside are people I personally like. In addition to working with good people, I also find it easy to be committed to projects because I care about solving the problem or problems that the project is addressing.

3.6 Time management by calendar. I have multiple calendars that I pull together into one view. One of my calendars is called ‘Doing’ and it shows up on my calendar in red. Everything I have to do gets scheduled on the calendar and I work hard to stick to my schedule. I don’t wait to feel motivated to do things; I start doing them when I’ve scheduled myself to do them. Motivation usually follows once I start the task, but if it doesn’t, I just suck it up and push through to finish. Making this system work requires being brutally honest with myself about how long certain tasks take and when I am most likely to do them well. Whenever I finish a task, I flip it to another calendar called ‘Done,’ which shows up in grey. It’s intensely satisfying. This works reasonably well because some years back, I recognized that I was not doing well at estimating how long things take, so I spent a few years tracking how long different tasks take me and learning from my mistakes. I am not perfect at it now, but when I make a mistake, it’s usually because I didn’t want to admit to myself that the task would likely take longer than I wanted it to take. What I like most about this system is that it helps me draw very clear boundaries around my work, something with which I’ve struggled. It’s so easy for me to find myself working every possible moment, and some moments that I probably shouldn’t. Defined boundaries are helpful for me. Sometimes those boundaries leak, but the more I work at it, the better they hold. Others with similar systems report similar benefits.

3.7 Waiting 24 hours to say yes. I allow myself to say no to requests right away but I try to wait 24 hours to say yes. Many thanks to Dr. Sharon Straus for this tip. It’s brilliant and works beautifully for me. Twenty-four hours is enough time to go from, “They want me! I’m so flattered!” to, “Do I really want to spend time on this? Where in my calendar am I going to fit this in?”

3.8 An hour a day for email. One day, a few years back, I had a fantastically productive day. At the end of the day, I noticed that my email client was closed. Correlation isn’t causation “but it does waggle its eyebrows suggestively”. That first experience really made me think, and I started experimenting. The more I experimented, the more I found that I am more productive when I chunk my time spent on email. I try to keep it to an hour a day, once a day, sometimes split into two or three blocks of time. I keep my email client closed the rest of the time. When I open my email, I quickly deal with the bulk of it during the scheduled hour and I try not to agonize over typos. Any messages that can’t be answered quickly get scheduled on my calendar in the coming week. The 1 hour for email works because my lab is on Slack. My students and staff all know to contact me on Slack for non-urgent issues and to text me for urgent issues. It also works because I aggressively filter my email. All email clients have some way to do this; there’s nothing magic about it. My emails go into the following folders:

Folders I check a few times a week:

  • Greetings: This folder catches most academic spam by using just a few keywords (terms that have nothing to do with my work like omics or mouse, plus the word greetings, which catches a lot of academic spam) but people do send real greetings sometimes, so I always check the folder before deleting it all.
  • Lists hyperlocal: Talks organized by my research centre, groups of which I’m a part and that have a habit of sending inbox-clogging group emails, etc.
  • Lists local: University-wide announcements.
  • Three other lists folders, two for topic-specific listservs and one for journals and conferences.

Folders I check daily:

  • Inbox (I am in the To field, and the email wasn’t picked up in one of the filters above)
  • Inbox cc (I am in the cc field, and the email wasn’t picked up in one of the filters above)

3.9 No TV or movies Limited TV and movies. I have limited spare time, and I don’t enjoy TV and movies enough to spend it there. If I liked TV/movies more, I would give up something else instead. Twitter, books, and board games are usually my preferred entertainment. Note: I did have to come back and edit this title because I recently saw my first movie in a theatre in over eleven years. My point here is just that I try to be thoughtful and deliberate about how I spend time outside of my key priorities (family, career, health).

3.10 Writing grants early. For me, that means my first complete draft is done 6-8 weeks before the grant deadline. I do the hard push to get the full draft done well ahead of deadline, which gives me time to revise extensively. I’ve never had a major grant funded that didn’t have at least 6 weeks of pre-submission revision, meaning I’m sending around complete first, second, third drafts, begging asking my co-investigators and external reader colleagues to read it as a harsh reviewer, noting their criticisms, and rewriting. (Thank you, thank you, thank you, to colleagues who have been harsh reviewers for me.) I strongly suspect this is at least part of why I’ve gotten a number of my grants on the first try and most my grants so far have scored in the top 3-12%. By the time I submit, it’s as if I’ve already been through a panel of reviewers many times. Finishing a draft early did not come naturally to me. The first grant I ever wrote was a horrible sprint to the finish. It was not funded, and I hated the process. I hate writing in a rush, staying up late to work, and throwing my whole routine off balance. It takes me so long to get back on track after a period like that, partly because, way too often, a sprint like that leaves me sick. So I worked hard to develop more discipline, and although I’m still far from perfect, I’m much better at getting things done without also getting sick.

3.11 Maximizing expected utility. Right now, in Canada and in a lot of places (but not all places, sigh, Switzerland) funding is, to put it as politely as I can, a crapshoot. Therefore, this is an easy thing to write and a hard thing to accomplish, but I always try to decide whether or not to apply to a competition based on, essentially, the expected utility. What are the chances that I will get it, how well does my work fit into this call, how big of a grant is it, and how much work will it be to prepare? In my experience, small grants take almost as much work to prepare as big ones but it’s hard to get big ones if you haven’t gotten any small ones. I now have a CIHR Foundation Grant (sort of like an NIH R01) so my stats are no longer helpful to anyone who isn’t fortunate to have this kind of funding yet but for reference, in my first 14 months as faculty I submitted 10 funding applications as PI and 7 were funded. Three of the 7 were revised versions of unfunded applications to other competitions. That was a lot of grants to write in a little over a year but I work in an area with limited start-up funds so I had to scramble to get funding to be able to do anything. There were also competitions to which I didn’t apply because I didn’t think I had a good enough chance of getting the grant to devote the time to writing a really good application. I try very hard not to waste my time, my colleagues’ time, or reviewers’ time by doing a substandard job. I still make this decision regularly. For example, I recently decided not to apply for an interdisciplinary competition, even though I think I’d be well-suited for it, because there wasn’t a category into which my work fit clearly.

3.12 RTFM. If it’s available, I always read the reviewer manual very carefully and structure my grants according to the sections reviewers are expected to judge. For example, for the Foundation Grant, reviewers were expected to comment on how well you’ve considered challenges and mitigating strategies. So I literally made subsections titled: “Challenges & Mitigation Strategies.” I work hard to organize my description of my science in a way that will optimize my reviewers’ experience. When I write, I am always thinking, “How can I make my reviewers’ jobs easier? Where are they going to be looking for information about issue X? How can I make sure they can write their review as easily as possible? What questions are they going to be asking here?” When I am circulating copies of my grants in preparation, I am essentially user testing my grants. I do very interdisciplinary work so I will never, ever get 100% reviewers who are experts in all of the fields my work unites. This means my writing and structure have to be carefully constructed to make sure I’m giving enough detail for the experts in a given aspect of my proposal and also enough explanation for those who are less familiar with that specific aspect.

3.13 Getting copies of successful grants. I pay attention to why they were successful. Whenever possible, I get grants from more junior people, because those grants probably got funded more on the strength of the grant and less on the good reputation of the researcher.

3.14 Sole PI. Some junior people find it helpful to have a more senior co-PI. I’ve never liked that strategy–it doesn’t suit the way I do research. I listen hard to everyone who collaborates with me, but at the end of the day, I am accountable for decisions so I prefer to be sole PI. That’s how I’ve structured my grants so far, and it works for me. I do recognize the strategic value of a big name as co-PI and that it’s hard to break in, so I see why it’s a technique that a lot of other junior faculty use. However, it makes me frustrated that they find it necessary, and I also worry that it may make it harder for the junior person to get the next grant on their own. (If you review grants, please remember that junior faculty are people usually in their mid- to late-30s or early to mid-40s who have 10-15 years of specialized training. We can do the work. Really. Also please remember that junior people who are co-PIs on multi-PI grants and who lead components of big team grants are often showing significant leadership within the team.)

4. Changing the System

I sometimes feel like I scrabbled and stumbled my way into a system that isn’t made for people like me. Even now, I continue to discover things that are apparently common, tacit knowledge for others, and I feel ignorant and ashamed. (For example, I learned recently that you can expense pricey networking events that I hadn’t been attending because I couldn’t fit them into my family’s budget.) So far I’ve had success, but there’s a lot more hill to climb. I worry about my next stage, and I worry about those who haven’t yet been able to find the toeholds I found. I worry about my trainees and colleagues who face barriers I don’t; for example, racism. So it’s important to me to do what I can to improve the system so that all the best and brightest can contribute to the advancement of science and research.

Caveat: I am a believer in change from within. This is related to the fact that, like many other disabled people, I would have a very hard time surviving more than 48-72 hours in conditions of great social disorder. I could probably make it a few months if I had a good supply of insulin. Disabled people are almost always the first to be negatively affected by social disorder. This influences how I see all systems in need of change. I believe in consistent, incremental progress. If you are a believer in change through total destruction & rebuilding, you may find my suggestions insufficiently radical.

4.1 Being vocal. I always try to advocate for fairness. I remember that each group is a minority on our own, but if we all speak up on behalf of each other, suddenly that’s a lot of voices. I do this because it’s the moral thing to do, it may help in small ways to shape the world into the kind of world I want to leave future generations, and because it’s what’s best for research and science. Some people make the mistake of talking about equity and merit/excellence as if they are in conflict. This is completely backwards. A lack of fairness in the system impedes true excellence. When biases influence the results of a funding program, we fail to hire the best person or fund the best research.

Some people make the mistake of talking about equity and merit/excellence as if they are in conflict. This is completely backwards. A lack of fairness in the system impedes true excellence.

4.2 Being accountable. When I screw up, I try to notice, learn, and apologize. I am human, and out of ignorance, sloppiness, or other reasons, sometimes I make mistakes. I work to notice, learn, and sincerely apologize. I try to always keep in mind how it feels to be on the other side, which happens to me once in a while. It breaks my heart when I bring something up to a colleague and they dig in their heels defensively. I do not want to cause others’ hearts to break, especially when they are making themselves vulnerable by telling me about something I did or said that was a problem for them. So I pay attention to the fact that even though I didn’t mean to hurt people, there are issues that I don’t understand, and when someone brings them up, I have an opportunity to learn. Here is a very nice explanation of this by a talented writer, Ms. Alicia Elliot.

4.3 Learning from people I know and I also seeking out information on my own. It is useful when friends and colleagues are willing to provide insights about their lived experience as a member of an underrepresented group of which I am not a member, but I can’t expect them to teach me everything. They have their own lives to live and careers to advance. Also–I know this from my own experience–it can get pretty tiresome always starting at level 101. People may not want to serve on yet another an organization’s access, diversity, and inclusion committee, especially if it’s the fourth such committee and the institution still hasn’t implemented their suggestions from the first one. So in addition to learning from friends and colleagues, I read a lot. (I am currently reading Written/Unwritten, which I would recommend.)

4.4 Paying attention to short lists. Whenever I have a role in selecting speakers, hiring, or selecting for awards, I pay attention to the composition of the short list and assess whether it includes appropriate representation by members of all groups. It’s so easy for a field to get into a cycle in which the same people get nominated or invited to speak. An idea my colleague Dr. Janice Bailey shared with me is to always suggest that statistics be tabulated and kept on these things. This aligns with this article by Dr. Jennifer Martin about gender equity at conferences. When I have a role in selecting speakers, I do the work to draft an inclusive short list. There are many excellent, qualified people who give great talks, and there are more and more places to find them, including where you can view their talks. For example, here is a non-exhaustive list of some sources to find women:

4.5 Valuing work that improves science. When I’m reviewing CVs, I try to make sure I am appropriately valuing outreach, mentorship, and other work that people, especially members of underrepresented groups, do outside of their “pure” research. That’s one of the things that people do to improve the field by making sure that we truly recruit and retain all the best and brightest. I also pay attention to how metrics can disadvantage people because some types of research requires working respectfully with communities. This can take longer and may result in fewer tangible outputs like papers, at least in the short run, because it takes time to build relationships. A colleague who works in partnership with Indigenous communities, Dr. Jon McGavock, once described a 10-year evolution of research that ended in impressive results by noting, “I still haven’t published a single paper out of this work.” Because members of underrepresented communities may be more likely to work with communities, their CVs may be penalized by such realities.

4.6 Providing opportunity. I try to put my money where my ethics are in my personal financial choices, and I do the same with my service time and research funds. For example, last year I gave up some funding that had been earmarked for me so that a colleague who works with Indigenous communities could use it instead. Also, a colleague in my department and I volunteered to develop a plan to give more medical students a look at what their career could be like in academic medicine, particularly in primary care. We will be offering opportunities to all medical students but we’re making sure to reach out to members of underrepresented groups that might not as easily see themselves in academic medicine to make sure they consider these opportunities. I’ve committed some funds to support three such students, help them see what research is all about, and provide them with an opportunity to build their CVs if they want to do so. I wouldn’t be doing this work I love if someone hadn’t introduced me to research–now it’s my turn to offer that to others.

4.7 Respecting territory and first peoples. Many of us live in settler colonial states. I did not really start to understand what this meant until later than I should have understood it. Like a lot of people in Canada, I’m working and trying to do my part to move toward genuine truth and reconciliation. As an academic, that means that, among other things, one very fundamental thing I try to do is ensuring I always respect the territory I’m on and the territory on which I live and work. Sometimes it feels awkward and uncomfortable. I always worry that I’m inadequately walking the fine line between doing justice to the important issue of land and losing the chance to influence my colleagues. I put explicit territorial acknowledgements in my academic bio a while back and it still makes me nervous when I send my bio to people. I think my nervousness and awkwardness are good signs, though. I think of it this way: what if someone invaded my home, took over, promised to treat me & my children well–as if that somehow justified taking over–and then went back on their word while continuing to occupy my home. It ought to feel awkward to acknowledge that. When I am asked to an invitational meeting or to give an invited talk, I ask about the protocols for the territory on which the talk will be held. In my experience, this feels extra awkward, especially when I know I’m pushing senior people on this topic. I’m never quite sure I’m doing it right, but I listen, learn, read, and keep trying. This is such a basic, fundamental thing, and it’s only one of many things that we all need to do, but I think it’s an important starting point. If you are in North America, you can look up the peoples and languages of the territory you are on using this map as a starting point for learning and reading more. Your institution should also have an office that can point you towards more learning. By stumbling through these processes, I have learned more about protocols, ceremony, and first peoples in different places, and so have some of the people who invited me, I think. I believe it’s very important for those of us who are settlers to come to terms with our roles. It felt uncomfortable to me to identify as a settler. I am here partly because my paternal grandparents came here as indentured servants with four of their six children, including my dad. They were sponsored to come from the Netherlands after World War II and had to work off that sponsorship for years in an unfamiliar place with no family and where they didn’t speak the language. It hurt to think about my grandparents doing something wrong. They were kind people who cared deeply about doing the right thing. Near the end of his life, when dementia took everything but his personality, my grandfather was beloved by the nurses caring for him because he was so kind and gentle. My mother’s family were settler farmers who had come a few generations earlier. When I got over myself and looked at the situation honestly, not letting myself be biased by my hurt feelings about not belonging in the way I thought I did, my family came here and settled on land that had already been cared for and lived on for millennia. We were and are settlers. Part of my job now–all of our jobs–is to do our work for reconciliation, including as a minimal starting point: reading, learning, and advocating for implementation of the Truth and Reconciliation Commission’s Calls to Action, many of which are relevant to academia, others of which are relevant to our roles as citizens. Damage cannot be undone, and it will not be easy to do some of this work and to make amends, but it has now been 150 years of colonization as a country after hundreds of years of colonization previously. It is unacceptable and immoral to do nothing. At the very, very least, we all need to get better informed so we can be better academics and citizens. I recommend a single book as a very accessible starting point, which I explain in the following Twitter thread. Here is the direct link to the start of the thread if you’d like to read it on Twitter. Below, I have pasted the text of those tweets. The closing statement applies here as well.

1/Hey Canadian science/research/health care tweeps. Especially those of us who are non-Indigenous & white.

2/We’re here on Twitter, often naming our professional identities as professors, scientists, scholars, health professionals, students, etc.

3/As we should. Part of our role is to be scholars in public. This also carries responsibilities.

4/We tweet about science/research, and other topics. Sometimes we express opinions about Canada in comparison to the US.

5/I’m not going to link to them here, but I have many specific tweets in mind that have basically expressed:

6/”Thank goodness we aren’t racist and divisive like the US.” You know who you are. I like & respect you, but you’re sadly wrong about this.

7/I’ve been thinking about this a lot since I heard such ideas expressed by Canadian scientists at a science policy conference Nov 8-10.

8/I sat with scientists & policy people, discussing the US election, struggling to convince them that in fact, Canada has big problems, too.

9/For example, many of the health & social disparities Black people experience in the US are even worse for Indigenous peoples in Canada.

10/Also, many aspects of racism that non-Indigenous people of color face in the US, people of colour face in Canada, too.

11/A story. I grew up mostly on Treaty 4 territory, in Regina, Saskatchewan.

12/I attended 3 high schools: 1 in Regina & 2 in Toronto, after we moved to get away from my mother’s (n-2)th abusive partner.

13/I will always remember, after I left, hearing of the murder of Pamela George, an Indigenous woman, in an area I knew outside Regina.

14/One of her murderers attended the same high school I did in Regina. I didn’t know him (different circles) but I recognized the name.

15/I knew he played basketball. I’d heard the gossip that he defecated on the living room carpet at a party at someone’s parents’ house.

16/I read the press coverage of Ms. George’s murder, of the murder trial, of their convictions and incredibly light sentences.

17/The coverage that was so much gentler to them, white men who murdered an Indigenous woman, than it was to her.

18/My schoolmate wasn’t a privileged man whose entitlement ran from shitting on a rug to murdering a woman, he was ‘a basketball star’.

19/Ms. George wasn’t a mother of two children and a member of the Saulteaux nation, she was ‘a prostitute’. It was breathtakingly awful.

20/It forever changed my view of Canada. I had bought the multicultural mosaic story. I knew of past horrors, but I thought they were past.

21/I was ignorant. I didn’t know the past was present everywhere around me, and I had been enjoying the privilege of not seeing it.

22/Every time I post about something like this that isn’t science/science funding, a bunch of scientists unfollow me. It’s fine.

23/It’s funny, though, because many started following me due to my activism & work on science funding policy.

24/And yet, if I didn’t care about fairness & being a better country, I wouldn’t still be organizing re: funding. After all, I’m funded.

25/But it’s truly fine if you unfollow. This may not be for you. You may not be for this. Or maybe I’m not doing the topic justice.

26/(Please feel free to let me know if I’m not doing it justice. I gratefully take corrections.)

27/But please, even if you don’t want to read my RTs & occasional tweets about this, please read the rest of this thread before unfollowing.

28/We have to understand that treaties have been broken in our name. To understand that horrific, unethical experiments have been done.

29/Canadian scientists withheld food from underfed Indigenous children to better understand the effects of malnutrition. Let that sink in.

30/Remember that families had no choice. Their children were removed by law. Imagine men with guns showing up to collect your 6-year-old.

31/This is recent, not ancient, history. I have personally met residential school survivors.

32/There are associations between children’s residential school experiences and current health & social issues in Indigenous communities.

33/We also have to understand how rights we enjoy as Western women are rooted in Indigenous peoples’ examples of equality.

34/We’re defaulting on our debt. All #womeninSTEM and anyone who cares about equity should understand this.

35/Meanwhile, intergenerational trauma is playing out. We may not have endorsed it or been here at the time but it was done in our name.

36/We have to tell our government what we want done in our name now. The coming years are going to test us.

37/The US will have issues. Meanwhile, we’ll hear #MMIWG inquiry results. We’ll see action against pipelines that touch Indigenous land.

38/We owe it to our institutions, to our students, to ourselves and to our country to be ready. And by ready I mean informed.

39/Everything current will need to be put in context. Those of us who don’t know enough history (including me) need to learn more.

40/Most syllabii/reading lists on this are daunting. I’m going to suggest a single book. It is broad & accessible. I read it in my spare time in <1 week.

41/Please read Indigenous Writes by Chelsea Vowel. You can get it here or elsewhere:

42/The author is also here on Twitter if you want to follow her: @apihtawikosisan

43/You should also consider reading the Truth & Reconciliation Commission’s final report:

[ed: that link is now dead; the report may be found at the website of the National Centre for Truth & Reconciliation]

44/It takes longer (it took me a few weeks, and it was hard reading) but it is important for understanding contemporary issues.

45/We don’t have an unblemished history. We don’t have an unblemished present. We have work to do if we want to have a better future.

46/Let’s do the work. We owe it to the people who were here first, and who are still here.

47/We’re on their land. Acquiring a more accurate & complete understanding of our shared issues is truly the least we can do.

48/48 Thank you for reading to the end. Please go get the book if you haven’t already.

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