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FORUMMeeting Aims to Stir Up Solutions for PostdocsEarlier this year, like many of Harvard's postdoctoral fellows, Bryan Vought found himself floundering at tax time without an official cumulative record of the year's income and worried about his income tax obligations. The University payroll office stopped its unrequired reporting of certain fellowship payments to the IRS this year.
Basic NeedsThis local variation on a national theme—the plight of postdoctoral fellows—sounded at an April 26 town meeting at HMS. Although only about 20 people showed up, common issues emerged. Postdocs at HMS struggle to find affordable housing for their families, worry about their inability to save for retirement, expect guidance from a mentor and growth toward independence, and desire administrative support and benefits commensurate with their professional status.In the last 15 years, the number of postdocs in this country has doubled to an estimated 39,000, due in large part to an excess of PhDs with limited job prospects. About half of the country's postdocs are non-U.S. citizens. A 1998 survey showed that Harvard University had the most postdocs at 3,407 (followed by the University of California, San Francisco, at 1,165). About half of them work on the Medical School campus or at the affiliated hospitals, said Roslyn Orkin, HMS assistant dean for faculty affairs. About 700 of them work on the Quad and another 150 are at HSPH. HMS postdocs can expect to settle in for more than five years. Core ConcernNationally, the average academic postdoc was paid about $28,000 in 1998, according to a report by the National Academies. Meanwhile, according to HMS postdoc Paula Krosky, the average age of postdocs is steadily rising, now standing at about 34 years old. About half are married, and at least one quarter of them have children. "The number one issues everywhere are salary and benefits," Krosky said.Salary and benefits also are among the most intractable issues. Harvard and other universities bestow employee status on some of their postdocs, while others are considered stipendees, based on the source of their funding. "The vast majority of Quad-based postdocs receive salaries that are processed through Harvard," explained Orkin. "Of these, half are salaried by their sponsors' grants ('employee postdocs') and half have fellowships or training grants from the NIH or from private foundations ('stipendee postdocs')." Funding from sponsors' grants includes a salary plus fringe benefit rate, which covers the costs of partial employee fringe benefits and permits these employee postdocs access to health care plans available to faculty and staff. Quad-based stipendee postdocs, on the other hand, earn a salary but no fringe benefits, Orkin said. Occasionally, the supporting foundation or agency provides a small institutional allowance, which may sometimes be used to offset the costs of health care. Efforts to provide broader benefits for all postdocs have been stymied in large part by an NIH policy that designates "trainee" status for postdocs supported through NIH fellowships or training grants. The policy explicitly prohibits granting them employee status, which would allow them access to employee benefits. Private foundations often follow the NIH's lead, and tax laws further complicate matters. Last year, for example, the Department of Cell Biology tried to cover fringe benefits for all of its postdocs, who account for about one third of the HMS postdocs on the Quad, only to be told it was illegal. Orkin is part of a Harvard committee examining University policies in an effort to obtain better benefits for postdocs. Things are improving on other fronts. A landmark report last year from the National Academy of Sciences acknowledged the key role of postdocs in carrying out the day-to-day work of research and made recommendations to improve the postdoc experience. In March, the NIH proposed a 10 percent annual increase in entry level stipends for postdocs up to a ceiling of $45,000 in 2006, but it has not yet been put into effect. The Local AngleCloser to home, the HMS Faculty Council voted unanimously in November to support efforts to bring equitable salary and benefits to all its postdocs. HMS dean Joseph Martin has also mandated access to health insurance for all Quad-based postdocs and their families supported by sponsors' grants or department funds when no stipend allowance is available.Early this year, HMS opened the Office for Postdoctoral Fellows, staffed part-time by Dorothy Berkoben. At this early stage, Berkoben aims to establish a presence, identify existing resources for postdocs, and provide support to a postdoc association if HMS postdocs decide to form a professional group on campus. At the department level, Cell Biology administrator Gerald Greenhouse reported a standing-room-only crowd at the department's first workshop for its nearly 200 postdoctoral fellows to meet another important need: how to find an academic job. The effort to improve the postdocs' lot on the Quad is largely driven by HMS faculty and administration, with the participation of a handful of HMS postdocs who are seeking jobs and leaving campus soon. "The administration is receptive, but it can only do so much," Greenhouse told the small audience. "It will take sustained enthusiasm from you folks." —Carol Cruzan Morton The Sacred Trust Beyond Patient and Doctor
Tell me what you think about this statement: 'Medicine is a sacred profession.'" This was the first philosophical question I had been asked during any of my residency interviews. Intrigued by the question, I took a moment to think about it before finally saying, "I agree ... and I disagree." This was not an attempt to be vague. I really meant it. Medicine is sacred in the sense that it involves a deep level of trust and respect between people. Patients entrust doctors with choices that literally affect the beating of their heart, the electrical activity of their brain, and the safe delivery of their children. Patients divulge personal information knowing that their doctor is someone who cares and will use the information to help rather than judge or harm. But if the sacredness of medicine is meant to imply that the qualities of the patient–doctor relationship are unique, then I disagree, for is there any human relationship that should not be based on trust and concern for others? Is there any person towards whom care and kindness should not be expressed? Is there anyone who does not possess intrinsic dignity or deserve to be treated any way other than with respect? In medical school we receive extensive instruction on the significance of the patient–doctor relationship. From the three-year patient–doctor course to the patients who come to talk to the first- and second-year students about their illness experience, there is no shortage of reminders that being a physician requires the utmost of compassion, concern, and understanding. Yet somehow when the issue is how we as physicians treat one another, nurses, and other hospital staff, the message is forgotten. Sure, there are tutorials that stress the importance of teamwork, and one is told throughout medical school that being nice to staff will make your life easier, but these mainly focus on what will make the system work more efficiently as opposed to emphasizing the core humanitarian values that should be the basis of all relationships. As I graduate this June, I am thankful for the many wonderful and talented attendings, residents, and tutors who have taught me. But within that group, there are a particular few who stand out, because their inspiration lay not just in their expertise or bedside manner but in the way they treat all those around them. I speak of an attending who pulled me aside at lunch so he could learn more about me, of a course director who took the time to give his students a pep talk regarding the imminent results of Match Day, and of a mentor who cared as much about the personal lives of residents and nurses as his patients. I will also remember the residents who were always eager to compliment, the nurses who supported and encouraged my role in patient care, and the patients who referred to me as their doctor not because of my knowledge but because of my concern. These were my greatest teachers, who reminded me that the key to medical training and practice is not learning compassion but rather never losing it. —David Gordon, HMS '01 |
