Female docs 30 times more likely to manage childcare amid COVID: survey

Physician mothers were more likely than physician fathers to be responsible for childcare, schooling, and household chores; work mostly from home; reduce their work hours; have work-family conflicts; and have symptoms of depression and anxiety during the COVID-19 pandemic, according to a survey-based study published late last week in JAMA Network Open.

The study, led by University of Michigan at Ann Arbor researchers, involved 276 US physicians enrolled in the Intern Health Study, which assessed stress and depression in their first year of residency and who completed an online follow-up survey in August 2018 and again 2 years later.

The survey included 3 single-item questions, the Work and Family Conflict Scale, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 scale.

Increased household demands for women

Of all physician parents, 53% were women, and the weighted mean age was 40.1 years. Compared with women, men were more likely to be married, have at least three children, work in a surgical specialty, have worked full-time before the pandemic, and have a partner who didn't work full-time.

After adjusting for sampling weight and age of the youngest child, women were much more likely to have lost childcare during the pandemic than men (84.3% vs 65.7%). Relative to men, women were more likely to be responsible for childcare or schooling (24.6% vs 0.8%) and household tasks (31.4% vs 7.2%) during the pandemic. No men reported taking a primarily role in managing increased childcare and school demands amid pandemic disruptions.

Similarly, women were more likely to work mostly from home (40.9% vs 22.0%) and reduce their work hours (19.4% vs 9.4%). Women whose partner was a full-time physician were even more likely to primarily work from home (65.0% vs 24.6% and reduce their work hours (25.7% vs 2.6%) than were men with a full-time physician partner.

In a weighted model accounting for specialty, number of children, age of youngest child, and partner job status, compared with men, women had a greater probability of work-to-family conflict (β = 2.79, family-to-work conflict (β = 3.09), depression (β = 1.76), and anxiety (β = 2.87).

There was a difference between women and men in depressive symptoms during the pandemic (average PHQ-9 score, 5.05 in women vs 3.52 in men) that was not present before (3.69 vs 3.60). Less sleep was also linked with more work-to-family conflict (β =−1.62).

Among dual full-time physician couples, the differences between men and women with household responsibilities was even greater than in the overall group (44.9% of women vs 4.8% of men).

Stress on women could compromise healthcare

"This study found significant gender disparities in work and family experiences and mental health symptoms among physician parents during the COVID-19 pandemic, which may translate to increased risk for suicide, medical errors, and lower quality of patient care for physician mothers," the authors wrote.

Studies from early in the pandemic suggested that women experienced more negative professional consequences and lower productivity when they worked from home than their male counterparts.

"Even short-term adjustments can have serious long-term repercussions as they may lead to lower earnings and negatively impact opportunities for promotion, further exacerbating gender inequalities in compensation and advancement," the researchers wrote. "Although the greater availability of telehealth services has increased work flexibility, women who are rarely onsite may miss out on critical career opportunities and experience the added strain of simultaneously managing work and childcare at home."

As a result of the increased burdens among physician mothers during COVID-19, some may have left or planned to leave the profession. "As some recent studies have found that female physicians spend more time with patients and have better patient outcomes, this loss could be devastating to the US health care system," the researchers added.

They called for creating a viable path for women who leave the field because of household responsibilities and then choose to return.

"These findings underscore the importance of taking immediate action to ensure women have access to the resources and supports necessary to navigate this unprecedented and uncertain time and the work-family challenges that may ensue moving forward," the authors concluded.

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