Pandemic stress, burnout more common among women in medicine than men

ByMaria Marabito

Women in medicine were more likely than men to take on childcare responsibilities and report burnout, mental health symptoms and work-life imbalance during the COVID-19 pandemic, according to recent findings from two separate studies.

“Mothers across professions have been torn between their careers and their home lives during the pandemic,” Srijan Sen, MD, PhD, the director of the Frances and Kenneth Eisenberg and Family Depression Center at the University of Michigan, said in a press release.

Graphical depiction of data included in article. — Frank E, et al. *JAMA Netw Open*. 2021;doi:10.1001/jamanetworkopen.2021.34315.

Balancing work and a ‘second shift’ at home

In a prospective cohort study published in JAMA Network Open, Sen and colleagues examined gender differences in work-family factors and mental health among physician parents during the pandemic. They enrolled 276 U.S. physicians during their first year of residency training in 2007 and 2008, although their current analysis was limited to 215 physicians who participated through August 2020. Among these physicians, 53% were women and the mean age was 40.1 years. The participants completed three single-item questions on work-family experience, the Work and Family Conflict Scale, the Patient Health Questionairre-9 (PHQ-9) and the Generalized Anxiety Disorder-7 scale.

Sen and colleagues found that male physicians were more likely to be married (91.2% vs. 86.5%), have three or more children (36.1% vs. 20.9%), work in a surgical specialty (23.5% vs. 14.8%), work fulltime before the pandemic (91.2% vs. 73.1%) and have a partner who did not currently work fulltime compared with female physicians.

Overall, survey results showed that 24.6% (95% CI, 19-30.2) of physicians who were mothers were responsible for childcare or schooling and 31.4% (95% CI, 25.4-37.4) were responsible for household tasks compared with 0.8% (95% CI, 0.01-2.1) and 7.2% (95% CI, 3.5-10.9), respectively, of physicians who were fathers. Mothers were also more likely to work primarily from home (40.9%; 95% CI, 35.1-46.8 vs. 22%; 95% CI,17.2-26.8), reduce their work hours (19.4%; 95% CI, 14.7-24.1 vs. 9.4%; 95% CI, 6-12.8) and experience greater work-to-family conflict, family-to-work conflict, depressive symptoms and anxiety, according to Sen and colleagues. On average, female physicians had a depressive symptom PHQ-9 score of 5.05 during the pandemic compared with 3.69 prior to the pandemic. Meanwhile, male physicians had an average score of 3.52 during and 3.6 prior to the pandemic.

“Women experienced significantly higher levels of conflict between their roles as physicians and parents,” Sen, who is also the Frances and Kenneth Eisenberg Professor of Depression and Neurosciences, and colleagues wrote. “To relieve the intensifying pressures of their professional life and ‘second shift’ at home, in line with recent trends in other fields, we found that physician mothers disproportionately downshifted at work by reducing their work hours or working primarily from home.”

The researchers noted that the findings suggest the gender gap in physician retention will continue to grow.

Elena Frank

“There are these deeply ingrained patriarchal roots in medicine and a lot of work needs to be done to change the culture,” Elena Frank, PhD, lead author of the study and the director of the Intern Health Study in the Michigan Neuroscience Institute at the University of Michigan, told Healio Primary Care.

The findings show that existing gender inequalities have worsened, and the pandemic has caused new mental health symptoms to emerge, particularly among women, Frank said. Leveling the playing field in medicine “is going to take a big move,” she added.

“When women don’t have the support that they need when it comes to family, something needs to change,” she said.

Burnout and job satisfaction

In a separate article published in the Journal of General Internal Medicine, Ellis C. Dillon, PhD, an assistant scientist at the Palo Alto Medicinal Foundation Research Institute, and colleagues surveyed 3,176 clinicians from June 2020 to August 2020 about their work and personal lives, specifically burnout, wellbeing and work experiences.

“We had two immediate goals,” Dillon told Healio Primary Care. “First, to express appreciation and acknowledge the challenges our clinicians were facing by listening to them share their experiences. Second, we wanted to gather meaningful and actionable information to inform leadership about opportunities for improvement during the pandemic.”

Ellis C. Dillon

The survey respondents worked in nine medical groups and 17 hospitals at Sutter Health, a health care system in Northern California. Among them, 51% were women and most were aged 35 to 54 years. Also, 88.8% were physicians and 11.2% were nonphysicians. The largest proportion of respondents worked in general internal medicine (15.6%) and family medicine (13.8%).

Overall, 29.2% of respondents reported burnout and 46% reported decreased overall wellbeing and more job stress. Burnout was more common among women than men (39% vs. 22.7%; P < .01), as were decreased feelings of overall wellbeing (51.1% vs 42.5%, P < .01) and more job stress (51.1% vs. 41.3%, P < .0001).

Middle-aged clinicians reported significantly more job stress (51.4% among those aged 35-54 years vs. 45.8% among those younger than 35 years and 36.8% among those aged 55 years and older) and decreased wellbeing (50.8% among those aged 35-54 years vs. 45.3% among those younger than 35 years and 39.5% among those aged 55 years and older) compared with younger and older clinicians.

In multivariate analyses, the researchers reported that being a woman was associated with a substantially higher odds of burnout (OR = 2.19, 95% CI, 1.51–3.17), while being aged 55 years or older was associated with lower odds of burnout (OR = 0.54, 95% CI, 0.34–0.87).

Similar to Frank, Sen and colleagues’ findings, Dillon and colleagues found that more women reported that childcare or caregiving was impacting work compared with men (32.9% vs. 19%; P < .01). Clinicians who reported that childcare or caregiving responsibilities impacted their work had substantially higher odds of burnout (OR = 2.19, 95% CI, 1.54–3.11).

Dillon and colleagues also found that fewer women felt highly valued compared with men (63.7% vs. 71.5%; P < .01). More women were worried about losing their job (27.2% vs. 18.3%; P < .0001), and more often desired support for mental health (15.6% vs. 9.9%, P < .01) and more flexible schedules (29.4% vs. 21.6%; P < .0001) compared with men.

Organizational factors were the largest drivers of burnout and wellbeing at work, Dillon said. The findings demonstrate that burnout out is an ongoing issue, she added.

“Work continues on how best to support our female clinicians, particularly those feeling an increased burden of caregiving at home,” Dillon said.