Among early-career physician parents in the United States who served during the COVID-19 pandemic, mothers were more impacted by work-family struggles and mental health symptoms compared with fathers, according to research published in JAMA Network Open.
This is the first study to examine gender differences in work-family conflict and wellbeing in a cohort of physician parents before and during the COVID-19 pandemic, the researchers reported.
The study included 215 US physicians (aged 40.1±3.57 years 53% women) who participated in the Intern Health Study, which assessed stress and depression during the first year of residency training, during the 2007 to 2008 and 2008 to 2009 academic years. The doctors completed an online survey in August 2018 and August 2020 in exchange for $25. Researchers asked participants to declare any loss of childcare or school closure they experienced and whether they or their partners worked primarily from home, voluntarily reduced work hours, and took primary responsibility for childcare or schooling and day-to-day household tasks.
Participants completed the five-question Work and Family Conflict Scale utilizing a seven-point Likert scale. They also completed the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder seven-item scale (GAD-7). All physicians surveyed had completed their medical training. The researchers also conducted a subanalysis of physicians without children.
The investigators found that, among parents, women (84.3%) were significantly more likely to lose childcare during the COVID-19 pandemic compared with men (65.7% P <.001). Women (25%) tended to be primarily responsible for childcare or schooling compared with men (0.8% P <.001). Women were more likely to take care of most household duties (31.4% women 7.2% men P <.001). In couples of 2 full-time physicians, women were even more likely to handle household responsibilities (44.9% women vs 4.8% men P =.004) and childcare and schooling (28.6% vs 0% P=.001), compared with the overall cohort.
Women were twice as likely as men to primarily work from home (40.9% vs 22.0% P <.001) and voluntarily decrease their work time (19.4% vs 9.4% P =.007). These differences were greater among couples of physicians who both typically worked full-time (work from home 65.0% vs 24.6% P <.001 reduced work hours 25.7% vs 2.6% P =.007).
Mothers were more likely to report increased work-to-family (β = 2.79; P=.03) and family-to-work (β = 3.09 P =.02) conflict. Less sleep was linked with increased work-to-family conflict (β = -1.62 P =.01). Mothers’ scores were higher on the PHQ-9 (β = 1.76 P =.046) and GAD-7 (β = 2.87 P <.001). Less sleep was linked with higher PHQ-9 scores (β = −1.19 P =.003) and GAD-7 (β = −1.13 P =.03).
Among the 180 doctors who were parents in 2018 and completed that year’s assessment, women had a significantly higher mean PHQ-9 scores compared with men (5.05 vs 3.52 P =.009) on the 2020 edition but not the 2018 edition (3.69 vs 3.60).
Women and men without children did not have significantly different work and family experiences or conflict or PHQ-9 or GAD-7 scores.
Limitations of the study involve generalization to physicians in other countries and inability to determine the magnitude of group differences.
“Findings from this national study suggest that gender disparities within medicine may have increased in association with pandemic work and home conditions, with disproportionate consequences for the mental health and careers of physician mothers,” the investigators said.
“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.”
Frank E, Zhao Z, Fang Y, Rotenstein LS, Sen S, Guille C. Experiences of work-family conflict and mental health symptoms by gender among physician parents during the COVID-19 pandemic. JAMA Network Open. Published online November 12, 2021. doi: 10.1001/jamanetworkopen.2021.34315