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Experiences of a Health System’s Faculty, Staff, and Trainees’ Career Development, Work Culture, and Childcare Needs During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the associations of the COVID-19 pandemic with career development and what are the work culture and childcare needs of employees and trainees?

Findings  In this survey study, most participants with children did not have childcare fully available and many considered leaving the workforce and were worried about their career. Being female with children or having a clinical job role was associated with consideration for leaving the workforce and reducing hours.

Meaning  These findings suggest that a substantial number of employees and trainees experienced major stress and work disruptions because of the COVID-19 pandemic.


Importance  In March 2020, US public buildings (including schools) were shut down because of the COVID-19 pandemic, and 42% of US workers resumed their employment duties from home. Some shutdowns remain in place, yet the extent of the needs of US working parents is largely unknown.

Objective  To identify and address the career development, work culture, and childcare needs of faculty, staff, and trainees at an academic medical center during a pandemic.

Design, Setting, and Participants  For this survey study, between August 5 and August 20, 2020, a Qualtrics survey was emailed to all faculty, staff, and trainees at University of Utah Health, an academic health care system that includes multiple hospitals, community clinics, and specialty centers. Participants included 27 700 University of Utah Health faculty, staff, and trainees who received a survey invitation. Data analysis was performed from August to November 2020.

Main Outcomes and Measures  Primary outcomes included experiences of COVID-19 and their associations with career development, work culture, and childcare needs.

Results  A total of 5030 participants completed the entire survey (mean [SD] age, 40 [12] years); 3738 (75%) were women; 4306 (86%) were White or European American; 561 (11%) were Latino or Latina (of any race), Black or African American, American Indian, Alaska Native, and Native Hawaiian or Pacific Islander; and 301 (6%) were Asian or Asian American. Of the participants, 2545 (51%) reported having clinical responsibilities, 2412 (48%) had at least 1 child aged 18 years or younger, 3316 (66%) were staff, 791 (16%) were faculty, and 640 (13%) were trainees. Nearly one-half of parents reported that parenting (1148 participants [49%]) and managing virtual education for children (1171 participants [50%]) were stressors. Across all participants, 1061 (21%) considered leaving the workforce, and 1505 (30%) considered reducing hours. Four hundred forty-nine faculty (55%) and 397 trainees (60%) perceived decreased productivity, and 2334 participants (47%) were worried about COVID-19 impacting their career development, with 421 trainees (64%) being highly concerned.

Conclusions and Relevance  In this survey of 5030 faculty, staff, and trainees of a US health system, many participants with caregiving responsibilities, particularly women, faculty, trainees, and (in a subset of cases) those from racial/ethnic groups that underrepresented in medicine, considered leaving the workforce or reducing hours and were worried about their career development related to the pandemic. It is imperative that medical centers support their employees and trainees during this challenging time.

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Article Information

Accepted for Publication: February 8, 2021.

Published: April 2, 2021. doi:10.1001/jamanetworkopen.2021.3997

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Delaney RK et al. JAMA Network Open.

Corresponding Author: Angela Fagerlin, PhD, Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108 (angie.fagerlin@hsc.utah.edu).

Author Contributions: Drs Delaney and Fagerlin had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Delaney, Locke, Pershing, Precourt Debbink, Tanner, Anzai, Fagerlin.

Acquisition, analysis, or interpretation of data: Delaney, Locke, Pershing, Geist, Clouse, Precourt Debbink, Haaland, Fagerlin.

Drafting of the manuscript: Delaney, Pershing, Fagerlin.

Critical revision of the manuscript for important intellectual content: Delaney, Locke, Geist, Clouse, Precourt Debbink, Haaland, Tanner, Anzai.

Statistical analysis: Delaney, Geist, Clouse, Haaland.

Obtained funding: Fagerlin.

Administrative, technical, or material support: Locke, Pershing, Geist, Precourt Debbink, Tanner, Anzai.

Supervision: Locke, Geist, Fagerlin.

Conflict of Interest Disclosures: Dr Delaney’s salary is supported by a T32 Cardiovascular Research Award outside the submitted work. Dr Precourt Debbink reported receiving grants from Reproductive Scientist Development Program Award, and her salary is supported by a K-12 Professional Development award outside the submitted work. Dr Haaland reported receiving personal fees from Prometics Life Sciences, Astra Zeneca, National Kidney Foundation, and Value Analytics Labs and nonfinancial travel support from Flatiron Health outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by the Jon M. Huntsman Presidential Endowed Chair (award to Dr Fagerlin).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Christina Yong, MA (University of Utah), provided editing assistance and was not compensated beyond her regular salary.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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