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Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic

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

Question  Has the COVID-19 pandemic been associated with differences in careers and mental health between physician mothers and fathers?

Findings  In this cohort study of 276 physicians during the COVID-19 pandemic, mothers were more likely than fathers to be responsible for childcare or schooling and household tasks, to work primarily from home, to reduce their work hours, and to experience work-to-family conflict, family-to-work conflict, and depressive and anxiety symptoms. A gender difference in depressive symptoms was observed among physician parents during the COVID-19 pandemic that was not present before the pandemic.

Meaning  This study suggests that pandemic conditions are associated with an increase in gender inequalities within medicine and signals the importance of further attention and resources to mitigate the potential adverse consequences for the careers and well-being of physician mothers.


Importance  The COVID-19 pandemic has placed increased strain on health care workers and disrupted childcare and schooling arrangements in unprecedented ways. As substantial gender inequalities existed in medicine before the pandemic, physician mothers may be at particular risk for adverse professional and psychological consequences.

Objective  To assess gender differences in work-family factors and mental health among physician parents during the COVID-19 pandemic.

Design, Setting, and Participants  This prospective cohort study included 276 US physicians enrolled in the Intern Health Study since their first year of residency training. Physicians who had participated in the primary study as interns during the 2007 to 2008 and 2008 to 2009 academic years and opted into a secondary longitudinal follow-up study were invited to complete an online survey in August 2018 and August 2020.

Exposures  Work-family experience included 3 single-item questions and the Work and Family Conflict Scale, and mental health symptoms included the Patient Health Questionnaire–9 (PHQ-9) and Generalized Anxiety Disorder–7 scale.

Main Outcomes and Measures  The primary outcomes were work-to-family and family-to-work conflict and depressive symptoms and anxiety symptoms during August 2020. Depressive symptoms between 2018 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic) were compared by gender.

Results  Among 215 physician parents who completed the August 2020 survey, 114 (53.0%) were female and the weighted mean (SD) age was 40.1 (3.57) years. Among physician parents, women were more likely to be responsible for childcare or schooling (24.6% [95% CI, 19.0%-30.2%] vs 0.8% [95% CI, 0.01%-2.1%]; P < .001) and household tasks (31.4% [95% CI, 25.4%-37.4%] vs 7.2% [95% CI, 3.5%-10.9%]; P < .001) during the pandemic compared with men. Women were also more likely than men to work primarily from home (40.9% [95% CI, 35.1%-46.8%] vs 22.0% [95% CI, 17.2%-26.8%]; P < .001) and reduce their work hours (19.4% [95% CI, 14.7%-24.1%] vs 9.4% [95% CI, 6.0%-12.8%]; P = .007). Women experienced greater work-to-family conflict (β = 2.79; 95% CI, 1.00 to 4.59; P = .03), family-to-work conflict (β = 3.09; 95% CI, 1.18-4.99; P = .02), and depressive (β = 1.76; 95% CI, 0.56-2.95; P = .046) and anxiety (β = 2.87; 95% CI, 1.49-4.26; P < .001) symptoms compared with men. We observed a difference between women and men in depressive symptoms during the COVID-19 pandemic (mean [SD] PHQ-9 score: 5.05 [6.64] vs 3.52 [5.75]; P = .009) that was not present before the pandemic (mean [SD] PHQ-9 score: 3.69 [5.26] vs 3.60 [6.30]; P = .86).

Conclusions and Relevance  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. Institutional and public policy solutions are needed to mitigate the potential adverse consequences for women’s careers and well-being.

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Article Information

Accepted for Publication: September 16, 2021.

Published: November 12, 2021. doi:10.1001/jamanetworkopen.2021.34315

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

Corresponding Author: Elena Frank, PhD, Michigan Neuroscience Institute, University of Michigan, 205 Zina Pitcher Pl, 1068, Ann Arbor, MI 48109 (emfrank@med.umich.edu).

Author Contributions: Drs Frank and Guille 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: Frank, Zhao, Rotenstein, Sen, Guille.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Frank, Zhao, Rotenstein.

Critical revision of the manuscript for important intellectual content: Frank, Zhao, Fang, Sen, Guille.

Statistical analysis: Zhao, Fang.

Obtained funding: Sen.

Administrative, technical, or material support: Zhao, Rotenstein.

Supervision: Sen, Guille.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant R01MH101459 from the National Institutes of Health (Dr Sen) and grant 8D477-01 from the American Foundation for Suicide Prevention (Drs Sen and Guille).

Role of the Funder/Sponsor: The funders 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: We thank the physicians taking part in this research.

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