[Skip to Content]
[Skip to Content Landing]

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.

Abstract

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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

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.

References
1.
World Health Organization. Weekly epidemiological update—6 July 2021. 2021. Accessed July 7, 2021. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19—6-july-2021
2.
Brubaker  L .  Women physicians and the COVID-19 pandemic.   JAMA. 2020;324(9):835-836. doi:10.1001/jama.2020.14797PubMedGoogle ScholarCrossref
3.
Spector  ND , Overholser  B .  COVID-19 and the slide backward for women in academic medicine.   JAMA Netw Open. 2020;3(9):e2021061-e2021061. doi:10.1001/jamanetworkopen.2020.21061PubMedGoogle ScholarCrossref
4.
Jagsi  R , Fuentes-Afflick  E , Higginbotham  E .  Promoting equity for women in medicine—seizing a disruptive opportunity.   N Engl J Med. 2021;384(24):2265-2267. doi:10.1056/NEJMp2104228PubMedGoogle ScholarCrossref
5.
Richter  KP , Clark  L , Wick  JA ,  et al.  Women physicians and promotion in academic medicine.   N Engl J Med. 2020;383(22):2148-2157. doi:10.1056/NEJMsa1916935PubMedGoogle ScholarCrossref
6.
Ly  DP , Seabury  SA , Jena  AB .  Differences in incomes of physicians in the United States by race and sex: observational study.   BMJ. 2016;353:i2923. doi:10.1136/bmj.i2923PubMedGoogle Scholar
7.
Jolly  S , Griffith  KA , DeCastro  R , Stewart  A , Ubel  P , Jagsi  R .  Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers.   Ann Intern Med. 2014;160(5):344-353. doi:10.7326/M13-0974PubMedGoogle ScholarCrossref
8.
Ly  DP , Jena  AB .  Sex differences in time spent on household activities and care of children among US physicians, 2003-2016.   Mayo Clin Proc. 2018;93(10):1484-1487. doi:10.1016/j.mayocp.2018.02.018PubMedGoogle ScholarCrossref
9.
Lyu  HG , Davids  JS , Scully  RE , Melnitchouk  N .  Association of domestic responsibilities with career satisfaction for physician mothers in procedural vs non-procedural fields.   JAMA Surg. 2019;154(8):689-695. doi:10.1001/jamasurg.2019.0529PubMedGoogle ScholarCrossref
10.
Frank  E , Zhao  Z , Sen  S , Guille  C .  Gender disparities in work and parental status among early career physicians.   JAMA Netw Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340PubMedGoogle Scholar
11.
Dyrbye  LN , Shanafelt  TD , Balch  CM , Satele  D , Sloan  J , Freischlag  J .  Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex.   Arch Surg. 2011;146(2):211-217. doi:10.1001/archsurg.2010.310PubMedGoogle ScholarCrossref
12.
Soares  A , Thakker  P , Deych  E , Jain  S , Bhayani  RK .  The impact of COVID-19 on dual-physician couples: a disproportionate burden on women physicians.   J Womens Health (Larchmt). 2021;30(5):665-671. doi:10.1089/jwh.2020.8903PubMedGoogle ScholarCrossref
13.
De Brier  N , Stroobants  S , Vandekerckhove  P , De Buck  E .  Factors affecting mental health of health care workers during coronavirus disease outbreaks (SARS, MERS & COVID-19): a rapid systematic review.   PLoS One. 2020;15(12):e0244052. doi:10.1371/journal.pone.0244052PubMedGoogle Scholar
14.
Lai  J , Ma  S , Wang  Y ,  et al.  Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.   JAMA Netw Open. 2020;3(3):e203976-e203976. doi:10.1001/jamanetworkopen.2020.3976PubMedGoogle ScholarCrossref
15.
Li  W , Frank  E , Zhao  Z ,  et al.  Mental health of young physicians in China during the novel coronavirus disease 2019 outbreak.   JAMA Netw Open. 2020;3(6):e2010705-e2010705. doi:10.1001/jamanetworkopen.2020.10705PubMedGoogle ScholarCrossref
16.
Guille  C , Frank  E , Zhao  Z ,  et al.  Work-family conflict and the sex difference in depression among training physicians.   JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138PubMedGoogle ScholarCrossref
17.
Langballe  EM , Innstrand  ST , Aasland  OG , Falkum  E .  The predictive value of individual factors, work-related factors, and work-home interaction on burnout in female and male physicians: a longitudinal study.   Stress Health. 2011;27:73-87. doi:10.1002/smi.1321Google ScholarCrossref
18.
Ahmad  A .  Work-family conflict among junior physicians: its mediating role in the relationship between role overload and emotional exhaustion.   J Soc Sci. 2010;6(2):265-271. doi:10.3844/jssp.2010.265.271Google Scholar
19.
Vincent-Lamarre  P , Sugimoto  CR , Larivière  V .  The Decline of Women’s Research Production During the Coronavirus Pandemic. Nature Index; 2020:19.
20.
Krukowski  RA , Jagsi  R , Cardel  MI .  Academic productivity differences by gender and child age in science, technology, engineering, mathematics, and medicine faculty during the COVID-19 pandemic.   J Womens Health (Larchmt). 2021;30(3):341-347. doi:10.1089/jwh.2020.8710PubMedGoogle ScholarCrossref
21.
Matulevicius  SA , Kho  KA , Reisch  J , Yin  H .  Academic medicine faculty perceptions of work-life balance before and since the COVID-19 pandemic.   JAMA Netw Open. 2021;4(6):e2113539. doi:10.1001/jamanetworkopen.2021.13539PubMedGoogle Scholar
22.
Linos  E , Halley  MC , Sarkar  U ,  et al.  Anxiety levels among physician-mothers during the COVID pandemic.   Am J Psychiatry. 2021;178(2):203-204. doi:10.1176/appi.ajp.2020.20071014PubMedGoogle ScholarCrossref
23.
National Academies of Sciences, Engineering, and Medicine.  Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine. National Academies Press; 2021.
24.
Sen  S , Kranzler  HR , Didwania  AK ,  et al.  Effects of the 2011 duty hour reforms on interns and their patients: a prospective longitudinal cohort study.   JAMA Intern Med. 2013;173(8):657-662. doi:10.1001/jamainternmed.2013.351PubMedGoogle ScholarCrossref
25.
Haslam  D , Filus  A , Morawska  A , Sanders  MR , Fletcher  R .  The Work-Family Conflict Scale (WAFCS): development and initial validation of a self-report measure of work-family conflict for use with parents.   Child Psychiatry Hum Dev. 2015;46(3):346-357. doi:10.1007/s10578-014-0476-0PubMedGoogle ScholarCrossref
26.
Kroenke  K , Spitzer  RL , Williams  JB .  The PHQ-9: validity of a brief depression severity measure.   J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.xPubMedGoogle ScholarCrossref
27.
Spitzer  RL , Kroenke  K , Williams  JB .  Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study.   JAMA. 1999;282(18):1737-1744. doi:10.1001/jama.282.18.1737PubMedGoogle ScholarCrossref
28.
DeBell  M . Best practices for creating survey weights. In: Vannette  D , Krosnick  J , eds.  The Palgrave Handbook of Survey Research. Palgrave Macmillan; 2018:159-162. doi:10.1007/978-3-319-54395-6_21
29.
American College of Surgeons. Surgical specialties. Accessed June 10, 2021. http://www.facs.org/member-services/join/specialties
30.
Jacobson  CC , Nguyen  JC , Kimball  AB .  Gender and parenting significantly affect work hours of recent dermatology program graduates.   Arch Dermatol. 2004;140(2):191-196. doi:10.1001/archderm.140.2.191PubMedGoogle ScholarCrossref
31.
Grant  L , Simpson  LA , Rong  XL , Peters-Golden  H .  Gender, parenthood, and work hours of physicians.   J Marriage Fam. 1990;52:39-49. doi:10.2307/352836Google Scholar
32.
Hinze  SW .  Inside medical marriages: the effect of gender on income.   Work Occup. 2000;27(4):464-499. doi:10.1177/0730888400027004003Google ScholarCrossref
33.
Sasser  AC .  Gender differences in physician pay tradeoffs between career and family.   J Hum Resour. 2005;40(2):477-504. doi:10.3368/jhr.XL.2.477Google ScholarCrossref
34.
Bianchi  SM , Sayer  LC , Milkie  MA , Robinson  JP .  Housework: who did, does or will do it, and how much does it matter?   Soc Forces. 2012;91(1):55-63. doi:10.1093/sf/sos120PubMedGoogle ScholarCrossref
35.
Hochschild  A , Machung  A .  The Second Shift: Working Families and the Revolution At Home. Penguin; 2012.
36.
McKinsey and Co. Women in the workplace. 2020. Accessed January 14, 2021. https://www.mckinsey.com/featured-insights/diversity-and-inclusion/women-in-the-workplace
37.
Tyssen  R , Vaglum  P , Grønvold  NT , Ekeberg  O .  Suicidal ideation among medical students and young physicians: a nationwide and prospective study of prevalence and predictors.   J Affect Disord. 2001;64(1):69-79. doi:10.1016/S0165-0327(00)00205-6PubMedGoogle ScholarCrossref
38.
Schernhammer  ES , Colditz  GA .  Suicide rates among physicians: a quantitative and gender assessment (meta-analysis).   Am J Psychiatry. 2004;161(12):2295-2302. doi:10.1176/appi.ajp.161.12.2295PubMedGoogle ScholarCrossref
39.
Fahrenkopf  AM , Sectish  TC , Barger  LK ,  et al.  Rates of medication errors among depressed and burnt out residents: prospective cohort study.   BMJ. 2008;336(7642):488-491. doi:10.1136/bmj.39469.763218.BEPubMedGoogle ScholarCrossref
40.
Center for American Progress. Valuing women’s caregiving during and after the coronavirus crisis. Accessed January 14, 2021. https://www.americanprogress.org/issues/women/reports/2020/06/03/485855/valuing-womens-caregiving-coronavirus-crisis/
41.
Freund  KM , Raj  A , Kaplan  SE ,  et al.  Inequities in academic compensation by gender: a follow-up to the National Faculty Survey Cohort Study.   Acad Med. 2016;91(8):1068-1073. doi:10.1097/ACM.0000000000001250PubMedGoogle ScholarCrossref
42.
Wamsley  CE , Kramer  A , Kenkel  JM , Amirlak  B .  Trends and challenges of telehealth in an academic institution: the unforeseen benefits of the COVID-19 global pandemic.   Aesthet Surg J. 2021;41(1):109-118. doi:10.1093/asj/sjaa212PubMedGoogle ScholarCrossref
43.
Ganguli  I , Sheridan  B , Gray  J , Chernew  M , Rosenthal  MB , Neprash  H .  Physician work hours and the gender pay gap—evidence from primary care.   N Engl J Med. 2020;383(14):1349-1357. doi:10.1056/NEJMsa2013804PubMedGoogle ScholarCrossref
44.
Tsugawa  Y , Jena  AB , Figueroa  JF , Orav  EJ , Blumenthal  DM , Jha  AK .  Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians.   JAMA Intern Med. 2017;177(2):206-213. doi:10.1001/jamainternmed.2016.7875PubMedGoogle ScholarCrossref
45.
Salles  A , Jagsi  R .  Institutional imperatives for the advancement of women in medicine and science through the COVID-19 pandemic.   Lancet. 2021;398(10304):937-939. doi:10.1016/S0140-6736(21)01912-7PubMedGoogle ScholarCrossref
46.
Narayana  S , Roy  B , Merriam  S ,  et al; on behalf of the Society of General Internal Medicine’s Women and Medicine Commission.  Minding the gap: organizational strategies to promote gender equity in academic medicine during the COVID-19 pandemic.   J Gen Intern Med. 2020;35(12):3681-3684. doi:10.1007/s11606-020-06269-0PubMedGoogle ScholarCrossref
47.
Das  D , Lall  MD , Walker  L , Dobiesz  V , Lema  P , Agrawal  P .  The multifaceted impact of COVID-19 on the female academic emergency physician: a national conversation.   AEM Educ Train. 2020;5(1):91-98. doi:10.1002/aet2.10539PubMedGoogle ScholarCrossref
48.
Choo  EK , Byington  CL , Johnson  NL , Jagsi  R .  From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment?   Lancet. 2019;393(10171):499-502. doi:10.1016/S0140-6736(19)30251-XPubMedGoogle ScholarCrossref
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.

Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close
Close

Lookup An Activity

or

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close