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Childcare Stress, Burnout, and Intent to Reduce Hours or Leave the Job During the COVID-19 Pandemic Among US Health Care Workers

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

Question  Is high childcare stress (CCS) associated with burnout, intent to reduce clinical hours, and intent to leave the job among US health care workers during the COVID-19 pandemic?

Findings  In this survey study, with 58 408 respondents conducted between April and December 2020, high CCS was associated with 80% greater odds of burnout in all health care workers.

Meaning  These findings suggest there is an association between reporting high CCS and burnout, and programs to reduce CCS may be beneficial for workers and health systems.


Importance  Childcare stress (CCS) is high during the COVID-19 pandemic because of remote learning and fear of illness transmission in health care workers (HCWs). Associations between CCS and burnout, intent to reduce (ITR) hours, and intent to leave (ITL) are not known.

Objective  To determine associations between CCS, anxiety and depression, burnout, ITR in 1 year, and ITL in 2 years.

Design, Setting, and Participants  This survey study, Coping with COVID, a brief work-life and wellness survey of US HCWs, was conducted between April and December 2020, assessing CCS, burnout, anxiety, depression, workload, and work intentions. The survey was distributed to clinicians and staff in participating health care organizations with more than 100 physicians. Data were analyzed from October 2021 to May 2022.

Main Outcomes and Measures  The survey asked, “due to…COVID-19, I am experiencing concerns about childcare,” and the presence of CCS was considered as a score of 3 or 4 on a scale from 1, not at all, to 4, a great extent. The survey also asked about fear of exposure or transmission, anxiety, depression, workload, and single-item measures of burnout, ITR, and ITL.

Results  In 208 organizations, 58 408 HCWs (15 766 physicians [26.9%], 11 409 nurses [19.5%], 39 218 women [67.1%], and 33 817 White participants [57.9%]) responded with a median organizational response rate of 32%. CCS was present in 21% (12 197 respondents) of HCWs. CCS was more frequent among racial and ethnic minority individuals and those not identifying race or ethnicity vs White respondents (5028 respondents [25.2%] vs 6356 respondents [18.8%]; P < .001; proportional difference, −7.1; 95% CI, −7.8 to −6.3) and among women vs men (8281 respondents [21.1%] vs 2573 respondents [17.9%]; odds ratio [OR], 1.22; 95% CI, 1.17 to 1.29). Those with CCS had 115% greater odds of anxiety or depression (OR, 2.15; 95% CI, 2.04-2.26; P < .001), and 80% greater odds of burnout (OR, 1.80; 95% CI, 1.70-1.90; P < .001) vs indidivuals without CCS. High CCS was associated with 91% greater odds of ITR (OR, 1.91; 95% CI, 1.76 to 2.08; P < .001) and 28% greater odds of ITL (OR, 1.28; 95% CI, 1.17 to 1.40; P < .001).

Conclusions and Relevance  In this survey study, CCS was disproportionately described across different subgroups of HCWs and was associated with anxiety, depression, burnout, ITR, and ITL. Addressing CCS may improve HCWs’ quality of life and HCW retention and work participation.

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Article Information

Accepted for Publication: May 27, 2022.

Published: July 18, 2022. doi:10.1001/jamanetworkopen.2022.21776

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Harry EM et al. JAMA Network Open.

Corresponding Author: Elizabeth M. Harry, MD, School of Medicine, UCHealth, University of Colorado, 12401 E 17th Ave, Mail Stop F448, Leprino Building, Office 942, Aurora, CO 80045 (elizabeth.harry@cuanschutz.edu).

Author Contributions: Dr Linzer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Harry, Sinsky, Brown, Goelz, Linzer.

Acquisition, analysis, or interpretation of data: Harry, Carlasare, Brown, Nankivil, Linzer.

Drafting of the manuscript: Harry, Brown, Goelz, Linzer.

Critical revision of the manuscript for important intellectual content: Harry, Carlasare, Sinsky, Brown, Nankivil, Linzer.

Statistical analysis: Brown.

Administrative, technical, or material support: Carlasare, Nankivil.

Supervision: Nankivil, Linzer.

Conflict of Interest Disclosures: Dr Brown reported receiving personal fees from the American Medical Association (AMA) during the conduct of the study and outside the submitted work. Dr Goelz reported receiving support from the AMA and Institute for Healthcare Improvement (IHI) for work on burnout initiatives and measurement during the conduct of the study. Dr Linzer reported receiving grants from the AMA to Hennepin Healthcare (employer) for burnout reduction studies during the conduct of the study and grants from the National Institutes of Health, IHI, the American College of Physicians, the American Board of Internal Medicine Foundation, Optum Office for Provider Advancement, Essentia Health System, Gillette Children’s Hospital, and Agency for Healthcare Research and Quality; and personal fees from Harvard University outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grant 100001459 from the AMA to Dr Goelz.

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.

Disclaimer: The opinions expressed in this article are those of the authors and should not be interpreted as AMA policy.

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 credit toward the CME of the American Board of Surgery’s Continuous 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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