Let's talk about wellness in female physicians. We are bringing you the DATA on why women in medicine have HIGHER rates of burnout than their male colleagues. If you haven't yet read Part 1 and Part 2, click the links to read those first. Don't miss any part of this awesome series on Women & Wellness in medicine!
Work-Life Integration
Schwingshackle states that “the pursuit of a work-life balance acts as quicksand in our professional and personal lives resulting in slow drowning in frustration, depression, and exhaustion.”(20) In simpler terms, work-life balance is seen as a fallacy where work is bad and life is good. This is commonly reported as a contributing factor to burnout amongst women physicians.(2,20) Increasing responsibilities outside of the workplace contributes to a time management conflict, which impinges upon women physicians and is a major career advancement barrier.(21) With these increasing responsibilities and obstacles, work life integration suffers and risk of burnout thus increases. In addition to this misconception of work-life balance, women physician trainees report more negative interference from home to work and greater emotional demands than their male colleagues. Both of which are associated with higher levels of burnout.(22)
Maternal Responsibilities & Discrimination
Despite the historical expectation from society for women to start a family, evidence suggests that female physicians who are mothers face many barriers for career development, experience discrimination from colleagues, and are held to different standards than the paternal parent or a physician father. The timing of having children during medical training has been a stressor for female physicians for decades and may not be appealing due to fear of further discrimination within their professional lives.(6,23) According to the literature, women have to take into a myriad of factors in order to determine the best time to have children during training or a professional career.(6,23) In fact, one study reports only 51% of women dermatologists report considering having children in residency. (24) Barriers to having children in residency include lack of maternity leave (or having to delay graduation with the potential for unpaid leave), the appearance of being less committed to residency in comparison to peers, and lack of time/privacy for breastfeeding.24 Not having children during medical education training may put women more at risk for infertility and the inability to start a family, as female physicians have been found to have infertility rates that are double the national average (24.1% vs 12.1%). (25)
Once female physicians do start a family, they experience bias and discrimination for being a mother. Of the 66.5% of 4507 respondents who reported experiencing gender discrimination, 35.8% of these respondents reported having experienced maternally-related discrimination. (4)
Female physicians who have children have reported receiving less institutional support, producing fewer publications and experiencing decreased career satisfaction. (6) The opportunity gap that women face in starting their career may in fact widen as they embark on the journey of being a mom in medicine, both due to maternal bias and due to their new set of priorities. Studies show that despite more women in the workplace, the gendered stereotypes of male and female roles at home have not drastically changed. In a study comparing male and female surgeons in academics, domestic expectations, including but not limited to childcare, cooking, grocery shopping, and vacation planning, were reported to be primarily handled by females and perceived by both male and female surgeons to be the responsibility of women. (26) For surgeons-in-training, the data was similar, however, childcare was perceived as a shared responsibility amongst both parents, (26) which may suggest an adjustment of the gender roles in a younger generation. While the data on child-care is encouraging, female physicians are still spending more time than their male counterparts on domestic duties. One study found that female primary care physicians spent 39.7 hours a week (vs 11.4 hours for male colleagues) on child care, and 13.9 hours a week (vs 8.2 hours for male colleagues) on household maintenance. (27) This data suggests female physicians in primary care spend significantly more time on domestic expectations then male physicians of the same profession who also have children, (27) which comes at the expense of their professional activities. Onsite child-care with extended hours similar to what most physicians are working provided by hospitals and institutions would certainly improve work-life balance for female physicians.
Also, women in medicine have the tendency to expect perfection especially as it relates to work-life integration and patient care.(2) The current state of affairs with increased domestic responsibilities at home compared to their male colleagues (but less time at home compared to stay-at-home moms) and less time at work than their male colleagues is setting female physicians up for failure at home and at work. That feeling like a failure at work, or imposter syndrome, sets in creating low self-esteem and an understatement of a woman’s skills and successes.(21,28) Low self esteem, as well as heightened self-blame for medical errors, increase expectations that women carry for themselves, ultimately leading to a taxing emotional toll. (21) The conflicting expectations and high standards that women physicians receive and set for themselves, only contributes to the stress that is undergone and elevating rates of burnout and associated risks. (2,7,8) We, as women in medicine, may have to adjust our expectations of ourselves as well. We may have to stop expecting perfection and start showing ourselves some grace.
Conclusion
There are many factors that contribute to career satisfaction for a physician. A lack of career satisfaction contributes heavily to burnout and mental health. While the data for overall career satisfaction between men and women is statistically similar, male and female physicians experience different aspects of decreased career satisfaction. (15) Women report decreased opportunities for promotion, unfriendly workplace and harassment, reduced financial compensation, lack of mentorship, and perceived lack of time for relationships with patients, colleagues, and family as factors contributing to decreased job satisfaction more than men.(15) A recent 2017 suggests, that emotional demands, rather than workload or mental demands, are the most important contributor to burnout in women, supporting these findings.(22)
Gender bias is not the only cause of burnout in physicians, but it is a significant contributor the burnout of female physicians and likely the reason why female physicians experience higher rates of burnout than their male colleagues. As figure 1 (shown below) so nicely portrayed, gender bias has so many paths it can take to push physicians towards burnout. While it is unlikely that the house of medicine will eradicate the gender biases that female physicians are exposed to by patients and society, there are changes that institutions and hospitals can make to improve physician wellness as it pertains to gender discrimination. Implicit bias training has been shown to improve bias awareness and change behavior patterns when implemented.(19) Strict policies regarding sexual harassment must be implemented, as well as providing protected opportunities for those who want to report harassment. Leadership courses and formal mentoring programs for women may help improve the leadership gap. Improved family leave policies, strict policies against maternal discrimination, and on-site child-care can help female physicians transition into motherhood, improve wellness and keep women in the field of medicine. Wellness for women in medicine does not just require more yoga, massages and meditation; it requires equality in medicine.
Hope this series helped you to learn a little bit about the gendered issues that women in medicine face. Let's create #EqualityInMedicine!
Medscape National Physician Burnout, Depression & Suicide Report 2019. https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056#4. Accessed April 3, 2019.
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Sexual harassment is rampant in science, landmark report finds. https://www.statnews.com/2018/06/12/sexual-harassment-science-nasem-report/. Accessed April 3, 2019.
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