Physician Moms: Too Many Hats to Wear

COVID-19 pandemic had its life changing effect on women in general and women in the health care system in particular. A lot of pandemic-related measures such as prolonged periods of social isolation, unexpected employment disruptions, school closures, financial distress, and changes to routine, are having an unprecedented negative impact on women’s mental well-being¹ including women physicians and women in the healthcare field.

Studies show that women physicians are more likely than male physicians to experience depression, burnout, and suicidal ideation.¹ One group of physicians has been affected by this pandemic more profoundly, specifically, physician moms. This group of physicians has always been torn between their careers and their home lives, let alone juggling these two responsibilities during a global pandemic.

At the beginning of the pandemic one of us (EO) was a single physician mother of two boys, with no close family for help. The other (HH) was a physician mother of three, coming from a dual physician household with also no close family to reach out for help. We both had our fair share of teary moments behind our closed office doors. The situation felt scary, overwhelming, and quite frankly oftentimes surreal. Between work duties, managing online learning, dealing with last minute disease exposure announcements from schools, and countless COVID tests, we both would not even imagine what each day will bring forth.

Physician moms have unique personal characteristics. They can be married or single. Some have newborns, others have older children. Some have multiple children. Some have children with special needs. Very often they come from dual physician households. Sometimes these physician moms care for elderly and sick parents or other family members.

Physician moms also have a wide range of professional responsibilities. They are health care executives, private practice owners, academic physicians, employees of hospitals, or group practices. They are professors, medical directors, researchers, or business owners. No matter what the setting or parameters, there is one common denominator. They are all mothers; and balancing a carrier in medicine while raising children is an ongoing challenge, with or without a pandemic.

The COVID pandemic disrupted everything about our lives, family, social activities, sports, exercise, spiritual practices, shopping, vacation time, leisure activities, and sleep. Physician moms often bear a disproportionate burden of childcare and domestic responsibilities. In majority of cases they comprise the backbone of the household. School and day care closings during the pandemic were the biggest sources of stress on our daily lives. There was a need for alternative ways to educate children whether that meant finding online instructors or completely transition to homeschooling. Finding childcare when schools were closed was sometimes impossible and definitely very expensive.

We conducted a short survey on an online/social media group of physician mothers. We asked them to name the greatest challenge they had to face during the COVID pandemic. Not surprisingly, most responses were related to childcare instability and health and safety of their families. Some of the responses included the following: taking care of sick children when there is no available daycare while needing to be at work at the same time; dealing with last minute cancellations and closures of schools and daycares; finding child care for after school and on days of illness; balancing the guilt of childcare and work; being scared of dying and leaving the kids behind; bringing COVID home to children that are too young to be vaccinated; having unrealistic expectations for last minute coverage; having unrealistic expectations for academic productivity and low priority administrative tasks; the cognitive overload of having to be constantly making risk-benefit decisions about what one feels comfortable doing; dealing with frequently changing CDC recommendations not based on science; having a profoundly different experience than non-physicians; lack of insight from the rest of the professional world about what we are experiencing; and getting significant pay cuts as compared to our male colleagues.

Due to lack of social support, the COVID pandemic had multiple unintended consequences on this group of professionals. Such consequences included loss of a job and income, increased furlough rates compared to male physicians, and loss of academic productivity. Many physician mothers had to consider non-clinical carriers that would allow them to work from home, and others had to take family medical leave. On the far end of the spectrum, some physician mothers decided to leave medicine altogether. Ehrenstein et al. found that during the 2006 influenza pandemic, 24% of physicians felt it was acceptable to abandon their workplaces to protect themselves and their families and 25% felt they should be allowed to decide if they should report to work.²

On the other hand, the pandemic exacerbated gender inequalities. Another pandemic study data³ showed distinct disparity between women and men physicians with physician mothers being much more likely than physician fathers to lose childcare or in-person school for their children (84% vs 66%); far more likely to have primary responsibility for childcare or schooling (25% vs 1%); and more likely to perform the majority of daily household tasks (31% vs 7%). They were nearly twice as likely to maintain work from home during the pandemic’s early months (41% vs 22%). Women physicians were more than twice as likely to have voluntarily reduced their work hours during the pandemic (19% vs 9%), even though physician mothers were already less likely to work full-time than physician fathers before the pandemic (73% vs 91%). In couples where both were physicians working full-time before the pandemic, 26% women reduced their hours vs 3% of men.³

The COVID pandemic has definitely increased awareness of health system strengths and weaknesses and the central role of physicians. This short survey illustrated that physician mothers are primarily concerned with childcare and health and safety of their families. These concerns should be prioritized in future disaster planning to ensure this specific workforce can continue to perform their jobs and workplaces need to be cognizant of the needs of women physicians with children at home. Pandemic planning by academic institutions and hospitals should incorporate childcare options for employees and provide ample time for parents to find childcare options when scheduling shifts.⁴

We need to find ways for greater support for family care needs, such as childcare and paid family leave, along with wellness programs tailored for physician mothers. A shift in the culture around work-family balance issues is also needed, such as normalizing the use of sick days and parental leave among male physicians in order to weaken gender biases in work and family expectation.⁵ Physician mothers need access to the resources and support necessary to navigate similar unprecedented and uncertain situations in the future.