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. 2025 Sep 4;15(5):e200533. doi: 10.1212/CPJ.0000000000200533

Impact of Caregiver Status on Academic Achievements and Family-Work Conflict

A Cross-Sectional Analysis of US Neurology Faculty

Parneet Grewal 1,*,✉, Jane B Allendorfer 2,*, Mathew J Gregoski 3, Natasha Frost 4, Neishay Ayub 5, Christa O'Hana S Nobleza 6, Myriam Abdennadher 7, Doris Kung 8, Suma Shah 9, Halley B Alexander 10, Kamala Rodrigues 11, Sarah Durica 12, Seema Nagpal 13, June Yoshii-Contreras 14, Katherine Zarroli 15, Padmaja Sudhakar 16, Chen Zhao 17,18, Sol De Jesus 17, Deborah Young Bradshaw 19, Nicole Brescia 19, Nancy Foldvary-Schaefer 20, Laura M Tormoehlen 21, Laurie Gutmann 21, Sneha Mantri 9, Ailing Eileen Yang 22, Annie He 22, Cynthia Zheng 23, Neil A Busis 24, Julie K Silver 25, Alyssa F Westring 26, Sima Patel 27,†, Sasha Alick-Lindstrom 28,†
PMCID: PMC12413178  PMID: 40917456

Abstract

Background and Objectives

With more women entering the medical workforce, caregiving challenges and family-work conflicts are of growing importance to today's neurologists. The aim of this study was to assess the impact of caregiver (CG) status on academic achievements in neurology, analyze the division of labor and time devoted to domestic responsibilities, and measure family-work conflict in US academic neurology faculty.

Methods

A total of 19 US neurology departments completed a survey on baseline demographics, academic achievements, CG status, division of domestic time and labor, and responses on a FWC scale. Variables were assessed using independent samples t tests (or Mann-Whitney U for non-normally distributed data) and X2 analyses as appropriate, with CGs vs noncaregivers (N-CGs) serving as the independent groups.

Results

Women were twice as likely as men to categorize themselves as caregivers (p = 0.005). There were no significant differences in academic achievements between the CG and N-CG groups. However, CG men had a statistically significantly higher number of leadership positions (p = 0.022), number of publications as first or last author (p = 0.020), and number of awards (p = 0.004) when compared with CG women. The percentage of CG women faculty who reported spending more than 22 hours per week on child care was significantly higher than that of CG men (p = 0.003). Caregiver women also reported doing more work at home; taking care of children when they are sick; taking days off work when children are sick; handling more chores related to child care (e.g., managing activities/schedules); and doing laundry, cooking, and cleaning related to child care. Finally, the CG group experienced a higher level of FWC, as evidenced by responses on the FWC scale (p < 0.001). This finding was same for CG women compared with CG men (p = 0.034).

Discussion

Although the caregiving burden did not directly affect academic productivity, it significantly increased FWC in US academic neurology faculty surveyed. Female CG faculty disproportionately shouldered domestic and household responsibilities. Beyond recognizing CG challenges, advocating for a change in paradigm and providing solutions to these pervasive issues could be instrumental in preventing further attrition of professionals from our field, particularly women with caregiving roles.

Introduction

Academic medicine faculty navigate numerous demands intrinsic to their highly specialized careers. Caregiving responsibilities introduce an additional layer of complexity, which can be a source of strain, missed career opportunities, and heightened personal and familial tension.1-3 Family and work conflict is a bidirectional phenomenon that arises when the demands of family life make it more challenging to participate in work effectively and vice versa over a period of time.4,5 While integrating professional and personal life poses challenges for all professionals, the data indicate that women, mainly working physician mothers, experience these challenges more acutely than men.6,7 Regarding child care or elderly dependent care, working women are disproportionately burdened with balancing career demands and the responsibility of being a primary caregiver (CG).8 Women also do more cognitive labor to maintain the household than men; this demanding work of anticipating needs, making decisions, and monitoring progress is often overlooked.9 In fact, data have shown that in a cohort of young physician-researchers with a mean age of 40.3 years, women tend to work an additional 8.5 hours on domestic tasks and are more likely to have to take time off work for child care duties in dual working households.6 However, few data on the number of additional hours caregivers spend on domestic tasks and caregiving responsibilities have been acquired and assessed in relation to the impact on productivity in the academic neurology workforce.10

As of December 31, 2022, women comprise 48.2% of active neurology residents and 44.3% of full-time neurology faculty at all US medical schools.11,12 Addressing caregiving challenges is especially important in today's society of dual-career or single-parent family structures, given a dramatic increase in the percentage of women entering the medical field. Despite this reassuring increase in numbers, gender differences in burnout, leadership roles, and compensation persist.13,14 The causes for gender disparities are multifactorial. Still, the interplay between work and family responsibilities may present an enduring hurdle in attaining full career potential or satisfaction.10 These observations and high levels of burnout in neurology are increasingly recognized.13,14 The topic is paramount because job characteristics, including salary and potential for incentives, stress level, quality of life, and perceived flexibility, affect career choices.15,16 In this study, we focus on the extent to which caregiving responsibilities, including elder care and child care, interfere with performance and satisfaction in the work domain, specifically family-work conflict (FWC), which is defined as when “participation in the work role is made more difficult by virtue of participation in the family role.”17 The lack of, or limited availability of, institutional policies supporting caregiving in academia, along with demands for high productivity, research, and teaching expectations, contributes to high levels of burden and stress for many early-career women.15,16 Previous work has evaluated factors associated with burnout and desire to leave medicine or the neurology specialty, but few have looked explicitly at CG status as an independent predictor.18 As such, the objectives of this study were to (1) assess the impact of caregiving on academic achievement in neurology, (2) analyze the perception of the division of labor and time devoted to domestic responsibilities between CG men and women, and (3) measure FWC experienced by academic neurology faculty caregivers in the United States. We hypothesized that FWC would be higher for CG faculty, especially for female caregivers, and that this conflict could negatively affect productivity and academic achievements.

Methods

Sampling and Data Collection

This study was a cross-sectional survey of faculty at 19 academic neurology departments nationwide, with regional representation across the United States encompassing urban and suburban settings. These are academic, research-oriented institutions with neurology residency programs, typically located in proximity to university campuses.19 Each study site was recruited through the American Academy of Neurology (AAN) Women in Neurology synapse section, Women Neurologists Group social media group announcements, and professional contacts outreach. This study presents a subanalysis of the survey with a focus on self-identified CG status and sex in the analysis of career metrics, domestic tasks, and FWC (eAppendix 1).19 The format of the survey included multiple-choice, ranking, and short-answer questions. The survey was maintained and hosted by the University of Texas Southwestern Medical Center on Research Electronic Data Capture (REDCap), was anonymous, and was sent to participants at recruited sites. A site principal investigator at each institution enlisted faculty members with an advanced degree (MD, DO, PhD, MD/PhD, MBBS, MS) within the institution's adult and/or pediatric neurology departments. The survey's final analysis did not include residents, fellows, medical students, nurse practitioners, physician assistants, and nonfaculty members of the neurology departments. Participation was voluntary and anonymous, and no compensation was provided. Participants were invited to complete the REDCap survey from February 19, 2021, to April 6, 2022.

Standard Protocol Approvals, Registrations, and Participant Consents

Each site's principal investigator obtained institutional review board approval or exemption and approval from their Department of Neurology chair. The survey results were anonymous.

Outcome Measures

Primary outcomes assessed were academic achievements, FWC, and domestic or household burden of neurology faculty in the CG group compared with noncaregivers. Regarding CG status, survey respondents were divided into caregivers vs noncaregivers based on their answer to the question “Do you provide dependent care for the following: children, elderly parents/siblings, other differently-abled persons, or none.” Anyone who responded “yes” to any of the first 3 options was included in the CG group, and people who answered “none” were included in the N-CG group for analysis. The term CG in the context of this article included both child care and elderly care as well as care for differently abled persons. In accordance with a recent publication by National Academies, a broad definition was included to capture the various ways in which academic faculty provided unpaid care for loved ones to understand its impact.20 We also analyzed the differences in the primary outcomes based on sex in the CG group. For gender categorization, participants were asked to self-identify with the following survey options: “Man,” “Woman,” “Non-binary gender,” “Prefer not to answer,” and “A gender not listed above” (free individualized entry was allowed). However, for analytical purposes regarding the impact of sex and its relationship with caregiving, only responses with “Man” and “Woman” were used because of limited (fewer than 5) responses in the remaining categories combined. Other variables used to characterize the groups included race, academic rank, years worked in profession, number of years in current rank, whether on tenure track, average hours worked per week, and employment status (i.e., full-time, part-time, or other).

Academic achievements that were analyzed included having a leadership role, number of leadership positions held, number of publications over the past 5 years, number of publications as first or last author, number of total funded projects, number of awards received, and number of guest speaker invitations.

Two questionnaires created by the study team assessed household and domestic responsibilities for caregivers. The first asked about the number of hours spent per week on child care, hours per week on domestic tasks (not including child care), hours per week outsourcing domestic tasks (not including child care), days taken off per year for dependent/child care, and whether the institution provides backup dependent care to avoid canceling clinics for clinical faculty. The second questionnaire focused explicitly on child care and the responsibility division with a partner for taking care of children when sick, taking days off when children are sick, handling chores related to child care (i.e., laundry, cooking, and cleaning), managing children's activities and schedule, and playing with or doing activities with children.

The FWC scale used in the survey was developed and validated by Netemeyer, Boles, and McMurrian (1996) and included 5 items rated on a Likert scale ranging from strongly disagree to strongly agree.21 This scale was developed to precisely measure the degree of conflict a person's role in family engagement may cause and how it may negatively affect work. The original instrument also includes a second part with a validated work-family conflict (WFC) scale, which we did not use fully because this did not pertain to the focus of our study on the impact of caregiving/family on work outcomes. However, participants were asked a single query from the WFC part of the instrument about the impact of work on personal life with the question “Does your work/career interfere with your personal life?”21

Statistical Analysis

Statistical analyses were completed using SPSS version 28 (IBM corporation, Armonk, NY). All data were examined for normality using Kolmogorov-Smirnov tests of normality with Lilliefors significance corrections. Means and SDs (or medians and interquartile range [IQRs]) were calculated for all continuous variables, and frequencies and percentages for all categorical variables. Variables with continuous outcome differences were assessed using independent samples t tests (or Mann-Whitney U for non-normally distributed data), with CGs vs N-CGs serving as the independent groups. All continuous outcomes were examined using the Levene test for equality of variances. If significant variance differences were found between groups, results were reported based on adjusted degrees of freedom using the Welch-Satterthwaite method. Categorical variables were assessed using X2 analyses or Fisher exact tests as appropriate (Bonferroni corrections were used for multiple categories). For the FWC scale analysis, statements ranged from very strongly disagree to very strongly agree, and all the responses were assigned numerical values of 1–7 (eAppendix 1).21 The values were added to calculate means, which were then compared using t tests between groups, with higher scores indicating higher levels of conflict. Any missing data points were excluded from the final analysis.

Data Availability

Aggregated data can be shared with qualified investigators with approval on reasonable request.

Results

Baseline Characteristics and Academic Achievements

A total of 474 responses were obtained from the survey (median response rate 39% from 19 sites, ranging from 11% to 53%), of which 15 were excluded because the respondents' degrees were other than MD, DO, MBBS, MS, or Ph.D. A total of 64 participant responses (13.5%) were excluded because of nonresponse to the dependent care question. The final number of participants included in the analysis was 395 (Table 1): 53.2% (n = 210) of participants were women, 45.3% (n = 179) were men, and 1.2% (n = 5) preferred not to answer the gender identity question or did not identify as a man or woman. Most of the cohort identified as White (68.4%, n = 270), followed by Asian (22.3%, n = 88) and Black/African American (1.0%, n = 4). Most responders identified as caregivers (n = 258, 58.5% women and 39.9% men). A higher percentage of women (n = 151, 58.5%) than men (n = 103, 39.9%) categorized themselves as caregivers (p = 0.005). In the CG group, 81.7% (n = 211) reported caring for children, 6.9% (n = 18) reported caring for elderly parents/siblings, 0.8% (n = 2) reported that they cared for other differently abled persons, 9.3% (n = 24) cared for both children and elderly, 0.4% (n = 1) cared for children and other differently abled persons, 0.4% (n = 1) cared for elderly and differently abled persons, and 0.4% (n = 1) provided care to all 3. The CG group had a higher percentage of assistant professors (46.5% vs 37.2%) and associate professors (31.8% vs 14.6%) vs the N-CG group. By contrast, the N-CG group had a higher percentage of professors (40.9% vs 17.4%, p < 0.001, Table 1). No statistically significant differences were observed between CG and N-CG groups concerning leadership roles, leadership positions, publications in the past 5 years, publications as first or last author, total funded projects, awards received, or speaker engagements (Table 1).

Table 1.

Demographics and Academic Achievement in Caregiver (CG) and Noncaregiver (N-CG) Groups

CG
(N = 258)		 N-CG
(N = 137)		 p Value
Demographics
 Gender identity, N (%) 0.005
  Man 103 (39.9) 76 (55.5)
  Woman 151 (58.5) 59 (43.1)
  Prefer not to answer/not listed above 4.0 (1.6) 1.0 (1.4)
 Race, N (%)
  White 171 (66.3) 99 (72.3) 0.224
  Asian 61 (24.8) 27 (19.7) 0.371
  African American/Black 3.0 (1.2) 1.0 (0.7) 1.000
  American Indian/Alaskan Native 1.0 (0.3) 0.0 (0.0) 1.000
  Native Hawaiian/Pacific Islander 2.0 (0.6) 1.0 (0.7) 1.000
  Prefer not to say/unknown/unreported 14 (5.4) 7 (5.1) 0.944
 Academic rank, N (%) <0.001
  Instructor or senior instructor 3 (1.2) 6 (4.4)
  Assistant professor 120 (46.5) 51 (37.2)
  Associate professor 82 (31.8) 20 (14.6)
  Professor 45 (17.4) 56 (40.9)
  Other 8 (3.1) 4 (2.9)
 Years in profession since completion of training, median (IQR) 12.0 (13.0) 20.0 (28.0) 0.001
 Years in current rank, median (IQR) 4.0 (5.0) 5.0 (9.3) 0.077
 Tenure track—yes, N (%) 39 (15.1) 20 (14.6) 0.891
 Average hours per wk at work, N (%) 0.575
  <20 h 1 (0.7) 1 (0.7)
  21–40 h 22 (8.5) 6 (4.4)
  41–60 h 144 (55.8) 81 (59.1)
  61–80 h 71 (27.5) 39 (28.5)
  >80 h 20 (7.8) 10 (7.3)
 Employment status, N (%) 0.578
  Full-time 245 (95.0) 128 (93.4)
  Part-time 12 (4.7) 7 (5.1)
  Other 1 (0.4) 2 (1.4)
Academic achievements
 Leadership role—yes, N (%) 187 (72.5) 95 (69.3) 0.511
 Number of leadership positions, median (IQR) 2.0 (2.0) 2.0 (2.0) 0.077
 Number of publications in the past 5 y, median (IQR) 2.0 (3.0) 2.0 (3.0) 0.888
 Number of publications as first or last author, median (IQR) 3.0 (8.0) 3.0 (5.0) 0.250
 Number of total funded projects, median (IQR) 1.5 (6.0) 2.0 (15.0) 0.059
 Number of awards, median (IQR) 1.0 (3.0) 1.0 (7.0) 0.344
 Number of speaker engagements, median (IQR) 5.5 (18) 10 (35) 0.146
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Gender subgroup analysis of the CG group showed that more CG men were married than CG women (98.1% vs 91.4%, p = 0.027). There were more assistant professors among CG women than among CG men (53.6% vs 36.9%) and few full professors (11.3% vs 26.2%, p = 0.005). There were also statistically significant differences in the number of leadership positions when comparing CG men with CG women (median interquartile range [IQR], 2.0 [2.0] vs 2.0 [2.0], p = 0.022) as well as in the number of publications as first or last author (median [IQR], 5.0 [8.0] vs 2.0 [7.0], p = 0.020) and number of awards (median [IQR], 2.0 [5.0] vs 0.00 [3.0], p = 0.004) (Table 2). There was also no difference in academic achievements regarding having a leadership role, number of publications in the past 5 years, number of total funded projects, and number of guest speaker engagements (p ≥ 0.05) (Table 2).

Table 2.

Subgroup Comparison of Caregivers by Sex

CG men CG women p Value
(N = 103, 39.9%) (N = 151, 58.5%)
Marital status (married)—yes, N (%) 101 (98.1) 138 (91.4) 0.027
Academic rank, N (%)
 Instructor/senior instructor <5 (n/a) <5 (n/a)
 Assistant professor 38 (36.9) 81 (53.6)
 Associate professor 36 (35.0) 46 (30.5)
 Professor 27 (26.2) 17 (11.3)
 Other 1.0 (1.0) 5 (3.3)
Tenure track—yes, N (%) 18 (17.5) 20 (13.2) 0.353
Average work hours/wk, N (%) 0.043
 <20 h <5 (n/a) 5 (n/a)
 21–40 h 3.0 (2.9) 19 (12.6)
 41–60 h 61 (59.2) 82 (54.3)
 61–80 h 30 (29.1) 39 (25.8)
 >80 h 8 (7.8) 11 (7.3)
Employment status, N (%) 0.235
 Full-time 99 (96.1) 142 (94.0)
 Part-time 3.0 (2.9) 9 (6.0)
Number of years in current rank, median (IQR) 4.5 (5.0) 3.0 (4.0) 0.091
Leadership role—yes, N (%) 79 (76.7) 105 (69.5) 0.210
Number of leadership positions, median (IQR) 2.0 (2.0) 2.0 (2.0) 0.022
Number of publications in the past 5 y, median (IQR) 2.0 (3.0) 1.0 (3.5) 0.073
Number of publications as first or last author, median (IQR) 5.0 (8.0) 2.0 (7.0) 0.020
Number of total funded projects, median (IQR) 2.0 (6.0) 1.0 (6.0) 0.086
Number of awards, median (IQR) 2.0 (5.0) 0.0 (3.0) 0.004
Number of speaker engagements, median (IQR) 8.0 (18.0) 5.0 (18.0) 0.164
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Domestic and Child Care Task Division

The percentage of CG women self-reporting spending more than 22 hours per week on child care was higher than that of CG men (n = 63, 41.7% vs n = 23, 22.3%, p = 0.003). There was no significant difference between CG men and CG women regarding time spent on domestic tasks other than child care (i.e., cleaning, laundry, cooking, and lawn care, p = 0.325). We found no significant difference reported in days taken off per year for dependent care (p = 0.062, Figure 1). An equal percentage of male and female caregivers reported that their institution did or did not provide backup dependent care (e.g., sick days/daycare closure) to avoid canceling clinics (yes: 89 [35.2%], no: 84 [33.2%], do not know: 80 [31.6%], p = 0.471).

Figure 1. Gender Differences in the Caregiver (CG) Group for (A) Hours per Week Spent on Child Care, (B) Hours per Week Outsourced for Domestic Tasks, (C) Hours per Week Spent on Domestic Tasks, and (D) Days per Year Taken Off for Caregiving.

Figure 1

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Regarding child care specifically, CG women reported doing more work at home caring for children when they are sick (CG women: n = 51, 36.4%, vs CG men: n = 11, 11.7%; p < 0.001). Similarly, CG men reported that their partners provided more care for children when sick (CG men: n = 41, 43.6% vs CG women: n = 32, 22.9%, p < 0.001). Caregiver women also reported taking more days off from work when children are sick (CG women: n = 34, 24.3% vs, CG men: n = 11, 11.7%, p = 0.037); handling chores related to child care such as laundry, cooking, or cleaning (CG women: n = 74, 52.9%, vs CG men: n = 8, 8.5%, p < 0.001); managing children's activities/schedules (CG women: n = 89, 63.6%, vs CG men: n = 7, 7.4%, p < 0.001); and/or playing or doing activities with children (CG women: n = 51, 36.4%, vs CG men: n = 17, 18.1%, p = 0.012) (Figure 2).

Figure 2. Gender Differences in the Domestic Division of Work at the Home Among Caregiver (CG) Parents in the Academic Neurology Workforce.

Figure 2

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(A) Taking care of a child or children when they are sick at home; (B) taking days off from work when they are sick; (C) handling chores related to a child or children (e.g., laundry, cooking, and cleaning); (D) managing a child's or children's activities and schedule; (E) playing or doing activities with a child or children.

FWC

There was a higher degree of conflict experienced by the CG group compared with the N-CG group (mean [SD, 95% CI] 20.4 [7.2, 19.5–21.3] vs 16.2 [5.9, 15.2–17.2], p < 0.001), as determined by the average responses across the 5 items in the FWC scale. This pattern was consistent across all 5 questions of the FWC scale when assessing individually also (p < 0.001) (Figure 3A). There were also significant differences in the levels of degrees of conflict based on the FWC scale between CG women and CG men (mean [SD, 95% CI] 21.3 [7.4, 20.1–22.4] vs 19.4 [6.7, 18.2–20.8], p = 0.034) (Figure 3B).

Figure 3. Perceived Conflict Between Family and Work as Assessed Using the 5 Questions of the Family-Work Conflict Scale (FWC 1–5).

Figure 3

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(A) Comparison of means between all responses of caregiver (CG) and noncaregiver (N-CG) groups. (B) Comparison of means between all responses of CG men and CG women groups. FWC 1: The demands of my family and/or spouse/partner interfere with my work-related activities. FWC 2: I have to put off doing things at work because of the demands on my time at home. FWC 3: Things I want to do at work do not get done because of the demands of my family and/or spouse/partner. FWC 4: My home life interferes with my responsibilities at work such as getting to work on time, accomplishing daily tasks, and working overtime. FWC 5: Family-related strain interferes with my ability to perform job-related duties. *p < 0.05.

WFC

Regarding the impact of work on personal life, more CG women than CG men agreed that work often interferes with personal life (35.1% vs 22.9%, p = 0.014).

Discussion

In this study, our objectives were to assess whether academic neurology faculty's caregiving responsibilities affect productivity, to elucidate the division of labor and associated time devoted to domestic duties between CG men and women, and to evaluate the FWC experienced by caregivers compared with those without caregiving responsibilities. Academic neurology faculty are expected to engage in activities besides clinical work, such as advancing research or knowledge in the field and education. Meeting these expectations and excelling in service, teaching, and research are core requirements for academic promotion. In the practice of medicine, clinical workload and time commitments are usually nonflexible. Hence, those with significant caregiving and domestic responsibilities might compromise their research and teaching time.

There were no significant differences in academic achievements between the CG and N-CG groups. This finding is contrary to the prevailing perception that caregiving responsibilities may be detrimental to productivity.2,3 However, within the CG group, subgroup analysis by sex showed that CG men had a statistically higher number of leadership positions, publications as first and last author, and awards (p < 0.05). This is in line with other literature where men had a significantly higher number of publications than women at all academic ranks especially in studies comparing men with children and women with children, which show that women have fewer publications (p < 0.001), slower self-perceived career progress (p < 0.001), and lower career satisfaction (p < 0.001).7,22-25 A recent study from University of California-Irvine showed that women faculty were less likely to attain tenure if they had a child within 5 years of joining a tenure-track position.26 Of interest, it should also be noted that the CG group despite same academic aptitude experienced a higher level of conflict, as evidenced by responses on the FWC scale (p < 0.001). Given that most of our CG cohort comprised women (58.5%), a potential concern is that, ultimately, women with dependent care duties may choose to leave academic medicine, including neurology, because of a constant ongoing conflict between competing roles, leading to frustration and burnout.27,28

Assessment of the division of labor at home and dedicated time for these endeavors provides some insight into the sources of conflict. We discovered that the percentage of CG women faculty who reported spending more than 22 hours per week on child care was significantly higher than that of CG men (p = 0.003) and more CG women agreed that work often interferes with their personal lives (p = 0.014). Overall, caregiver women reported doing more work at home; taking care of children when they are sick; taking days off work when children are ill; handling more chores related to child care (even managing activities/schedules); and doing laundry, cooking, and cleaning related to child care. Caregiver men supported this by stating that their partners do more in these roles. These differences were statistically significant.

Working women who are also parents often succumb to “mom guilt,” a well-known phenomenon when obligations force them to spend time away from their children.29 Women with dual professional and caregiving roles may then frequently choose to work fewer hours or go part-time, as well as opt not to pursue specialties or academic positions that might interfere with their responsibilities.11,28,30 This is worrisome because we anticipate a worsening shortage in the neurology workforce, with a limited 7% increase in the supply of neurologists from 2012 to 2025 and the demand for neurologists rising by 16%.31 A paucity of research to date has investigated how academic neurology faculty allocate time to domestic responsibilities and caregiving roles, plus the impact of these factors on academic progression and measures of success.24 Our nationwide data from geographically diverse academic neurology departments contribute essential information on these aspects. This is relevant because understanding the intricacies of the caregiving dynamic may elucidate potential barriers to achieving professional parity and help recognize faculty at risk of attrition from the neurology workforce. A better understanding of caregiving and domestic responsibilities and burdens will facilitate the development of improved workplace policies to enhance quality of life, improve retention, and attract future trainees to the field. Demographically, early-career faculty are more likely to be in a CG role, and this held true for female faculty in our survey.26,32 Women carry the biological and societal burden of pregnancy, delivery, and lactation. In addition, the literature supports that it is also women who take on child-rearing activities and ensure that both physical and mental needs of dependents are met.16,27,33 Many institutions still do not have formal policies for paid parental leave, lactation support, or caregiving support, which can lead to further disheartenment as well as emotional, and physical exhaustion.16,34,35 Among professionals, there may also be ongoing stigma in taking maternity or other family-related leave.36

Our assertions do not mean to imply that women contribute more in all partnerships. Still, discrepancies frequently exist, and our study highlights these by showing the faculty's perception of unequal involvement in home and caregiving responsibilities among the academic neurologists surveyed. These findings of discrepant domestic involvement between men and women are similar to those reported by the US Bureau of Labor Statistics, which showed that among a more heterogeneous population of men and women with young children, mothers who worked full-time spent 1537 more hours on child care and domestic chores than fathers with wives who were employed full-time. Multiple reports in the literature have demonstrated the critical role played by sex in discrepancies in salary, leadership positions, grant funding, and productivity.30 Our study adds the missing pieces of household labor and caregiving duties as crucial variables in explaining some of the issues in academic neurology.6,31,38-40

Caregiver burden is a universal phenomenon. The Association of American Medical Colleges and multiple other national and international specialty organizations have proposed many policies to achieve equity and facilitate academic success.20,41 The authors suggest that the solutions for these pressing issues should be implemented at individual, institutional, state, and national levels (Figure 4).

Figure 4. Proposed Strategies and Policies at Different Levels to Mitigate Caregiver Burden in Medical Professionals.

Figure 4

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There are potential strategies individual faculty can implement to alleviate some burdens of caregiving and FWC. In a study of women physicians evaluating successful work-life balance in rural communities, most participants reported the support of life partners as essential to career success and well-being.42 In another study, participants reported how setting up workstations in common home areas to work together as a family or developing a particular daily or weekly quality activity helped in embracing family and work.43 Good psychological health can be facilitated by accepting the fluid nature of work-life balance and ensuring adequate support.25 Another strategy can be outsourcing tasks that do not provide personal joy, including housekeeping, gardening, shopping, laundry, or meal prepping, and simplifying life to spend more dedicated family quality time.43 Nannies, daycares, babysitters, and private caregivers for other dependents can also reduce some caregiving burdens for dual-working couples.7,16 We also propose that individual faculty members strive to know the metrics used for promotion criteria and work toward negotiating contracts that fit their needs and professional goals.

Universities and academic departments should work toward fostering a healthier and more sustainable environment for caregivers. Some strategies that may merit investment include on-site child care facilities, priority on lists of locally available child care and elderly care centers, flexible work hours, and supportive parental leave policies. Academic institutions could partner with organizations that collaborate with employers to offer accessible and affordable caregiving solutions, using technology or services to reduce caregiving burdens for their employees. Institutional leadership should become aware of and acknowledge the challenges caregivers experience through regular workplace assessments. They may then supply proper support, eliminate any overt or subtle penalties for taking CG leave, and provide appropriate lactation support, which entails adequate lactation space and paid/protected time for this physiologic and basic human need.28,44,45 Several examples of strategies that can be implemented are found online, and several institutions describe their implemented programs in detail, such as the SOPPort program at Mass General Hospital.46

Formal dedicated mentorship and sponsorship programs also facilitate success for academic neurology faculty. A dedicated mentor invested in your career and success can guide faculty regarding life changes and caregiving strategies and set expectations for career advancement based on knowledge and experience.16,47 This can, in turn, help with mitigating high levels of stress and burnout in faculty dealing with FWC. In addition, the professional tenure and promotion time lines could also be temporarily extended or made flexible after childbirth or a major life event for all eligible faculty. Finally, recognizing and removing barriers to early-career and mid-career caregivers' promotion and career development would be crucial to promoting success.19,27,44,48

At the state and national levels, specific research to devise solutions to ensure gender equity at work should be invested in and pursued. Governmental agencies can also mandate institutional parental leave policies and extend grant application cycles after childbirth, major life events, or extenuating circumstances.49

Our study has several important strengths. Our study includes a diverse geographic representation of neurology departmental faculty across the United States. The survey included faculty with a wide range of personal and practice characteristics in different subdivisions of neurology. The extensive information collected in the study facilitated detailed insights into CG relationships and academic achievements and the domestic responsibilities of academic faculty nationwide. Our results provide a high-level overview of factors associated with increased FWC, which can ultimately affect well-being, job satisfaction, and academic career.

A limitation is that the study surveyed only 19 US academic neurology institutions, and the mean response rate was 39% (response rates varied by institution). The response rate was lower than expected as published for physicians overall but similar to some of the other more recent specialty physician surveys.50 Another caveat is that although the sample size was relatively large, results may not be fully generalizable throughout the United States because of self-selection bias and potential survey fatigue. Geographically, the institutions in the study were limited to the United States but were spread nationwide without clustering in any particular region. We also lacked representation of all racial, ethnic, and cultural groups, with most of the respondents identifying as White or Asian, and further studies are needed in the context of the communities/areas being studied. Respondents included in the final analysis only had a man/woman binary gender identity because of the low number of respondents in transgender or other gender identity groups. We could not extrapolate meaningful data with few participants in this group, and further studies with more robust representation are needed to understand their experience, as well as the experience of people in same-sex relationships. In this study, for the term CG, a very broad definition in line with National Academies of Sciences, Engineering, and Medicine was used, which included both elder care and care of differently abled persons and children, although most of the respondents were in child caregiving category.1,20 Given that these caregiving responsibilities include different challenges, a future study looking at nuances of each would be warranted. In addition, as discussed above, rank and age may have factored into the potential differences between caregivers and noncaregivers, which would be an area of investigation for future, more extensive studies.

Furthermore, we only studied the effect of involvement in household chores and work-family relationships among academic neurology faculty without collecting any data about their partners. However, we analyzed the self-perception of the participants (men and women) about their own and their partner's involvement, and this perception was complementary. This is also a quantitative study, but it would be enlightening if qualitative analyses in a mixed-methods design could support critical findings. We designed our questions using carefully developed or validated survey instruments from other studies. Nevertheless, responses to items inquiring about time spent on domestic activities may be susceptible to gender and recall biases.

This study focuses on CG burden and FWC among academic neurology faculty. In conclusion, caregiving burden significantly increased FWC among the faculty surveyed, although it did not directly affect academic productivity. In addition, female CG faculty disproportionately shouldered domestic and household responsibilities, yet this imbalance did not affect productivity. We propose that acknowledging and addressing added CG challenges and disparities in domestic duties between men and women in the academic world is critical. Beyond their recognition, viable buffers and solutions need to be devised. Advocating for a change in paradigm and providing solutions to these pervasive issues will be instrumental in attracting more individuals to academic neurology and preventing further attrition of professionals from our field, particularly women with caregiving roles.

Acknowledgment

This publication was supported, in part, by the National Center for Advancing Translational Sciences of the NIH under Grant Number UL1TR001450. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author Contributions

P. Grewal: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. J.B. Allendorfer: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. M.J. Gregoski: analysis or interpretation of data. N. Frost: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; analysis or interpretation of data. N. Ayub: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; analysis or interpretation of data. C.O’H.S. Nobleza: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. M. Abdennadher: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. D. Kung: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. S. Shah: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. H.B. Alexander: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. K. Rodrigues: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. S. Durica: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data S Nagpal: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. Yoshii-Contreras: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. K. Zarroli: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. P. Sudhakar: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. C. Zhao: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. S. De Jesus: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. D.Y. Bradshaw: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. N. Brescia: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. N. Foldvary-Schaefer: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. L.M. Tormoehlen: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. L. Gutmann: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. S. Mantri: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data. A.E Yang: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data .A. He: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design. C. Zheng: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design. N.A. Busis: drafting/revision of the manuscript for content, including medical writing for content. J.K. Silver: drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data. A.F. Westring: drafting/revision of the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data. S. Patel: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data. S. Alick-Lindstrom: drafting/revision of the manuscript for content, including medical writing for content; major role in the acquisition of data; study concept or design; analysis or interpretation of data

Study Funding

The authors report no targeted funding.

Disclosure

P. Grewal received support from the Palatucci Advocacy Leadership Forum Grant from the AAN for the project and personal compensation for serving as a speaker for the AAN and as the AAN's Wellness Subcommittee. J.B. Allendorfer is funded by grants from the US Department of Defense (W81XWH-17-1-0619), the Evelyn F. McKnight Brain Institute (PI), LivaNova Inc, and NIH (R01HD102723 [PI]) for studies unrelated to this study; has received lecture honoraria from the Cleveland Clinic, travel funds from the International League Against Epilepsy, and consultant fees from LivaNova Inc; participates on a Data Safety and Monitoring Board at the University of Alabama at Birmingham/University of Colorado Anschutz Medical Campus; and serves on the American Epilepsy Society Scientific Program Committee and the editorial board for Epilepsy & Behavior Reports. N. Frost has received grant funding from the Patient-Centered Outcomes Research Institute and NIH. N. Ayub received honoraria for facilitating anti-racism discussions at Brown University. D.H. Kung has received royalties from Springer, honoraria from the PRI-MED conference, and meeting/travel support from the AAN for the Undergraduate Education Subcommittee. S. Shah has received research support from Novartis. H.B. Alexander receives compensation from the AAN for her position as Deputy Editor of the Neurology Minute podcast and is funded by the National Center for Advancing Translational Sciences, NIH (NIH; Grant #KL2TR001421); she has received lecture honoraria from the American Epilepsy Society. K. Zarroli has received grant funding from Eisai (investigator-initiated study grant) and has participated on the SK Life Sciences Advisory Board. N. Brescia has received funding from SUNY Upstate Patient Advocacy Fund for a study not related to this manuscript. L.M. Tormoehlen received author royalties from Up To Date, payment/consulting fees for medical-legal consultation, and honoraria and support for conference fees for neurology/toxicology lectures and participates on a Data Safety and Monitoring Board at Indian University for studies involving ethanol infusion. S. Mantri has received grant support from Cerevel Therapeutics and the Parkinson Foundation; consulting fees from Deep Brain Innovations LLC and Grey Matter Tech, Inc.; honoraria for lectures or presentations from Clinical Care Options, Parkinson Foundation, and Michael J Fox Foundation; and travel support for attending the AAN and Michael J Fox Foundation meetings. N.A. Busis has received personal compensation for serving as an editorial advisory board member for Neurology Today and as a speaker for the AAN and as the AAN's primary advisor to the American Medical Association's CPT Editorial Panel. J.K. Silver has received support from the Binational Scientific Foundation Grant for Culinary Medicine, has received textbook royalties from Textbook Essentials of PM&R and Easy EMG, is an advisor for Simplified for lactation consulting, and is a Third Culture Capital venture partner. S. Patel has received honoraria for lectureship from Hofstra University, has served as an expert witness and legal consultant, is on the Epilepsy Foundation of Minnesota Board of Directors, is funded by drug trials for Xenon and UCB Pharma, chairs the American Epilepsy Society Digital Advisory Committee, and serves on the University of Minnesota Center for Women and Medicine group and the American Neurological Association Ideas Task Forces. S. Alick-Lindstrom has performed paid consultancy work in magnetoencephalography for MEGIN; has performed industry clinical trials as PI or Co-I for Xenon, Sunovion, UCB, and Neurona; is on the Executive Committee for the Epilepsy Foundation as PAB Chair of Public Health and Education; serves on the University of Texas faculty senate as president-elect; and serves on the American Epilepsy Society Treatments Committee, AAN Guidelines Subcommittee, and American Clinical Neurophysiology Society Program Committee. All other authors report no interests to declare. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

TAKE-HOME POINTS

  • → Among academic neurology faculty surveyed, caregiving burden significantly increased FWC, although it did not directly affect academic productivity.

  • → Women neurology faculty disproportionately shoulder domestic and household caregiving responsibilities.

  • → There is a need to acknowledge and decrease caregiving burden among practicing neurologists using comprehensive and sustained approaches at individual, organizational, and systemic levels.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Aggregated data can be shared with qualified investigators with approval on reasonable request.

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