Abstract
This survey study evaluates behavioral health risks and burnout among physician mothers who have caregiving responsibilities for persons in addition to their patients and children.
Many physician mothers care for their children as well as their patients. Some also care for a child, spouse, parent, friend, or others with a major health problem, illness, or disability. Such additional caregiving responsibilities may have consequences for the woman’s health, well-being, and career longevity. We sought to determine the proportion of physician mothers with caregiving responsibilities beyond their patients and children and how these additional responsibilities affected the women’s health and practice.
Methods
Methods for studying physician mothers have been previously described.1 In 2016, a survey directed to the Physicians Moms Group online community was posted. The present study was conducted from June 17 to July 30, 2016. The University of California San Francisco institutional review board approved the study. Agreement online to participate in the survey was considered consent. The participants did not receive financial compensation.
Members of the Physicians Moms Group identify themselves as physician mothers, including adoptive and foster mothers. Among an estimated 16 059 members who viewed the post, 5613 (35.0%) based in the United States completed questions about caregiving responsibilities. To identify physician mothers with additional caregiving responsibilities, we used a question from the Behavioral Risk Factor Surveillance System, “During the last year, did you provide regular care or assistance to a friend or family member with a serious health problem, long-term illness, or disability?”2 To screen for risky drinking, we used the Alcohol Use Disorders Identification Test–Clinicians.3 To assess substance abuse, we asked, “How often have you used or do you use the following: prescription drugs for nonmedical reasons/illegal drugs (excluding marijuana)/marijuana?” We asked a mental health question, “Have you ever had a mood or anxiety disorder?” We also asked a career dissatisfaction question, “Are you generally satisfied with your career?” To identify burnout, we used the Mini Z Burnout Survey.4 We used 2-tailed t tests and Pearson χ2 tests for comparisons and multivariate logistic regression models to determine adjusted relative risks (aRRs). Findings were considered significant at P < .05. Statistical analysis was conducted using SAS, version 14.1 (SAS Institute Inc).
Results
Of the 5613 respondents, 918 (16.4%) reported additional caregiving responsibilities. Characteristics of physician mothers with and without additional caregiving responsibilities are reported in Table 1. Among those with additional caregiving responsibilities, 443 (48.3%) reported caring for ill parents, 155 (16.9%) for children or infants, 71 (7.7%) for partners, and 263 (28.6%) for other relatives; 153 (16.7%) cared for more than 1 person.
Table 1. Sociodemographic and Practice Characteristics of Physician Mothers With and Without Additional Caregiving Responsibilitiesa.
| Characteristic | Physician Mothers With Additional Caregiving Responsibilities (n = 918) |
Physician Mothers Without Additional Caregiving Responsibilities (n = 4695) |
P Value |
|---|---|---|---|
| Age, mean (SD), y | 40.7 (6.9) | 38.0 (5.3) | <.001 |
| Age categories, y, No. (%) | |||
| <30 | 13 (1.4) | 60 (1.3) | <.001 |
| 30-39 | 464 (50.5) | 3119 (67.1) | |
| 40-49 | 348 (37.9) | 1327 (28.5) | |
| 50-59 | 73 (8.0) | 119 (2.6) | |
| ≥60 | 20 (2.2) | 25 (0.5) | |
| Race/ethnicity, No. (%) | |||
| Non-Hispanic white | 643 (70.0) | 3263 (69.8) | .008 |
| Asian/Pacific Islander | 107 (11.7) | 703 (15.0) | |
| Hispanic white | 58 (6.3) | 270 (5.8) | |
| Black/African American | 33 (3.6) | 166 (3.5) | |
| Other/no answer | 77 (8.4) | 276 (5.9) | |
| Marital status, No. (%) | |||
| Married | 851 (92.7) | 4452 (94.9) | .008 |
| Otherb | 67 (7.3) | 237 (5.1) | |
| Stage of training/practice, No. (%) | |||
| Student, resident, or fellow | 64 (7.0) | 456 (9.7) | .005 |
| Physician | 848 (92.4) | 4228 (90.1) | |
| Retired | 6 (0.7) | 11 (0.2) | |
| Practice type, No. (%) | |||
| Academic | 279 (30.5) | 1643 (35.1) | .002 |
| Private/HMO | 397 (43.4) | 1953 (41.7) | |
| Public hospital | 72 (7.9) | 350 (7.5) | |
| VA/military | 25 (2.7) | 173 (3.7) | |
| Not working | 31 (3.4) | 83 (1.8) | |
| Other | 111 (12.1) | 479 (10.2) | |
| Specialty, No. (%)c | |||
| Pediatrics | 172 (18.9) | 817 (17.4) | .02 |
| Family medicine | 164 (18.0) | 687 (14.7) | |
| Internal medicine | 123 (13.5) | 628 (13.4) | |
| Obstetrics and gynecology | 103 (11.3) | 564 (12.0) | |
| Emergency medicine | 74 (8.1) | 418 (8.9) | |
| Psychiatry | 46 (5.0) | 239 (5.1) | |
| Anesthesiology | 26 (2.9) | 155 (3.3) | |
| General surgery | 17 (1.9) | 106 (2.3) | |
| Neurology | 28 (3.1) | 103 (2.2) | |
| Other nonsurgical specialtiesd | 91 (10.0) | 511 (10.9) | |
| Other surgical specialtiese | 28 (3.1) | 227 (4.8) | |
| Other write-in descriptions | 40 (4.4) | 229 (4.9) | |
| Self-perceived medical mistake (ever), No. (%) | |||
| Yes | 502 (57.0) | 2265 (50.2) | <.001 |
| No | 378 (43.0) | 2246 (49.8) | |
| Person with serious health issue who requires caregiving, No. (%)f | |||
| Infant | 26 (2.8) | NA | |
| Child | 129 (14.1) | NA | |
| Partner | 71 (7.7) | NA | |
| Parent | 443 (48.3) | NA | |
| Other relative | 263 (28.6) | NA | |
| Friend | 145 (15.8) | NA | |
| ≥1 Person | 153 (16.7) | NA |
Abbreviations: HMO, health maintenance organization; NA, not applicable; VA, Veterans Administration.
Not all respondents answered all questions. The frequency distributions for each question derive from the respondents who answered that specific question.
Includes respondents who answered that they were separated, divorced, widowed, or never married.
Specialties with less than 2% prevalence were included in 1 of the following categories: other nonsurgical, other surgical, or other write-in. When comparing specialties of any prevalence between caregiver subgroups, P = .02, as stated.
Includes, in order of descending prevalence: internal medicine-pediatrics and diagnostic radiology (equal prevalence), dermatology, anatomic and clinical pathology, physical medicine and rehabilitation, allergy and immunology, rheumatology, radiation oncology, medical genetics, sleep medicine, and preventive medicine.
Includes, in order of descending prevalence: ophthalmology, orthopedic surgery, otolaryngology, urology, plastic surgery, neurologic surgery, colon and rectal surgery, and thoracic surgery.
May be providing care for more than 1 person such that the sum of the percentages is greater than 100.
The prevalence and adjusted relative risk of behavioral health and career challenges among physician mothers with and without additional caregiving responsibilities are reported in Table 2. Compared with other physician mothers, physician mothers with additional caregiving responsibilities had significantly higher rates and aRRs of mood or anxiety disorders (aRR, 1.21; 95% CI, 1.04-1.42; P = .02) and burnout (aRR, 1.25; 95% CI, 1.06-1.46; P = .007). The frequency of career satisfaction was similar in physicians with and without additional caregiving responsibilities (9.5% vs 7.5%; P = .06), as were the frequencies of risky drinking (16.6% vs 17.7%, P = .42) and substance abuse (2.8% vs 3.0%, P = .72).
Table 2. Prevalence and aRR of Challenges to Behavioral Health and Careers Among Physician Mothers Grouped According to Caregiving Responsibilities.
| Characteristic | Prevalence of Self-reported Characteristics Among Physician Mothers | aRR Among Physician Mothers With Additional Caregiving Responsibilitiesa | ||||
|---|---|---|---|---|---|---|
| All Respondents, No. (%) (n = 5613) |
Caregiving Subgroups | |||||
| Physician Mothers With Additional Responsibilities, No. (%) (n = 918) |
Physician Mothers Without Additional Responsibilities, No. (%) (n = 4695) |
P Value | aRR (95% CI) | P Value | ||
| Behavioral health issue | ||||||
| Risky drinking (in past year) | 975 (17.5) | 152 (16.6) | 823 (17.7) | .42 | 0.96 (0.79 to 1.17) | .71 |
| Substance abuse (ever)b | 166 (3.0) | 26 (2.8) | 140 (3.0) | .72 | 0.85 (0.54 to 1.32) | .46 |
| Mood or anxiety disorder (ever)c | 1845 (33.4) | 358 (39.3) | 1487 (32.2) | <.001 | 1.21 (1.04 to 1.42) | .02 |
| Challenge to careers | ||||||
| Career dissatisfaction (current)d | 435 (7.8) | 87 (9.5) | 348 (7.5) | .06 | 0.95 (0.72 to 1.24) | .71 |
| Burnout (current) | 2140 (38.6) | 412 (45.2) | 1728 (37.3) | <.001 | 1.25 (1.06 to 1.46) | .007 |
Abbreviation: aRR, adjusted relative risk.
Models identified aRRs of behavioral health and career characteristics among physician mothers with additional caregiving responsibilities compared with those without such responsibilities while adjusting for other characteristics reported in Table 1: age, race/ethnicity, marital status, practice type, specialty, and self-perceived medical mistake (ever).
Response options: never, once or twice, monthly, weekly, and daily or almost daily. A response of monthly, weekly, or daily or almost daily to any question indicated a positive assessment.
Response options: yes or no. A response of yes indicated a positive assessment.
Response options: always, almost always, usually, rarely, or never. A response of rarely or never satisfied indicated a positive assessment (career dissatisfaction).
Discussion
In an online community of individuals who identify themselves as physician mothers based in the United States, 16.4% of the respondents to our survey reported regular care or assistance to a person or persons with a serious health problem, long-term illness, or disability. These physician mothers had significantly higher rates of mood or anxiety disorders and burnout than other physician mothers. Women physicians are at high risk of work-family conflict.5 Studies and supportive efforts have focused on childbearing leave, breastfeeding, and child-rearing.6 Our findings highlight the additional caregiving responsibilities of some women physicians and the potential consequences of these additional responsibilities for their behavioral health and careers.
Limitations of our study include the use of an online survey with a relatively low response rate and a convenience sample that may not be representative of all women physicians or physician mothers. Our survey design precluded the collection of longitudinal data. We have no data on physician fathers or other male physicians; thus, we were not able to compare respondents with male physicians or female physicians who are not mothers.
Among US physician mothers responding to an online survey, those who cared for seriously ill children, spouses, parents, or others experienced higher rates of mood or anxiety disorders and burnout than other physician mothers. To reduce burnout and improve workforce retention, health care systems should develop new approaches to identify and address the needs of these physician mothers.
References
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