Dear Editor,
The COVID‐19 pandemic drastically changed dermatology practice. 1 Our objectives were to assess dermatologist work modifications and work–life balance during the pandemic.
After exemption by Weill Cornell Medicine Institutional Review Board, an anonymous voluntary survey was emailed to dermatologists nationally using email LISTSERVS (January 4, 2020–January 8, 2020). Data were collected using REDCap. Descriptive statistics described the patient cohort using N (%). Multivariable logistic regression was performed for gender effect on childcare and research effect on work–life balance.
There were 197 participants, including 73.1% females, and the majority were attending dermatologists (85.9%). Practice settings were primarily private (102, 52.1%) in urban areas (101, 51.3%). The majority were married (156, 79.2%), spent more time working from home (135, 69.6%), and 36% had children <18 (Table 1). Work–life balance was mostly improved (45%) or lessened (34.5%) (Table 1). Researchers were 3.44 times more likely to report improved work–life balance (P value = 0.00761) (Table 1).
Table 1.
Survey data and analysis
Survey responses | |||
---|---|---|---|
Question | Response | ||
Gender | Female | 144 | 73.10% |
Male | 52 | 26.40% | |
Prefer not to answer | 1 | 0.51% | |
Level of training | Resident | 23 | 11.68% |
Fellow | 5 | 2.54% | |
Attending, <5 years postresidency | 33 | 16.75% | |
Attending, 5–10 years postresidency | 15 | 7.61% | |
Attending, >10 years postresidency | 121 | 61.42% | |
Practice environment | Academic, chairperson | 6 | 3.05% |
Academic, faculty | 66 | 33.50% | |
Private practice, owner | 64 | 32.49% | |
Private practice, employee | 38 | 19.29% | |
Other | 23 | 11.68% | |
Setting | Urban | 101 | 51.27% |
Suburban | 89 | 45.18% | |
Rural | 7 | 3.55% | |
Marital status | Single, not in a relationship | 12 | 6.09% |
Single, in a relationship | 20 | 10.15% | |
Married | 156 | 79.19% | |
Divorced | 8 | 4.06% | |
Separated | 1 | 0.51% | |
Do you have children? | No | 126 | 63.96% |
Yes | 71 | 36.04% | |
Primary source of childcare prior to the pandemic? | Childcare professional (nanny, babysitter) | 13 | 18.84% |
Daycare/School | 49 | 71.01% | |
Family member | 4 | 5.80% | |
Spouse | 3 | 4.35% | |
Myself | 0 | 0% | |
Primary source of childcare during the pandemic? | Childcare professional (nanny, babysitter) | 15 | 22.06% |
Daycare/School | 5 | 7.35% | |
Family member | 12 | 17.65% | |
Spouse | 23 | 33.82% | |
Myself | 13 | 19.12% | |
Are you dedicating more time to childcare? | No | 19 | 27.54% |
Yes | 50 | 72.46% | |
Has childcare affected your ability to work? | Yes | 36 | 18.27% |
No | 70 | 35.53% | |
N/A—I do not have children | 91 | 46.19% | |
Are you spending more time working from home? | No | 60 | 30.46% |
Yes | 137 | 69.54% | |
Are you spending more time doing any of the following? | Yes | No | |
Reading academic journals | 82 (41.62%) | 115 (58.38%) | |
Conducting research | 49 (24.87%) | 148 (75.13%) | |
Spending time with family | 143 (72.59%) | 54 (27.41%) | |
Household responsibilities | 144 (73.10%) | 53 (26.9%) | |
Exercising | 88 (44.63%) | 109 (55.33%) | |
Do you use telemedicine? | No | 43 | 21.83% |
Yes | 154 | 78.17% | |
How would you describe your patients’ attitudes toward telemedicine? | Favorable | 119 | 60.41% |
I am not sure | 17 | 8.63% | |
Unfavorable | 18 | 9.14% | |
NA—I do not use telemedicine | 43 | 21.82% | |
After the COVID‐19 pandemic resolves, and restrictions are lifted, do you plan to? | Continue working the same hours in the office as I did before the pandemic | 148 | 75.13% |
Do mostly telemedicine and see only urgent visits in the office Do partial telemedicine and work less hours in the office |
4 | 2.03% | |
45 | 22.84% | ||
Hours spent seeing patients in‐person before the pandemic | 0–10 | 14 | 7.11% |
11–20 | 16 | 8.12% | |
21–30 | 33 | 16.75% | |
31–40 | 71 | 36.04% | |
41–50 | 50 | 25.38% | |
51–60 | 11 | 5.58% | |
61–70 | 2 | 1.02% | |
Hours spent seeing patients in‐person after the pandemic | 0–10 | 76 | 38.58% |
11–20 | 32 | 16.24% | |
21–30 | 42 | 21.32% | |
31–40 | 18 | 9.14% | |
41–50 | 21 | 10.66% | |
51–60 | 3 | 1.52% | |
61–70 | 2 | 1.02% | |
71–80 | 1 | 0.51% | |
81–90 | 2 | 1.02% | |
How many patients were you seeing in‐person before the pandemic? | 0–10 | 7 | 3.55% |
11–20 | 4 | 2.03% | |
21–30 | 9 | 4.57% | |
31–40 | 11 | 5.58% | |
41–50 | 15 | 7.61% | |
51–60 | 20 | 10.15% | |
61–70 | 12 | 6.09% | |
71–80 | 11 | 5.58% | |
81–90 | 17 | 8.63% | |
91–100 | 11 | 5.58% | |
101–200 | 66 | 33.5% | |
201–300 | 11 | 5.6% | |
301–400 | 3 | 1.5% | |
How many patients were you seeing in‐person after the pandemic? | 0–10 | 42 | 21.32% |
11–20 | 30 | 15.23% | |
21–30 | 22 | 11.17% | |
31–40 | 21 | 10.66% | |
41–50 | 12 | 6.09% | |
51–60 | 16 | 8.12% | |
61–70 | 11 | 5.58% | |
71–80 | 5 | 2.54% | |
81–90 | 6 | 3.05% | |
91–100 | 4 | 2.03% | |
101–200 | 24 | 12.2% | |
201–210 | 3 | 1.52% | |
211–220 | 1 | 0.51% |
Most dermatologists worked 30–50 h (61.42%) in‐person before but only 0–20 h during the pandemic (54.8%). About 78.2% used telemedicine during the pandemic (Table 1). Most (75.1%) planned to continue working their prior in‐person schedule, and 22.8% planned on doing partial telemedicine after the pandemic (Table 1).
Of dermatologists with children, 71% cited daycare/school as primary childcare before the pandemic, 72.5% spent more time doing childcare, and 33.9% reported childcare affecting the ability to work during the pandemic (Table 1), with a significant impact on females versus males (Table 2, OR 13.5, P value: 0.001). There were no significant associations with the level of training or practice setting (Table 2).
Table 2.
Factors affecting work–life balance and use of telemedicine
How has working from home impacted your work–life balance? | Do you plan to continue telemedicine after the pandemic resolves? | |||||
---|---|---|---|---|---|---|
Improved | Lessened | Unchanged | No | Yes, mostly telemedicine | Yes, partial telemedicine | |
Gender | ||||||
Female | 59 | 47 | 22 | 107 | 3 | 34 |
41.0% | 32.6% | 15.3% | 74.3% | 2.1% | 23.6% | |
Male | 17 | 11 | 14 | 41 | 1 | 10 |
32.7% | 21.2% | 26.9% | 78.8% | 1.9% | 19.2% | |
Training level | ||||||
Attending, 5–10 years postresidency |
8 | 4 | 1 | 10 | 0 | 5 |
53.3% | 26.7% | 6.7% | 66.7% | 0.0% | 33.3% | |
Attending, >10 years postresidency | 36 | 34 | 32 | 91 | 3 | 27 |
29.8% | 28.1% | 26.4% | 75.2% | 2.5% | 22.3% | |
Attending, <5 years postresidency | 18 | 10 | 1 | 27 | 1 | 5 |
54.5% | 30.3% | 3.0% | 81.8% | 3.0% | 15.2% | |
Fellow | 2 | 1 | 1 | 4 | 0 | 1 |
40.0% | 20.0% | 20.0% | 80.0% | 0.0% | 20.0% | |
Resident | 13 | 9 | 1 | 16 | 0 | 7 |
56.5% | 39.1% | 4.3% | 69.6% | 0.0% | 30.4% | |
Practice setting | ||||||
Academic, chairperson | 1 | 0 | 3 | 4 | 0 | 2 |
16.7% | 0.0% | 50.0% | 66.7% | 0.0% | 33.3% | |
Academic, faculty | 29 | 20 | 11 | 43 | 2 | 21 |
43.9% | 30.3% | 16.7% | 65.2% | 3.0% | 31.8% | |
Other | 14 | 6 | 3 | 18 | 0 | 5 |
60.9% | 26.1% | 13.0% | 78.3% | 0.0% | 21.7% | |
Private practice, employee | 16 | 10 | 4 | 28 | 1 | 9 |
42.1% | 26.3% | 10.5% | 73.7% | 2.6% | 23.7% | |
Private practice, owner | 17 | 22 | 15 | 55 | 1 | 8 |
26.6% | 34.4% | 23.4% | 85.9% | 1.6% | 12.5% | |
Marital status | ||||||
Divorced | 5 | 3 | 0 | 5 | 0 | 3 |
62.5% | 37.5% | 0.0% | 62.5% | 0.0% | 37.5% | |
Married | 56 | 49 | 29 | 117 | 3 | 36 |
35.9 | 31.4% | 18.6% | 75.0% | 1.9% | 23.1% | |
Separated | 0 | 0 | 1 | 1 | 0 | 0 |
0.0% | 0.0% | 100.0% | 100.0% | 0.0% | 0.0% | |
Single, in a relationship | 12 | 4 | 3 | 14 | 0 | 6 |
60.0% | 20.0% | 15.0% | 70.0% | 0.0% | 30.0% | |
Single, not in a relationship | 4 | 2 | 3 | 11 | 1 | 0 |
33.3% | 16.7% | 25.0% | 91.7% | 8.3% | 0.0% |
Predictor | OR | 95% CI: Low | 95% CI: High | P‐Value |
---|---|---|---|---|
Factors predicting if childcare affects ability to work | ||||
Gender: female vs. male (referent) | 13.5 | 3.37 | 102 | 0.00162 |
Level of Training: resident/fellow vs. attending (referent) | 0.133 | 0.00219 | 2.32 | 0.223 |
Practice environment: other vs. academic (referent) | 12.2 | 0.64 | 447 | 0.114 |
Practice environment: private practice vs. academic (referent) | 0.63 | 0.236 | 1.67 | 0.352 |
Setting: urban vs. rural (referent) | 1.81 | 0.683 | 4.85 | 0.234 |
Conducting more research: yes vs. no (referent) | 3.44 | 1.44 | 8.98 | 0.00761 |
Level of training: resident/fellow vs. attending (referent) | 0.545 | 0.138 | 1.98 | 0.364 |
Practice environment: other vs. academic (referent) | 2.19 | 0.533 | 10.3 | 0.292 |
Practice Environment: private practice vs. academic (referent) | 0.775 | 0.341 | 1.75 | 0.538 |
The pandemic had a variable effect on work–life balance with positive benefit for researchers and a significant impact on those with children, with mothers disproportionately affected compared with fathers. Academic dermatologists have competing interests in clinical responsibilities and research. Therefore, it was expected that researchers with less patient care would have improved work–life balance. In a survey of academic dermatologists (n = 91), lack of protected time for research and teaching are commonly cited as reasons for burnout. 2 Female physicians were disproportionally impacted during the pandemic with increased familial responsibilities following school/daycare closures. 3 , 4 Women with clinical as well as administrative or leadership roles may have difficulties in balancing familial responsibilities. 3
All dermatologists surveyed report their work being affected by the pandemic. While teledermatology allowed balance of patient care with COVID‐19 relief efforts in a survey of 24 academic dermatologists, 45.8% reported lower quality care with televisits versus in‐person, with 65% reporting skin condition progression with telemedicine. 5 Therefore, quality‐care concerns may explain why many of our participants reported improved work–life balance working from home, with only a minority planning to do telemedicine following the pandemic.
This study was limited by sample size and inclusion of more women, potentially introducing selection bias.
Our study showed dermatologists' preference for working in‐person, improved work–life balance for researchers working from home, and highlighted increased childcare demands on female dermatologists. Therefore, telemedicine may not allow dermatologists with significant childcare responsibilities to achieve improved work–life balance. Academic institutions and employers should inquire about dermatologists’ satisfaction with work–life balance and provide resources to meet their needs.
Ms. Waqas, Mr. Matushansky, and Ms. Thomas have no conflicts of interest. Dr. Lipner is a consultant for Ortho‐dermatologics, Hoth therapeutics, and Verrica.
Funding source: None.
The authors have not published findings or presented this work previously.
IRB status: Exempt.
References
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