Dermatologist work practices and work–life balance during COVID‐19: a cross‐sectional survey

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.