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. 2021 Oct 27;61(5):e158–e162. doi: 10.1111/ijd.15955

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

Bukhtawar Waqas 1, Justin T Matushansky 2, Charlene Thomas 3, Shari R Lipner 4,
PMCID: PMC8653110  PMID: 34706054

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


Articles from International Journal of Dermatology are provided here courtesy of Wiley

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