The 2022 Medscape poll on physician burnout confirms what has been painfully obvious to doctors on the frontlines of COVID-19: Their burnout is intensifying. According to the survey of 13,000 doctors, the nation’s most burned-out physicians are those in emergency medicine (60%) and critical care (56%). Medscape, a leading health care publication, describes burnout as “long-term, unresolvable job-related stress that leads to exhaustion, cynicism, and feelings of detachment.” These types of psychological issues are a predictable outcome for physicians who’ve been fighting a continuous and often-losing battle against the coronavirus. But not all of Medscape’s burnout statistics are as easy to explain. Look directly below the two most burned-out specialties, and you’ll find obstetrics and gynecology (53%) and, not far behind it, pediatrics (49%). Among the 29 medical specialties surveyed, OB/GYN and pediatrics have reported some of the profession’s largest increases in burnout over the past two years. Compared to the 2020 Medscape poll (which included pre-pandemic data), the burnout rate for pediatric physicians is up 8% and, for OB/GYNs, 13%. Looking closer at OB/GYN and pediatrics Few in health care would have predicted these spikes. After all, OB/GYNs and pediatricians haven’t had to watch COVID-19 patients die day after day, wave after wave — not like their colleagues in the ERs and ICUs. And their rapid rise in burnout makes even less sense when you look at the No. 1 cause of physician dissatisfaction overall, according to Medscape. In 2022, 60% of doctors attributed their burnout to administrative tasks, such as filling out insurance and billing forms. Indeed, most doctors find it annoying and time-wasting to seek prior authorization and meet billing documentation requirements. But it’s not as though any one specialty is tasked with doing significantly more paperwork than others. Rather, this oft-cited complaint generally affects all specialties the same (and no other potential cause garnered more than 40% of physician votes). So, there must be another reason for the sudden spike in burnout among OB/GYNs and pediatricians. Part of the answer lies in what distinguishes these two specialties. According to recent estimates, 85% of all OB/GYNs and 73% of pediatricians are women, the highest percentages of female physicians among all specialties. To understand the spikes in burnout among these doctors, we need to ask: What’s been happening to women physicians? Times are changing, but not fast enough Women make up more than a third of all doctors and comprise a growing majority of medical students. These days, more women than ever are completing their residency training in surgical specialties, despite ongoing verbal discouragement from some of the men who still dominate these fields. Medicine has seen progress toward gender equality in recent decades, but the fact remains: Women physicians consistently report higher burnout rates than men. A lack of due recognition and fairness no doubt contribute. A 25% pay gap still stands between men and women in medicine. In academic periodicals, women are published far less often and account for only 1 in 5 editor-in-chief positions in top-ranked medical journals. In fact, women are underrepresented in nearly all health care leadership positions, making up only 18% of hospital CEOs and 16% of deans and department chairs. Among physician mothers, nearly 1 in 3 have experienced discrimination because of pregnancy or breastfeeding. But even these long-standing gender inequities fail to explain the recent increases in burnout among women-led specialties. And they don’t help us understand why the burnout gap has widened by several percentage points over the past two years. Among doctors today, 56% of women are burned out vs. 41% of men. Putting the pieces together, the best explanation for the recent surge among OB/GYNs and pediatricians stems from events happening outside the medical profession. For the past five months, this series (called Breaking The Rules Of Health Care) has focused on the unwritten rules of medicine, which dictate the “right way” for doctors to behave. This article, however, examines a different kind of rule: not one emanating from within health care but, rather, from American society. It best explains the uptick in burnout among women physicians. The rule: Women are expected to work three jobs, men only one and a half For women in medicine, the past two years have been a test of resilience. As one respondent wrote in the 2022 Medscape survey: “Home is just as busy and chaotic as work. I can never relax.” That quote is consistent with the results of a study published in the Annals of Internal Medicine, which found that doctor moms spend 8.5 hours more on household work each week than doctor dads. And that data was collected in 2014, long before COVID-19. During the pandemic, women have been working more in all phases of life. It’s what sociologists and psychologists call the “third shift.” Meaning, women work one shift at home, another at their job, and then a third, which involves taking on extra responsibilities at work and at home. The pandemic added more duties than ever to the third shift at home. When schools closed, women (disproportionately more than men) supervised their kids’ remote learning and attended more often to the emotional needs of the entire household. Lareina Yee, a senior partner at McKinsey, wrote in an article for Fast Company that the third shift is comparable to housework in that it’s “unpaid, underestimated, unglamorous — and essential.” For women in medicine, this triple shift is causing heightened levels of frustration, fatigue, and unfulfillment, both in life and at work. Stress at work, stress at home Doctors are acutely aware of the impact professional burnout has had on their lives outside of work. In the Medscape poll, more than two-thirds of physicians say it is having a negative effect on their personal relationships. Those who are burned out at work report getting angry at home, having less interest in romance, and feeling guilty when stress gets in the way of spending time with the kids. When physicians are asked about their burnout, they often talk about the negative impact the health care system and the workplace have on their personal life. This interplay between work stress and home stress now dominates the agendas of health care conferences across the country. Entire event programs are dedicated to teaching doctors how to achieve “work-life balance.” There, physicians undergo resilience training, learn breathing techniques and attend lectures on how to psychologically detach from work. It’s a very unidirectional way of problem-solving. I’ve yet to come across a medical conference or training session that acknowledges how much more responsibility women shoulder outside of the office and what kind of impact that might have on women inside the office. This “life-work imbalance,” which has only worsened during the pandemic, best explains the growing burnout gap between female and male doctors. If we want to alleviate the fatigue and frustration women physicians are experiencing, we can always start by solving two old problems: (1) All doctors need fewer bureaucratic tasks forced upon them, and (2) women physicians must be able to work in environments free of harassment and discrimination. There’s yet another solution that must come from outside the workplace. The spouses and partners of women physicians must confront any gender inequalities that may exist within their relationship. It would be impossible for anyone to work eight extra hours each week at home — on top of a busy work schedule — without experiencing greater exhaustion, cynicism, and feelings of detachment (a.k.a. burnout). We know from the data that occupational burnout harms personal relationships. If not addressed, it will continue to add stress to doctors’ home lives. But physicians must also recognize that gender inequality at home strongly contributes to burnout in the workplace. It, too, must be addressed. Source
