The Third Shift: Women Physicians on Overload
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The unusual stresses of clinical care, administrative tasks and personal life combine to increase burnout among women physicians. There are numerous contextual and personal factors that must be understood to lighten the load and increase their retention in healthcare.
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The Third Shift: Women Physicians on Overload
- 1. The Third Shift Women Physicians on Overload
- 2. Demographics More than 1/3 of physicians practicing today are women + 80% of them are in domestic relationships Specialties Women are >50% of OB/Gyn + Family Medicine Physicians – 2 of the top 5 groups reporting burnout Habits Women physicians spend the equivalent of 3 extra 40-hour weeks per year entering data in EHR Third Shift - Indications
- 3. Female physicians tend to follow clinical guidelines more often, provide more preventive care, and give more counseling than their male counterparts. Salaries for women physicians are about 20% less than male counterparts Childbearing years for women physicians are compressed, often overlapping with caring for aging parents Women had different documentation patterns, longer notes, greater use of the copy/paste, more patient contacts returned within 24 hours, and fewer visits closed on same day. Female physicians score higher on empathy scales Female physicians spend more time on EHR than male counterparts, including total minutes in the system per day, outside of 7 am to 7 pm, and outside of scheduled hours A Few Facts Women physicians carry the “mental load“ for their families -- calendars of appointments, carpools, activities, and everything else Male physicians are expected to have 1½ roles, while women physicians have 3 roles
- 4. Breakout Groups What socio-cultural norms persist that impact the lives of women physicians, and contribute to the 3rd Shift? How does the 3rd Shift pose threats to the personal and professional lives of women physicians? What’s your approach to coach women physicians on the 3rd Shift? How does a male coach work with women physicians caught up in the 3rd Shift?
- 5. Conclusions
- 6. References Gupta K, Murray S, Sarkar U, Mourad M, Adler-Milstein J. Differences in ambulatory EHR use patterns for male vs. female physicians. NEJM Catalyst 2019. Available at: https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0690?cid=DM84520&bid=135167530. Győrffy et al. Workload, mental health and burnout indicators among female physicians Human Resources for Health (2016) 14:12 DOI 10.1186/s12960-016-0108-9. Kane L, Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger, Medscape, 2022. Available at: https://www.medscape.com/slideshow/2022-lifestyle-burnout-6014664 Luft HS. Physician Work Hours and the Gender Pay Gap - Evidence from Primary Care. New England Journal of Medicine. 2020 Dec 31; 383(27):2688. doi: 10.1056/NEJMc2032395. PMID: 33382939. Oppenheimer L. 2020. The Surprise Origin of Women's Mental Load. Available at: https://www.brighthorizons.com/employer-resources/mental-load-starts-at-the-office. Santhosh L, Keenan BP, Jain S. The "Third Shift": A Path Forward to Recognizing and Funding Gender Equity Efforts. Journal of Women's Health (Larchmont). 2020;29(11):1359-1360. doi:10.1089/jwh.2020.8679 Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Internal Medicine 2017;177:206–2136.
Notas del editor
- In the 1970s as large numbers of women rejoined the workforce, a book called The Second Shift was published describing the complexities they faced in juggling multiple responsibilities. During that time several of my female friends were in medical school. One close friend started her medical training at the age of 40, married and with 3 children. I also was privileged to know one very famous woman physician, Dr. Jimmie Holland, the founder of the field of psycho oncology – the mother of 6 children. They never left me with the impression that they were not managing work/life balance. Recently, however, as I coached women physicians it seemed like the last 50 years had overlooked them. The are under enormous pressure. Women physicians are working a 3rd shift and they are on overload. The 3rd Shift is the undocumented work done by women physicians outside of clinical hours, beyond family and domestic responsibilities, which is taking a serious toll on their professional and personal lives, and their physical and mental health.
- In 2020 41% of male physicians, and 56% of female physicians were burned out. Burnout is prevalent among physicians, however, despite some shared concerns the underlying causes differ for men and women. I’ve reviewed articles from the US, England, China, Hungary, and the additional roles and responsibilities of women physicians have no boundaries. Physician burnout has attracted an increasing amount of attention as a global public health problem. It is associated with negative clinical and organizational outcomes, including lower patient satisfaction, patient safety, and quality of care. According to recent estimates, 85% of all OB-GYNs and 73% of pediatricians are women, the highest percentages of female physicians among all specialties. 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%. Female physicians spent a mean of 33.4 more minutes in the EHR per day compared with their male counterparts – the equivalent to more than 3 additional 40-hour work weeks per year. A study in the Annals of Internal Medicine in 2014 found that doctor moms spend 8.5 hours more on household work each week than doctor dads. After a full day at work, dinner, homework, and putting kids to bed, women physicians regularly have “pajama time” – hours of patient record entry and updates.
- On the Clinical Side: Physician. Researcher. Educator. Advocate for gender equity. Defender from microaggressions. Writer of opinion pieces. Organizer of the office social. Keeper of the birthday calendar. Mentor to medical students. Female PCPs generated less visit revenue than male colleagues in the same practices owing to a lower volume of visits, yet spent more time in direct patient care per visit, per day, and per year. After adjustment for PCP, patient, and visit characteristics, female PCPs generated equal revenue but spent 15.7% more time with a patient (2.4 minutes) On the Homefront: Mother. Wife. Friend. Daughter. Chauffer, meal planner, social secretary, interior decorator, spouse/partner. 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. And I am hearing that frequently from my woman physician clients. Wellness programs are not the answer. Promoting the well-being of women physicians requires innovative approaches beyond the traditional scope of physician well-being efforts and careful attention to the unique barriers women face. I believe coaching is one of the best responses available.
- You have 30 minutes to discuss the 4 questions. Please identify a reporter who will share a summary of your responses back to the whole group.