17 minute read
Why the life-work imbalance for physicians has only worsened during the pandemic
from REP Sept 22
Gender Inequality and Physician Burnout
Why the life-work imbalance for physicians has only worsened during the pandemic.
By Dr. Robert Pearl
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 healthcare 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 burnedout 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 healthcare 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 billingdocumentation 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 onethird 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 at top-ranked medical journals. In fact, women are underrepresented in nearly all healthcare 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 womenled 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 Healthcare) 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 healthcare 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
Which Physicians Are Most Burned Out?
Image reproduced with permission from Medscape via Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger, published January 21, 2022, online at: Medscape.com MEDSCAPE
had on their lives outside of work. In the Medscape poll, more than twothirds 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 healthcare system and the workplace have on their personal life.
This interplay between workstress and home-stress now dominates the agendas of healthcare 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, (2) and 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 (aka 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.
A Positive Influence
How distributors are helping reps and team members improve their sense of well-being.
Pursuing important life goals is strictly an after-hours proposition for many people, to be pursued and nurtured outside the workplace. But some employers believe they can help their people nurture their work and personal lives at the same time. Are people ready to accept and trust a helping hand from their employers? At least two medical distributors – Henry Schein and Concordance Healthcare Solutions – believe the answer is “yes.”
“It is no longer sufficient for a company to be a place where an employee can collect a paycheck,” says Josh Naftolin, strategic account manager, Henry Schein Medical. “Just like other employees, sales reps want their company to have a broader purpose and positive influence on society. Loyalty is something that we must continually earn.” In 2020, the company launched the Henry Schein Mental Wellness Committee, “with a mission to empower every Team Schein Member to be their best self – mentally, emotionally, and physically – by offering resources, guidance, and support,” he says.
A Positive Influence
Brad Clark
Doreen Nersesian, Concordance Healthcare Solutions’ executive vice president of human resources, says, “We realize employees spend a lot of time at work, and the more they can align their interests with the company culture, the better the connectivity to keep employees engaged in the organization and the work they perform. We make a positive impact through our service to healthcare providers across the country and through a variety of programs aimed at expanding our purpose into the lives of our employees and the communities we serve.”
Concordance Healthcare Solutions has trademarked “Positively Impacting Lives” to emphasize its dedication to having a positive effect on employees, healthcare providers and their patients. In January 2022, the company launched an employee volunteer program named “Concordance in the Community,” which allows staff members to volunteer in their community during normal working hours, up to eight hours annually.
“Before the pandemic, many of us were going a hundred miles per hour,” says Naftolin. “We needed to stop, pivot, and look inward at our well-being. We needed to be intentional in our thinking, which was – and still is – a struggle for many. The pandemic helped show reps that they are human and that perfection is unattainable. It brought feelings that had been present for years to the surface.” He believes the lesson of the “Three Ps” – championed by Henry Schein Executive Director of Strategic Accounts Brad Clark – has much to offer in terms of well-being. The
Josh Naftolin
Time to stop
It’s no coincidence that Henry Schein launched its Mental Wellness Committee in the early days of the COVID-19 pandemic. first “P” – Personal – refers to looking inward at one’s personal journey. The second – Perceptive – refers to having or showing sensitive insight with a focus on being intentional. The third – Prospective – has to do with looking forward and being adaptable to change. “Looking at life through this lens has changed my vision of my future, and I hope it helps others see their own path.”
Employee-centered culture
The Concordance in the Community program is the company’s way of giving back and serving the communities they serve and that support Concordance’s business and livelihoods, says Nersesian.
A Positive Influence
“Inherently, I think people like to help others,” she says. “Being given the latitude by your employer and getting paid for doing so gives employees the freedom to give back and help their community. Our healthcare providers and their patients are members of our respective communities. The patient that we are providing for in the hospital could very easily receive some sort of benefit from what we do in our community at large. We see Concordance in the Community as an ideal foundational program to build our employee-centered culture and to positively impact lives…on many levels.”
An essential element of an employee-centered culture is recognizing and acting on the needs and interests of employees beyond the work environment, she adds. “It is one more element that connects employees to the work environment of today. We realize employees spend a lot of time at work, and the more they can align their interests with the company culture, the better the connectivity. ... I understand the separation of work from personal life, but I think if employees have the support at work in interests they have outside of work, they could be connected more.”
Resiliency
Naftolin believes that the changes and challenges of the pandemic prioritized mental health and resiliency among the Henry Schein workforces. “Our sales force has always worked remotely, but the environment changed. Reps were unable to visit their customers in person for almost one and a half years. That meant that even their remote work routines had to change, and this is where the need to build resiliency and become more intentional with how we work came in.
“There were also new concerns for reps. Having a place to express those feelings in a safe environment was necessary.” Henry Schein created a microsite for employees with resources on topics such as working remotely, caregiving, mental health, emotional health, financial wellness and more.
“There are many differences from 10 to 15 years ago that have been taking shape, regardless of COVID,” he says. “Being able to extol the features and benefits of product is no longer sufficient. We must be able to show the customer how the product will improve their business (efficiency, revenue, etc.). And with COVID, we must be able to do that through both in-person and virtual selling.
“Additionally, the complexity of the medical landscape has been increasing the demands on reps’ time.” But they can rely on teams outside of sales to help provide service and support, Naftolin says. For example, Marketing can help educate customers and provide qualified leads, and E-commerce can help create a self-service and seamless buying experience.
“In the end, as a salesforce we trust our leadership and the direction that our company continues to go in. Loyalty, purpose, and service is reflected by the tenure of our sales team. Even during the most difficult of times, we continue to see growth in our business and others wanting to join our organization.”
Bringing it to life
Creating an employee-centered culture – one that people trust – is a deliberate process. It doesn’t happen overnight.
“You need to start somewhere and start small,” says Nersesian. “Pilot something and have someone close to the initiative, so it gets the attention it needs and gets off to the right start. We piloted our Inclusive Hire program at our headquarters in Tiffin, Ohio. We worked out kinks early on, before we introduced it to the rest of the company. Once we were able to fine-tune the program, it was easier to roll it out to other facilities.”
The company followed the same process with other initiatives, such as Concordance Cares for You (CC4U), an employee assistance fund, as well as Concordance in the Community. “We listened to the feedback from employee surveys and used suggestions to gradually introduce new programs, so employees and the company could grasp and incorporate the new programs.”
The manager’s role
Both Concordance and Henry Schein believe managers are a crucial link in building an effective companywide program to promote wellbeing.
“We find that educating our leaders – supervisors and above – when we introduce a new program is crucial to its deployment and success,” says Nersesian. “More recently we have had meetings via Teams where we go over program highlights and field any questions
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A Positive Influence
so they can address them with their respective teams. We find that this approach helps streamline the rollout of the program.”
Concordance has also developed a team of volunteer ambassadors at each location to promote volunteer opportunities within local communities and team events. Some managers have become volunteer ambassadors themselves, and others support their staff in doing so. Since the rollout of Concordance in the Community, the company has had team meetings during which a volunteer event was planned for the city in which the meeting took place, she adds. “Aside from what they are doing for the community, it is an excellent teambuilding exercise.”
Henry Schein’s partnership with YES Community Counseling Center, an external non-profit organization, helps the company deliver education on wellness awareness to all people managers in the United States, says Naftolin. These education sessions highlight the importance of a manager’s role in supporting their team’s overall wellness, he adds.
For example, managers learn how to identify when a rep may be struggling and how best to approach that rep in an effective manner. For managers to be effective, the company must foster a culture based on trust, openness and vulnerability, he says.
“A present manager is one of the most important aspects of a cohesive team. As a manager, I always strived to be a sounding board for my team. My goal was to support them no matter what, and work with them regularly in the field. I would call them just to say hello and ask how they were doing. I would foster that relationship individually, as I do with customers.
“A manager must be intentional in their support for their team,” he continues. “They must do their best to understand the feelings and needs of their reps. They must be able to talk to them and show empathy toward them. Being there when a rep needs you most is one of the strongest actions a manager can take.”
Managers are the first line of defense to help their teams, and they need to take the time to build trust so their team can come to them in times of need, continues Naftolin. “I have always said that managers need to have difficult conversations and help direct and support the mental health of their reps. Henry Schein has, and continues to, implement support tools for its managers. In turn, we see that reps feel more comfortable having those courageous conversations.
“Years ago, reps might not have uttered the words, asked for help, or looked for assistance. Today, there is a deeper understanding and acceptance of resources that can help identify and address mental health awareness in the workplace.”
The bottom line
Ensuring that reps feel connected to the company’s purpose is important to Henry Schein’s bottom line, he says. “When a company provides a work environment that prioritizes career development, enables work-life balance, and connects team members to their purpose, they will retain and attract top talent. When team members feel connected and understand the importance of their role in healthcare, they naturally provide an improved, seamless experience for the customer. This influences a customers’ loyalty and impacts customer acquisition and retention costs.
“My motto is, ‘What we do in life, echoes in eternity.’ These are words I live by every day. We all need a motto or a mission statement that will guide each of us to our own personal success and help maintain a healthy wellbeing.”
