Burnout prevalence is 20 to 60 percent higher among women physicians than their male colleagues. Understanding why women physicians are burning out is important for identifying effective ways to address the problem.
Here’s my take on the underlying causes:
1. Women physicians provide more time-intensive care. Female primary care physicians have longer patient visits and engage in more patient-centered communication. Female surgeons in training write longer notes, spend more time in clinical review, and spend more time handling in-box messages than their male peers.
2. Female patients gravitate to women physicians and tend to want to talk more than male patients. A 2018 study found that women physicians have more female patients than male physicians do, and female patients want longer visits and more empathetic listening, especially from women. However, female physicians are generally not afforded additional time to meet these additional patient expectations.
3. Women physicians are more likely to be married to spouses who work full time than male physicians. A 2014 study of young physician-researchers showed that female physicians were far more likely to have a spouse that worked full time than male physicians (86% versus 45%). Two careers usually equates to more money, but also more stress and trickier logistical challenges.
4. Female physicians are women in our culture, meaning that gender roles affect them too. Who makes sure the kids have dental appointments? That they have a gift for that upcoming birthday party? That there are groceries in the fridge? That the dry cleaning has been picked up? Sure, there are many heterosexual couples where the men take on these responsibilities. But quite often in our culture these tasks, or at least the monitoring of them, falls on women. A 2019 study of physicians who are mothers found that most had sole responsibility for most domestic tasks.
5. Women face gender-based inequity and sexual harassment in the workplace. When I was in medical school I wrote an article called “Sexism in Medicine,” about what I’d observed and personally experienced. When it was published in the school newspaper, I found myself the brunt of criticism and comments that I was “too sensitive.” Other women physicians, like this one, have shared similar stories. A recent study of surgical residents found that more women physicians had experienced mistreatment (gender or racial discrimination, verbal or physical abuse, or sexual harassment) than their male colleagues (71% versus 36%). Women in this study had higher burnout rates than men, but when adjusted for mistreatment, the difference disappeared. Unequal treatment and harassment exacerbate an already stressful, chaotic work environment.
The first three factors in this list relate to issues within medicine. Some can be addressed through greater understanding of what women physicians need to have more time in their professional and personal lives. These needs are specific to the woman and her work situation, so a menu of interventions would be most effective
There’s a parallel here to addressing health inequities. The best way to reduce inequities in health care is not to standardize and provide the same service to everyone, but to tailor the environment and resources to ensure that everyone has access to the care and services they need. This approach applies to women physicians. The key question is not “Why can’t women ‘keep up’?” but “What changes will support women physicians to be their best selves and do their best work?”
Flexible scheduling, part-time work, shared positions, and on-site day care are not luxuries, they are some of the levers that smart organizations are using to retain valuable personnel and maintain a productive, healthy work environment. Given that women now make up more than half of all medical students, retaining women physicians is critical for the profession as a whole.
The last two factors in the list stem directly from societal influences. I don’t have any great answers here, but was intrigued by the step taken by a male science professor in Australia to reduce gender and race inequity. He has chosen to delay accepting a promotion until inequities in his department are rectified.
We need to understand the issues that drive the higher rate of burnout in women physicians—and prioritize steps to address them. Not only will this help us retain valuable human capital in health care, it will also, in my humble opinion, support male physicians in doing their best work, and improve patient experience as well.
(Photo credit: Liz Boehm, lizboehmphotography.com)