The impact of work-family imbalances on women physicians

A career in medicine is characterized by long work hours, rigid schedules, and a prevailing culture of putting patient care above personal needs, placing healthcare workers at increased risk for conflicts between work and family or life responsibilities.

It’s defined as the extent to which people are satisfied with their work and family roles, as well as the various factors that influence an individual’s ability to integrate work and family.

Work-family integration

Conditions that result in poor work-family integration (defined as elevated work-family conflict) force an individual to choose between multiple competing interests due to time and resource constraints.

Feelings of dissatisfaction with work-family and work-life integration are more common among physicians compared with the general working population, and are strongly correlated with feelings of burnout and a desire to reduce work hours or leave medicine.

Physicians are also more likely to report that their careers have a negative impact on relationships with their children relative to the general working population. This effect is most pronounced for female physicians.

Factors affecting work-life integration

In a 2021 study of more than 4,300 physicians published in JAMA Network Open, work-life integration was measured using an eight-item scale, with work-life integration scores ranging from 0 to 100.^[]

Higher scores indicated better work-life integration. Researchers found that female physicians had worse work-life integration scores than male physicians (52 vs 57). In addition, the largest gender gaps in work-life integration were documented for mid-career physicians (45 to 54 years old).

Overall, lower scores were correlated with being over age 35, being single, working more hours, and having more call nights. The specialties with the lowest work-life integration scores included emergency medicine, urology, general surgery, anesthesiology, and family medicine.

"Work-life integration is strongly related to burnout—even more so than a lot of the typical demographic factors that are commonly considered drivers of burnout such as gender and age,” said Daniel Tawfik, MD, MS, lead author of the study, in an interview with HealthLeaders.^[]

Work-life integration for female physicians

Female physicians may experience more work-family conflicts than male physicians for a number of reasons.

At the workplace, female physicians may spend more time with patients and more often address psychosocial issues than male physicians. At home, female physicians also spend more time engaging in household and childcare activities than male physicians. This added burden for women—both at home and work—may explain the increased work-family conflicts female physicians report.

In a 2022 study published in the Journal of Bone and Joint Surgery, 347 orthopedic surgeons (153 female and 194 male) participated in an anonymous survey that examined their levels of satisfaction with work-family integration.^[]

Female surgeons, who represent only 6.5% of the American Academy of Orthopedic surgeons, are particularly at risk of work-family conflicts. The study found that female surgeons were less likely to hold faculty positions (19% vs 39.2%) or have academic and leadership titles (30.7% vs 47.4%).

There was also a significant pay gap between female surgeons (average yearly income $300,000 to $400,000) and male surgeons (average yearly income $400,000 to $500,000).

Female surgeons were also more likely to have never been married or to have married at a later age. Female surgeons were more likely to have no children (29.4% vs 7.8%), be in need of fertility treatments (32.% vs 11.9%), and delay having children until completing medical training (63.0% vs 31.1%).

Overall, satisfaction with work-family balance was 72.3% in females and 82.1% in males.

This study highlights the disparities in work-family integration that affect female orthopedic surgeons most adversely. This discrepancy must be addressed so that women are supported and retained as successful orthopedic surgeons, and as physicians in general.

Improving work-life integration

The 2021 JAMA Network Open article listed five actionable items that healthcare organizations can incorporate to improve physician work-life integration.

1. Introduce flexible scheduling. While the approach each organization or practice takes for scheduling varies depending on numerous variables such as specialty, one way to improve work-life integration is to allow non–time-sensitive tasks to be completed in a flexible manner. For outpatient specialties, this can be achieved by allowing the needs of the clinic staff to dictate appointments. Similarly, organizations should ensure that there are sufficient resources and staff available to enable physicians to decrease work hours without concerns that they’re burdening colleagues or endangering patients.

2. Improve practice efficiency. To help physicians achieve balanced work-life integration, healthcare organizations should reduce the clerical burden placed on them. This can include introducing scribes to help physicians document patient encounters, or making sure that physicians utilize their electronic health records most efficiently. Reducing the clerical burden placed on physicians could help relieve one aspect that affects work-life integration. Some organizations use trained scribes, for example, to help physicians document patient encounters. Also, physicians can customize their electronic health records to make their use of them more efficient.

3. Decrease gender gaps in compensation, retention, and promotions. Although there have been some positive strides toward closing the gender gaps in medicine, we still have a long way to go. Healthcare organizations must prioritize recruiting female physicians and keep these gender disparities in mind when evaluating physicians for promotion.

4. Establish gender-specific mentorship, coaching, and networking opportunities. Removing the gender disparities that exist in medicine will require long-term systemic changes, but in the meantime, organizations can provide female physicians access to gender-specific mentorship and coaching opportunities, to promote positive change faster.

5. Provide childcare. Healthcare organizations can improve physician work-life integration by offering quality childcare on site. This is especially important during holidays or prolonged school closures.