Women in Medicine: Burned Out and Fed Up

For years, there have been discussions about burnout among healthcare providers, but the conversation has now been pushed to the forefront by the challenges of the COVID pandemic. Women physicians, in particular, have long been overextended and underappreciated, and the viral consequences of the last 2 years have only exacerbated those issues. Multiple studies, as reviewed in a recent paper in Medical Care, have confirmed that women in medicine report more symptoms of burnout than men.

An obvious factor in this gender inequality is that women are more likely to be caregivers, whether for children or aging family members. A survey of over 3000 healthcare providers conducted during the summer of 2020 analyzed concerns of burnout, well-being, and work experience. Survey results published in the Journal of General Internal Medicine showed that burnout, decreased feelings of overall well-being, and job stress were more common among women than men. More women reported that childcare or caregiving impacted their work, and those women had substantially higher odds of burnout.

In addition to the caregiver responsibilities, women still perform more household duties than men, too. A Pew Research Center survey from October 2020 suggests that this statistic didn't change during the pandemic. Nearly 60% of women reported doing more household chores than their partner, while 47% of women also managed the household finances and almost three quarters of women coordinated the schedules and activities of their offspring. By comparison, men who responded to the survey consistently overestimated their contribution to each of these responsibilities.

Microaggression and Sexism in the Medical Workplace

Certainly, the long-standing disparities in caregiving and household duties significantly affect work-life balance for women physicians. But what about the workplace issues that concurrently cause stress for female providers? Fewer women report feeling highly valued at work compared with men. Women are still paid less than their male counterparts, and they suffer from pregnancy and childcare biases from administrators and colleagues. Perhaps even more concerning is the less recognized (and less acknowledged) presence of gender-based microaggression and sexism in the medical workplace.

Research has shown that women providers commonly have their abilities underestimated, suffer through sexually inappropriate comments, feel marginalized and excluded (especially from teams, events, or opportunities), and are relegated to mundane tasks. These unaddressed and unabated conditions have been shown to cause decreased confidence and performance, increased stress, and lowered well-being — all of which can lead to morale problems, feelings of isolation, poor self-esteem, and burnout. Pushed far enough, some women feel the need to leave medicine altogether. Indeed, the attrition rate for females in medicine is worrisome: Four out of 10 women transition to part-time work or quit completely within 6 years of finishing their training.

As a female infectious diseases consultant, I wish I could report that the workplace has become more equitable and less stressful over time. Sadly, it hasn't for me. Just a few years ago, my female medical partner and I were offered less money to assume the administrative work of a retiring male colleague. Like every other woman in medicine, I could fill an entire book with the conversations and interactions at work that have made me feel uncomfortable and unworthy. And these encounters happen again and again, nearly every day.

Some of my experiences have been overt, like when male patients refused to be treated by me and demanded to see my male partner. I've seen patients tell my female colleagues that they were "too pretty to be a doctor but could perform a physical exam on them anytime." Both patients and colleagues have told inappropriate jokes and shared insensitive digital images or memes at work. Male patients have wrongly touched my body as I've leaned over their bed during a history or physical.

Subtle but Damaging

Other experiences are more subtle, but just as damaging. Many patients ask if I've arrived to take away their breakfast tray, even though I've already introduced myself as their doctor. One male colleague walked into a room and began a conversation with a patient without any acknowledgement of my presence while I was actively listening to their heart with my stethoscope. I've watched both men and women make eye contact with only the male residents on my consultative team, even though I'm the one talking. An orthopedic surgeon referred to me as "one of those ladies in infectious diseases" when telling a patient to expect my visit. More than one male colleague couldn't be bothered to remember my name or recognize my face, even though I performed consultations on their patients at the same hospital for over 10 years.

After 15 years in practice, these experiences (and many, many more) contributed to my own bout of burnout, primarily manifested as overwhelming mental/physical fatigue and severe "pager rage." I was fed up all the time at work, and that anger began to spill over into my after-work hours. Though I seriously contemplated retiring early, I ultimately chose to quit my permanent hospital employment and transition to locum tenens practice — fortunately, that switch has been good for me. Less time at the hospital, longer periods of respite between work assignments, and more restorative sleep at night diminished my burnout symptoms and eased my bitterness.

How can we better protect women providers from burnout? It seems obvious that medical systems need to offer equitable salaries and research funding, improved access to child and elder care resources (including assistance for emergency situations), more flexible schedules, and increased parental or family leave benefits. Significant others and spouses must commit to being fully engaged in both household and caregiving responsibilities.

Also, all men and women should be educated on how to respond to microaggressions and harassment in the medical workplace (both personally and as bystanders), and unconscious bias training should be standard. All healthcare institutions should offer a confidential and anonymous reporting system for victims of microaggressions or harassment, with prompt responses guided by a zero-tolerance policy. Hopefully, with purposeful change, women in medicine can continue to practice without suffering from symptoms of burnout, while also mentoring the next generation of even healthier and happier female physicians.

Comments to this blog post are welcomed and encouraged. If you have another infectious disease topic you'd be interested in reading about here, please don't hesitate to mention it.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

Join Medscape's new blog initiative! We're looking for physicians, nurses, PAs, specialists, and other healthcare professionals who are willing to share their expertise in one to two paid blog posts per month. Please email Medscape-Blogs@webmd.net for more information.

About Dr Roni Devlin

Roni K. Devlin, MD, MBS, is an infectious diseases physician currently residing in the Midwest. She is the author of several scholarly papers and two books on influenza. With a longstanding interest in reading and writing beyond the world of medicine, she has also owned an independent bookstore, founded a literary nonprofit, and published articles and book reviews for various online and print publications. You can reach her via LinkedIn.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.