Video Abstract
Physicians must balance career and home responsibilities, yet previous studies on work-life balance are focused primarily on work-based tasks. We examined gender discrepancies and factors related to household responsibilities and work-life balance among pediatricians.
We used 2015 data from the American Academy of Pediatrics Pediatrician Life and Career Experience Study, a longitudinal study of early-career pediatricians. χ2 tests and multivariable logistic regression were used to examine the effects of gender on household responsibilities, satisfaction, and work-life balance attainment. We formally reviewed responses from 2 open-ended questions on work-life balance challenges and strategies for common themes.
Seventy-two percent of participants completed the survey (1293 of 1801). Women were more likely than men to report having primary responsibility for 13 of 16 household responsibilities, such as cleaning, cooking, and routine care of children (all P < .001). All gender differences except budget management remained significant when controlling for part-time work status and spouse or partner work status (P < .05). Women were less satisfied with their share of responsibilities relative to others (52% vs 62%; P < .001), and few women and men report being very successful at achieving balance between their job and other life areas (15% vs 19%, respectively; P = .05). Open-ended responses (n = 1145) revealed many barriers to achieving work-life balance. Strategies to increase work-life balance included reducing work hours, outsourcing household-related work, and adjustments to personal responsibilities and relationships.
Female pediatricians spend more time on household responsibilities than male pediatricians, and gender is a key factor associated with work-life balance satisfaction.
Previous research has revealed that women perform the majority of household labor, yet the extent to which this discrepancy exists for pediatricians is unknown. Work-life conflicts are known to be associated with negative consequences, including professional burnout and career dissatisfaction.
Early- and mid-career female pediatricians spend more time on household responsibilities than male pediatricians, regardless of the intensity of work commitments, and gender is a key factor associated with work-life balance satisfaction.
Physician careers involve multiple professional commitments that must also be balanced with responsibilities at home. Although most physicians report career and life satisfaction, struggles with work-life balance are common, and dissatisfaction with life and career is a concern for some.1–7 Research reveals that work-life conflicts (ie, the need to perform both work- and personal-affiliated tasks) are common for physicians and have been associated with higher rates of burnout and personal distress.8 Furthermore, health care workers who report higher rates of behaviors associated with successful attainment of work-life balance have higher rates of teamwork-related and patient safety–related norms and behaviors.9 Therefore, researchers have hypothesized that improving work-life balance among health care providers may also improve quality outcomes for patients in addition to improving the life of the individual health care worker.9
Previous studies revealed that female physicians are more likely than male physicians to report struggles with work-life balance and are less likely to report career satisfaction.1,3,10,11 This is particularly salient in the field of pediatrics, in which the majority of early-career pediatricians are women with young children,12 and early- and mid-career pediatricians are known to report particular struggles with the attainment of work-life balance.1 Authors of limited previous studies have examined the role of work-based factors associated with gender discrepancies in the attainment of work-life balance.1 The manner in which non–workplace-based associated factors (such as the division of household responsibilities) might contribute to these gender discrepancies within the field of pediatrics is unknown.
Despite women’s increased participation in the labor force, research reveals that women continue to perform the vast majority of household labor,13 and there is little evidence that men’s proportionate share of family work has changed much during the past decade or so. Of note, a greater perceived unequal distribution of responsibilities for household tasks has been associated with poor health outcomes for women.14,15 Although a handful of studies have examined gender differences in household responsibilities and satisfaction with work-life balance,4,16–18 these studies had limitations to generalizability and/or were not focused on the perceptions of pediatricians.
Our goals for this study were (1) to examine the extent to which female pediatricians spend more time on household responsibilities compared with male pediatricians, (2) to examine the extent to which gender and other pediatrician characteristics are associated with perceptions of satisfaction with the division of household responsibilities and the attainment of work-life balance, and (3) to seek to understand pediatrician perceptions of challenges and successes regarding work-life balance.
Methods
Participants
We analyzed cross-sectional data collected in 2015 from the American Academy of Pediatrics (AAP) Pediatrician Life and Career Experience Study (PLACES), a national longitudinal study in which the work and life experiences of pediatricians are tracked across their careers.12 PLACES participants are surveyed twice each year; the main survey covers several domains (eg, work characteristics, satisfaction, work-life balance, and life experiences), which are repeated each year, and there is a shorter survey with topics of importance to participants that vary each year.
PLACES includes 2 cohorts of pediatricians on the basis of their residency training completion year (2009–2011 and 2002–2004). PLACES participants were identified by using an AAP database that included all pediatricians who completed US residency programs and both AAP members and nonmembers. Forty-one percent of pediatricians randomly selected to participate in PLACES initially signed up for the study. Details regarding PLACES methodology, including target population, sample size analysis, and nonresponse and poststratification weights, have been described previously.12 Initial study weights were calculated because nonresponse bias tests revealed that PLACES participants in each cohort were significantly more likely to be women, AAP members, and graduates of US medical schools than pediatricians in the respective target cohorts. For the current study, these initial study weights were adjusted on the basis of sex, AAP membership status, and medical school location of participants who completed the 2015 survey and were applied to all analyses presented in this article.
We analyzed data from a survey fielded in 2015 (which was conducted via e-mail and mail, depending on participant preference). These data included pediatricians who were not married or partnered. The AAP Institutional Review Board approved the study.
Measures
The survey included several questions on household responsibilities that were modified from other studies,19,20 including the Families and Work Institute report “Modern Families.”21 Questions were primarily fixed-response questions and were developed on the basis of a review of other studies and input from the AAP PLACES Project Advisory Committee.
Participants answered questions regarding who had the primary responsibility for 9 household and 7 child care activities. Response options included the following: (1) “Largely, I do,” (2) “Largely my spouse/partner does,” (3) “Equally shared between me and my spouse/partner/other,” (4) “Others do” (eg, child, relative, ex-spouse or ex-partner, or friend), and (5) not applicable, which was excluded from analysis. Therefore, n for each specific task varied from 688 to 1288. Participants also answered questions about whether they hired help (for cleaning, outdoor work, routine care of children, laundry, and cooking), felt rushed with their time, were satisfied with their share of responsibilities relative to others in their home, and felt successful in balancing their job and other areas of life.
The survey concluded with 2 open-ended questions: “What has been your greatest challenge in trying to balance your work and personal responsibilities?” and “Please share a tip that has helped you achieve a higher level of work-life balance.” Data were incorporated on participants’ demographic and job characteristics collected earlier in 2015 via the main PLACES survey.
Data Analysis
Quantitative Data: Division of Household Responsibilities and Work-Life Balance According to Gender and Other Pediatrician Characteristics
We used χ2 tests to compare participants’ responses to questions on home responsibilities (9 household and 7 child care questions) and gender. Responses were categorized as follows: primary responsibility (“Largely, I do”), shared responsibility (“Equally shared between me and spouse/partner/other” and “Others do”), and spouse or partner responsibility (“Largely, my spouse/partner does”). We also examined the relationship of gender with (1) hiring help for cleaning, outdoor work, routine care of children, laundry, and cooking (yes versus no); (2) feeling rushed with time (always feeling rushed versus sometimes or almost never); (3) satisfaction with one’s share of home responsibilities relative to others in the home (completely or very satisfied versus somewhat, not very, or not at all satisfied); and (4) success in balancing job and other areas of life (very versus somewhat, not very, or not at all successful).
For the above outcomes that varied significantly by gender in the bivariate analysis, multivariable logistic regression models were used to examine for independent gender effects while controlling for cohort, own work hours (part-time versus full-time), work status of spouse or partner (full-time versus not married or partnered or spouse or partner not working or working part-time), having children <18 years old, specialty (primary care versus hospitalist, subspecialist, or other), concern with educational debt (very or somewhat concerned versus not concerned), and income of the survey respondent. Characteristics included in the models were based on a priori hypotheses that they would be related to household responsibility.
The number of cases in each analysis varied slightly because of missing values for specific questions. All data presented are weighted as described above. All analyses were conducted with PASW Statistics 18 (SPSS, Inc, Chicago, IL), with P ≤ .05.
Qualitative Data: Work-Life Balance Challenges and Solutions
Two authors reviewed all open-ended responses in which challenges and success tips were addressed. They created a list of codes, and by using a conventional content analysis approach, comments were tagged and assessed by using these codes.22 Codes were updated during iterative readings of the comments and coding process. Coding agreement was 94.6%; discrepancies between the authors were resolved through discussion. Themes that emerged from the data on challenges and sample quotes were identified to help illustrate the data. Success tips that participants provided were not specific (eg, take care of yourself, exercise more) so we rereviewed these data for examples that might address the identified themes on challenges.
After coding, we totaled the number of challenges reported per participant and applied t tests and the χ2 analysis to examine differences by gender in the number and types of challenges identified.
Results
Seventy-two percent of PLACES pediatrician participants completed the 2015 surveys (1293 of 1801). Most respondents commented on the open-ended questions on challenges (84.1%) and tips (77.5%) related to work-life balance.
Respondent Characteristics
Two-thirds of pediatrician respondents were women (64.3%), 88.4% were married or partnered, and 79.2% reported being parents. Among those with children, nearly all had children age <18 years (97.3%); 17.6% had 1 child, 51.1% had 2 children, 22.7% had 3 children, and 8.6% had ≥4 children. Of the respondents who were married or partnered, 65.6% reported having a full-time working spouse or partner, including 80.5% of women and 40.2% of men (P < .001). Nearly one-third (30.1%) had a spouse or partner who is a physician. Thirty-two percent of married or partnered male pediatricians and 12.4% of female pediatricians had a spouse or partner who was not working. Among the spouses or partners who were not working, 34.9% had a bachelor’s degree, 31.2% had a masters’ degree, and 18.6% had a graduate or professional degree (eg, MD, DDS, DVM, JD).
Four in 10 pediatrician respondents reported working in a primary care position, 38.3% reported working in a subspecialty or primary and subspecialty care position, 9.5% reported working as a hospitalist, 5.6% reported working in fellowship training, 3.6% reported “other,” and 1.9% were not working. Twenty percent were working part-time, including 30.0% of women and 2.4% of men (P < .001).
Division of Home Responsibilities According to Gender
Women pediatricians were more likely than men to report having primary responsibility for 6 of the 9 household responsibilities, including coordinating schedules, doing laundry, grocery shopping, cooking and cleaning, and caring for pets (Fig 1). Men were more likely to report having primary responsibility for the remaining activities (home and/or car repair and maintenance, outdoor work, and home budget management; P < .001). In the multivariable analysis, after we controlled for work hours, work status of spouse or partner, cohort, number of children, specialty, concern with educational debt, and income, all gender effects remained significant (P < .05), except for home budget management (see Supplemental Table 3).
Percentage of participants who have primary responsibility and shared responsibility for household work. The survey question was “In your household, who has the primary responsibility for each of the following items?” Response options were as follows: “Largely, I do”; shared responsibility, which included “Others do” (eg, child, relative, ex-spouse or ex-partner, or friend) and “Equally shared between me and spouse/partner/other”; “Largely, my spouse/partner does”; and not applicable. “Not applicable” responses were removed from analysis; n varies from 688 (caring for pets) to 1288 (cooking). A percentage is not shown for “spouse/partner has primary responsibility.” P < .001 for all χ2 tests in which primary responsibility, shared responsibility, and spouse/partner has primary responsibility were compared by gender.
Percentage of participants who have primary responsibility and shared responsibility for household work. The survey question was “In your household, who has the primary responsibility for each of the following items?” Response options were as follows: “Largely, I do”; shared responsibility, which included “Others do” (eg, child, relative, ex-spouse or ex-partner, or friend) and “Equally shared between me and spouse/partner/other”; “Largely, my spouse/partner does”; and not applicable. “Not applicable” responses were removed from analysis; n varies from 688 (caring for pets) to 1288 (cooking). A percentage is not shown for “spouse/partner has primary responsibility.” P < .001 for all χ2 tests in which primary responsibility, shared responsibility, and spouse/partner has primary responsibility were compared by gender.
Female pediatricians were more likely than male pediatricians to report having primary responsibility for the 7 home responsibilities related to the care of their own children (P < .001; Fig 2). These relationships with gender remained in the multivariable analysis (P < .001; Supplemental Table 4).
Percentage of participants who have primary responsibility and shared responsibility for activities related to own children. The survey question was “In your household, who has the primary responsibility for each of the following items?” Response options were as follows: “Largely, I do”; shared responsibility, which included “Others do” (eg, child, relative, ex-spouse or ex-partner, and friend) and “Equally shared between me and spouse/partner/other”; “Largely, my spouse/partner does”; and not applicable. “Not applicable” responses were removed from the analysis; n varies from 750 (homework) to 1012 (routine care). A percentage is not shown for “spouse/partner has primary responsibility.” P < .001 for all χ2 tests in which primary responsibility, shared responsibility, and spouse/partner has primary responsibility were compared by gender.
Percentage of participants who have primary responsibility and shared responsibility for activities related to own children. The survey question was “In your household, who has the primary responsibility for each of the following items?” Response options were as follows: “Largely, I do”; shared responsibility, which included “Others do” (eg, child, relative, ex-spouse or ex-partner, and friend) and “Equally shared between me and spouse/partner/other”; “Largely, my spouse/partner does”; and not applicable. “Not applicable” responses were removed from the analysis; n varies from 750 (homework) to 1012 (routine care). A percentage is not shown for “spouse/partner has primary responsibility.” P < .001 for all χ2 tests in which primary responsibility, shared responsibility, and spouse/partner has primary responsibility were compared by gender.
Likelihood to Hire Help According to Gender
Female pediatricians were more likely than male pediatricians to report hiring help for cleaning (P < .001), outdoor work (P < .05), and routine care of children (P < .01; Fig 3). Among all respondents, in the multivariable analysis (Supplemental Table 5), female pediatricians were more likely than male pediatricians to hire help for cleaning (adjusted odds ratio [aOR] = 1.54; 95% confidence interval [CI]: 1.16–2.05), yet gender was not significant for hiring for outdoor work or routine care of children.
Percentage of participants who hire help for home responsibilities (n = 1289). P < .05 for all χ2 tests in which hiring help was compared by gender. a The survey question was “In your household, do you have hired help for each of the following items?” The response option was yes or no.
Percentage of participants who hire help for home responsibilities (n = 1289). P < .05 for all χ2 tests in which hiring help was compared by gender. a The survey question was “In your household, do you have hired help for each of the following items?” The response option was yes or no.
Time, Satisfaction, and Work-Life Balance Attainment According to Gender
Regarding their time, 44.2% of respondents always felt rushed, 51.1% felt rushed only sometimes, and 4.7% almost never felt rushed. Half of female pediatricians and one-third of male pediatricians reported always feeling rushed (P < .001). This relationship remained in the multivariable analysis (aOR = 2.47; 95% CI: 1.85–3.29; Table 1). Fifty-six percent of respondents were completely or very satisfied with their share of home responsibilities. Female pediatricians were less likely than male pediatricians to report such satisfaction (52.3% vs 62.0%, respectively; P < .01), and this relationship remained in the multivariable analysis (aOR = 0.66; 95% CI: 0.49–0.87; Table 1). Seventeen percent reported that they were very successful in balancing their job and other areas of their life, including 15.1% of women and 19.3% of men (P = .05); 60% (59% of women and 62% of men) reported being somewhat successful. In the multivariable analysis, women were less likely than men to report being very successful (aOR = 0.61; 95% CI: 0.42–0.88). In addition to gender, concerns about educational debt and working part-time were significant factors associated with all 3 outcomes.
Factors Associated With Rushed All the Time, Satisfied With Share of Responsibilities, and Success Balancing Job and Other Areas of Life
| Always Feel Rushed, aOR (95% CI)a | Completely or Very Satisfied With Share of Household Responsibilities, aOR (95% CI)b | Very Successful Balancing Job and Other Areas of Life, aOR (95% CI)c | |
|---|---|---|---|
| Female sex (referent: male sex) | 2.47 (1.85–3.29)* | 0.66 (0.49–0.87)* | 0.61 (0.42–0.88)* |
| Have children <18 y of age (referent: no) | 2.83 (2.05–3.92)* | 0.74 (0.53–1.03) | 0.68 (0.46–0.99)* |
| Very or somewhat concerned with educational debt (referent: not concerned) | 2.00 (1.54–2.60)* | 0.69 (0.54–0.90)* | 0.57 (0.40–0.82)* |
| Full-time working spouse or partner (referent: not married or partnered or spouse or partner not working or working part-time) | 1.22 (0.94–1.59) | 0.67 (0.51–0.87)* | 0.79 (0.56–1.11) |
| Specialty (referent: primary care) | |||
| Hospitalist | 0.90 (0.58–1.39) | 0.91 (0.60–1.40) | 1.01 (0.59–1.73) |
| Subspecialist | 1.19 (0.90–1.56) | 0.87 (0.66–1.14) | 0.70 (0.49–1.00)* |
| Other | 0.94 (0.61–1.46) | 1.02 (0.66–1.58) | 0.79 (0.44–1.44) |
| Own work hours are part-time (referent: full-time) | 0.67 (0.48–0.93)* | 1.44 (1.04–2.00)* | 2.33 (1.53–3.56)* |
| 2009–11 resident graduates cohort (referent: 2002–04 residency graduates) | 0.66 (0.50–0.85)* | 1.09 (0.84–1.42) | 1.11 (0.79–1.56) |
| Own income (referent: <$200 000), $ | |||
| 200 000–249 999 | 0.84 (0.61–1.16) | 1.00 (0.73–1.38) | 1.70 (1.15–2.52)* |
| ≥250 000 | 0.80 (0.57–1.12) | 1.01 (0.72–1.42) | 1.25 (0.81–1.94) |
| Always Feel Rushed, aOR (95% CI)a | Completely or Very Satisfied With Share of Household Responsibilities, aOR (95% CI)b | Very Successful Balancing Job and Other Areas of Life, aOR (95% CI)c | |
|---|---|---|---|
| Female sex (referent: male sex) | 2.47 (1.85–3.29)* | 0.66 (0.49–0.87)* | 0.61 (0.42–0.88)* |
| Have children <18 y of age (referent: no) | 2.83 (2.05–3.92)* | 0.74 (0.53–1.03) | 0.68 (0.46–0.99)* |
| Very or somewhat concerned with educational debt (referent: not concerned) | 2.00 (1.54–2.60)* | 0.69 (0.54–0.90)* | 0.57 (0.40–0.82)* |
| Full-time working spouse or partner (referent: not married or partnered or spouse or partner not working or working part-time) | 1.22 (0.94–1.59) | 0.67 (0.51–0.87)* | 0.79 (0.56–1.11) |
| Specialty (referent: primary care) | |||
| Hospitalist | 0.90 (0.58–1.39) | 0.91 (0.60–1.40) | 1.01 (0.59–1.73) |
| Subspecialist | 1.19 (0.90–1.56) | 0.87 (0.66–1.14) | 0.70 (0.49–1.00)* |
| Other | 0.94 (0.61–1.46) | 1.02 (0.66–1.58) | 0.79 (0.44–1.44) |
| Own work hours are part-time (referent: full-time) | 0.67 (0.48–0.93)* | 1.44 (1.04–2.00)* | 2.33 (1.53–3.56)* |
| 2009–11 resident graduates cohort (referent: 2002–04 residency graduates) | 0.66 (0.50–0.85)* | 1.09 (0.84–1.42) | 1.11 (0.79–1.56) |
| Own income (referent: <$200 000), $ | |||
| 200 000–249 999 | 0.84 (0.61–1.16) | 1.00 (0.73–1.38) | 1.70 (1.15–2.52)* |
| ≥250 000 | 0.80 (0.57–1.12) | 1.01 (0.72–1.42) | 1.25 (0.81–1.94) |
The survey question was “In general, how do you feel about your time? Would you say…?” Response options included the following: “I always feel rushed,” “I only sometimes feel rushed,” and “I almost never feel rushed.” Responses were dichotomized as follows: rushed all the time (always feel rushed) versus sometimes or almost never feel rushed.
The survey question was “How satisfied are you with your share of responsibilities relative to others in your home?” Response options included the following: not at all satisfied, not very satisfied, somewhat satisfied, very satisfied, completely satisfied, and not applicable. “Not applicable” responses were removed from analysis. Responses were dichotomized as follows: completely satisfied or very satisfied versus somewhat satisfied, not very satisfied, or not at all satisfied.
The survey question was “How successful do you feel at balancing your job and the other areas of your life?” Response options included the following: not at all successful, not very successful, somewhat successful, and very successful. Responses were dichotomized as follows: very successful versus somewhat successful, not very successful, or not at all successful.
P ≤ .05.
Work-Life Balance Challenges and Solutions
We reviewed open-ended comments from 1145 participants who described challenges with and/or solutions for the need to balance work and personal responsibilities. Major themes used to summarize participants’ comments and example quotes to support these themes are reported in Table 2. Predominant themes were time management; expectations and/or perfectionism; self-care; work and career requirements, including doing work after hours; personal responsibilities, relationships, and support; and financial challenges. Example quotes that participants provided on tips that have helped with work-life balance are provided next to the appropriate challenge.
Challenges to Balancing Personal and Work Responsibilities and Tips From Participants
| Themesa | Illustrative Quotes Describing Challengesb | Illustrative Quotes Describing Suggested Tipsc |
|---|---|---|
| Time | ||
| Not enough time in the day for all responsibilities | “Not enough hours in the day. Between work responsibilities, chores and caring for our 2 and 4 year old there is little to no time left for couple time with my husband or alone time for me.” | “Online family calendar (google calendar) to keep track of all the appointments and obligations – EVERYTHING goes in there.” |
| Expectations and/or perfectionism | ||
| Expect to be perfect in all facets of life and to be there for everyone; feelings of guilt when one cannot be there for family or patients | “It is very hard to be there 100% for each aspect of my life – I feel like I am always splitting my time/energy/attention between the different facets of my life and nothing ever gets done fully or completely.” | “Learning to say ‘no’ to projects and recognizing my limitations. We haven’t been taught to turn down opportunities in the medical field…” |
| “Expecting myself to do it all. It can’t be done to the level of perfection that I want without compromise. So learning to prioritize and let some things that are not essential go & delegating other things.” | “Let it go. Sometimes minor things seem major and we use up too much energy. Realize the bigger picture and roll with it.” | |
| Self-care | ||
| Everyone’s needs are prioritized before one’s own; too exhausted and short on time for own health and well-being | “Finding time for myself, I put everyone else before me and my needs.” | “(1) Give yourself permission to engage in SELF-CARE. If I can’t care for myself, then I can NOT be present for others. (2) It’s ok to have hired help and ask for help.” |
| Work and career requirements and doing work “after hours” | ||
| Excessive work demands, including call, documentation, and career requirements (CME, MOC); work-life bleed | “The pace of work is relentless. A bad day, during which I am unable to complete enough charts or clinic extends translates into multiple evening and weekend hours away from my family. I like my job...the issue is mainly the charting and administrative side of things. I ALWAYS have charts to do and could pretty much work continuous 12 hour days if I wanted to...Sometimes you end up feeling like no amount of effort is good enough...nobody liked dinner AND you still have delinquent charts.” | “I feel incredibly lucky to be able to work part time. I cannot imagine any kind of balance without that option.” |
| — | “…I know that I need to create templates for myself on the EMR to help me be more efficient.” | |
| Personal responsibilities, relationships, and support | ||
| Demands and support at home; delegating household chores | “Being a working mom, although rewarding, is tough. Expectations at work seem to grow along with your children. Both need and want more of you as time goes by. Our children are victims of their own unconditional love, much more tolerant of our outside obligations than the reverse.” | “Essentially my tip would be to find a great spouse who isn’t going to be resentful of the division of labor in a household.” |
| “I would say that balancing a happy married life with truly shared responsibilities with my spouse has been a great challenge. And finding time to spend with my spouse given that he himself is also a physician and an extreme sport aficionado.” | “Hiring someone to help with laundry, cleaning and driving. Also I have a very modern husband who has a creative schedule and is willing to share home responsibilities equally.” | |
| “Helping my spouse more with household activities & childcare. I am full-time and she is 70%, but [she] does a disproportionate share of home & childcare [tasks].” | “HIRED HELP!!! My husband doesn’t like spending the money but he sees now that it takes some pressure off me which makes me happier.” | |
| — | “What worked for me was leaving academic medicine and taking a job with very regular working hours. I also found the new job with its predictable schedule allowed me and my partner to more equitably share our responsibilities at home and with our children.” | |
| Financial challenges | ||
| Education debt, salary, and lack of money to hire help | “We are a two doctor household, and both my husband and I could use a 1950s era ‘wife.’ But we are too burdened by [medical] school debt to have discretionary income to ‘hire out’ the tasks that might help ease the pressure.” | No tips identified in comments. |
| Themesa | Illustrative Quotes Describing Challengesb | Illustrative Quotes Describing Suggested Tipsc |
|---|---|---|
| Time | ||
| Not enough time in the day for all responsibilities | “Not enough hours in the day. Between work responsibilities, chores and caring for our 2 and 4 year old there is little to no time left for couple time with my husband or alone time for me.” | “Online family calendar (google calendar) to keep track of all the appointments and obligations – EVERYTHING goes in there.” |
| Expectations and/or perfectionism | ||
| Expect to be perfect in all facets of life and to be there for everyone; feelings of guilt when one cannot be there for family or patients | “It is very hard to be there 100% for each aspect of my life – I feel like I am always splitting my time/energy/attention between the different facets of my life and nothing ever gets done fully or completely.” | “Learning to say ‘no’ to projects and recognizing my limitations. We haven’t been taught to turn down opportunities in the medical field…” |
| “Expecting myself to do it all. It can’t be done to the level of perfection that I want without compromise. So learning to prioritize and let some things that are not essential go & delegating other things.” | “Let it go. Sometimes minor things seem major and we use up too much energy. Realize the bigger picture and roll with it.” | |
| Self-care | ||
| Everyone’s needs are prioritized before one’s own; too exhausted and short on time for own health and well-being | “Finding time for myself, I put everyone else before me and my needs.” | “(1) Give yourself permission to engage in SELF-CARE. If I can’t care for myself, then I can NOT be present for others. (2) It’s ok to have hired help and ask for help.” |
| Work and career requirements and doing work “after hours” | ||
| Excessive work demands, including call, documentation, and career requirements (CME, MOC); work-life bleed | “The pace of work is relentless. A bad day, during which I am unable to complete enough charts or clinic extends translates into multiple evening and weekend hours away from my family. I like my job...the issue is mainly the charting and administrative side of things. I ALWAYS have charts to do and could pretty much work continuous 12 hour days if I wanted to...Sometimes you end up feeling like no amount of effort is good enough...nobody liked dinner AND you still have delinquent charts.” | “I feel incredibly lucky to be able to work part time. I cannot imagine any kind of balance without that option.” |
| — | “…I know that I need to create templates for myself on the EMR to help me be more efficient.” | |
| Personal responsibilities, relationships, and support | ||
| Demands and support at home; delegating household chores | “Being a working mom, although rewarding, is tough. Expectations at work seem to grow along with your children. Both need and want more of you as time goes by. Our children are victims of their own unconditional love, much more tolerant of our outside obligations than the reverse.” | “Essentially my tip would be to find a great spouse who isn’t going to be resentful of the division of labor in a household.” |
| “I would say that balancing a happy married life with truly shared responsibilities with my spouse has been a great challenge. And finding time to spend with my spouse given that he himself is also a physician and an extreme sport aficionado.” | “Hiring someone to help with laundry, cleaning and driving. Also I have a very modern husband who has a creative schedule and is willing to share home responsibilities equally.” | |
| “Helping my spouse more with household activities & childcare. I am full-time and she is 70%, but [she] does a disproportionate share of home & childcare [tasks].” | “HIRED HELP!!! My husband doesn’t like spending the money but he sees now that it takes some pressure off me which makes me happier.” | |
| — | “What worked for me was leaving academic medicine and taking a job with very regular working hours. I also found the new job with its predictable schedule allowed me and my partner to more equitably share our responsibilities at home and with our children.” | |
| Financial challenges | ||
| Education debt, salary, and lack of money to hire help | “We are a two doctor household, and both my husband and I could use a 1950s era ‘wife.’ But we are too burdened by [medical] school debt to have discretionary income to ‘hire out’ the tasks that might help ease the pressure.” | No tips identified in comments. |
CME, continuing medical education; EMR, electronic medical record; MOC, Maintenance of Certification .
Predominant themes were identified in review of open-ended comments on the following question: “What has been your greatest challenge in trying to balance your work and personal responsibilities?”
Open-ended comments on challenges.
Open-ended comments on tips: “Please share a tip that has helped you achieve a higher level of work-life balance.”
Among the participants who reported ≥1 challenge in balancing their responsibilities, the number of challenges was slightly higher among female (2.1) participants compared with male (1.8) participants (P < .001). Female pediatricians were also more likely than male pediatricians to report the following challenges: self-care (22.5% vs 15.6%; P < .01), time management (21.5% vs 12.6%; P < .001), personal relationships (18.5% vs 11.3%; P < .01), expectations and/or perfectionism (12.5% vs 4.3%; P < .001), and financial challenges (4.6% vs 2.4%; P < .05). Male pediatricians were more likely than female pediatricians to report challenges focused on work and career requirements (52.3% vs 44.7%; P < .01); however, female pediatricians were more likely to specifically comment on doing work after hours (9.5% vs 5.0%; P < .01).
Discussion
We conducted a cross-sectional study to examine factors associated with the division of household responsibilities for early- and mid-career pediatricians who are known to struggle with work-life balance. Among the most important findings in this study is that female pediatricians spend more time on household responsibilities than male pediatricians and that gender is a key factor associated with work-life balance satisfaction. Importantly, only approximately half of women were satisfied with their share of responsibilities in the home, a smaller percentage than men. Additionally, female pediatricians were more likely than male pediatricians to report feeling rushed and were less likely to report achieving success in balancing their job and other areas of their life.
Our findings were consistent with our hypothesis that female pediatricians spend more time on household and child care responsibilities than male pediatricians and are similar to studies of these trends in the general population.23–26 Research used to examine the amount of time spent on household activities by gender over time reveals that although the gap is beginning to close, women currently continue to spend more time in these activities than men.24 Interestingly, in our study, although personal responsibilities, relationships, and support emerged as key themes related to work-life balance, only a few participants identified the need for more equitable sharing of household responsibilities and child care tasks with spouses and partners as a potential solution. It has been suggested that patterns of inequitable household responsibilities may start as early as childhood,19 suggesting the possibility that inequitable responsibilities may be considered the norm.
Previous single-institution studies of physicians have revealed similar findings of female faculty reporting the devotion of more time to household tasks and child care,4,16,17 yet our study is a national sample of pediatricians, including those working in primary, subspecialty, and hospital care. It is interesting to find the persistence of these gender disparities as they relate to the care of one’s own children, particularly in the field of pediatrics in which professionals dedicate their careers to caring for children. Identifying ways to ameliorate these disparities are particularly important because more perceived time spent in household tasks, including child-rearing and housework, has been associated with psychological distress, adverse physiologic outcomes,4,16,17,27 and poor patient safety outcomes.8–10,20
The frequency of women graduating from medical school has increased significantly over the last half-century (51% of matriculants in 2018),28 with a concurrent increase in the percentage of dual-profession and dual-physician relationships. Our data revealed that of pediatrician respondents who were married or partnered, two-thirds (80% of women and 40% of men) reported having a full-time working spouse or partner. Dual-professional relationships are known to be particularly prone to work-home conflicts, which are a key contributing factor to burnout, depression, and job dissatisfaction.29,30 Challenges with work-life balance have been cited as obstacles for women in leadership roles in medicine.16,31 Although we do not examine leadership roles in our study, our findings of gender disparities in home responsibilities and work-life balance in a broad sample of pediatricians reveal that such factors may contribute to gender disparities in leadership roles at work.
Our study has several limitations, including that all data are self-reported. Second, we did not collect data from respondents’ spouses and/or partners in our study. Previous studies that include both individuals in a partnership revealed agreement between partners on reports of the extent of division of household responsibilities.21 Third, our study was limited to early- and mid-career pediatricians; therefore, the generalizability of the findings to other specialties or career stages remains unclear. Fourth, although the response rate among PLACES participants who completed the study survey was high, the initial project sign-up rate was lower at 41%. However, efforts were made to account for nonresponse bias by using a data-weighting procedure, and the sign-up rate is similar to or higher than that of other longitudinal studies reported in the literature.12 Fifth, in our survey, we asked if participants were married or partnered but did not ask if they were same- or different-sex couples. Previous reports have revealed that same-sex couples were more likely to share household responsibilities.21 Sixth, although our survey was focused primarily on execution of concrete tasks related to household duties, we did not examine the extent to which some of the more “invisible” activities related to the work of child care and household maintenance (eg, the mental, emotional, and information-processing work of child care, which has previously been shown to occupy women to a greater extent than men) might further exacerbate the identified gender discrepancies.32,33 Seventh, although we were able to control for pediatrician income in our models, we did not have data on spouse or partner income, which might impact the division of responsibilities. Finally, the data reported in this article are cross-sectional and therefore do not permit an understanding of the temporal nature of how factors associated with physician health and wellness might have an impact over time, which will be possible with future PLACES data.
Conclusions
Work-life balance remains a priority for pediatricians and is known to be associated with career satisfaction and productivity. In this study, we identify significant gender disparities of distribution of activities in the home that may contribute to work-life balance dissatisfaction for physicians. Focused attention on programs that develop skills to negotiate the balance of responsibilities in the home as well as in the workplace setting may have the potential to ameliorate these disparities and contribute to increased work-life balance and satisfaction.
Acknowledgments
We thank the pediatricians participating in PLACES who are all giving generously of their time to make this project possible. Members of the AAP PLACES Project Advisory Committee include the following: Bobbi J. Byrne, MD, FAAP, Chairperson; Gary L. Freed, MD, MPH, FAAP; Shesha Kalyan Katakam, MD, MPH, FAAP; Laurel K. Leslie, MD, MPH, FAAP; Ashley A. Miller, MD, FAAP; and Amy J. Starmer, MD, MPH, FAAP.
Dr Starmer conceptualized and designed the study, assisted with interpretation of the data, drafted the initial manuscript, and reviewed and revised the manuscript; Ms Frintner assisted with the conception and design of the study, conducted the initial analyses, coordinated and supervised data collection, and reviewed and revised the manuscript; Ms Somberg assisted with data collection and analysis and critically reviewed the manuscript; Drs Freed, Matos, and Byrne assisted with the conception and design of the study and critically reviewed the manuscript; and all authors approved the final manuscript as submitted.
FUNDING: Supported by the American Academy of Pediatrics.
Dr Matos' current affiliation is People Science Practice, Culture Amp, New York, New York.
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