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OBJECTIVE

To compare pediatrician career satisfaction and wellbeing by sex during the coronavirus disease 2019 pandemic with prepandemic years using longitudinal survey data.

METHODS

Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine career satisfaction and wellbeing from 2012 to 2021 among 2002–2004 and 2009–2011 residency graduates (n = 1760). Mixed effects logistic regression, including key pediatrician characteristics, examined career satisfaction and wellbeing measures for sex (female vs male), pandemic year (2012–2019 vs 2020–2021), and their interaction effect. Adjusted predicted percentage values (PVs) were determined.

RESULTS

In total, 73.4% of participants identified as female. Adjusting for key pediatrician characteristics, differences were found by sex for satisfaction and 4 of 5 wellbeing measures, by pandemic year for 2 wellbeing measures, and the interaction of sex and pandemic year for 3 wellbeing measures. Female pediatricians reported higher levels of anxiety, sadness, and work stress, with greater differences during the pandemic. For example, female pediatricians (PV = 22.6, confidence interval [CI] = 21.0–24.3) were more likely than male pediatricians (PV = 14.2, CI = 12.0–16.4) to report anxiety during pre-pandemic years, and the difference between female pediatricians (PV = 29.3, CI = 26.7–32.0) and male pediatricians (PV = 12.4, CI = 9.3–15.5) increased during pandemic years (sex by pandemic year interaction, P < .001).

CONCLUSIONS

Compared with male pediatricians, female pediatricians reported worse anxiety, sadness, and stress at work, and the differences were more pronounced during the pandemic.

What’s Known on This Subject:

Among specialties, pediatrics has the highest percentage of female physicians. Before the COVID-19 pandemic, important differences between female and male physicians were reported, including work–life balance challenges.

What This Study Adds:

Based on 10 years of longitudinal survey data from pediatricians, compared with male pediatricians, female pediatricians reported lower career satisfaction and wellbeing on measures of anxiety, sadness, and stress at work, with differences more pronounced during the COVID-19 pandemic.

Pediatrician careers can be both personally rewarding and, at times, frustrating.1,2 Pediatrics has the highest proportion of female physicians among specialties (65% in 2021).3 Studies have revealed important differences between female and male physicians, including that female physicians are more likely to report that they practice general rather than subspecialty pediatrics,4,5 work fewer hours,5 earn less income,5,7 and have more work–life challenges,8,10 including bearing the primary responsibility for household tasks and childcare.11,12 Previous studies using survey data from the American Academy of Pediatrics (AAP) Pediatrician Life and Career Experience Study (PLACES) revealed that among early and midcareer pediatricians, 8 in 10 reported they were satisfied with their career as a physician,13,15 and nearly 9 in 10 pediatricians found their work personally rewarding across 9 years (2012–2020).1 

The coronavirus disease 2019 (COVID-19) pandemic and its aftermath have taken a toll on children and families and caused additional stress for many, including pediatricians who are often working parents themselves. However, little has been published on pediatrician wellbeing, especially during the pandemic.

Using longitudinal survey data, we examined pediatrician career satisfaction and wellbeing by sex during the first 2 years of the COVID-19 pandemic (2020–2021) compared with pre-pandemic years (2012–2019).

We used 10 years of survey data from the national AAP study, PLACES, that were collected from the same pediatrician participants each year.16 PLACES was launched in 2012 to track the career and life choices and experiences of pediatricians. Participants were recruited early in their careers by using a longitudinal design. Participants are surveyed twice annually, completing a main study annual survey covering several domains measured each year (eg, work attributes, satisfaction, wellbeing, life experiences) and a shorter survey on rotating topics prioritized by participants. The current study uses data from 2 age cohorts who graduated from residency from 2002 to 2004 or from 2009 to 2011 and were recruited in 2012; the mean ages in 2021 were 49.0 and 42.2 years, respectively. Four in 10 pediatricians (1925/4677) invited to participate in PLACES initially signed up for the longitudinal study and included both AAP members and nonmembers. Additional details regarding the PLACES methodology, including recruitment, have been described previously.16 Some attrition occurred across years, with participation rates ranging from a high of 94% in 2012 to 76% in 2021; 1760 (98%) responded to the main study annual survey in multiple years and were included in these analyses.

The content domains and questions for the PLACES main study annual surveys were developed through (1) content prioritization by a project advisory committee, (2) a literature review to identify related, existing questions, and (3) cognitive interviews and pilot tests to assess how questions were interpreted by participants. When available, survey questions were adapted from other physician or national studies.17,22 

All study data were self-reported. During study recruitment, PLACES participants provided some demographic information and answered, “What is your sex?” (response options included female and male). We use sex instead of gender throughout this manuscript to be consistent with the survey wording. Each year, from 2012 to 2021, participants answered the same survey questions about their satisfaction and wellbeing. For the current study, we examined 1 global measure of career satisfaction that was adapted from the Physician Worklife Study17,18 and defined as agreement with “All things considered, I am satisfied with my career as a physician.” We also examined 5 measures of wellbeing, including self-reported anxiety, sadness, stress at work, stress balancing home or work responsibilities, and overall general health, which were also adapted from other physician and survey studies17,18,20,22 and are described in Table 1.

TABLE 1

Career Satisfaction and Wellbeing Survey Questions and Responsesa

QuestionResponse Options
Satisfaction measure  
 All things considered, I am satisfied with my career as a physician. Strongly disagree; Disagree; Neither agree nor disagree; Agree; Strongly agree 
Wellbeing measures  
 Anxiety: In the past year, how often have you felt anxious or nervous? Never; Almost never; Sometimes; Fairly often; Very often 
 Sadness: In the past year, how often have you felt sad or depressed? Never; Almost never; Sometimes; Fairly often; Very often 
 Stress at work: In general, how stressed do you feel at work? Not at all stressed; A little stressed; Moderately stressed; Very stressed 
 Stress balancing home and work responsibilities: In general, how stressed do you feel in your efforts to balance work and personal responsibilities? Not at all stressed; A little stressed; Moderately stressed; Very stressed 
 General health: In general, would you say your health is: Poor; Fair; Good; Very good; Excellent 
QuestionResponse Options
Satisfaction measure  
 All things considered, I am satisfied with my career as a physician. Strongly disagree; Disagree; Neither agree nor disagree; Agree; Strongly agree 
Wellbeing measures  
 Anxiety: In the past year, how often have you felt anxious or nervous? Never; Almost never; Sometimes; Fairly often; Very often 
 Sadness: In the past year, how often have you felt sad or depressed? Never; Almost never; Sometimes; Fairly often; Very often 
 Stress at work: In general, how stressed do you feel at work? Not at all stressed; A little stressed; Moderately stressed; Very stressed 
 Stress balancing home and work responsibilities: In general, how stressed do you feel in your efforts to balance work and personal responsibilities? Not at all stressed; A little stressed; Moderately stressed; Very stressed 
 General health: In general, would you say your health is: Poor; Fair; Good; Very good; Excellent 
a

Survey questions were developed by AAP health services researchers who have written or reviewed >100 physician surveys. The questions were based on literature reviews, other published surveys17,,18,20,21 ,22 and input by practicing pediatricians and the PLACES project advisory committee.

As shown in Table 2, participants also answered questions on their race and ethnicity, medical school location, parenthood status, part-time hours, and subspecialty training.

TABLE 2

Pediatricians’ Reported Characteristics

CharacteristicPercentage (n)
Sex  
 Female 73.4 (1291) 
 Male 26.6 (469) 
Age cohort  
 2009–2011 residency graduates 49.9 (878) 
 2002–2004 residency graduates 50.1 (882) 
Race and ethnicity  
 URM (Black or African American, Hispanic or Latino, American Indian, Alaska Native, Native Hawaiian, other Pacific Islander) 14.6 (257) 
 Non-URM (white, Asian, or other) 85.4 (1503) 
Medical school location  
 United States 87.0 (1531) 
 International 13.0 (229) 
Parenthood status in 2021*  
 Yes 89.7 (1214) 
 No 10.3 (140) 
Part-time hr in 2021*  
 Yes 24.9 (319) 
 No 75.1 (960) 
Subspecialty training  
 No subspecialty fellowship 58.3 (1026) 
 Subspecialty fellowship 41.7 (734) 
CharacteristicPercentage (n)
Sex  
 Female 73.4 (1291) 
 Male 26.6 (469) 
Age cohort  
 2009–2011 residency graduates 49.9 (878) 
 2002–2004 residency graduates 50.1 (882) 
Race and ethnicity  
 URM (Black or African American, Hispanic or Latino, American Indian, Alaska Native, Native Hawaiian, other Pacific Islander) 14.6 (257) 
 Non-URM (white, Asian, or other) 85.4 (1503) 
Medical school location  
 United States 87.0 (1531) 
 International 13.0 (229) 
Parenthood status in 2021*  
 Yes 89.7 (1214) 
 No 10.3 (140) 
Part-time hr in 2021*  
 Yes 24.9 (319) 
 No 75.1 (960) 
Subspecialty training  
 No subspecialty fellowship 58.3 (1026) 
 Subspecialty fellowship 41.7 (734) 

URM, underrepresented in medicine.

*

Percentages and numbers are included for 2021 only; some participants did not respond in 2021, which is why the number is lower than the other characteristics.

We used mixed effects logistic regression for longitudinal analysis to examine career satisfaction and the 5 wellbeing measures and obtain derived adjusted predicted percentage values (PV)23 for (1) sex (female vs male), (2) pandemic year (2012–2019 vs 2020–2021), and (3) the interaction of sex and pandemic year. This approach uses all available data, regardless of whether the pediatrician responded in all years or had some missing values. It accounts for the fact that the same individual is responding on multiple occasions.24 We report the PVs and 95% confidence intervals (CIs) and significant differences for (1) sex, (2) pandemic year, and (3) the interaction of sex and pandemic year. Each of the 6 models (1 career satisfaction measure and 5 wellbeing measures) included the following variables: sex, pandemic year, survey year, age cohort, race and ethnicity, medical school location, parenthood status, part-time hours, and subspecialty training, which were each held at their respective sample mean to obtain the PVs.

All analyses were conducted by using Stata 17 (StataCorp, College Station, TX), and a P value of < .05 was considered statistically significant. The AAP Institutional Review Board approved the study.

As shown in Table 2, 73.4% of PLACES participants identified as female, 14.6% identified as a race or ethnicity underrepresented in medicine, and 13.0% graduated from an international medical school. A total of 42% of participants reported they completed a subspecialty fellowship.

As shown in Table 3, a large majority of pediatricians reported satisfaction with their careers. This was true for both female (PV = 80.9, CI = 79.4–82.4) and male (PV = 87.0, CI = 85.0–89.1) pediatricians, although overall rates were significantly higher for male pediatricians (P < .001).

TABLE 3

Female and Male Pediatricians’ Reported Career Satisfaction and Wellbeing Pre-Pandemic and Pandemic Year

Adjusted PV* (95% CI)
 All years 2012–2021 P, female vs male main effect Pre-pandemic year 2012–2019 Pandemic year 2020–2021 P, pre-pandemic year vs pandemic year main effect P, interaction: sex and pandemic year 
Satisfaction measure       
 Satisfied with career as a physician: strongly agree or agree  <.001   .07 .50 
  Female 80.9 (79.4–82.4)  80.7 (79.2–82.2) 81.9 (79.7–84.0)   
  Male 87.0 (85.0–89.1)  86.6 (84.4–88.8) 88.9 (86.0–91.8)   
Wellbeing measures       
 Anxiety: anxious or nervous very or fairly often  <.001   <.001 <.001 
  Female 23.7 (22.1–25.4)  22.6 (21.0–24.3) 29.3 (26.7–32.0)   
  Male 13.9 (11.8–16.0)  14.2 (12.0–16.4) 12.4 (9.3–15.5)   
 Sadness: sad or depressed very or fairly often  <.001   .16 <.05 
  Female 11.7 (10.6–12.9)  11.4 (10.2–12.6) 13.5 (11.4–15.5)   
  Male 7.2 (5.7–8.6)  7.5 (5.9–9.1) 5.9 (3.8–8.0)   
 Stress at work: very stressed  <.001   <.01 <.001 
  Female 9.3 (8.3–10.3)  8.6 (7.6–9.7) 12.7 (10.6–14.8)   
  Male 5.3 (4.1–6.5)  5.6 (4.3–6.8) 4.1 (2.4–5.8)   
 Stress balancing home and work responsibilities: very stressed  <.001   .08 .99 
  Female 17.9 (16.5–19.3)  18.1 (16.7–19.6) 16.7 (14.5–18.9)   
  Male 8.1 (6.6–9.6)  8.4 (6.8–10.0) 7.0 (4.8–9.3)   
 General health: poor or fair  .77   .05 .46 
  Female 6.9 (5.8–8.0)  7.1 (6.0–8.2) 6.2 (4.8–7.7)   
  Male 6.7 (5.1–8.3)  7.0 (5.3–8.7) 5.4 (3.4–7.4)   
Adjusted PV* (95% CI)
 All years 2012–2021 P, female vs male main effect Pre-pandemic year 2012–2019 Pandemic year 2020–2021 P, pre-pandemic year vs pandemic year main effect P, interaction: sex and pandemic year 
Satisfaction measure       
 Satisfied with career as a physician: strongly agree or agree  <.001   .07 .50 
  Female 80.9 (79.4–82.4)  80.7 (79.2–82.2) 81.9 (79.7–84.0)   
  Male 87.0 (85.0–89.1)  86.6 (84.4–88.8) 88.9 (86.0–91.8)   
Wellbeing measures       
 Anxiety: anxious or nervous very or fairly often  <.001   <.001 <.001 
  Female 23.7 (22.1–25.4)  22.6 (21.0–24.3) 29.3 (26.7–32.0)   
  Male 13.9 (11.8–16.0)  14.2 (12.0–16.4) 12.4 (9.3–15.5)   
 Sadness: sad or depressed very or fairly often  <.001   .16 <.05 
  Female 11.7 (10.6–12.9)  11.4 (10.2–12.6) 13.5 (11.4–15.5)   
  Male 7.2 (5.7–8.6)  7.5 (5.9–9.1) 5.9 (3.8–8.0)   
 Stress at work: very stressed  <.001   <.01 <.001 
  Female 9.3 (8.3–10.3)  8.6 (7.6–9.7) 12.7 (10.6–14.8)   
  Male 5.3 (4.1–6.5)  5.6 (4.3–6.8) 4.1 (2.4–5.8)   
 Stress balancing home and work responsibilities: very stressed  <.001   .08 .99 
  Female 17.9 (16.5–19.3)  18.1 (16.7–19.6) 16.7 (14.5–18.9)   
  Male 8.1 (6.6–9.6)  8.4 (6.8–10.0) 7.0 (4.8–9.3)   
 General health: poor or fair  .77   .05 .46 
  Female 6.9 (5.8–8.0)  7.1 (6.0–8.2) 6.2 (4.8–7.7)   
  Male 6.7 (5.1–8.3)  7.0 (5.3–8.7) 5.4 (3.4–7.4)   
*

PVs were obtained by using mixed effects logistic regression. Each model examined sex and pandemic year and included survey year, cohort, race and ethnicity, medical school location, parenthood status in 2021, part-time hours in 2021, and subspecialty training (each held at their respective sample mean).

On 4 of the 5 measures of wellbeing, female pediatricians were more likely to report negative experiences, with higher numbers reporting periods of anxiety, sadness, stress at work, and stress balancing home and work responsibilities. For example, female pediatricians (PV = 23.7, CI = 22.1–25.4) were more likely than male pediatricians (PV = 13.9, CI = 11.8–16.0) to report feeling anxious very or fairly often (P < .001).

As shown in Table 3, pediatricians reporting satisfaction with their career did not diminish during the pandemic; for both female and male pediatricians it remained high. However, female pediatricians reported increased rates of anxiety, sadness, and stress at work during the pandemic. Male pediatricians did not have the same increased rates. PVs for female pediatricians were double those of male pediatricians on all 3 measures (Fig 1). For example, female pediatricians (PV = 22.6, CI = 21.0–24.3) were more likely than male pediatricians (PV = 14.2, CI = 12.0–16.4) to report feeling anxious during pre-pandemic years, and the difference in reported anxiety for female pediatricians (PV = 29.3, CI = 26.7–32.0) and male pediatricians (PV = 12.4, CI = 9.3–15.5) increased during pandemic years, resulting in a statistically significant sex by pandemic year interaction (P < .001).

FIGURE 1

Female and male pediatricians’ reported anxiety, sadness, and stress at work pre-pandemic and pandemic year: adjusted predicted percentage.

PVs were obtained by using mixed effects logistic regression. Each model examined sex and pandemic year and included survey year, cohort, race and ethnicity, medical school location, parenthood status, part-time hours, and subspecialty training (each held at their respective sample mean).

FIGURE 1

Female and male pediatricians’ reported anxiety, sadness, and stress at work pre-pandemic and pandemic year: adjusted predicted percentage.

PVs were obtained by using mixed effects logistic regression. Each model examined sex and pandemic year and included survey year, cohort, race and ethnicity, medical school location, parenthood status, part-time hours, and subspecialty training (each held at their respective sample mean).

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Based on 10 years of longitudinal data (2012–2021) from a national study of pediatricians, female pediatricians reported lower wellbeing than male pediatricians on assessed measures of anxiety, sadness, and stress at work. These differences were more pronounced during the COVID-19 pandemic. Eight in 10 pediatricians reported satisfaction with their careers, although overall, female pediatricians were slightly less satisfied than male pediatricians. To our knowledge, no other comparison of a national sample of US physicians’ satisfaction and wellbeing before and during the COVID-19 pandemic has been conducted.

Our analysis highlighted overall worse wellbeing outcomes for female pediatricians on reported measures of anxiety, sadness, stress at work, and stress balancing home and work responsibilities. Although we did not see a change in reported stress balancing home and work responsibilities during the pandemic, overall, female pediatricians reported twice as much stress as male pediatricians. Previous studies conducted before the pandemic reveal that female physicians were more likely than male physicians to report challenges with work–life balance.12,13,25 A study that used PLACES data collected in 2015 revealed that female pediatricians reported spending more time on household and childcare responsibilities than male pediatricians, feeling less satisfied with their share of home responsibilities, and feeling more rushed with their time.11 

Our findings on the pandemic’s impact on adverse outcomes parallel a smaller study among obstetrics and gynecology professionals,26 another specialty with high rates of female physicians. The cross-sectional survey conducted in 2020 among clinicians, including nurses and physicians working in a large hospital system in New York City, revealed that female clinicians were more likely than male clinicians to screen positive for anxiety and less likely to report professional fulfillment.

Study limitations include that data are self-reported and limited to a narrow age range of participants. The generalizability of findings to other specialties or career stages is unclear. Although we used previously published measures of career satisfaction and wellbeing from reliable sources, we did not validate the survey items. Survey participation rates were high across years,1 but the initial project enrollment rate was lower.16 We were limited by the survey wording and response options for demographic questions, including sex. Finally, it is not known at this time whether the pandemic effects improved during the later stages of the pandemic.

In summary, our study revealed that from 2012 to 2021, female pediatricians reported worse wellbeing than male pediatricians, and the differences widened during the COVID-19 pandemic years of 2020 and 2021. Among pediatrics, which has a high rate of female physicians, there is a need for more attention on programs and policies at the organizational and structural levels designed to ameliorate these disparities and better support female pediatricians.27 

This study was supported by the AAP. The research presented in this paper is that of the authors and does not reflect the official policy of the AAP or the American Board of Pediatrics. We would like to acknowledge the valuable contribution of the PLACES participants.

Ms Frintner conceptualized the study, designed the data collection instruments, conducted analyses, and drafted the manuscript; Drs Leslie, Starmer, Byrne, and Freed conceptualized the study and participated in the drafting of the manuscript; Ms Gottschlich coordinated the collection of data, participated in the drafting of the manuscript, and reviewed the analyses; and all authors reviewed and revised the manuscript, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

FUNDING: The American Academy of Pediatricians (AAP) supported this project. The research presented in this paper is that of the authors and does not reflect the official policy of the AAP or the American Board of Pediatrics.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose.

AAP

American Academy of Pediatrics

CI

confidence interval

COVID-19

coronavirus disease 2019

PLACES

Pediatrician Life and Career Experience Study

PV

predicted percentage value

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