Still Exhausted: The Role of Residual Caregiving Fatigue on Women in Medicine and Science Across the Pipeline (Preprint)

Abstract

BACKGROUND Women account for approximately 70% of the global health care workforce1 Studies indicate that women have been disproportionately affected by the stresses of the pandemic2. While healthcare workers in all gender groups who were in caregiving roles at home, whether that be childcare or eldercare, experienced fear and anxiety about bringing the virus home3. However, prior research suggests that women in caregiving roles are more likely than men to experience stress and other adverse health impacts4. A recent study reported that female gender and caregiver status were predictors of increased stress during the pandemic5. In fact, as a result of COVID-19, female healthcare workers reportedly experienced a significant increase in symptoms such as depression, stress, anxiety, and insomnia in response to the COVID-19 pandemic2. Healthcare workers who were mothers or in mothering roles also experienced feelings of guilt during the COVID-19 pandemic derived from the dual expectations of worker and mother identities3. Even during more certain times, caregiving requires time and energy, which are limited resources for people with occupational demands. Family obligations can lead to physical, emotional, and financial strain on the caregiver6. Women working in the healthcare field experience increased stress and anxiety surrounding their caregiving roles at work and in the home, a phenomenon called double-duty caregiving6. COVID-19 only heightened these experiences for healthcare workers, in part due to lack of organizational support. With increases in patient volume and the closing of child and adult care facilities, women in the healthcare field experienced a disproportionate increase in their professional and personal caregiving and reported feeling that there was not enough support for them to care for their families from their organizations2. In a recent study, 49% of healthcare workers reported that emergency childcare needs disrupted their work, including canceling clinics and surgeries7. OBJECTIVE In this brief article, we explore the incidence of stress from childcare and eldercare responsibilities as well as caregiver exhaustion from caregiving during the pandemic. We explore the experiences of women in medicine and science, looking at trainees, biomedical researchers, physicians and physician-scientists. While current rates of caregiving stress are low, women have a disproportionately higher rate of residual stress from caregiving duties during the pandemic. METHODS We surveyed 6,466 healthcare workers at a large academic medical center in the United States in 2022 regarding their stress related to caregiving, including childcare and eldercare, as well as residual stress and exhaustion from caregiving during the pandemic. While the incidence of stress from present caregiving was relatively low, the rates of exhaustion from caregiving during the pandemic remained high. We found that of all healthcare workers, 1.22% of men and 1.73% of women expressed current stress related to childcare and an additional 6.55% of men and 7.87% of women indicated stress from eldercare. Contrastingly, of all healthcare workers, 23.06% of those who identified as women indicated caregiving exhaustion from responsibilities during the pandemic, while only 13.67% of those who identified as men reported this lingering stressor (Table 1). RESULTS In this analysis, we focused specifically on physicians and clinicians (n=422), physician scientists (n=91), biomedical researchers (n=623), and medical and biomedical trainees (n=218) to examine gender-specific rates of pandemic caregiving stress in the medical and research career paths. We report no significant association between gender and current childcare stress (p=.17) or gender and current eldercare stress (p=.052) in this sample. However, residual stress and caregiving exhaustion from the pandemic varied significantly by job role (p<.05), with physician and clinician faculty (23.7%) citing the highest frequency of caregiving exhaustion across role designations, followed by physician scientists (18.7%), biomedical researchers (17.01%), and trainees (14.2%). There was a significant association between gender and caregiving exhaustion (p<.001). Across indicated job roles, women reported higher frequencies of caregiver exhaustion compared to male colleagues (Table 1). Caregiving exhaustion and overall distress were significantly associated (p<.001), indicating increased risk of suicidal ideation and burnout due to this stressor 8,9. Interestingly, the association between individual resilience and exhaustion was not significant (p=.343), suggesting that the stress derived from caregiving exhaustion is not likely to result from a lack of individual resilience. The perception of organizational support and caregiving exhaustion were significantly associated (p<.001), highlighting the weight of organizational influence on exhaustion and burnout related to caregiving (Table 2). CONCLUSIONS Given the association of perceived organizational support on exhaustion and the well-demonstrated negative emotional, financial and patient care associated impacts of a burned-out workforce, healthcare organizations must carefully evaluate their current state and consider mechanisms for improvement. One approach to decreasing caregiving stressors is available on-site childcare, which is very important to healthcare workers, particularly for emergency caregiving needs7. Other options include home-based childcare and eldercare services, concierge services and school break camps, and paid parental and sick leave. In addition to providing direct caregiving support, organizations should consider making strategic investments in employees with caregiving burdens as a recruitment and retention mechanism. For example, the Doris Duke Foundation initiated a program called the COVID-19 Fund to Retain Clinical Scientists which invested over $20 million in combined foundation and institutional matching funds to supporting clinical scientists affected by caregiving responsibilities in continuing and advancing their research agendas10. The money does not pay for care directly, but rather aims to aid scientists affected by caregiving responsibilities to increase their research productivity. Many organizations have paid parental leave and paid sick time which can apply to the illness of a child or dependent, or adult family member, there is an important difference between having the benefit, and having a culture where people feel safe and encouraged to use it. Others have demonstrated that organizational culture is a correlate of parental leave use11,12. 13Organizations must observe and measure utilization of these benefits and rectify any cultural practices or norms that dissuade people from using them. Doing so is not only necessary to help alleviate the accrual of caregiving fatigue, but is also important for recruitment and retention efforts13. This study highlights the need for organizations to prioritize support for those affected by caregiving responsibilities, through the lens of gender-specific crisis response. Especially in the context of the evolving pandemic, it is important to remember that in addition to increased nonwork-related caregiving responsibilities, women healthcare workers are predisposed to increased risk of disease exposure, barriers to resources, heavier workloads, and decreased leadership and decision-making opportunities14-19. This is especially salient when considering the recent increased exodus of trainees from training programs, with trainees citing lack of support for working parents20 and negative effects of increased caregiving responsibilities on productivity21. When job demands exceed the resources available for the trainees and workforce to perform optimally, organizations risk the loss of current and future employees. The lingering effect of caregiver exhaustion from the pandemic highlights the importance of caregiver support as a crisis management and emergency preparedness priority. Though the respondents reported relatively low current stress from caregiving, they remain deeply affected by the challenges of that time period22. This is an important finding for organizational leaders who must keep in mind that the reopening of schools and care facilities does resolve the lingering impact on the women who cared for them during the years of the pandemic.