Housework Leads Some Proceduralist Moms to Rethink Specialty

Troy Brown, RN

April 12, 2019

Physician mothers have more responsibilities around the home than their partners or spouses, which is not surprising. But among physician mothers in surgical specialties, those with heavier loads at home were more likely to say they were dissatisfied with their careers compared with those with fewer domestic responsibilities.

"Respondents in nonprocedural specialties did not report a significant desire to switch careers or specialty regardless of the amount of responsibilities they had at home," the researchers write.

The nature of procedural specialties may explain part of this discrepancy, Julie Ann Freischlag, MD, FRCS(Edin), Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, told Medscape Medical News.

"It really is hard to balance what's going on each day if you have family at home, because some of what you do can't be put off until tomorrow — it's urgent [or] emergent," said Freischlag, who authored an accompanying commentary.

Heather G. Lyu, MD, Division of Gastrointestinal and General Surgery at Brigham and Women's Hospital in Boston, Massachusetts, and colleagues published their findings online April 10 in JAMA Surgery.

The researchers analyzed data from anonymous online surveys completed by female physician mothers from the Physician Moms Group on Facebook. A total of 2363 respondents completed the survey and the analysis included 1712 attending physicians, 1250 (73%) of whom were from nonprocedural specialties and 462 (27%) of whom were from procedural specialties.

"Unequal division of domestic labor is a common topic amongst female physicians, particularly for those with children. This is supported by current literature on women in surgery that show that female physicians, particularly those in procedural specialties, face many challenges in balancing responsibilities between work and home," senior author Nelya Melnitchouk, MD,  also from the Division of Gastrointestinal and General at  Brigham and Women's, told Medscape Medical News.

"We conducted this study to test our hypothesis that these challenges may affect career satisfaction more negatively for physician mothers in procedural specialties than those in nonprocedural specialties," Melnitchouk said.

Most respondents were married or had partners (1698; 99.2%); of those, 458 (27%) practiced in procedural specialties. Physician mothers had sole responsibility for most domestic tasks compared with their spouse or partner, including routine childcare plans (57.2% vs 11.2%), back-up or emergency childcare plans (43.5% vs 26.3%), cooking (43.9% vs 25.4%), grocery shopping (45.9% vs 24.8%), shopping for children's clothing (86.4% vs 2.7%), vacation planning (50.2% vs 15.2%), helping with homework (22.1% vs 3.9%), and laundry (46.4% vs 13.1%).

Spouses or partners were more likely to be solely responsible for home repairs (62.6% vs 11%), finances (45.4% vs 30.0%), and automobile maintenance (57.5% vs 10.2%).

The breakdown of domestic tasks did not differ significantly between procedural and nonprocedural specialties.

However, among the women in procedural specialties, those with primary responsibility for five or more domestic tasks were statistically more likely to report wanting to change careers compared with women responsible for fewer than five domestic chores (55% vs 42.1%; P = .008).

There was no such association between increased domestic responsibilities and career dissatisfaction among nonproceduralists (32.4% for those with ≥ 5 tasks vs 32.6% for those with < 5 tasks; P > .99).

"While the results of our study showed a statistically significant difference in career dissatisfaction between these two groups, we believe that there are likely many physicians in non-procedural specialties who still struggle to balance domestic responsibilities with their careers and many also report dissatisfaction," Melnitchouk said.

"However, when comparing these two groups, physician mothers who actively choose more life-style compatible specialties may be more satisfied when their expectations of work-life balance are met," she added.

Among the proceduralist group, primary responsibility for at least five domestic tasks was independently associated with wanting to change to a less demanding career or specialty after adjustment for age, practice type, total household income, years of experience, and spouse or partner occupation (odds ratio, 1.5; 95% confidence interval, 1.0 - 2.2; P = .05).

The researchers adjusted their findings for a number of potential confounders but acknowledge there may be other confounders that account for their findings. "[W]e attempted to distinguish between proceduralists and nonproceduralists by grouping specialties as procedure heavy vs medical; however, there is significant variation among these fields, with some tracks within procedural specialties that are much more family friendly than others. This difference may warrant further study with more granular data on individual specialties and practice types," they explain.

Outsourcing Chores, Writing Own Rules Key to Survival?

"The key to career satisfaction is to outsource those domestic chores you do not want to do and to make your own rules," Freischlag writes in her commentary.

Physician mothers need good supports so their children are well-cared for and so they are at their best when caring for patients, she explains. Freischlag said when her children were growing up, outsourcing housekeeping tasks she did not enjoy allowed her to focus on doing things that brought her joy, such as cooking with her children and spending time at their schools.

"Luckily, if you're a physician, you have resources so you can outsource [chores]," Freischlag said.

Melnitchouk echoed Freischlag's comments. "It is important to consider potential solutions such as extended child care services, increased flexibility in scheduling, outsourcing tasks when needed, and emphasizing more equitable division of household labor," Melnitchouk told Medscape Medical News.

These imbalances limit women physicians from fully engaging in leadership roles as well, Freischlag explained, noting that all these time management strategies also apply to women in leadership.

Freischlag cautioned that women need to give each other space to choose what works for them, and that for some it may mean reducing working hours or taking time off from work. She urged women to avoid comparing themselves with others and to be accepting of other women's choices.

"As more women enter the surgical workforce, it is very important to discuss issues surrounding gender disparities and parenthood. We believe that by publishing studies on these topics, we are identifying areas for positive interventions to allow all physicians, including men and women, to achieve more flexible and family-friendly careers," Melnitchouk explained.

The authors and commentator have disclosed no relevant financial relationships.

JAMA Surg. Published online April 10, 2019. Abstract, Editorial

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