Parental satisfaction of U.S. physicians: associated factors and comparison with the general U.S. working population

Physician marriage survey reveals sex and specialty differences in marital satisfaction factors

Physician marriage is a valuable indicator of how vocational factors (e.g. work hours, stressors) impact satisfaction in relationships and physician wellness overall. Previous studies suggest that gender and specialty influence marriage satisfaction for physicians, though these often come from limited, local, cohorts. A cross-sectional survey was designed and distributed to publicly available email addresses representing academic and private practice physician organizations across the United States, receiving 321 responses (253 complete). Responses included data on demographics, medical specialty, age at marriage, stage of training at marriage, number of children, and factors leading to marital satisfaction/distress. A multivariable ordinal logistic regression was conducted to find associations between survey variables and marriage satisfaction. Survey results indicated that 86.5% of physicians have been married (average age at first marriage was 27.8 years old), and the rate of first marriages ending is at least 14.7%. Men had significantly more children than women. Physicians married at least once averaged 1.98 children. "Other" specialty physicians had significantly more children on average than psychiatrists. Marrying before medical school predicted practicing in private practice settings. Job stress, work hours, children, and sex were most frequently sources of marital distress, while strong communication, finances, and children were most frequently sources of marital stability. Sex differences were also found in distressing and stabilizing marital factors: Female physicians were more likely to cite their spouse's work hours and job stress as sources of marital distress. Finally, surgery specialty and Judaism were associated with higher marriage satisfaction, whereas possession of an M.D. degree was associated with lower marriage satisfaction. This study elucidated new perspectives on physician marriage and families based on specialty, practice setting, and stage of training at marriage. Future studies may focus on factors mediating specialty and sex's impact on having children and marriage satisfaction. To our knowledge, this study is the first physician marriage survey which integrates multiple factors in the analysis of physician marriages.

Physician Work-Personal Intersection: A Scoping Review of Terms, Definitions, and Measures

PURPOSE

A substantial body of evidence describes the multidimensional relationship between the intersection of physicians' work and personal lives and health care quality and costs, workforce sustainability, and workplace safety culture. However, there is no clear consensus on the terms, definitions, or measures used in physician work-personal intersection (WPI) research. In this scoping review, the authors aimed to describe the terms and definitions used by researchers to describe physician WPI, summarize the measurement tools used, and formulate a conceptual model of WPI that can inform future research.

METHOD

The authors searched PubMed, CINAHL, Scopus, and Web of Science for studies that investigated U.S. practicing physicians' WPI and measured WPI as an outcome from January 1990 to March 2022. The authors applied thematic analysis to all WPI terms, definitions, and survey questions or prompts in the included studies to create a conceptual model of physician WPI.

RESULTS

Ultimately, 102 studies were included in the final analysis. The most commonly used WPI terms were work-life balance, work-life integration, and work-home or work-life conflict(s). There was no consistency in the definition of any terms across studies. There was heterogeneity in the way WPI was measured, and only 8 (7.8%) studies used a validated measurement tool. The authors identified 6 key driver domains of WPI: work and personal demands; colleague and institutional support and resources; personal identity, roles, health, and values; work schedule and flexibility; partner and family support; and personal and professional strategies.

CONCLUSIONS

The authors found significant variability in the terms, definitions, and measures used to study physician WPI. They offer a conceptual model of the WPI construct that can be used to more consistently study physician WPI in the future. Future work should further investigate the validity of this model and generate consensus around WPI terms, definitions, and measures.

Can you have it all? Parenting in Urology and Work-Life Balance Satisfaction

OBJECTIVE

To evaluate the association between work-life balance satisfaction for practicing urologists who have children <18 years compared to those who do not have children or have children ≥18 years.

METHODS

We evaluated the association between work-life balance satisfaction based on partner status, partner employment status, child status, primary responsible party for family, total work hours per week, and total vacation weeks per year using 2018 and 2019 American Urological Association (AUA) census data with post-stratification adjustment methods.

RESULTS

Of 663 respondents, 77 (9.0%) were female and 586 (91%) were male. Female urologists are more likely to have an employed partner (79.vs 48.9%, P <.001), more likely to have children <18 years (75.0 vs 41.7%, P <.0001), and less likely to have a partner as primary caretaker of family (26.5 vs 50.3%, P <.0001) compared to male urologists. Urologists with children <18 years reported lower work-life balance satisfaction than those without (OR 0.65, P = .035). For every 5 additional hours works per week, urologists reported lower work-life balance (OR 0.84, P <.001). However, there are no statistically significant associations between work-life balance satisfaction and gender, employment status of their partner, primary responsible party for family responsibilities, and total weeks of vacation per year.

CONCLUSION

According to recent AUA census data, having children <18 years is associated with lower work-life balance satisfaction. This highlights opportunities to support young parents, both male and female, in the workplace to prevent burnout and maximize well-being among urologists.

The Impact of Parent and Family Caregiver Roles Among Canadian Radiation Oncologists

PURPOSE

Working parents, and a rising number of adults delivering care for aging relatives, experience numerous challenges in their personal, family, professional, and financial lives owing to multiple responsibilities. This study describes the experiences of Canadian radiation oncologist (RO) parents and family caregivers, reporting challenges that may exist in providing family care with clinical and academic work commitments.

METHODS AND MATERIALS

Canadian ROs, via RO heads of departments in cancer centers across Canada, and physician members of the Canadian Association of Radiation Oncology were invited to participate in an anonymous online survey between November 2021 and January 2022. The survey focused on demographics, experiences of pregnancy and leave, parenting and adult caregiving responsibilities, and self-care.

RESULTS

A total of 103 staff ROs (38%) completed the survey and 78 (75.7%) identified as having a parental (76 [89.7%]) and/or other family caregiver (8 [10.3%]) role; 41% were female and 59% were male, with no difference between genders in the number of children (median, 2; interquartile range, 1-3; P = .17). More female respondents took parental leave for their first child compared with male respondents (mean, 29 vs 6 weeks; P < .001). Of male respondents who started caring for their first child during residency, 27% took parental leave, compared with 77% who started caring for their first child as a staff member (P = .003). The majority of respondents described "always/usually" having collegial support for each pregnancy and parental leave. Both genders described parental responsibilities as negatively affecting attendance at conferences (male, 65%; female, 77%; P = .31) and early or late work-related meetings (male, 76%; female, 79%; P = 1.0). More female respondents described parental responsibilities as negatively affecting their career (50% vs 29%; P = .085). Of female respondents, 52% (vs 26% of male respondents; P = .044) identified a physician mentor or positive role model around parenting issues.

CONCLUSIONS

Parental and other family caregiving responsibilities are not gender unique in Canadian ROs, but competing work and family roles may affect genders differently.

Managing Physician Fatigue

Physician fatigue, also known as burnout, is a highly prevalent but often underrecognized result of workplace stressors. The consequences of burnout can include poor work-life integration, isolation, depression, and suicide. As a result, an organization may experience high physician turnover, patient safety issues, malpractice suits, and financial losses. Physicians should be encouraged to play a role in their wellness by taking mental time away from work, pursuing hobbies, attending wellness programs, and ensuring quality time with family. Ultimately, it is an organization that must acknowledge physician burnout, identify risk factors, and invest in targeted interventions to prevent this immense threat to their stability.

Personal and Professional Factors Associated With Work-Life Integration Among US Physicians

Importance

Poor work-life integration (WLI) occurs when career and personal responsibilities come in conflict and may contribute to the ongoing high rates of physician burnout. The characteristics associated with WLI are poorly understood.

Objective

To identify personal and professional factors associated with WLI in physicians and identify factors that modify the association between gender and WLI.

Design, Setting, and Participants

This cross-sectional study was based on electronic and paper surveys administered October 2017 to March 2018 at private, academic, military, and veteran's practices across the US. It used a population-based sample of US physicians across all medical specialties. Data analysis was performed from November 2019 to July 2020.

Main Outcomes and Measures

WLI was assessed using an 8-item scale (0-100 point scale, with higher scores indicating favorable WLI), alongside personal and professional factors. Multivariable linear regressions evaluated independent associations with WLI as well as factors that modify the association between gender and WLI.

Results

Of 5197 physicians completing surveys, 4370 provided complete responses. Of the physicians who provided complete responses, 2719 were men, 3491 were White/Caucasian (80.8%), 3560 were married (82.4%), and the mean (SD) age was 52.3 (12.0) years. The mean (SD) WLI score was 55 (23). Women reported lower (worse) mean (SD) WLI scores than men overall (52 [22] vs 57 [23]; mean difference, -5 [-0.2 SDs]; P < .001). In multivariable regression, lower WLI was independently associated with being a woman (linear regression coefficient, -6; SE, 0.7; P < .001) as well as being aged 35 years or older (eg, aged 35 to 44 years: linear regression coefficient, -7; SE, 1.4; P < .001), single (linear regression coefficient, -3 vs married; SE, 1.1; P = .003), working more hours (eg, 50 to 59 hours per week vs less than 40 hours per week: linear regression coefficient, -9; SE, 1.0; P < .001) and call nights (linear regression coefficient, -1 for each call night per week; SE, 0.2; P < .001), and being in emergency medicine (linear regression coefficient, -18; SE, 1.6, P < .001), urology (linear regression coefficient, -11; SE, 4.0; P = .009), general surgery (linear regression coefficient, -4; SE, 2.0; P = .04), anesthesiology (linear regression coefficient, -4; SE, 1.7; P = .03), or family medicine (linear regression coefficient, -3; SE, 1.4; P = .04) (reference category, internal medicine subspecialties). In interaction modeling, physician age, youngest child's age, and hours worked per week modified the associations between gender and WLI, such that the largest gender disparities were observed in physicians who were aged 45 to 54 years (estimated WLI score for women, 49; 95% CI, 47-51; estimated WLI score for men, 57, 95% CI, 55-59; P < .001), had youngest child aged 23 years or older (estimated WLI score for women, 51; 95% CI, 48-54; estimated WLI score for men, 60; 95% CI, 58-62; P < .001), and were working less than 40 hours per week (estimated WLI score for women, 61; 95% CI, 59-63; estimated WLI score for men; 70; 95% CI, 68-72; P < .001).

Conclusions and Relevance

This study found that lower WLI was reported by physicians who are women, single, aged 35 years or older, and who work more hours and call nights. These findings suggest that systemic change is needed to improve WLI among physicians.

Burnout and Professional Fulfillment in Early and Early-Mid-Career Breast Surgeons

BACKGROUND

Prior work has shown that burnout among breast surgeons is prevalent and highest in those earlier in their clinical practice career. Therefore, we sought to better understand and identify specific contributors to early-career breast surgeon burnout.

METHODS

We analyzed data from our 2017 survey of members of the American Society of Breast Surgeons. The 16-items of the Professional Fulfillment Index were used in determining overall burnout and professional fulfillment scores. Multivariable regressions were performed to evaluate factors related to overall burnout and professional fulfillment.

RESULTS

The mean overall burnout score was 1.23 (0-4 scale; higher score unfavorable) for surgeons in practice < 5 years, compared with 1.39 for surgeons in practice 5-9 years and 1.22 for those in practice ≥ 10 years. The mean professional fulfillment score was 2.71 (0-4 scale; higher score favorable) for surgeons in practice < 5 years, 2.66 for surgeons in practice 5-9 years, and 2.67 for surgeons in practice ≥ 10 years. Multivariable analysis showed that burnout was positively correlated with ≥ 60 work hours per week in the group practicing for < 5 years, and dedicating less than full time to breast surgery in the group in practice 5-9 years. Professional fulfillment was negatively associated with single relationship status in surgeons practicing < 5 years, and dedicating less than full time to breast surgery for those in practice 5-9 years.

CONCLUSION

Our study suggests that breast surgeons who have been in practice for 5-9 years have particularly high overall burnout rates and additional support focused on this group of breast surgeons may be needed.

Perceptions of Parenting Challenges and Career Progression Among Physician Faculty at an Academic Hospital

This survey study compares the perceptions of male and female physician faculty members who have children regarding parenting challenges and career progression at an academic hospital.

Motherhood and medicine: systematic review of the experiences of mothers who are doctors

OBJECTIVE

To synthesise what is known about women combining motherhood and a career in medicine by examining the published research into their experiences and perspectives.

STUDY DESIGN

We reviewed peer-reviewed articles published or available in English reporting original research into motherhood and medicine and published during 2008-2019. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Web of Science, and Scopus abstract databases.

DATA SYNTHESIS

The database search identified 4200 articles; after screening and full text assessment, we undertook an integrative review synthesis of the 35 articles that met our inclusion criteria.

CONCLUSIONS

Three core themes were identified: Motherhood: the impact of being a doctor on raising children; Medicine: the impact of being a mother on a medical career; and Combining motherhood and medicine: strategies and policies. Several structural and attitudinal barriers to women pursuing both medical careers and motherhood were identified. It was often reported that women prioritise career advancement by delaying starting a family, and that female doctors believed that career progression would be slowed by motherhood. Few evaluations of policies for supporting pregnant doctors, providing maternity leave, and assisting their return to work after giving birth have been published. We did not find any relevant studies undertaken in Australia or New Zealand, nor any studies with a focus on community-based medicine or intervention studies. Prospective investigations and rigorous evaluations of policies and support mechanisms in different medical specialties would be appropriate.

PROTOCOL REGISTRATION

PROSPERO CRD42019116228.

Effect of Surgical Oncologist Turnover on Hospital Volume and Treatment Outcomes Among Patients With Upper GI Malignancies

PURPOSE

Lack of surgical expertise may affect cancer care delivery. Here, we examined the impact of surgical oncologist vacancy and turnover in a community cancer center serving a mixed urban and rural population.

METHODS

Survival outcomes of patients with potentially resectable esophageal, gastric, and pancreatic carcinomas treated in the index hospital (n = 519) were compared with those of a then-contemporary control group derived from the state-specific SEER registry (n = 3,340). The onboarding period (ie, the period without a surgical oncologist) and early and late periods with a surgical oncologist were defined.

RESULTS

At the state level, there was a steady trend of patients who were annually referred (290.4 ± 34.3 patients per year; P < .001) and underwent operation (158.7 ± 18.7 patients per year; P < .001). We observed the absence of an analogous trend in the index hospital (P = .141). The index hospital diagnosed 12.2% of state cancers of interest during the years with surgical oncologists but only 6.7% of cancers when surgical oncologists were absent (P = .031). The survival model adjusted for age, stage, and primary disease site comparing the early and late periods demonstrated that being treated in the index hospital did not result in inferior survival (hazard ratio, 1.067; P = .265).

CONCLUSION

Loss of surgical oncologists was associated with referral decline and likely out-migration of patients, whereas prompt restoration of surgical oncology services reinstated volumes and preserved survival outcomes.

A surgeon, a doctor and a baby - combining parenthood with a medical career

Double-physician couples being parents have been shown to face greater difficulties in combining their private and professional lives when compared to other couples. In the present study, we aimed to analyze how double-physician couples manage to arrange their roles in their private and professional lives and how compatible their individual idea of being a mother or a father is with their career as a physician. Fifteen couples being parents and consisting of either two surgeons or a surgeon and a nonsurgeon were asked to participate in a survey to determine the average maternity or paternity leave, the reduction of hours worked per week after the birth of a child, and the need for professional childcare and additional support in childcare from relatives or babysitters per week. Furthermore, the couples were asked to mark on a six-item Likert scale how compatible their professional life is with their idea of being parents. The average maternity or paternity leave was 13 ± 2 months per child and the mean reduction of hours worked per week was 30 ± 12%. The couples made use of professional childcare for 41 ± 6 h/week on average and needed additional support in childcare from relatives or babysitters for 5 ± 3 h/week. On the Likert scale from "completely incompatible (0)" to "perfectly compatible (5)", the mean compatibility of professional and private lives was rated 2.5 ± 1.1. Becoming parents significantly influences the professional and private lives of double-physician couples. The relatively low compatibility of double-physician couples' private and professional lives might lead to relevant work-home conflicts. Such conflicts have been proven to be associated with surgeons not recommending surgery as a career. Therefore, efforts should be made to improve the compatibility of parenthood and a medical career.

Professional Satisfaction and the Career Plans of US Physicians

OBJECTIVE

To evaluate the relationship between burnout, satisfaction with electronic health records and work-life integration, and the career plans of US physicians.

PARTICIPANTS AND METHODS

Physicians across all specialties in the United States were surveyed between August 28, 2014, and October 6, 2014. Physicians provided information regarding the likelihood of reducing clinical hours in the next 12 months and the likelihood of leaving current practice within the next 24 months.

RESULTS

Of 35,922 physicians contacted, 6880 (19.2%) returned surveys. Of the 6695 physicians in clinical practice at the time of the survey (97.3%), 1275 of the 6452 who responded (19.8%) reported it was likely or definite that they would reduce clinical work hours in the next 12 months, and 1726 of the 6496 who responded (26.6%) indicated it was likely or definite that they would leave their current practice in the next 2 years. Of the latter group, 126 (1.9% of the 6695 physicians in clinical practice at the time of the survey) indicated that they planned to leave practice altogether and pursue a different career. Burnout (odds ratio [OR], 1.81; 95% CI, 1.49-2.19; P<.001), dissatisfaction with work-life integration (OR, 1.65; 95% CI, 1.27-2.14; P<.001), and dissatisfaction with the electronic health record (OR, 1.44; 95% CI, 1.16-1.80; P=.001) were independent predictors of intent to reduce clinical work hours and leave current practice.

CONCLUSION

Nearly 1 in 5 US physicians intend to reduce clinical work hours in the next year, and roughly 1 in 50 intend to leave medicine altogether in the next 2 years to pursue a different career. If physicians follow through on these intentions, it could profoundly worsen the projected shortage of US physicians.