Behavioral Health and Burnout Among Physician Mothers Who Care for a Person With a Serious Health Problem, Long-term Illness, or Disability

Many physician mothers care for their children as well as their patients. Some also care for a child, spouse, parent, friend, or others with a major health problem, illness, or disability. Such additional caregiving responsibilities may have consequences for the woman’s health, well-being, and career longevity. We sought to determine the proportion of physician mothers with caregiving responsibilities beyond their patients and children and how these additional responsibilities affected the women’s health and practice.

Methods for studying physician mothers have been previously described.¹ In 2016, a survey directed to the Physicians Moms Group online community was posted. The present study was conducted from June 17 to July 30, 2016. The University of California San Francisco institutional review board approved the study. Agreement online to participate in the survey was considered consent. The participants did not receive financial compensation.

Members of the Physicians Moms Group identify themselves as physician mothers, including adoptive and foster mothers. Among an estimated 16 059 members who viewed the post, 5613 (35.0%) based in the United States completed questions about caregiving responsibilities. To identify physician mothers with additional caregiving responsibilities, we used a question from the Behavioral Risk Factor Surveillance System, “During the last year, did you provide regular care or assistance to a friend or family member with a serious health problem, long-term illness, or disability?”² To screen for risky drinking, we used the Alcohol Use Disorders Identification Test–Clinicians.³ To assess substance abuse, we asked, “How often have you used or do you use the following: prescription drugs for nonmedical reasons/illegal drugs (excluding marijuana)/marijuana?” We asked a mental health question, “Have you ever had a mood or anxiety disorder?” We also asked a career dissatisfaction question, “Are you generally satisfied with your career?” To identify burnout, we used the Mini Z Burnout Survey.⁴ We used 2-tailed t tests and Pearson χ² tests for comparisons and multivariate logistic regression models to determine adjusted relative risks (aRRs). Findings were considered significant at P < .05. Statistical analysis was conducted using SAS, version 14.1 (SAS Institute Inc).

Of the 5613 respondents, 918 (16.4%) reported additional caregiving responsibilities. Characteristics of physician mothers with and without additional caregiving responsibilities are reported in Table 1. Among those with additional caregiving responsibilities, 443 (48.3%) reported caring for ill parents, 155 (16.9%) for children or infants, 71 (7.7%) for partners, and 263 (28.6%) for other relatives; 153 (16.7%) cared for more than 1 person.

The prevalence and adjusted relative risk of behavioral health and career challenges among physician mothers with and without additional caregiving responsibilities are reported in Table 2. Compared with other physician mothers, physician mothers with additional caregiving responsibilities had significantly higher rates and aRRs of mood or anxiety disorders (aRR, 1.21; 95% CI, 1.04-1.42; P = .02) and burnout (aRR, 1.25; 95% CI, 1.06-1.46; P = .007). The frequency of career satisfaction was similar in physicians with and without additional caregiving responsibilities (9.5% vs 7.5%; P = .06), as were the frequencies of risky drinking (16.6% vs 17.7%, P = .42) and substance abuse (2.8% vs 3.0%, P = .72).

In an online community of individuals who identify themselves as physician mothers based in the United States, 16.4% of the respondents to our survey reported regular care or assistance to a person or persons with a serious health problem, long-term illness, or disability. These physician mothers had significantly higher rates of mood or anxiety disorders and burnout than other physician mothers. Women physicians are at high risk of work-family conflict.⁵ Studies and supportive efforts have focused on childbearing leave, breastfeeding, and child-rearing.⁶ Our findings highlight the additional caregiving responsibilities of some women physicians and the potential consequences of these additional responsibilities for their behavioral health and careers.

Limitations of our study include the use of an online survey with a relatively low response rate and a convenience sample that may not be representative of all women physicians or physician mothers. Our survey design precluded the collection of longitudinal data. We have no data on physician fathers or other male physicians; thus, we were not able to compare respondents with male physicians or female physicians who are not mothers.

Among US physician mothers responding to an online survey, those who cared for seriously ill children, spouses, parents, or others experienced higher rates of mood or anxiety disorders and burnout than other physician mothers. To reduce burnout and improve workforce retention, health care systems should develop new approaches to identify and address the needs of these physician mothers.

Accepted for Publication: September 21, 2018.

Corresponding Author: Christina Mangurian, MD, MAS, Department of Psychiatry, Weill Institute for Neurosciences, Center for Vulnerable Populations, University of California, San Francisco, 1001 Potrero Ave, Ste 7M, San Francisco, CA 94110 (christina.mangurian@ucsf.edu).

Published Online: January 28, 2019. doi:10.1001/jamainternmed.2018.6411

Author Contributions: Dr Yank had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Yank, Rennels, Linos, Choo, Mangurian.

Acquisition, analysis, or interpretation of data: Yank, Choo, Jagsi, Mangurian.

Drafting of the manuscript: Yank, Rennels, Linos, Mangurian.

Critical revision of the manuscript for important intellectual content: Choo, Jagsi, Mangurian.

Statistical analysis: Linos.

Obtained funding: Linos, Mangurian.

Administrative, technical, or material support: Rennels, Mangurian.

Supervision: Linos, Mangurian.

Conflict of Interest Disclosures: Dr Yank is supported by grants K23DK097308 and 5P30DK092924 from the National Institute of Diabetes and Digestive and Kidney Diseases, grant R01AG057855 from the National Institute on Aging, and grant 20180728/P0514743 from the Mount Zion Health Fund. Ms Rennels was supported by the Research Allocation Program for Trainees of the University of California San Francisco School of Medicine at the time of the study. Dr Linos is supported by grants R21CA212201 from the National Cancer Institute, K76AGO54631 from the National Institute of Aging, and DP2CA225433 from the National Institute of Health. Dr Choo was supported by grant NIDA K23 DA031881 from the National Institute of Drug Abuse at the time of the study and is founder of Equity Quotient. Dr Jagsi is supported by grant R01 CA201356 from the National Cancer Institute and grants from the Susan Komen Foundation, Blue Cross Blue Shield of Michigan, the Greenwall Foundation, and the Doris Duke Charitable Foundation’s Fund to Retain Clinician Scientists; she has received consulting fees from Amgen and Vizient and stock options for serving on the advisory board for Equity Quotient. Dr Mangurian was supported by grant K23MH093689 from the National Institute of Mental Health (NIMH) at the time of the study and is currently supported by grants R01MH112420 from the NIMH, R03DK101857 from the National Institute of Diabetes and Digestive and Kidney Diseases, and the Doris Duke Charitable Foundation’s Fund to Retain Clinician Scientists.

Additional Contributions: We thank the members of Physician Moms Group for their participation. Jimmy Hwang, PhD, provided data analysis and Nicholas S. Riano, MAS (University of California, San Francisco), prepared the manuscript; there was no compensation outside of salary.