Our Experiences as Women, Physicians, & Parents Coping with COVID-19

August 26, 2020
At the start of the coronavirus pandemic, the group text chain where I connect with my girlfriends from residency on a near-daily basis erupted with a flurry of unanswerable questions. We shared updates and data from each of our healthcare systems and compared strategies of how various hospitals and private practices planned to combat the virus and keep workers safe. As understanding of the virus evolved, so did the information and sentiments shared; we swapped strategies for conducting telehealth visits while managing our own young children at home and discussed the Multisystem Inflammatory Syndrome in Children (MIS-C), comparing cases each of us had encountered and our institutions’ policies and guidelines for management. Beneath all of this ran a steady current of support and encouragement as we shared our fears for the safety of our families and ourselves.

More recently, as the start of the school year draws near with little clarity regarding plans for in-person versus remote learning, the focus has been singular: childcare. Earlier debates about the safety of schools and daycares reopening have been supplanted by the reality that, while hospitals and outpatient offices have largely transitioned from remote visits back to full, in-person service, daycares have not followed suit. An article in The Washington Post pointed out that 75% of the healthcare workforce is female, and that it is likely to become significantly diminished if reliable childcare cannot be arranged, whether through schools, daycares, or in-home providers. Still, most physician parents are struggling to coordinate reliable childcare, especially as many centers have closed or severely restricted their hours. Many physicians, including the majority of women in my peer group, do not live near family. Those that do hesitate to rely on older parents or relatives for fear of putting their health at risk.

Colleen, a general pediatrician in Connecticut, sums up the current conundrum: “Women like us are vitally important to our healthcare system, which we need to be running at 110% right now…. So why are we all up at night trying to piece together childcare?” Like many of us, her partner also works full-time and is unable to perform his work remotely. Jessie, a primary care physician who, along with her husband, works for the Indian Health Service, decided to enroll her children at a preschool 35 minutes from their home for three days per week while continuing to pay her nanny full-time. Her reasoning: this will ensure they have backup available in case the daycare closes. It’s “stupid expensive but cheaper (and less crazy making) than one of us not working,” she explains.

It’s not lost on any of us that, for the most part, making childcare arrangements—whether by interviewing and hiring a nanny, scouting out daycares, or negotiating the schedule flexibility required when these options fail to cover the standard hours for most working physicians—falls to women. A year ago, our text chain was abuzz with anger and indignation at a New York Times article proclaiming that medicine had become a “stealth family-friendly profession.” The reasoning behind this assertion was female physicians, compared with women in other professions, are more likely to continue working after having children. The article profiled a woman who had been on track to enter an intensive subspecialty fellowship but changed course when she became pregnant. She ultimately reduced her work hours, shifting her schedule multiple times as the family’s needs evolved. Her husband, by contrast, continued his fellowship training as planned. 

The reason medicine appears so family friendly, noted Jess (a pediatric subspecialist in New England), is that we “do what it takes to make it work.” For many of us, leaving medicine or switching to a part-time schedule is neither desirable nor financially plausible given the burden of student loans. Among this group of women, especially those who are married to physicians, we are the ones who have adjusted our hours or scaled back to part-time work after having children. Even when both parents work full-time, the women more often handle drop-off and pick-up from school or daycare and coordinate nanny shares, babysitter schedules, and pay.

The added complication of having limited childcare options only furthers the stress experienced by physicians, especially those who continue to provide patient care during this extended crisis. Juanita, an endocrinologist in the Pacific Northwest whose husband is also a physician with long work hours, says, “I’m feeling so defeated. Our daycare decided to do limited hours through the fall. And my hospital just decided to close their daycare completely to save money because of all the losses from COVID. Clearly they just don’t care at all how this is affecting everyone. There really is no good option.” Jess echoes her frustrations. “Our government could do so much more to support us.” She lists the following examples: “Forgive student loans that cause undue financial burden. Subsidize childcare alternatives…I know so many frontline friends who sent their kids away.”

In addition to canceling their previous childcare options, many hospitals—among them some of the nation’s most renowned—have eliminated physician bonuses and annual salary increases. Says Alison, a neonatologist in the mid-Atlantic who is employed by one such institution, “I’m so pissed at [her hospital] for taking our bonus and our yearly salary increase and then telling us to be grateful we have a job when we are leaving our children at home and stakes are even higher and more stressful, and somehow we are supposed to be healthcare heroes. A sign in your front yard doesn’t help me.”

“Anyone else just beyond burned out from the constant stress?” Colleen implored a few days ago. “I’m so grumpy all the time. And [then there are] all the tough calls about what is and isn’t safe to do.” Meghan, an emergency medicine physician in New England whose family members are spread across the country, concurs: “Yes!… [I have so much] disdain for just about everything.” In addition, she notes, “I miss my family so much and I can’t see how anything is going to change by the holidays. It just makes me so sad.”

So far, none of us has left our jobs. Our current childcare arrangements, however tenuous, remain in place. Nearly all of us have had friends or acquaintances impacted by the virus. None of us has thus far contracted it, though several have been tested and have had family members quarantined following potential exposure. “The emotional stress is beyond anything that anyone who is not a physician working mom would understand,” states Alison. Still, she notes, “I know I’m so blessed,” despite all the frustrations.

By Rebecca E. MacDonell-Yilmaz, MD, MPH

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