Listen as our expert guests, Kelly Graham, MD, MPH (@KellyGrahamMD) and Lekshmi Santhosh, MD MAEd (@LekshmiMD), detail the professional and personal challenges faced by women in medicine during the COVID-19 pandemic.
Produced by: Leah Witt MD & Shreya Trivedi MD
Written by: Molly Heublein MD, Isabel Valdez PA-C, Leah Witt MD & Shreya Trivedi MD
Infographic & Cover Art: Edison Jyang
Hosts: Leah Witt MD & Shreya Trivedi MD, Justin Berk MD, MPH, MBA
Editor: Molly Heublein MD and Matthew Watto MD (written materials); Clair Morgan of nodderly.com
Guests: Kelly Graham, MD, MPH; Lekshmi Santhosh, MD MAEd
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Dr. Graham: Caring for children at home while also working on the front lines during the COVID-19 pandemic is exceedingly difficult. There is little national dialogue around this challenge– there has been silence regarding the practicalities of being an essential worker while having unreliable and difficult-to-find childcare.
The Hippocratic Oath neglects any call to protect the families of health care providers (we need a rewrite with the perspectives of women physicians!). In order to do our best, we need support in caring for our own families.
“If we had been there writing it, we would have said something about the fact that we need to take care of each other and our families so that we can go and do this high-risk work.”
(Do we need a new “Blackwell Oath”?)
Dr. Santhosh: Let go of mom-guilt! Women overwhelmingly bear the burden of caregiving for relatives/children/partners with illnesses, and carry many additional roles beyond clinician, researcher, teacher. In addition, women are often household managers, childcare coordinators, and now home-school teachers (Caregiving in the US). This creates a significant mental load (emotional labor).
Emotional labor = invisible cognitive decisions that women mentally juggle at all times such as the microtasks of maintaining a home and family. (Dr. Graham’s example– it’s the fact that she knows exactly when her children’s socks need to be replaced).
Dr. Graham: Name the labor! Writing down mental load tasks and sharing these with your partner can help name your workload and perhaps you can work toward a re-distribution. Look into Fair Play by Eve Rodsky to use on your next date night.
Partners: Women disproportionately shoulder the burden of organizing the household. Motherhood penalty, fatherhood bonus: Women often suffer a loss of pay after childbirth, while men often experience a “halo effect” and a subsequent pay raise (NYT 2014, EconLife 2018)
Patients: Women are disproportionately in the clinician-educator roles in academic medicine (Science 2014). The clinical burden of the pandemic is falling on this exact group and women are being asked to care for more patients, and in some locations taking pay cuts and losing jobs.
Panels: In the COVID-19 crisis, the “man-el” (“expert” panels of mostly senior, often Caucasian, and all-male faculty members) has had a resurgence, as leaders may be relying on old models of expertise. The cure? Think of all who would be qualified to speak and would create a diverse group, then ask who would appreciate the opportunity to participate. Manels prominently highlight men as experts, and neglect the significant work women are often doing “behind the scenes”.
Two pandemics, one response (CDC 2020): The additional pandemics of structural racism and gender bias are centuries old. The COVID-19 crisis highlights these inequities– minorities suffer more from the economic and health consequences of this pandemic (Price-Haywood et al. NEJM 2020). Women bear much more of the caregiving responsibility (and economic consequences) of changing work and school schedules (NYT 2020).
Breadwinner- homemaker bias: Most of the structures that we operate in our society come with an implicit bias that there is someone managing the home full-time while someone is at work full-time (this framework is outdated, inequitable and not even economically sustainable in most cities). You won’t be able to unsee this bias once you’ve seen it: it’s why the school day ends at 2:50pm and the national conversation centers on people returning to work without a conversation about schools or daycare reopening (NYT 2020). Because of this bias, the childcare structure in the US was never designed to give women a successful launch into the workplace, and this pandemic is uncovering the very thin margins of this structure.
Publication bias during the pandemic: Because of lack of childcare, even senior women scientists have had difficulty prioritizing academic productivity. This has resulted in fewer women first author publications during the pandemic than male first authors (Andersen et al 2020). The research productivity of early-career women has been affected in particular.
Female physician burnout: Women are more likely to experience burnout and suicidality (Schernhammer et al 2004, Templeton et al 2019).. This is a particular risk for women with intersectional identities, at risk of experiencing the minority tax. We are enough! Take time for self care.
Minority Tax: physicians and scientists burdened by bias (e.g. people of color and women) are being pulled into institutional initiatives to run town halls, write policies around inclusivity, and come up with solutions to the very problems that disproportionately impact them (Nature 2020). Assuming women and people of color should be the face of an institution’s efforts further exacerbates burnout. Call to action: institutions should take a proactive instead of reactionary approach, and consider the tax on people being asked to serve in these initiatives. Don’t assume when making decisions for other people and ask people what works for them.
Dr. Graham: The pandemic has encouraged telehealth and video conferencing–these are essential for working parents because they reduce commute and allow flexibility for childcare. More broadly, Dr. Graham sees a few keys to success in medicine:
Dr. Santhosh: Another silver lining– be more clear and firm with boundaries: “no, I can’t make that meeting on Friday, that is the day I am responsible to care for my children”. During the pandemic, there is a shared acknowledgment that we are all in this together.
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Discuss how the new challenges of COVID and working from home mean that women are often doing extra double duty
After listening to this episode listeners will…
Kelly Graham, MD, MPH and Lekshmi Santhosh, MD MAEd report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Graham K, Santhosh L, Trivedi S, Berk J, Witt L, Valdez I, Heublein M, Watto MF. “#225 Women in Medicine: COVID Edition”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list. Original air date: July 16, 2020.
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