Physician Health

Higher physician burnout risk for moms in “sandwich generation”

In addition to caring for their patients and children, about one in six physician moms report caring for a child, spouse, parent, friend or other person with a serious health problem, long-term illness or disability, a new study shows.

And those extra responsibilities are taking a toll on their health and rate of physician burnout.

Committed to making physician burnout a thing of the past, the AMA has studied, and is addressing, issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand the challenges physicians face. AMA’s STEPS Forward™ is an open-access platform featuring more than 50 modules that offer actionable, expert-driven strategies and insights supported by practical resources and tools.

Nearly 40% of physician mothers with extra caregiving obligations reported mood or anxiety disorder, compared with about 32% of physician mothers who did not have the additional duty, according to the research letter published in JAMA Internal Medicine.

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The AMA resource, “Caring for the caregiver: A guide for physicians,” may also be useful to doctors who find themselves in this all-too-common position. According to this guide, common causes of caregiver burnout include role confusion, unrealistic expectations, lack of control and unreasonable demands.

In the JAMA Internal Medicine survey, about 45% of physician mothers caring for others reported burnout, while about 37% of physician moms without the extra duties reported physician burnout.

The responsibilities, however, did not appear to affect other areas, according to the study’s first author and internist Veronica Yank, MD, a University of California, San Francisco (UCSF) assistant professor in the medicine department.

For example, among mothers reporting additional caregiving responsibilities:

  • 16.6% reported risky drinking, compared with 17.7% of moms not providing extra care
  • 2.8% reported substance abuse, compared with 3% of moms not providing extra care.
  • 9.5% reported career dissatisfaction, compared with 7.5% of moms not providing extra care.

Overall, 5,613 members of the online Physicians Moms Group responded to the survey and 918 of those women reported they had additional caregiving responsibilities. Among those women:

  • 48.3% cared for parents.
  • 28.6% cared for other relatives.
  • 16.9% cared for children or infants.
  • 16.7% cared for more than one person.
  • 15.8% cared for friends.
  • 7.7% cared for partners.

Call to meet these moms’ needs

The study’s senior and corresponding author, Christina Mangurian, MD, is a professor and vice chair for diversity and health equity in the UCSF psychiatry department. She is also a mom who has been in the position of caring for a child who had a long-term hospitalization as an infant.

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"The fact that one in six physician mothers are caring for someone they love at home is pretty shocking," she said. "It is amazing how resilient these triple-duty caregivers are."

She believes health care systems should provide paid family leave when someone is caring for someone they love.

"Since women typically serve as informal caregivers, this kind of support from employers could likely help retain women in the workforce," Dr. Mangurian said in an interview. "I also think systems should start measuring how many of their providers have these responsibilities at home and start to develop other ways to support them."

Elder care and flexible hours may be two ways to offer more support, she said.

Dr. Mangurian also believes health care systems could learn much from these women's experiences on how to change the delivery system for the better. She noted that they are not only insiders to the system as physicians, but as caregivers they know first-hand what system changes could make the patient and family experience better.

"I was a caregiver for my ill son years ago and spotted lots of room for improvement, including low-hanging fruit like protecting sleep for patients at night," she said.

Several STEPS Forward modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.

The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.