Work-Family Conflict and the Sex Difference in Depression Among Training Physicians

Abstract

IMPORTANCE Depression is common among training physicians and may disproportionately affect women. The identification of modifiable risk factors is key to reducing this disease burden and its negative impact on patient care and physician career attrition. OBJECTIVE To determine the presence and magnitude of a sex difference in depressive symptoms and work-family conflict among training physicians; and if work-family conflict impacts the sex difference in depressive symptoms among training physicians. DESIGN, SETTING, AND PARTICIPANTS A prospective longitudinal cohort study of medical internship in the United States during the 2015 to 2016 academic year in which 3121 interns were recruited across all specialties from 44 medical institutions. MAIN OUTCOMES AND MEASURES Prior to and during their internship year, participants reported the degree to which work responsibilities interfered with family life using the Work Family Conflict Scale and depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). RESULTS Mean (SD) participant age was 27.5 (2.7) years, and 1571 participants (49.7%) were women. Both men and women experienced a marked increase in depressive symptoms during their internship year, with the increase being statistically significantly greater for women (men: mean increase in PHQ-9, 2.50; 95% CI, 2.26-2.73 vs women: mean increase, 3.20; 95% CI, 2.97-3.43). When work-family conflict was accounted for, the sex disparity in the increase in depressive symptoms decreased by 36%. CONCLUSIONS AND RELEVANCE Our study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.

Academic Surgical Oncologists’ Productivity Correlates with Gender, Grant Funding, and Institutional NCI Comprehensive Cancer Center Affiliation

“…35 Female physicians’ increased time commitments to home and child-bearing and rearing responsibilities, coupled with male physicians’ longer career durations, offer alternative potential explanations for this discrepancy in academic productivity. 20,21,23,36,37 Finally, another explanation may be that females are more likely to pursue career advancement through clinical excellence and teaching responsibilities, which are more difficult to objectively quantify and are not accounted for in the h-index. For example, lower rates of academic productivity among female surgical oncologists may originate from differential career choices of faculty track (i.e., research vs. clinical track).…”

Physician mothers’ experience of workplace discrimination: a qualitative analysis

“…When directly asked, 70-77% of women physicians report experiencing gender discrimination,910 and 30% of academic women physicians report having experienced sexual harassment 9. Discrimination may also explain at least part of the gender gap in leadership roles, a phenomenon particularly well documented in academic medicine: while women comprise 46% of US residents (doctors in training), they comprise only 38% of faculty (academic medicine) positions, 21% of full professors, and 15% of department chairs 1112…”

Importance of and strategies for achieving gender equity in hematology

“…5 To determine whether rifaximin was capable of reducing CANs in SCD, 11 patients (6 males and 5 females) with HbSS received rifaximin 550 mg twice a day (ClinicalTrials.gov Identifier: NCT03719729). It has been used for a long term in patients with advanced liver disease.…”

“…[4][5][6] Multiple advocacy groups have been recently formed with the mission of achieving gender equity in medicine, including within medical society leadership, speakers, and panels at national meetings; editorial boards; and positions of leadership such as department chairs, medical school deans, and hospital CEOs. Although we have achieved gender parity in medical schools of the United States, there remains a significant deficiency in the percentage of women physicians who serve as full professors (21%), department chairs (15%), medical school deans (16%), and other positions of leadership.…”