A call to action for female front-line healthcare workers

While the pandemic adversely affected healthcare workers (HCWs) regardless of gender, recent studies suggest that female front-line HCWs experienced substantially more deleterious effects of the pandemic compared to their male counterparts, with higher rates of burnout and psychiatric illness. As a result, turnover and decreased productivity have increased disproportionately among female HCWs, which has substantial economic consequences for the healthcare organizations that employ them. Specific interventions that decrease distress, one form of which is burnout, among female HCWs can reduce turnover and increase productivity. In order to support the wellbeing and retention of female front-line HCWs, we propose an action plan to mitigate work- and home-related stressors among women in the intensive care unit.

Covid-19; Intensive care; Front-line healthcare workers; Mental health; Female health care workers; Burnout; Gender disparities; Attrition

[1] Catenaccio E, Rochlin JM, Simon HK. Addressing gender-based disparities in earning potential in academic medicine. JAMA Network Open. 2022; 5: e220067.

[2] Richter KP, Clark L, Wick JA, Cruvinel E, Durham D, Shaw P, et al. Women physicians and promotion in academic medicine. New England Journal of Medicine. 2020; 383: 2148–2157.

[3] AAMC. 2018–2019 The state of women in academic medicine: exploring pathways to equity. 2020. Available at: https://www.aamc.org/data-reports/data/2018-2019-state-women-academic-medicine-exploring-pathways-equity (Accessed: 9 January 2024).

[4] Carr PL, Raj A, Kaplan SE, Terrin N, Breeze JL, Freund KM. Gender differences in academic medicine: retention, rank, and leadership comparisons from the national faculty survey. Academic Medicine. 2018; 93: 1694–1699.

[5] Goddard AF, Patel M. The changing face of medical professionalism and the impact of COVID-19. The Lancet. 2021; 397: 950–952.

[6] Shaukat N, Ali DM, Razzak J. Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review. International Journal of Emergency Medicine. 2020; 13: 40.

[7] Van Wert MJ, Gandhi S, Gupta I, Singh A, Eid SM, Haroon Burhanullah M, et al. Healthcare worker mental health after the initial peak of the COVID-19 pandemic: a US medical center cross-sectional survey. Journal of General Internal Medicine. 2022; 37: 1169–1176.

[8] Ferry AV, Wereski R, Strachan FE, Mills NL. Predictors of UK healthcare worker burnout during the COVID-19 pandemic. QJM: An International Journal of Medicine. 2021; 114: 374–380.

[9] Power K. The COVID-19 pandemic has increased the care burden of women and families. Sustainability: Science, Practice and Policy. 2020; 16: 67–73.

[10] Frank E, Zhao Z, Fang Y, Rotenstein LS, Sen S, Guille C. Experiences of work-family conflict and mental health symptoms by gender among physician parents during the COVID-19 pandemic. JAMA Network Open. 2021; 4: e2134315.

[11] Templeton K, Bernstein CA, Sukhera J, Nora LM, Newman C, Burstin H, et al. Gender-based differences in burnout: issues faced by women physicians. 2019. Available at: https://nam.edu/gender-based-differences-in-burnout-issues-faced-by-women-physicians/ (Accessed: 09 January 2024).

[12] Frogner BK, Dill JS. Tracking turnover among health care workers during the COVID-19 pandemic. JAMA Health Forum. 2022; 3: e220371.

[13] Murthy VH. Addressing health worker burnout: the U.S. surgeon general’s advisory on building a thriving health workforce. 2022. Available at: https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf (Accessed: 09 January 2024).

[14] Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Annals of Internal Medicine. 2014; 160: 344–353.

[15] Crimi C, Carlucci A. Challenges for the female health-care workers during the COVID-19 pandemic: the need for protection beyond the mask. Pulmonology. 2021; 27: 1–3.

[16] Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain, Behavior, and Immunity. 2020; 88: 901–907.

[17] Rahman A, Plummer V. COVID-19 related suicide among hospital nurses; case study evidence from worldwide media reports. Psychiatry Research. 2020; 291: 113272.

[18] Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and childbearing among American female physicians. Journal of Women’s Health. 2016; 25: 1059–1065.

[19] World Health Organization. Infertility prevalence estimates: 1990–2021. 2023. Available at: https://iris.who.int/bitstream/handle/10665/366700/9789240068315-eng.pdf?sequence=1&isAllowed=y (Accessed: 09 January 2024).

[20] Rangel EL, Castillo-Angeles M, Easter SR, Atkinson RB, Gosain A, Hu Y, et al. Incidence of infertility and pregnancy complications in us female surgeons. JAMA Surgery. 2021; 156: 905.

[21] Matsuo K, Green JM, Herrman SA, Mandelbaum RS, Ouzounian JG. Severe maternal morbidity and mortality of pregnant patients with COVID-19 infection during the early pandemic period in the US. JAMA Network Open. 2023; 6: e237149.

[22] Centers for Disease Control and Prevention. Exoskeletons and occupational health equity. Available at: https://blogs.cdc.gov/niosh-science-blog/2020/12/14/exoskeletons-health-equity (Accessed: 21 January 2022).

[23] Perez CC. Invisible women: the Sunday Times number one bestseller exposing the gender bias women face every day. 2019. Available at: Invisible Women. Random House. http://books.google.ie/books?id=MKZYDwAAQBAJ&printsec=frontcover&dq=Criado+Perez,+Caroline.+Invisible+Women:+Data+Bias+in+A+World+Designed+for+Men.+Harry+N.+Abrams,+2019&hl=&cd=1&source=gbs_api (Accessed: 07 March 2019).

[24] Doos D, Barach P, Sarmiento E, Ahmed R. Reuse of personal protective equipment: results of a human factors study using fluorescence to identify self‐contamination during donning and doffing. The Journal of Emergency Medicine. 2022; 62: 337–341.

[25] UN Women Data Hub. COVID-19: emerging gender data and why it matters. Available at: https://data.unwomen.org/resources/covid-19-emerging-gender-data-and-why-it-matters (Accessed: 26 June 2020).

[26] Zhang S, Zhao Z, Zhang H, Zhu Y, Xi Z, Xiang K. Workplace violence against healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Environmental Science and Pollution Research. 2023; 30: 74838–74852.

[27] Aguglia A, Belvederi Murri M, Conigliaro C, Cipriani N, Vaggi M, Di Salvo G, et al. Workplace violence and burnout among mental health workers. Psychiatric Services. 2020; 71: 284–288.

[28] Sanford J, Agrawal A, Miotto K. Psychological distress among women healthcare workers: a health system’s experience developing emotional support services during the COVID-19 pandemic. Frontiers in Global Women’s Health. 2021; 2: 614723.

[29] Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, et al. Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis. Journal of Affective Disorders. 2020; 275: 48–57.

[30] Shanafelt TD, West CP, Dyrbye LN, Trockel M, Tutty M, Wang H, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clinic Proceedings. 2022; 97: 2248–2258.

[31] Hämmig O. Explaining burnout and the intention to leave the profession among health professionals—a cross-sectional study in a hospital setting in Switzerland. BMC Health Services Research. 2018; 18: 785.

[32] Ligibel JA, Goularte N, Berliner JI, Bird SB, Brazeau CMLR, Rowe SG, et al. Well-being parameters and intention to leave current institution among academic physicians. JAMA Network Open. 2023; 6: e2347894.

[33] Andersen JP, Nielsen MW, Simone NL, Lewiss RE, Jagsi R. COVID-19 medical papers have fewer women first authors than expected. eLife. 2020; 9: e58807.

[34] Gabster BP, van Daalen K, Dhatt R, Barry M. Challenges for the female academic during the COVID-19 pandemic. The Lancet. 2020; 395: 1968–1970.

[35] Chen Y, Orlas C, Kim T, Chang DC, Kelleher CM. Workforce attrition among male and female physicians working in US academic hospitals, 2014–2019. JAMA Network Open. 2023; 6: e2323872.

[36] Berlin G, Robinson N, Sharma M. Women in the healthcare industry: an update. 2023. Available at: https://www.mckinsey.com/industries/healthcare/our-insights/women-in-healthcare-and-life-sciences-the-ongoing-stress-of-covid-19 (Accessed: 30 March 2023).

[37] AAMC. Faculty roster: U.S. medical school faculty. Available at: https://www.aamc.org/data-reports/faculty-institutions/data/us-medical-school-faculty-trends-counts (Accessed: 9 January 2024).

[38] Perryman AA, Fernando GD, Tripathy A. Do gender differences persist? An examination of gender diversity on firm performance, risk, and executive compensation. Journal of Business Research. 2016; 69: 579–586.

[39] Maurer CC, Qureshi I. Not just good for her: a temporal analysis of the dynamic relationship between representation of women and collective employee turnover. Organization Studies. 2021; 42: 85–107.

[40] Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, et al. Estimating the attributable cost of physician burnout in the United States. Annals of Internal Medicine. 2019; 170: 784.

[41] Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Internal Medicine. 2017; 177: 1826.

[42] Atkinson W, Misra-Hebert A, Stoller JK. The impact on revenue of physician turnover: an assessment model and experience in a large healthcare center. The Journal of Medical Practice Management. 2006; 21: 351–355.

[43] Banerjee G, Mitchell JD, Brzezinski M, DePorre A, Ballard HA. Burnout in academic physicians. The Permanente Journal. 2023; 27: 142–149.

[44] Dyrbye LN, Awad KM, Fiscus LC, Sinsky CA, Shanafelt TD. Estimating the attributable cost of physician burnout in the United States. Annals of Internal Medicine. 2019; 171: 600.

[45] Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Services Research. 2014; 14: 325.

[46] Shanafelt TD, Mungo M, Schmitgen J, Storz KA, Reeves D, Hayes SN, et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clinic Proceedings. 2016; 91: 422–431.

[47] Child Care Aware of America. Child care for essential workers during coronavirus outbreak. 2020. Available at: https://www.childcareaware.org/coronavirus/child-care-essential-workers-coronavirus-outbreak (Accessed: 25 March 2020).

[48] Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA. 2020; 323: 2133.

[49] Adams TN, Ruggiero RM, North CS. Addressing mental health needs among frontline health care workers during the COVID-19 pandemic. Chest. 2023; 164: 975–980.

[50] Tome M, Zwahlen E. Lived experience of infertility and in vitro fertilization treatment. Australian Journal of General Practice. 2023; 52: 295–297.

[51] Aljohani B, Burkholder J, Tran QK, Chen C, Beisenova K, Pourmand A. Workplace violence in the emergency department: a systematic review and meta-analysis. Public Health. 2021; 196: 186–197.