Promoting the Wellbeing of Female Physicians

By Kamala Nelson and Dr. Maria Espinola

The COVID-19 pandemic has taken a disproportionate toll on the wellbeing of health care professionals around the world. While media coverage highlighted the stark reality of physician burnout and fatigue, the true crisis facing our healthcare system and society has not been fully recognized. By 2033, the United States will experience a shortage of up to 124,000 physicians (4). In fact, a recent survey of 20,665 health care workers found that approximately one in five physicians and two in five nurses intend to leave their practice within two years (5). Dr. Christine Sinsky, AMA vice president of professional satisfaction, says that “if even one-third to one-half of nurses and physicians carry out their expressed intentions to cut back or leave, we won’t have enough staff to meet the needs of patients” (2).?

One estimate attributes $4.6 billion in costs to our health care system each year due to physician burnout and this model was created prior to the pandemic (6). In addition to the clear consequences our society will face without medical professionals to care for our children, friends, and neighbors, there are more abstract ramifications that we must consider. For those who do not leave the profession and continue to experience unparalleled trauma, stress, and burnout, the quality of care they provide will suffer as a result. Burnout has been associated with significantly increased likelihood of medical errors (9). “Physically present but psychologically withdrawn”, a burned-out medical workforce may lack empathy, adversely affecting safety, quality of care, productivity, and patient satisfaction (10).?

The epidemic of physician burnout has not been equitable in its damage. Studies have shown that female physicians experience higher rates of burnout and lower rates of professional fulfillment compared to male physicians (11). There are numerous factors that contribute to this disparity. Female physicians generally spend more time documenting patient encounters on electronic health records after work hours (12), which has been linked to higher rates of burnout. Additionally, 66% of female physicians reported experiencing gender-specific bias in professional advancement, as compared to 10% of male physicians (13). It has been shown that female medical residents are granted less autonomy than their male counterparts, despite equal level of training (14). Additionally,? women who choose to have children during medical school, residency, or as attending physicians, face significant organizational and societal barriers that limit their opportunities for professional development and advancement (15). The stress of managing work-family balance was exacerbated for all physicians as a result of the COVID-19 pandemic, but physician mothers, specifically, were more likely than fathers to be responsible for childcare, schooling, and household tasks, resulting in a reduction in work hours, increased work-family conflict, and symptoms of depression and anxiety (16).?

Despite all the barriers that female physicians have to face, studies suggest they still outperform their male counterparts. Female physicians are more likely to follow clinical guidelines and evidence-based practice (17), counsel patients on preventative care (18), and engage in patient-centered communication (19). Furthermore, studies have shown reduced mortality and readmission rates amongst elderly hospitalized patients treated by female internists. Researchers have estimated that “approximately 32 000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year” (20). A recent study published by JAMA Surgery showed that female surgeons also outperform their male counterparts, particularly when they work with female patients. Specifically, female patients who are operated on by male surgeons have a 15 percent higher chance of adverse postoperative outcomes and 32 percent higher chance of death following the surgery (21). The loss of highly skilled, empathetic female physicians due to stress, burnout, and fatigue would cause unimaginable, irreparable consequences for our healthcare system and our society.?

There is a clear need for the implementation of research-informed interventions to care for our health care professionals, who face unprecedented stress in their professional and personal lives, impacting their ability to care for us. Physicians are reluctant to seek traditional mental health treatment due to a variety of reasons, including stigma and fear of difficulties when obtaining or renewing their license. In fact, nearly 40% of physicians indicated that they would hesitate to obtain formal medical treatment for mental health conditions due to concerns about medical licensure repercussions (7).

While platforms such as Zoom have provided an essential means of communicating and connecting during a difficult, distant time for many, mindfulness webinars and virtual wellness tips are not sufficient methods of support. The shortcomings of purely technology-based interventions become more clear when we consider the fact that provider burnout has been associated with excessive time spent using technology (8).

According to data from more than 200,000 Press Ganey physician engagement surveys, male and female physicians find similar amounts of meaning in their work. However, female physicians scored lower on four different areas addressing ability to decompress from their work, including enjoying personal time without worrying about work, freeing their mind from work while away, disconnecting from work communications, and losing sleep over work issues. This disparity persisted across female physicians from ages 30 to 65 (1). In order to counter, in some cases, a career’s worth of emotional exhaustion, some experts are looking into innovative, research-informed interventions to help promote the wellbeing of female physicians.?

The Institute for Health Equity and Innovation recently partnered with Trek Executive Coaching and WISe Wellness Guild to develop Wild Success, a program that uses data-driven methods to improve the mental, physical, and professional well-being of female physicians. Instead of focusing on technology-based interventions, Wild Success prioritizes nature-based interventions. Specifically, the program offers “Shinrin-yoku” or forest therapy, which is a traditional Japanese practice of making contact with nature and taking in the atmosphere of the forest (22). The benefits of forest therapy have been extensively studied and consistently demonstrate a reduction in salivary cortisol and pulse rate (23), improved sleep quality and self-rated depth of sleep (24), and increased feelings of subjective recovery and vitality (25). Forest therapy offers a much needed opportunity for physicians experiencing chronic stress and fatigue to disconnect from a job that can be all-consuming, allowing time for self reflection and relief from stress that can diminish feelings of burnout, improving efficacy and quality of patient care.?

During single day, weekend, or five day international retreats, experts focus on helping physicians improve their self-awareness, emotion regulation, stress management, leadership skills, and sense of meaning and purpose. Through four fundamental principles of education, experience, reflection, and community, Wild Success aims to help physicians develop resilience, decompress with internal reflection, and develop meaningful connections with other female physicians.

Patients rely heavily on female physicians for preventative care, psychosocial support, and high-quality care for which there is no alternative or replacement. In order to prevent the immense loss that we would face if female physicians do not receive the support that they so desperately need, we must encourage research-informed interventions that can effectively help improve the overall wellbeing of female physicians.?

Dr. Maria Espinola is the CEO of the Institute for Health Equity and Innovation and a co-founder of Wild Success.?

Kamala Nelson is a Research Fellow at the Institute for Health Equity and Innovation and a medical student at the University of Cincinnati College of Medicine.