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Exploring the Impact of COVID-19 on Women Hospitalists: A Mixed-Gender Qualitative Analysis

  • Original Research: Qualitative Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Women physicians have faced persistent challenges, including gender bias, salary inequities, a disproportionate share of caregiving and domestic responsibilities, and limited representation in leadership. Data indicate the COVID-19 pandemic further highlighted and exacerbated these inequities.

Objective

To understand the pandemic’s impact on women physicians and to brainstorm solutions to better support women physicians.

Design

Mixed-gender semi-structured focus groups.

Participants

Hospitalists in the Hospital Medicine Reengineering Network (HOMERuN).

Approach

Six semi-structured virtual focus groups were held with 22 individuals from 13 institutions comprised primarily of academic hospitalist physicians. Rapid qualitative methods including templated summaries and matrix analysis were applied to identify major themes and subthemes.

Key Results

Four key themes emerged: (1) the pandemic exacerbated perceived gender inequities, (2) women’s academic productivity and career development were negatively impacted, (3) women held disproportionate roles as caregivers and household managers, and (4) institutional pandemic responses were often misaligned with workforce needs, especially those of women hospitalists. Multiple interventions were proposed including: creating targeted workforce solutions and benefits to address the disproportionate caregiving burden placed on women, addressing hospitalist scheduling and leave practices, ensuring promotion pathways value clinical and COVID-19 contributions, creating transparency around salary and non-clinical time allocation, and ensuring women are better represented in leadership roles.

Conclusions

Hospitalists perceived and experienced that women physicians faced negative impacts from the pandemic in multiple domains including leadership opportunities and scholarship, while also shouldering larger caregiving duties than men. There are many opportunities to improve workplace conditions for women; however, current institutional efforts were perceived as misaligned to actual needs. Thus, policy and programmatic changes, such as those proposed by this cohort of hospitalists, are needed to advance equity in the workplace.

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Data Availability

De-identified data generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Jena AB, Olenski AR, Blumenthal DM. Sex Differences in Physician Salary in US Public Medical Schools. JAMA Intern Med. 2016;176(9):1294-1304. https://doi.org/10.1001/jamainternmed.2016.3284

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gottlieb AS, Jagsi R. Closing the Gender Pay Gap in Medicine. N Engl J Med. 2021;385(27):2501-2504. https://doi.org/10.1056/NEJMp2114955

    Article  PubMed  Google Scholar 

  3. 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. Acad Med J Assoc Am Med Coll. 2018;93(11):1694-1699. https://doi.org/10.1097/ACM.0000000000002146

    Article  Google Scholar 

  4. Richter KP, Clark L, Wick JA, et al. Women Physicians and Promotion in Academic Medicine. N Engl J Med. 2020;383(22):2148-2157. https://doi.org/10.1056/NEJMsa1916935

    Article  PubMed  Google Scholar 

  5. 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. Ann Intern Med. 2014;160(5):344-353. https://doi.org/10.7326/M13-0974

    Article  PubMed  PubMed Central  Google Scholar 

  6. Northcutt N, Papp S, Keniston A, et al. SPEAKers at the National Society of Hospital Medicine Meeting: A Follow-UP Study of Gender Equity for Conference Speakers from 2015 to 2019. The SPEAK UP Study. J Hosp Med. 2020;15(4):228-231. https://doi.org/10.12788/jhm.3401

    Article  PubMed  Google Scholar 

  7. Hart KL, Perlis RH. Trends in Proportion of Women as Authors of Medical Journal Articles, 2008-2018. JAMA Intern Med. 2019;179(9):1285-1287. https://doi.org/10.1001/jamainternmed.2019.0907

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jagsi R, Guancial EA, Worobey CC, et al. The “Gender Gap” in Authorship of Academic Medical Literature — A 35-Year Perspective. N Engl J Med. 2006;355(3):281-287. https://doi.org/10.1056/NEJMsa053910

    Article  CAS  PubMed  Google Scholar 

  9. Keller T, Wilson M, Chung K, Andrilla CH, Evans D, Cawse-Lucas J. Gender Differences in Authorship of Family Medicine Publications, 2002-2017. Fam Med. 2021;53(6):416-422. https://doi.org/10.22454/FamMed.2021.866524

    Article  PubMed  Google Scholar 

  10. Weaver AC, Wetterneck TB, Whelan CT, Hinami K. A matter of priorities? Exploring the persistent gender pay gap in hospital medicine. J Hosp Med. 2015;10(8):486-490. https://doi.org/10.1002/jhm.2400

    Article  PubMed  Google Scholar 

  11. Burden M, Frank MG, Keniston A, et al. Gender disparities in leadership and scholarly productivity of academic hospitalists. J Hosp Med. 2015;10(8):481-485. https://doi.org/10.1002/jhm.2340

    Article  PubMed  Google Scholar 

  12. Kibbe MR. Consequences of the COVID-19 Pandemic on Manuscript Submissions by Women. JAMA Surg. 2020;155(9):803-804. https://doi.org/10.1001/jamasurg.2020.3917

    Article  PubMed  Google Scholar 

  13. Wright KM, Wheat S, Clements DS, Edberg D. COVID-19 and Gender Differences in Family Medicine Scholarship. Ann Fam Med. 2022;20(1):32-34. https://doi.org/10.1370/afm.2756

    Article  PubMed  PubMed Central  Google Scholar 

  14. Andersen JP, Nielsen MW, Simone NL, Lewiss RE, Jagsi R. COVID-19 medical papers have fewer women first authors than expected. eLife. 9:e58807. https://doi.org/10.7554/eLife.58807

  15. Sumarsono A, Keshvani N, Saleh SN, et al. Scholarly Productivity and Rank in Academic Hospital Medicine. J Hosp Med. 2021;16(9):545-548. https://doi.org/10.12788/jhm.3631

    Article  Google Scholar 

  16. Gross T. Pandemic Makes Evident “Grotesque” Gender Inequality In Household Work. NPR. https://www.npr.org/2020/05/21/860091230/pandemic-makes-evident-grotesque-gender-inequality-in-household-work. Published May 21, 2020. Accessed June 13, 2022.

  17. Brown C, Jain S, Santhosh L. How Has the Pandemic Affected Women in Medicine? A Survey-Based Study on Perceptions of Personal and Career Impacts of COVID-19. Womens Health Rep New Rochelle N. 2021;2(1):396-399. https://doi.org/10.1089/whr.2021.0031

    Article  Google Scholar 

  18. Koval ML. Medscape Hospitalist Compensation Report 2022. Medscape. Accessed November 28, 2022. https://www.medscape.com/slideshow/2022-compensation-hospitalist-6015551#21

  19. Auerbach AD, Patel MS, Metlay J, et al. The Hospital Medicine Reengineering Network (HOMERuN): A learning organization focused on improving hospital care. Acad Med J Assoc Am Med Coll. 2014;89(3):415-420. https://doi.org/10.1097/ACM.0000000000000139

    Article  Google Scholar 

  20. Keniston A, McBeth L, Astik G, et al. Practical Applications of Rapid Qualitative Analysis for Operations, Quality Improvement, and Research in Dynamically Changing Hospital Environments. Jt Comm J Qual Patient Saf. Published online November 2022:S1553725022002689. https://doi.org/10.1016/j.jcjq.2022.11.003

  21. Creswell J. Qualitative Inquiry and Research Design: Choosing Among Five Approaches. Fourth Edition. Fourth Edition. SAGE Publications; 2017.

  22. Averill JB. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res. 2002;12(6):855-866. https://doi.org/10.1177/104973230201200611

    Article  PubMed  Google Scholar 

  23. Hamilton AB. Qualitative Methods in Rapid Turn-Around Health Services Research. Presented at: VA HSR&D Cyberseminar Spotlight on Women’s Health; December 11, 2013; VA Greater Los Angeles Healthcare Innovation, Implementation, & Policy. Accessed May 1, 2021. https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/780-notes.pdf

  24. Keniston A, Sakumoto M, Astik GJ, et al. Adaptability on Shifting Ground: a Rapid Qualitative Assessment of Multi-institutional Inpatient Surge Planning and Workforce Deployment During the COVID-19 Pandemic. J Gen Intern Med. Published online March 22, 2022:1–9. https://doi.org/10.1007/s11606-022-07480-x

  25. Birt L, Scott S, Cavers D, Campbell C, Walter F. Member Checking: A Tool to Enhance Trustworthiness or Merely a Nod to Validation? Qual Health Res. 2016;26(13):1802-1811. https://doi.org/10.1177/1049732316654870

    Article  PubMed  Google Scholar 

  26. Santhosh L, Keenan BP, Jain S. The “Third Shift”: A Path Forward to Recognizing and Funding Gender Equity Efforts. J Womens Health 2002. 2020;29(11):1359–1360. https://doi.org/10.1089/jwh.2020.8679

  27. Landau C. The Third Shift. The Third Shift. Published October 23, 2020. Accessed May 1, 2022. https://www.psychologytoday.com/us/blog/mood-prep-101/202010/the-third-shift

  28. Pay inequity, flex schedules top concerns for women physicians. American Medical Association. Accessed June 13, 2022. https://www.ama-assn.org/delivering-care/health-equity/pay-inequity-flex-schedules-top-concerns-women-physicians

  29. 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 Netw Open. 2021;4(11):e2134315. https://doi.org/10.1001/jamanetworkopen.2021.34315

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pino-Jones AD, Cervantes L, Flores S, et al. Advancing Diversity, Equity, and Inclusion in Hospital Medicine. J Hosp Med. 2021;16(4):198-203. https://doi.org/10.12788/jhm.3574

    Article  PubMed  PubMed Central  Google Scholar 

  31. Defoe MV, Cameron KA, Burden M, et al. Men and Women Pursue Nonlinear Career Paths, but Impacts Differ: a Cross-Sectional Study of Academic Hospitalists. J Gen Intern Med. 2022;37(12):3097-3104. https://doi.org/10.1007/s11606-022-07402-x

    Article  PubMed  PubMed Central  Google Scholar 

  32. Arogyaswamy S, Vukovic N, Keniston A, et al. The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers. J Gen Intern Med. 2022;37(6):1463-1474. https://doi.org/10.1007/s11606-021-07106-8

    Article  PubMed  Google Scholar 

  33. Sharma U. Ideal Hospitalist Workload in a 12-Hour Shift. Am J Med Qual. 2019;34(1):98-98. https://doi.org/10.1177/1062860618778347

    Article  PubMed  Google Scholar 

  34. Elliott DJ, Young RS, Brice J, Aguiar R, Kolm P. Effect of hospitalist workload on the quality and efficiency of care. JAMA Intern Med. 2014;174(5):786-793. https://doi.org/10.1001/jamainternmed.2014.300

    Article  PubMed  Google Scholar 

  35. Brown DR, Hernández A, Saint-Jean G, et al. A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation. Am J Public Health. 2008;98(1):28-38. https://doi.org/10.2105/AJPH.2006.091363

    Article  PubMed  PubMed Central  Google Scholar 

  36. Burks DJ, Robbins R, Durtschi JP. American Indian gay, bisexual and two-spirit men: a rapid assessment of HIV/AIDS risk factors, barriers to prevention and culturally-sensitive intervention. Cult Health Sex. 2011;13(3):283-298. https://doi.org/10.1080/13691058.2010.525666

    Article  PubMed  Google Scholar 

  37. Vindrola-Padros C, Chisnall G, Cooper S, et al. Carrying Out Rapid Qualitative Research During a Pandemic: Emerging Lessons From COVID-19. Qual Health Res. 2020;30(14):2192-2204. https://doi.org/10.1177/1049732320951526

    Article  PubMed  PubMed Central  Google Scholar 

  38. Beebe J. Rapid Qualitative Inquiry: A Field Guide to Team-Based Assessment. Second.

  39. Gale RC, Wu J, Erhardt T, et al. Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implement Sci. 2019;14(1):11. https://doi.org/10.1186/s13012-019-0853-y

    Article  PubMed  PubMed Central  Google Scholar 

  40. Moreau J. Rapid qualitative methods. Presented at: Colorado Pragmatic Research in Health Conference (Virtual Conference); August 12, 2020.

  41. Zuchowski JL, Chrystal JG, Hamilton AB, et al. Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies: A Qualitative Analysis. Med Care. 2017;55 Suppl 7 Suppl 1:S53-S60. https://doi.org/10.1097/MLR.0000000000000737

  42. Taylor B, Henshall C, Kenyon S, Litchfield I, Greenfield S. Can rapid approaches to qualitative analysis deliver timely, valid findings to clinical leaders? A mixed methods study comparing rapid and thematic analysis. BMJ Open. 2018;8(10):e019993. https://doi.org/10.1136/bmjopen-2017-019993

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kulkarni SA, Keniston A, Linker AS, et al. Building a thriving academic hospitalist workforce: A rapid qualitative analysis identifying key areas of focus in the field. J Hosp Med. 2023;18(4):329-336. https://doi.org/10.1002/jhm.13074

    Article  PubMed  Google Scholar 

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Acknowledgements

Thanks to our participants and members of the HOMERuN COVID-19 Collaborative Group, especially Tiffany Lee who skillfully manages this group.

Funding

Dr. Leykum receives salary support from the Department of Veterans Affairs (SDR 18–313). The views expressed do not represent the position of the Department of Veterans Affairs or other organizations affiliated with the authors.

Author information

Authors and Affiliations

  1. Division of Hospital Medicine, Dell Medical School, The University of Texas at Austin, 1500 Red River Street, Austin, TX, 78701, USA

    Johanna I. Busch MD, PhD, MPhil, Luci K. Leykum MD, MBA, MSc & Kirsten Nieto MD

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Angela Keniston PhD, MSPH & Marisha Burden MD, MBA

  3. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Gopi J. Astik MD, MS

  4. University of California, San Francisco School of Medicine, San Francisco, CA, USA

    Andrew Auerbach MD, MPH, Kirsten N. Kangelaris MD, Shradha A. Kulkarni MD & Matthew Sakumoto MD

  5. South Texas Veterans Health Care System, San Antonio, TX, USA

    Luci K. Leykum MD, MBA, MSc

  6. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Anne S. Linker MD,

  7. Denver Health, Denver, CO, USA

    Read G. Pierce MD

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  1. Johanna I. Busch MD, PhD, MPhil
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Correspondence to Johanna I. Busch MD, PhD, MPhil.

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Busch, J.I., Keniston, A., Astik, G.J. et al. Exploring the Impact of COVID-19 on Women Hospitalists: A Mixed-Gender Qualitative Analysis. J GEN INTERN MED 38, 3180–3187 (2023). https://doi.org/10.1007/s11606-023-08371-5

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  • DOI: https://doi.org/10.1007/s11606-023-08371-5

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