Much of the work of health care occurs because of a strong base of support—child care, housework, and other jobs that allow health care providers to show up every day at the clinic or hospital.
During the COVID-19 pandemic, “that base fell away,” says Elizabeth Harry, MD, associate professor of general internal medicine at the University of Colorado School of Medicine. “It was like a house of cards and everything collapsed because the base was gone.”
In recently published research, Harry and her co-researchers found that of more than 58,000 healthcare workers surveyed between April and December 2020, 21% reported experiencing childcare stress. Those with childcare stress were 115% more likely to experience anxiety or depression and 80% more likely to experience burnout than those without childcare stress.
In addition, high childcare stress was associated with 91% greater odds of intention to reduce hours and 28% greater odds of intention to leave the health profession.
“It’s interesting to see the reaction to this data,” Harry says. “It’s not very surprising, but I think it’s borne out by people’s experience. It definitely hits a nerve, which is good because we hope organizations will look at these numbers and look for ways to invest more in their workers.”
Severe stress from caring for the child
Harry and her co-researchers partnered with the American Medical Association to add a question about childcare stress to Coping with COVID, a short survey about the work life and health of US health care workers. The survey was distributed to clinicians and staff at participating health care organizations with more than 100 physicians. Participants completed the survey during the first months of the pandemic.
“Because everything was happening so quickly, the AMA wanted to start collecting data as soon as possible,” explains Harry. “So there are definitely limitations, but a decision had to be made whether to put something out quickly or do all the validation studies, so the decision was made to start collecting data right away.”
Survey respondents rated whether they were worried about child care due to COVID-19 on a scale of 1 to 4. The Coping with COVID survey also asked respondents about anxiety, depression, workload, as well as individual measures of burnout, intention to reduce hours and intention to leave the health profession.
“One of the key insights that emerged is the intention to reduce hours,” Harry says. “The high stress of raising children has led to a 91% intention to cut hours, and I often don’t think we fully appreciate the huge impact it can have on healthcare. This affects patient access to care, affects costs for the organization. Reduced hours may seem small, but they can have a very big impact.”
Tackling structural inequality
Another finding from the survey data was that 39% of male respondents with low childcare stress experienced burnout, while 53% of male respondents with high childcare stress experienced burnout. Although the rates were higher for women — 63 percent of women with high childcare stress experienced burnout — “it’s worth discussing whether men face a different kind of bias, that there’s always someone else who’s going to care for childcare or housework for them, that they can stay late at work and not have to worry about those things,’ says Harry.
The data also showed that racial or ethnic minority health care workers were 40% to 50% more likely to report stress related to childcare than white respondents. Also, childcare stress was most commonly noted among medical assistants, nursing assistants, speech therapists, and pharmacists.
“Looking at this as a structural inequality issue is really important,” Harry says. “We need to think about the average cost of childcare and what percentage of someone’s salary it is, and ask as an organization how we can support healthcare workers in every role. Here at CU, we are very lucky to have a school on campus, but this is very unusual. We also have a kindergarten, but the waiting list is so long that it is often not available for people.’
Further research could delve deeper not only into the dimensions of childcare stress, but also into other aspects of caregiver stress, Harry says. “People who do not report stress from caring for children may still experience stress from caring for elderly parents or other loved ones. It is important to understand how this leads to burnout, intention to cut hours, and intention to leave. We have people training in healthcare and we want them to stay in healthcare and stay full-time if that’s within their career goals.”