This month, yet another facet of gender bias contributing to female physician burnout was quantified.
In this blog post let's review the known sources of higher stress and workload on female physicians and let me show you yet another newly quantified stress on women doctors.
Links below provide a great gender bias review article from the National Academy of Medicine and downloads of two new studies on this additional stressor for female physicians.
Women physicians spend an average of 20% more time in the EHR than men because of this one gender-biased behavior by staff and patients.
I believe it all revolves around your answer to this query:
"If you had a question for a doctor, would you be more likely to ask a man or a woman?"
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Male Physicians -- Heads Up ... much of this is invisible to us and yet it is part of the day-to-day reality of our women colleagues. Please read and familiarize yourself with their additional sources of stress.
BE AWARE, for many female physicians, ALL of these stressors are in place AT THE SAME TIME.
Please notice that for many of these stressors, we men can play a significant role in mitigating or eliminating them as advocates for our female colleagues.
Notice too that all these stresses apply to ALL WOMEN in the healthcare workplace regardless of their role on the work team. We can advocate for all who don't hold our place of privilege in the practice pecking order.
When it comes to burnout, the playing field is tilted from the start against women who choose medicine as a career.
Every time researchers take a new angle on the different experiences of men and women doctors - in both medical education and medical practice - they find new new flavors of bias and new layers of unequal workloads.
Even before this new data we already know that women are at higher risk of burnout from several well-studied sources of female-specific physician stress. Here is a partial list.
Gender bias summary and full references in this NAM Publication:
Gender-Based Differences in Burnout:
Issues Faced by Women Physicians
Known Additional Stresses on Women Physicians
- Higher household and family workload outside of work
- Gender bias and discrimination in the workplace
- Lower pay than men - across the board, for the same job
- Less respect
- Fewer Grand Rounds speaking opportunities
- Fewer opportunities for mentorship and advancement
- Lower representation on the leadership team
- More often addressed by first name rather than title
- More often victims of workplace sexual harassment
- More mistreatment and discrimination by patients, their families, and visitors (Only recently quantified)
- All of this is worse if you are pregnant or breastfeeding
- All of this is worse if you belong to a racial or ethnic minority group
Now you can add in
Gender Biased Digital Communication Overload
The EMR and the Patient Portal don't have Gender Bias built into the computer program, but patterns in the way humans use these communication technologies result in yet another tilting of the playing field against life balance for female physicians.
Female physicians spend 25% more time in the EHR than their male counterparts because patients and staff expect a woman to answer their question more than a man.
And all that Q&A must be documented.
Two important new studies:
From the STUDIES:
"After adjusting for panel size and appointment volume, female PCPs spend 20% more time (1.9 h/month) in the EHR inbasket and 22% more time (3.7 h/month) on notes than do their male colleagues (p values 0.02 and 0.04, respectively).
Female PCPs receive 24% more staff messages (9.6 messages/month), and 26% more patient messages (51.5 messages/month) (p values 0.03 and 0.004, respectively).
The differences in EHR time are not explained by the percentage of female patients in a PCP’s panel.
The observed gender differences are likely driven by inherent and socialized physician traits, as well as by gendered differences in patient and staff expectations of physician accessibility.
So what can be done?
Acknowledging that some of this EHR time is valuable asynchronous care that patients have increasingly come to expect, clinical practice leaders might formally incorporate this work into clinician workflows. EXAMPLE: Designate the first 30 minutes of clinic sessions for responding to patient messages.
In parallel, practices can guide patients to use messages in more targeted ways, involve other clinical team members, and use artificial intelligence to triage messages.
Compensation models must also adapt to the reality that care is increasingly asynchronous, especially for women physicians. Current predominant fee-for-service payment models woefully undervalue time spent inside and outside of visits. To address this, UCSF health system is experimenting with having clinicians bill insurers for each patient message that requires medical evaluation or more than a certain response time."
My take on why this is happening
As a big, old, reasonably gruff and task oriented white guy, I am stunned by these findings and their magnitude. At the same time, I realize I am surely clueless and unaware because I am not effected by this phenomenon. My big, old, guy gruffness protects me from this inbound stream of questions like teflon.
It is a privilege I have that is invisible to me in the same fashion as my white privilege is invisible to me - unless I raise my own awareness.
I am shocked. And I can hear you perhaps saying "Duh" in response. And this is the first quantification of this bias I have seen. 20% is a MASSIVE additional burden.
Assuming we can generalize the results, on average, a male physician can complete the documentation and close out the chart on five patients in the same time it takes a woman physician to completes her documentation on just four. (Remember this is ON AVERAGE, some are even more distracted by this digital overwhelm) The female partner is behind by 20% from the first question in the shift they get from a staff member or patient.
InBasket, notes, patient messages, staff messages ... all of them 20 - 26% more than the men. YIKES!
Add this overload to all the other bullet points at the start of this post and it is abundantly clear the deck in healthcare education and practice is definitely stacked against women - in ways we are only just beginning to quantify.
I believe the source of this disparity is mostly gendered communication expectations.
Here is my spin and I am a big old white guy ... but let me take a stab at it.
=> Patients and staff ask questions to female doctors more often because they expect a woman to answer more than they expect a man to ... OR because they feel more comfortable interrupting/bothering a woman than a man.
=> When asked, women physicians are more likely to feel obligated to answer - and knows she will be more viciously labeled and judged than a man if she does not answer or asks the question be directed to someone else - all simply because she is a woman.
I have always said a man can get away with being short, brusque, even rude - and people interpret it as showing "leadership potential". Where a woman never gets away with any of that without being labeled with the "B" word.
What do YOU think about all of this?
PLEASE LEAVE A COMMENT
- Have you noticed this imbalance of inbound questions and EMR documentation in your practice?
- What happens when you try to avoid a question from a patient or staff member in your practice?
- What systems do you think my help to address this gendered workload discrepancy
- If you are a male physician, how can we help our female colleagues and begin to level this playing field?