Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic.

Importance: The COVID-19 pandemic has placed increased strain on health care workers and disrupted childcare and schooling arrangements in unprecedented ways. As substantial gender inequalities existed in medicine before the pandemic, physician mothers may be at particular risk for adverse professional and psychological consequences. Objective: To assess gender differences in work-family factors and mental health among physician parents during the COVID-19 pandemic. Design, Setting, and Participants: This prospective cohort study included 276 US physicians enrolled in the Intern Health Study since their first year of residency training. Physicians who had participated in the primary study as interns during the 2007 to 2008 and 2008 to 2009 academic years and opted into a secondary longitudinal follow-up study were invited to complete an online survey in August 2018 and August 2020. Exposures: Work-family experience included 3 single-item questions and the Work and Family Conflict Scale, and mental health symptoms included the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scale. Main Outcomes and Measures: The primary outcomes were work-to-family and family-to-work conflict and depressive symptoms and anxiety symptoms during August 2020. Depressive symptoms between 2018 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic) were compared by gender. Results: Among 215 physician parents who completed the August 2020 survey, 114 (53.0%) were female and the weighted mean (SD) age was 40.1 (3.57) years. Among physician parents, women were more likely to be responsible for childcare or schooling (24.6% [95% CI, 19.0%-30.2%] vs 0.8% [95% CI, 0.01%-2.1%]; P < .001) and household tasks (31.4% [95% CI, 25.4%-37.4%] vs 7.2% [95% CI, 3.5%-10.9%]; P < .001) during the pandemic compared with men. Women were also more likely than men to work primarily from home (40.9% [95% CI, 35.1%-46.8%] vs 22.0% [95% CI, 17.2%-26.8%]; P < .001) and reduce their work hours (19.4% [95% CI, 14.7%-24.1%] vs 9.4% [95% CI, 6.0%-12.8%]; P = .007). Women experienced greater work-to-family conflict (ß = 2.79; 95% CI, 1.00 to 4.59; P = .03), family-to-work conflict (ß = 3.09; 95% CI, 1.18-4.99; P = .02), and depressive (ß = 1.76; 95% CI, 0.56-2.95; P = .046) and anxiety (ß = 2.87; 95% CI, 1.49-4.26; P < .001) symptoms compared with men. We observed a difference between women and men in depressive symptoms during the COVID-19 pandemic (mean [SD] PHQ-9 score: 5.05 [6.64] vs 3.52 [5.75]; P = .009) that was not present before the pandemic (mean [SD] PHQ-9 score: 3.69 [5.26] vs 3.60 [6.30]; P = .86). Conclusions and Relevance: This study found significant gender disparities in work and family experiences and mental health symptoms among physician parents during the COVID-19 pandemic, which may translate to increased risk for suicide, medical errors, and lower quality of patient care for physician mothers. Institutional and public policy solutions are needed to mitigate the potential adverse consequences for women's careers and well-being.

Academic Medicine Faculty Perceptions of Work-Life Balance Before and Since the COVID-19 Pandemic.

Importance: How the COVID-19 pandemic has affected academic medicine faculty's work-life balance is unknown. Objective: To assess the association of perceived work-life conflict with academic medicine faculty intention to leave, reducing employment to part time, or declining leadership opportunities before and since the COVID-19 pandemic. Design, Settings, and Participants: An anonymous online survey of medical, graduate, and health professions school faculty was conducted at a single large, urban academic medical center between September 1 and September 25, 2020. Main Outcomes and Measures: Self-assessed intention to leave, reducing employment to part time, or turning down leadership opportunities because of work-life conflict before and since the COVID-19 pandemic. Results: Of the 1186 of 3088 (38%) of faculty members who answered the survey, 649 (55%) were women and 682 (58%) were White individuals. Respondents were representative of the overall faculty demographic characteristics except for an overrepresentation of female faculty respondents and underrepresentation of Asian faculty respondents compared with all faculty (female faculty: 649 [55%] vs 1368 [44%]; Asian faculty: 259 [22%] vs 963 [31%]). After the start of the COVID-19 pandemic, faculty were more likely to consider leaving or reducing employment to part time compared with before the pandemic (leaving: 225 [23%] vs 133 [14%]; P < .001; reduce hours: 281 [29%] vs 206 [22%]; P < .001). Women were more likely than men to reduce employment to part time before the COVID-19 pandemic (153 [28%] vs 44 [12%]; P < .001) and to consider both leaving or reducing employment to part time since the COVID-19 pandemic (leaving: 154 [28%] vs 56 [15%]; P < .001; reduce employment: 215 [40%] vs 49 [13%]; P < .001). Faculty with children were more likely to consider leaving and reducing employment since the COVID-19 pandemic compared with before the pandemic (leaving: 159 [29%] vs 93 [17%]; P < .001; reduce employment: 213 [40%] vs 130 [24%]; P < .001). Women with children compared with women without children were also more likely to consider leaving since the COVID-19 pandemic than before (113 [35%] vs 39 [17%]; P < .001). Working parent faculty and women were more likely to decline leadership opportunities both before (faculty with children vs without children: 297 [32%] vs 84 [9%]; P < .001; women vs men: 206 [29%] vs 47 [13%]; P < .001) and since the COVID-19 pandemic (faculty with children vs faculty without children: 316 [34%] vs 93 [10 %]; P < .001; women vs men: 148 [28%] vs 51 [14%]; P < .001). Conclusions and Relevance: In this survey study, the perceived stressors associated with work-life integration were higher in women than men, were highest in women with children, and have been exacerbated by the COVID-19 pandemic. The association of both gender and parenting with increased perceived work-life stress may disproportionately decrease the long-term retention and promotion of junior and midcareer women faculty.

Work-Family Conflict of Collegiate and Secondary School Athletic Trainers Who Are Parents.

CONTEXT: The work-life interface has been a much discussed and researched area within athletic training. The National Athletic Trainers' Association position statement on work-life balance highlighted the profession's interest in this topic. However, gaps in the literature remain and include the roles of time-based conflict and social support. OBJECTIVE: To compare work-family conflict (WFC) and social support among athletic trainers (ATs) employed in the 2 most common practice settings. DESIGN: Cross-sectional observational survey. SETTING: Collegiate and secondary school settings. PATIENTS OR OTHER PARTICIPANTS: A total of 474 (females = 231, males = 243) ATs who were employed in the collegiate (205, 43.2%) or secondary school (269, 56.8%) setting. MAIN OUTCOME MEASURE(S): Data were collected through a Web-based survey designed to measure conflict and social support. Likert responses were summed. Demographic information was analyzed for frequency and distribution. Independent t tests and Mann-Whitney U tests were calculated to determine group differences. Linear regression was used to determine if social support predicted WFC. RESULTS: Social provisions and WFC were negatively correlated, and the social provisions score predicted WFC. No WFC differences (P = .778) were found between collegiate and high school ATs even though collegiate ATs worked more hours (63 ± 11) during their busiest seasons compared with those in the high school setting (54 ± 13, P < .001). Similarly, no difference (P = .969) was present between men and women, although men worked more hours. Our participants scored highest on time-based WFC items. CONCLUSIONS: Work-family conflict was experienced globally in 2 of the most common athletic training settings and between sexes. This indicates WFC is universally experienced and therefore needs to be addressed, specifically with a focus on time-based conflict. In addition to time-management strategies, ATs need support from coworkers, peers, and family members.

Developing Stress Management Programs in a Public Primary Healthcare Institution: Should We Consider Health Workers' Sociodemographic Groups?

Background and Objectives: An essential part of occupational stress management is identifying target groups and developing a wellbeing program that tailors interventions to the specific needs of the target groups. This study aims to explore whether psychosocial risk determinants and organizational intervention objects differ across employees' groups based on sociodemographic factors in a Lithuanian public primary healthcare institution. Methods: All 690 health workers of the institution were invited to participate (response rate 68 %) in a cross-sectional survey between February and March 2017. The questionnaire contained items related to sociodemographic factors (gender, age, job seniority, education, and occupation), 14 psychosocial risk determinants, and 10 organisational intervention objects. Results: The results of the study showed that differences by gender were not statistically significant except for one organisational intervention object (work-life balance). Only a few organisational intervention objects (justice of reward, matching to the job demand, and variety of tasks) had mean rank scores differing statistically across age and job seniority groups. Five organisational intervention objects (work-life balance, variety of tasks, communication, manager feedback, and stress management training) had mean rank scores differing statistically across education groups, and all organisational intervention objects (except stress management training) had mean rank scores differing statistically across occupational groups. Regarding psychosocial risk determinants, excessive work pace had mean rank scores differing statistically across age and job seniority groups. Four (overtime, unclear role, conflicting roles, and being under-skilled) and six psychosocial risk determinants (work overload, overtime, tight deadlines, unclear role, being under-skilled, and responsibility) had mean scores differing statistically across education and occupational groups, respectively. Statistical significance was considered with p-value < 0.05 and 95 % confidence interval. Conclusions: The findings showed that different psychosocial risk determinants and organizational interventional objects were emphasized by different sociodemographic groups in the institution, but they did not impact groups in the same measure. Therefore, it is crucial to start by determining the risk group's specific needs before developing and implementing stress management programs.

Formal and Informal Work-Life Balance Practices of Athletic Trainers in Collegiate and University Settings.

CONTEXT: Organizational policies for work-life balance exist, but little is known about athletic trainers' (ATs') awareness of and willingness to use them. OBJECTIVE: To explore ATs' formal and informal work-life balance policies in the collegiate and university athletic training setting. DESIGN: Sequential mixed-methods study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: We sent 4673 e-mails to National Athletic Trainers' Association ATs (full-time employment for at least 1 year, nonacademic appointment); 1221 participants began our survey (access rate = 26.1%), and 783 completed the survey (64.1% completion rate). Demographics were as follows: men = 375 (48.0%) and women = 404 (51.7%); age = 36 ± 10 years; experience = 13 ± 9 years; years at current place of employment = 8 ± 8 years; and participants with children or minor dependents = 262 (33.5%). MAIN OUTCOME MEASURE(S): We created a 17-item instrument from an earlier qualitative study. A panel of experts (n = 3; employer, employee, and researcher) completed a content analysis. Variables of interest were confidence (scale = 1-4) and satisfaction (scale = 1-5) with policies. We used Pearson χ2 analyses to compare the effect of undergoing an orientation and the presence or absence of children on the main outcome measures. RESULTS: A majority of participants had experienced formal orientation through the human resources department (n = 522, 66.8%), the direct supervisor (n = 240, 30.7%), or a colleague (n = 114, 14.6%). However, many had received no orientation (n = 184, 23.6%). Those who had undergone orientation indicated greater confidence in knowing about (P < .001) and greater satisfaction with (P < .001) formal workplace policies and benefits. Those with children stated that they had greater confidence in knowing about (P < .001) and greater satisfaction with (P = .013) formal workplace policies and benefits. Those who had been oriented felt greater confidence in knowing about (P = .009) but no difference in satisfaction with (P = .060) informal workplace policies and benefits. We did not identify differences between those with and those without children regarding their confidence in knowing about (P = .653) or satisfaction with (P = .150) informal workplace policies and benefits. CONCLUSIONS: Athletic trainers in the collegiate and university setting were not confident in their knowledge of formal or informal work-life balance policies.

What type of worker are you? Work-related Inventory (WI-10): A comprehensive instrument for the measurement of workaholism.

BACKGROUND: In literature, there are many instruments for evaluating workaholism; however, they do not have convergent validity, because of the lack of a shared definition of workaholism. OBJECTIVE: We propose a new instrument for evaluating workaholism and work engagement, namely the Work-related Inventory (WI-10), which is based on Loscalzo and Giannini's (2017) comprehensive definition of workaholism. METHODS: We developed a pool of 36 items, covering: 1) addiction symptoms; 2) obsessive-compulsive symptoms, and 3) work engagement. Then, we conducted Exploratory and Confirmatory Factor analyses on a sample of 503 Italian workers (165 males, 337 females, one missing; Mean age = 38.26±10.84) aiming to reduce the number of items. RESULTS: The results showed a 10-items (2 filler) and 2-factor solution: 1) Workaholism and 2) Work Engagement; moreover, the WI-10 has good internal reliability, convergent and divergent validity. CONCLUSIONS: We found good psychometric properties for the WI-10. We also proposed the cut-off scores for the screening of the four kinds of workers proposed by Loscalzo and Giannini (2017): disengaged workaholics, engaged workaholics, engaged workers, and detached workers. The WI-10 will be useful for both research and preventive and clinical purposes.

[Keys for well-being and fulfilment at work]. / Des clés pour le bien-être et l'épanouissement au travail.

If organizations seek to be profitable, they have no choice but to help their employees live in harmony, to be serene and creative. Well-being at work is largely linked to our ability to adapt to the moving reality of the company, without losing ourselves. Guides and methods help to live this reality as well as possible.

After hours teleworking and boundary management: Effects on work-family conflict.

BACKGROUND: There is a need for a better understanding of how the use of technology to complete work outside regular office hours is related to work-life outcomes. Few studies have also investigated how individual differences in work-nonwork boundary management relate to work-life outcomes. OBJECTIVE: This study was conducted to examine how teleworking outside regular office hours and individual boundary management relate to work-family conflict. METHODS: A web survey was sent to fulltime employees at the headquarters of a multinational high-tech firm in Sweden. A total of 71 answers were obtained and analyzed using regression analysis. RESULTS: The extent of teleworking after hours was unrelated to work-family conflict. However, as previous research has shown, having more permeable boundaries and allowing work to interrupt nonwork behavior was related to higher levels of conflict. CONCLUSIONS: The findings suggest that teleworking after hours is not as problematic in terms of work-family conflict as has been reported in previous studies. Furthermore, in order to prevent high levels of work-family conflict, it is seemingly beneficial to avoid work interruptions during nonwork behavior.

The association between work-life balance and health status among Korean workers.

BACKGROUND: Although the relationship between work-life balance (WLB) and health is well known, it has been poorly studied in Korea. OBJECTIVE: This study investigated factors related to WLB for Korean workers, including working time features and the relationships between WLB and health outcomes. METHODS: Data were obtained from the third Korean Working Conditions Survey, which examined a representative working population. This study investigated general characteristics, working time characteristics, work related health, and WLB. A multivariate logistic regression was used to test the associations between WLB and health outcome variables, including general health status, mental health, work-related risks to health and safety, sickness absenteeism, presenteeism, musculoskeletal disease, headache/eyestrain, and fatigue. RESULTS: General characteristics including gender, age, working sector, occupation, and employment type were found to be related to WLB. Moreover, working time characteristics were found to be strongly related to WLB. In addition, WLB was significantly related to various health outcomes. CONCLUSIONS: Our findings indicate that WLB is strongly related to health outcomes among Korean workers. The results suggest that there is a need for interventions that focus on implementing working time strategies for better health.

Redefining the "Normal" Worker: Law and Policy Choices for Work-Family Balance in Canada: Redéfinir le 'travailleur normal': Regard sur les choix législatifs et de politiques publiques en matière de conciliation travail-famille au Canada.

While the need to reconcile work and family life has been recognized in discrete ways in legislation and policy over the years, there has not been a substantial shift away from the archetype of the "unencumbered" (male) worker to a new model of the "normal" worker. In Canada and elsewhere, legislative protection does not allow women or men to effectively reconcile work and family responsibilities over the life cycle. This paper examines the different ways in which work-family balance is regulated, with a focus on the Canadian federal jurisdiction and the province of Quebec, and underlines the need for coherent labor and social policy. The paper also explores the development of multi-stakeholder initiatives on work-family balance, including the development of voluntary standards and a proposal for a work-family "framework" law to ensure coherence among different laws and programs affecting work-family balance. The paper concludes by confirming the need to move away from an individualized approach toward a more mainstreamed and collectivized approach to work-family balance. Résumé Bien que la nécessité de concilier travail et vie familiale ait fait l'objet d'une reconnaissance timide dans la législation et les politiques publiques au fil des ans, il n'y a pas eu de changement substantiel de l'archétype du travailleur « sans engagements ¼ (homme) vers un nouveau modèle de « travailleur normal ¼. Au Canada et ailleurs, la protection législative ne permet pas aux femmes ou aux hommes d'arrimer efficacement leurs responsabilités professionnelles et familiales au cours de leur vie. Cet article examine les différentes façons dont la conciliation travail-famille est réglementée, particulièrement en droit fédéral canadien et dans la province de Québec, et souligne la nécessité d'une politique sociale et de travail cohérente. Le texte explore également le développement d'initiatives multipartites, y compris l'élaboration de normes volontaires de style ISO et une proposition de loi-cadre travail-famille afin d'assurer une cohérence entre les différents lois et programmes touchant la conciliation famille-travail au Québec. L'article conclut en confirmant la nécessité de passer d'une approche individualisée à une approche plus intégrée et collectivisée de la conciliation travail-famille.

Influence of job demands and job control on work-life balance among Taiwanese nurses.

AIM: This study investigated the extent to which the job demands and job control of nurses were related to their work-life balance. BACKGROUND: The inability to achieve work-life balance is one of the major reasons for the declining retention rate among nurses. Job demands and job control are two major work domain factors that can have a significant influence on the work-life balance of nurses. METHOD: The study measured the job demands, job control and work-life balance of 2040 nurses in eight private hospitals in Taiwan in 2013. RESULTS: Job demands and job control significantly predicted all the dimensions of work-life balance. Job demands increased the level of work-life imbalance among nurses. While job control showed positive effects on work/personal life enhancement, it was found to increase both work interference with personal life and personal life interference with work. CONCLUSION: Reducing the level of job demands (particularly for psychological demands) between family and career development and maintaining a proper level of job control are essential to the work-life balance of nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Flexible work practices and team-based management could be considered by nursing management to lessen job demand pressure and to facilitate job engagement and participation among nurses, thus promoting a better balance between work and personal life.

Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout.

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

Negotiating Work-Life Integration.

Introduction: Integrating work and home domains is a constant challenge for medical professionals. Only half of physicians report positive work-life satisfaction, implying that negotiating the inherent conflicts between work and home may not be intuitive. Early teaching of skills focused on professional sustainability may best prepare physicians to navigate conflicts between work and home domains. Methods: This interactive workshop targets trainees and junior faculty. It aims to highlight the current state of physician career satisfaction, to bring awareness to the risk of physician burnout, and to apply strategies that promote work-life integration as a lifelong practice for sustained career satisfaction. It includes a detailed presentation with structured resources to reinforce skill development. Results: This workshop was delivered five times to trainees and junior faculty. Workshop evaluations (n = 50) revealed that all participants believed the information presented was useful, addressed competencies relevant to their training, and increased their knowledge about how to create better work-life integration; all anticipated improvement in their professional work. They all recommended this program to a colleague. Discussion: This workshop offers an effective way to teach a skill set that enhances physicians' abilities to negotiate conflicting work and life domain boundaries. Our results indicate that learners intend to apply newly acquired strategies for work-life integration so as to improve career satisfaction and wellness. Such skill sets may mitigate physician burnout and promote career sustainability, both critical issues with far-reaching implications for the delivery of safe, high-quality health care at the provider and system levels.