The COVID-19 pandemic disproportionately affects females in the home and workplace. This study aimed to acquire information regarding the gender-specific effects of the COVID-19 lockdown on aspects of professional and personal lives of a subset of pediatric cardiologists. We sent an online multiple-choice survey to a listserv of Pediatric Cardiologists. Data collected included demographics, dependent care details, work hours, leave from work, salary cut, childcare hours before and after the COVID-19 peak lockdown/stay at home mandate and partner involvement. Two hundred forty-two pediatric cardiologists with dependent care responsibilities responded (response rate of 20.2%). A significantly higher proportion of females reported a salary cut (29.1% of females vs 17.6% of males, p = 0.04) and scaled back or discontinued work (14% vs 5.3%; p = 0.03). Prior to the COVID-19 lockdown phase, females provided more hours of dependent care. Females also reported a significantly greater increase in childcare hours overall per week (45 hours post/30 hours pre vs 30 hours post/20 hours pre for men; p < 0.001). Male cardiologists were much more likely to have partners who reduced work hours (67% vs 28%; p < 0.001) and reported that their partners took a salary cut compared with partners of female cardiologists (51% vs 22%; p < 0.001). In conclusion, gender disparity in caregiver responsibilities existed among highly skilled pediatric cardiologists even before the COVID-19 pandemic. The pandemic has disproportionately affected female pediatric cardiologists with respect to dependent care responsibilities, time at work, and financial compensation.
The COVID-19 pandemic continues to affect livelihoods around the world and its economic and social fallouts are disproportionately affecting women in the workplace and at home. Globally, the rate of job loss among women during this pandemic has exceeded 180% of the rate for men. Although women comprise 39% of the global work force, they have incurred 54% of all job losses. One reason for this disparity is that the virus has significantly increased the family burden of unpaid child and adult care, for which women carry a greater responsibility. Recent articles by Reza et al. and Brubaker highlight the need to retain and support female physicians during this pandemic. , Although this study was limited to pediatric cardiologists, findings are likely to be similar among other highly skilled medical professionals.
Methods
We obtained approval from the University of Florida Institutional Review Board and conducted an online REDCap-based survey of a subset of current North American Pediatric Cardiologists in practice and training (subscribers to the ‘PediHeartNet’ listserv: PediHeartNet- http://pediheart.net is a private, unmoderated discussion group of predominantly North American Pediatric Cardiologists) who had child or adult dependent care responsibilities. Our 33-item survey (Supplemental File) collected demographic information including age, gender, work experience and details about dependent care. Questions addressed changes in work hours, work leave, and compensation that occurred as a consequence of COVID-19. The survey captured the average amount of time spent by the respondent and by the respondent’s partner in providing care or supervision to child and adult dependents before and after many states issued COVID-19 stay-at-home mandates. Finally, the survey provided an opportunity for respondents to relate their most challenging experiences with changes in dependent care consequent to the COVID-19 pandemic. After obtaining permission from the moderators of the listserv, we emailed the survey in July 2020 to approximately 1,200 pediatric cardiologists and requested anonymous responses from pediatric cardiologist physicians in training or in practice whose household included child and/or adult dependents. We emailed a reminder 3, 7, and 14 days after the initial solicitation and closed data collection on day 16. As an incentive, we offered the opportunity to participate in a small online gift card drawing.
We performed descriptive and inferential statistical analyses using SAS v 9.4 and SPSS v 24. Categorical variables were expressed as frequencies and percentages and continuous variables were expressed as mean or median with standard deviation or ranges. The impact of COVID-19 was defined in terms of both categorical and continuous outcome variables. We analyzed categorical continuous variables using logistic regression with gender as the independent variable. Covariates that achieved a 0.15 level of significance were included in the model. We compared continuous variables between genders using t-test or Wilcoxon rank sum test. Significant covariates were included in a linear regression model. If the variable under consideration was not normally distributed then a log linear transformation was performed. p value <0.05 was considered significant.
The principal investigator and 2 other data analysts from the University of Florida with experience in qualitative research methodology (MAB and MF) reviewed all responses to the open-ended question that sought a narrative response to the dependent care challenges posed by COVID-19. Over a 3-week period, each member of the team sorted responses into 10 main topical areas and then all members organized the responses into 5 domains for analysis.
Results
A total of 256 respondents attempted the survey of which 242 respondents were actually eligible (response rate of 20.2%). Of these, 127 (52%) of respondents were female compared with 34% of all board certified pediatric cardiologists in the United States who are female. Demographics of respondents are outlined in Table 1 . The largest group of respondents were aged 30 to 39 and had been in practice for less than 5 years. Although there was no gender difference in the median age of surveyed trainees, female cardiologists in practice had a lower median age than male cardiologists. Interventional cardiac subspecialties accounted for 11.6% of overall respondents. Most (86.7%) cardiologists had childcare responsibilities and 12.8% cared for adults. Most single parents or adult caregivers tended to be female (p < 0.0001).
| All | Male | Female | p Value | |
|---|---|---|---|---|
| Variable | ||||
| Age Group (years) | ||||
| 20 – 29 | 5 | 4 (3.5%) | 1 (0.8%) | 0.22 † |
| 30 – 39 | 109 | 45 (39.8%) | 64 (50.4%) | |
| 40 – 49 | 85 | 44 (38.9%) | 41 (32.3%) | |
| 50 – 59 | 27 | 15 (13.3%) | 12 (9.4%) | |
| > 60 | 14 | 5 (4.4%) | 9 (7.1%) | |
| Gender | 240 | 113 (47.1%) | 127 (52.9%) | |
| Sexual Orientation | ||||
| Straight | 222 | 102 (90.3%) | 120 (94.5%) | 0.10 † |
| Lesbian/Gay | 9 | 6 (5.3%) | 3 (2.4%) | |
| Bisexual | 6 | 5 (4.4%) | 1 (0.8%) | |
| Race | ||||
| Asian | 67 | 31 (27.7%) | 36 (28.3%) | 0.23 * |
| Black/African American | 19 | 11 (9.8%) | 8 (6.3%) | |
| White | 132 | 59 (52.7%) | 73 (57.5%) | |
| Other | 15 | 9 (8%) | 6 (4.8%) | |
| Prefer not to answer | 6 | 2 (1.8%) | 4 (3.1%) | |
| Ethnicity | ||||
| Hispanic/Latino | 25 | 14 (12.7%) | 11 (8.8%) | 0.61 † |
| Non-Hispanic/Latino | 201 | 92 (83.6%) | 109 (87.2%) | |
| Prefer not to answer | 9 | 4 (3.6%) | 5 (4%) | |
| Employment: | ||||
| Fellowship | 32 | 13 (11.5%) | 19 (15.1%) | 0.42 * |
| Not in fellowship | 207 | 100 (88.5%) | 107 (84.9%) | |
| Years of fellowship | ||||
| 1 | 5 | 4 (30.8%) | 1 (6.7%) | 0.17 † |
| 2 | 5 | 3 (23.1%) | 2 (13.3%) | |
| 3 | 9 | 2 (15.4%) | 7 (46.7%) | |
| 4 | 7 | 4 (30.8%) | 3 (20%) | |
| 5 | 2 | 0 (0%) | 2 (13.3%) | |
| Years of practice | ||||
| ≤ 5 | 86 | 35 (31.3%) | 51 (40.5%) | 0.02 § |
| 6 – 10 | 56 | 23 (20.5%) | 33 (26.2%) | |
| 11 – 15 | 47 | 28 (25%) | 19 (15.1%) | |
| 16 – 20 | 28 | 19 (17%) | 9 (7.1%) | |
| ≥ 21 | 21 | 7 (6.3%) | 14 (11.1%) | |
| Sub-specialty | ||||
| Interventional | 28 | 18 (15.9%) | 10 (7.9%) | |
| Non interventional | 212 | 95 (84.1%) | 117 (92.1%) | 0.05 * |
| Time worked | ||||
| Full Time | 224 | 109 (96.5%) | 115 (91.3%) | 0.09 * |
| Percentage Part Time | 15 | 4 (3.5%) | 11 (8.7%) | |
| 60 – 69 | 6 | 1 | 5 | |
| 70 – 79 | 6 | 2 | 4 | |
| 80 – 89 | 3 | 1 | 2 | |
| Dependent Care | ||||
| Children | 197 | 97 | 100 | |
| <7 years Mean (Range) | 1.53 (1-4) | 1.38 (1-3) | 1.67 (1-4) | 0.049 ‡ |
| 7-17 years: Mean (Range) | 1.63 (1-6) | 1.69 (1-6) | 1.57 (1-3) | 0.87 ‡ |
| Adult | 18 | 6 | 12 | 0.16 * |
| Both Children and Adult | 13 | 6 | 7 | 0.78 * |
| Single Parent or Adult Caregiver | 20 | 1 | 19 | <0.0001 * |
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