Gender Discrepancies Related toPediatrician Work-Life Balance andHousehold ResponsibilitiesAmy J. Starmer, MD, MPH, FAAP,a Mary Pat Frintner, MSPH,b Kenneth Matos, PhD,c Chloe Somberg, BA,b

Gary Freed, MD, MPH, FAAP,d Bobbi J. Byrne, MD, FAAPe

abstractBACKGROUND: Physicians must balance career and home responsibilities, yet previous studies onwork-life balance are focused primarily on work-based tasks. We examined genderdiscrepancies and factors related to household responsibilities and work-life balance amongpediatricians.

METHODS: We used 2015 data from the American Academy of Pediatrics Pediatrician Life andCareer Experience Study, a longitudinal study of early-career pediatricians. x2 tests andmultivariable logistic regression were used to examine the effects of gender on householdresponsibilities, satisfaction, and work-life balance attainment. We formally reviewedresponses from 2 open-ended questions on work-life balance challenges and strategies forcommon themes.

RESULTS: Seventy-two percent of participants completed the survey (1293 of 1801). Womenwere more likely than men to report having primary responsibility for 13 of 16 householdresponsibilities, such as cleaning, cooking, and routine care of children (all P , .001). Allgender differences except budget management remained significant when controlling for part-time work status and spouse or partner work status (P, .05). Women were less satisfied withtheir share of responsibilities relative to others (52% vs 62%; P , .001), and few women andmen report being very successful at achieving balance between their job and other life areas(15% vs 19%, respectively; P = .05). Open-ended responses (n = 1145) revealed manybarriers to achieving work-life balance. Strategies to increase work-life balance includedreducing work hours, outsourcing household-related work, and adjustments to personalresponsibilities and relationships.

CONCLUSIONS: Female pediatricians spend more time on household responsibilities than malepediatricians, and gender is a key factor associated with work-life balance satisfaction.

WHAT’S KNOWN ON THIS SUBJECT: Previous research hasrevealed that women perform the majority of householdlabor, yet the extent to which this discrepancy exists forpediatricians is unknown. Work-life conflicts are knownto be associated with negative consequences, includingprofessional burnout and career dissatisfaction.

WHAT THIS STUDY ADDS: Early- and mid-career femalepediatricians spend more time on householdresponsibilities than male pediatricians, regardless of theintensity of work commitments, and gender is a keyfactor associated with work-life balance satisfaction.

To cite: Starmer AJ, Frintner MP, Matos K, et al. GenderDiscrepancies Related to Pediatrician Work-Life Balanceand Household Responsibilities. Pediatrics. 2019;144(4):e20182926

aDepartment of Medicine, Boston Children’s Hospital, Boston, Massachusetts; bDepartment of Research, AmericanAcademy of Pediatrics, Itasca, Illinois; cDepartment of Research, Life Meets Work, Park Ridge, Illinois;dDepartment of Pediatrics, University of Michigan, Ann Arbor, Michigan; and eSection of Neonatal-PerinatalMedicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana

Dr Starmer conceptualized and designed the study, assisted with interpretation of the data, draftedthe initial manuscript, and reviewed and revised the manuscript; Ms Frintner assisted with theconception and design of the study, conducted the initial analyses, coordinated and supervised datacollection, and reviewed and revised the manuscript; Ms Somberg assisted with data collection andanalysis and critically reviewed the manuscript; Drs Freed, Matos, and Byrne assisted with theconception and design of the study and critically reviewed the manuscript; and all authorsapproved the final manuscript as submitted.

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Physician careers involve multipleprofessional commitments that mustalso be balanced with responsibilitiesat home. Although most physiciansreport career and life satisfaction,struggles with work-life balance arecommon, and dissatisfaction with lifeand career is a concern for some.1–7

Research reveals that work-lifeconflicts (ie, the need to perform bothwork- and personal-affiliated tasks)are common for physicians and havebeen associated with higher rates ofburnout and personal distress.8

Furthermore, health care workerswho report higher rates of behaviorsassociated with successful attainmentof work-life balance have higher ratesof teamwork-related and patientsafety–related norms and behaviors.9

Therefore, researchers havehypothesized that improving work-life balance among health careproviders may also improve qualityoutcomes for patients in addition toimproving the life of the individualhealth care worker.9

Previous studies revealed that femalephysicians are more likely than malephysicians to report struggles withwork-life balance and are less likelyto report career satisfaction.1,3,10,11

This is particularly salient in the fieldof pediatrics, in which the majority ofearly-career pediatricians are womenwith young children,12 and early- andmid-career pediatricians are knownto report particular struggles with theattainment of work-life balance.1

Authors of limited previous studieshave examined the role of work-basedfactors associated with genderdiscrepancies in the attainment ofwork-life balance.1 The manner inwhich non–workplace-basedassociated factors (such as thedivision of householdresponsibilities) might contribute tothese gender discrepancies within thefield of pediatrics is unknown.

Despite women’s increasedparticipation in the labor force,research reveals that womencontinue to perform the vast majority

of household labor,13 and there islittle evidence that men’sproportionate share of family workhas changed much during the pastdecade or so. Of note, a greaterperceived unequal distribution ofresponsibilities for household taskshas been associated with poorhealth outcomes for women.14,15

Although a handful of studies haveexamined gender differences inhousehold responsibilities andsatisfaction with work-lifebalance,4,16–18 these studies hadlimitations to generalizability and/orwere not focused on the perceptionsof pediatricians.

Our goals for this study were (1) toexamine the extent to which femalepediatricians spend more time onhousehold responsibilities comparedwith male pediatricians, (2) toexamine the extent to which genderand other pediatrician characteristicsare associated with perceptions ofsatisfaction with the division ofhousehold responsibilities and theattainment of work-life balance, and(3) to seek to understand pediatricianperceptions of challenges andsuccesses regarding work-lifebalance.

METHODS

Participants

We analyzed cross-sectional datacollected in 2015 from the AmericanAcademy of Pediatrics (AAP)Pediatrician Life and CareerExperience Study (PLACES),a national longitudinal study in whichthe work and life experiences ofpediatricians are tracked across theircareers.12 PLACES participants aresurveyed twice each year; the mainsurvey covers several domains (eg,work characteristics, satisfaction,work-life balance, and lifeexperiences), which are repeatedeach year, and there is a shortersurvey with topics of importance toparticipants that vary each year.

PLACES includes 2 cohorts ofpediatricians on the basis of theirresidency training completion year(2009–2011 and 2002–2004).PLACES participants were identifiedby using an AAP database thatincluded all pediatricians whocompleted US residency programsand both AAP members andnonmembers. Forty-one percent ofpediatricians randomly selected toparticipate in PLACES initially signedup for the study. Details regardingPLACES methodology, includingtarget population, sample sizeanalysis, and nonresponse andpoststratification weights, have beendescribed previously.12 Initial studyweights were calculated becausenonresponse bias tests revealed thatPLACES participants in each cohortwere significantly more likely to bewomen, AAP members, and graduatesof US medical schools thanpediatricians in the respective targetcohorts. For the current study, theseinitial study weights were adjusted onthe basis of sex, AAP membershipstatus, and medical school location ofparticipants who completed the 2015survey and were applied to allanalyses presented in this article.

We analyzed data from a surveyfielded in 2015 (which wasconducted via e-mail and mail,depending on participant preference).These data included pediatricianswho were not married or partnered.The AAP Institutional Review Boardapproved the study.

Measures

The survey included severalquestions on householdresponsibilities that were modifiedfrom other studies,19,20 including theFamilies and Work Institute report“Modern Families.”21 Questions wereprimarily fixed-response questionsand were developed on the basis ofa review of other studies and inputfrom the AAP PLACES ProjectAdvisory Committee.

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Participants answered questionsregarding who had the primaryresponsibility for 9 household and 7child care activities. Response optionsincluded the following: (1) “Largely, Ido,” (2) “Largely my spouse/partnerdoes,” (3) “Equally shared betweenme and my spouse/partner/other,”(4) “Others do” (eg, child, relative, ex-spouse or ex-partner, or friend), and(5) not applicable, which wasexcluded from analysis. Therefore, nfor each specific task varied from 688to 1288. Participants also answeredquestions about whether they hiredhelp (for cleaning, outdoor work,routine care of children, laundry, andcooking), felt rushed with their time,were satisfied with their share ofresponsibilities relative to others intheir home, and felt successful inbalancing their job and other areasof life.

The survey concluded with 2 open-ended questions: “What has beenyour greatest challenge in trying tobalance your work and personalresponsibilities?” and “Please sharea tip that has helped you achievea higher level of work-life balance.”Data were incorporated onparticipants’ demographic and jobcharacteristics collected earlier in2015 via the main PLACES survey.

Data Analysis

Quantitative Data: Division of HouseholdResponsibilities and Work-Life BalanceAccording to Gender and OtherPediatrician Characteristics

We used x2 tests to compareparticipants’ responses to questionson home responsibilities (9household and 7 child care questions)and gender. Responses werecategorized as follows: primaryresponsibility (“Largely, I do”), sharedresponsibility (“Equally sharedbetween me and spouse/partner/other” and “Others do”), and spouseor partner responsibility (“Largely,my spouse/partner does”). We alsoexamined the relationship of genderwith (1) hiring help for cleaning,

outdoor work, routine care ofchildren, laundry, and cooking (yesversus no); (2) feeling rushed withtime (always feeling rushed versussometimes or almost never); (3)satisfaction with one’s share of homeresponsibilities relative to others inthe home (completely or verysatisfied versus somewhat, not very,or not at all satisfied); and (4) successin balancing job and other areas of life(very versus somewhat, not very, ornot at all successful).

For the above outcomes that variedsignificantly by gender in thebivariate analysis, multivariablelogistic regression models were usedto examine for independent gendereffects while controlling for cohort,own work hours (part-time versusfull-time), work status of spouse orpartner (full-time versus not marriedor partnered or spouse or partner notworking or working part-time),having children ,18 years old,specialty (primary care versushospitalist, subspecialist, or other),concern with educational debt (veryor somewhat concerned versus notconcerned), and income of the surveyrespondent. Characteristics includedin the models were based on a priorihypotheses that they would berelated to household responsibility.

The number of cases in each analysisvaried slightly because of missingvalues for specific questions. All datapresented are weighted as describedabove. All analyses were conductedwith PASW Statistics 18 (SPSS, Inc,Chicago, IL), with P # .05.

Qualitative Data: Work-Life BalanceChallenges and Solutions

Two authors reviewed all open-endedresponses in which challenges andsuccess tips were addressed. Theycreated a list of codes, and by usinga conventional content analysisapproach, comments were tagged andassessed by using these codes.22

Codes were updated during iterativereadings of the comments and codingprocess. Coding agreement was

94.6%; discrepancies between theauthors were resolved throughdiscussion. Themes that emergedfrom the data on challenges andsample quotes were identified to helpillustrate the data. Success tips thatparticipants provided were notspecific (eg, take care of yourself,exercise more) so we rereviewedthese data for examples that mightaddress the identified themes onchallenges.

After coding, we totaled the numberof challenges reported per participantand applied t tests and the x2 analysisto examine differences by gender inthe number and types of challengesidentified.

RESULTS

Seventy-two percent of PLACESpediatrician participants completedthe 2015 surveys (1293 of 1801).Most respondents commented on theopen-ended questions on challenges(84.1%) and tips (77.5%) related towork-life balance.

Respondent Characteristics

Two-thirds of pediatricianrespondents were women (64.3%),88.4% were married or partnered,and 79.2% reported being parents.Among those with children, nearly allhad children age ,18 years (97.3%);17.6% had 1 child, 51.1% had 2children, 22.7% had 3 children, and8.6% had $4 children. Of therespondents who were married orpartnered, 65.6% reported havinga full-time working spouse or partner,including 80.5% of women and40.2% of men (P , .001). Nearly one-third (30.1%) had a spouse orpartner who is a physician. Thirty-two percent of married or partneredmale pediatricians and 12.4% offemale pediatricians had a spouse orpartner who was not working. Amongthe spouses or partners who were notworking, 34.9% had a bachelor’sdegree, 31.2% had a masters’ degree,and 18.6% had a graduate or

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professional degree (eg, MD, DDS,DVM, JD).

Four in 10 pediatrician respondentsreported working in a primary careposition, 38.3% reported working ina subspecialty or primary andsubspecialty care position, 9.5%reported working as a hospitalist,5.6% reported working in fellowshiptraining, 3.6% reported “other,” and1.9% were not working. Twentypercent were working part-time,including 30.0% of women and 2.4%of men (P , .001).

Division of Home ResponsibilitiesAccording to Gender

Women pediatricians were morelikely than men to report havingprimary responsibility for 6 of the 9household responsibilities, includingcoordinating schedules, doinglaundry, grocery shopping, cookingand cleaning, and caring for pets(Fig 1). Men were more likely toreport having primary responsibilityfor the remaining activities (homeand/or car repair and maintenance,outdoor work, and home budget

management; P , .001). In themultivariable analysis, after wecontrolled for work hours, workstatus of spouse or partner, cohort,number of children, specialty, concernwith educational debt, and income, allgender effects remained significant(P , .05), except for home budgetmanagement (see SupplementalTable 3).

Female pediatricians were morelikely than male pediatricians toreport having primary responsibilityfor the 7 home responsibilitiesrelated to the care of their ownchildren (P , .001; Fig 2). Theserelationships with gender remainedin the multivariable analysis (P ,.001; Supplemental Table 4).

Likelihood to Hire Help According toGender

Female pediatricians were morelikely than male pediatricians toreport hiring help for cleaning (P ,.001), outdoor work (P , .05), androutine care of children (P , .01;Fig 3). Among all respondents, in themultivariable analysis (Supplemental

Table 5), female pediatricians weremore likely than male pediatricians tohire help for cleaning (adjusted oddsratio [aOR] = 1.54; 95% confidenceinterval [CI]: 1.16–2.05), yet genderwas not significant for hiring foroutdoor work or routine care ofchildren.

Time, Satisfaction, and Work-LifeBalance Attainment According toGender

Regarding their time, 44.2% ofrespondents always felt rushed,51.1% felt rushed only sometimes,and 4.7% almost never felt rushed.Half of female pediatricians and one-third of male pediatricians reportedalways feeling rushed (P, .001). Thisrelationship remained in themultivariable analysis (aOR = 2.47;95% CI: 1.85–3.29; Table 1). Fifty-sixpercent of respondents werecompletely or very satisfied with theirshare of home responsibilities.Female pediatricians were less likelythan male pediatricians to reportsuch satisfaction (52.3% vs 62.0%,respectively; P , .01), and thisrelationship remained in the

FIGURE 1Percentage of participants who have primary responsibility and shared responsibility for household work. The survey question was “In your household,who has the primary responsibility for each of the following items?” Response options were as follows: “Largely, I do”; shared responsibility, whichincluded “Others do” (eg, child, relative, ex-spouse or ex-partner, or friend) and “Equally shared between me and spouse/partner/other”; “Largely, myspouse/partner does”; and not applicable. “Not applicable” responses were removed from analysis; n varies from 688 (caring for pets) to 1288 (cooking).A percentage is not shown for “spouse/partner has primary responsibility.” P , .001 for all x2 tests in which primary responsibility, sharedresponsibility, and spouse/partner has primary responsibility were compared by gender.

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multivariable analysis (aOR = 0.66;95% CI: 0.49–0.87; Table 1).Seventeen percent reported thatthey were very successful inbalancing their job and other areasof their life, including 15.1% of

women and 19.3% of men (P = .05);60% (59% of women and 62% ofmen) reported being somewhatsuccessful. In the multivariableanalysis, women were less likelythan men to report being very

successful (aOR = 0.61; 95% CI:0.42–0.88). In addition to gender,concerns about educational debt andworking part-time were significantfactors associated with all 3outcomes.

FIGURE 2Percentage of participants who have primary responsibility and shared responsibility for activities related to own children. The survey question was “Inyour household, who has the primary responsibility for each of the following items?” Response options were as follows: “Largely, I do”; sharedresponsibility, which included “Others do” (eg, child, relative, ex-spouse or ex-partner, and friend) and “Equally shared between me and spouse/partner/other”; “Largely, my spouse/partner does”; and not applicable. “Not applicable” responses were removed from the analysis; n varies from 750(homework) to 1012 (routine care). A percentage is not shown for “spouse/partner has primary responsibility.” P, .001 for all x2 tests in which primaryresponsibility, shared responsibility, and spouse/partner has primary responsibility were compared by gender.

FIGURE 3Percentage of participants who hire help for home responsibilities (n = 1289). P, .05 for all x2 tests in which hiring help was compared by gender. a Thesurvey question was “In your household, do you have hired help for each of the following items?” The response option was yes or no.

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Work-Life Balance Challenges andSolutions

We reviewed open-ended commentsfrom 1145 participants whodescribed challenges with and/orsolutions for the need to balancework and personal responsibilities.Major themes used to summarizeparticipants’ comments and examplequotes to support these themes arereported in Table 2. Predominantthemes were time management;expectations and/or perfectionism;self-care; work and careerrequirements, including doing workafter hours; personal responsibilities,relationships, and support; andfinancial challenges. Example quotesthat participants provided on tips thathave helped with work-life balanceare provided next to the appropriatechallenge.

Among the participants who reported$1 challenge in balancing theirresponsibilities, the number ofchallenges was slightly higher amongfemale (2.1) participants compared

with male (1.8) participants (P ,.001). Female pediatricians were alsomore likely than male pediatricians toreport the following challenges: self-care (22.5% vs 15.6%; P , .01), timemanagement (21.5% vs 12.6%; P ,.001), personal relationships (18.5%vs 11.3%; P , .01), expectations and/or perfectionism (12.5% vs 4.3%; P,.001), and financial challenges (4.6%vs 2.4%; P , .05). Male pediatricianswere more likely than femalepediatricians to report challengesfocused on work and careerrequirements (52.3% vs 44.7%; P ,.01); however, female pediatricianswere more likely to specificallycomment on doing work after hours(9.5% vs 5.0%; P , .01).

DISCUSSION

We conducted a cross-sectional studyto examine factors associated withthe division of householdresponsibilities for early- and mid-career pediatricians who are knownto struggle with work-life balance.

Among the most important findingsin this study is that femalepediatricians spend more time onhousehold responsibilities than malepediatricians and that gender is a keyfactor associated with work-lifebalance satisfaction. Importantly, onlyapproximately half of women weresatisfied with their share ofresponsibilities in the home, a smallerpercentage than men. Additionally,female pediatricians were more likelythan male pediatricians to reportfeeling rushed and were less likely toreport achieving success in balancingtheir job and other areas of their life.

Our findings were consistent with ourhypothesis that female pediatriciansspend more time on household andchild care responsibilities than malepediatricians and are similar tostudies of these trends in the generalpopulation.23–26 Research used toexamine the amount of time spent onhousehold activities by gender overtime reveals that although the gap isbeginning to close, women currently

TABLE 1 Factors Associated With Rushed All the Time, Satisfied With Share of Responsibilities, and Success Balancing Job and Other Areas of Life

Always Feel Rushed,aOR (95% CI)a

Completely or Very Satisfied WithShare of Household Responsibilities,

aOR(95% CI)b

Very Successful Balancing Job andOther Areas of Life, aOR (95% CI)c

Female sex (referent: male sex) 2.47 (1.85–3.29)* 0.66 (0.49–0.87)* 0.61 (0.42–0.88)*Have children ,18 y of age (referent: no) 2.83 (2.05–3.92)* 0.74 (0.53–1.03) 0.68 (0.46–0.99)*Very or somewhat concerned with educational debt(referent: not concerned)

2.00 (1.54–2.60)* 0.69 (0.54–0.90)* 0.57 (0.40–0.82)*

Full-time working spouse or partner (referent: notmarried or partnered or spouse or partner notworking or working part-time)

1.22 (0.94–1.59) 0.67 (0.51–0.87)* 0.79 (0.56–1.11)

Specialty (referent: primary care)Hospitalist 0.90 (0.58–1.39) 0.91 (0.60–1.40) 1.01 (0.59–1.73)Subspecialist 1.19 (0.90–1.56) 0.87 (0.66–1.14) 0.70 (0.49–1.00)*Other 0.94 (0.61–1.46) 1.02 (0.66–1.58) 0.79 (0.44–1.44)

Own work hours are part-time (referent: full-time) 0.67 (0.48–0.93)* 1.44 (1.04–2.00)* 2.33 (1.53–3.56)*2009–11 resident graduates cohort (referent: 2002–04residency graduates)

0.66 (0.50–0.85)* 1.09 (0.84–1.42) 1.11 (0.79–1.56)

Own income (referent: ,$200 000), $200 000–249 999 0.84 (0.61–1.16) 1.00 (0.73–1.38) 1.70 (1.15–2.52)*$250 000 0.80 (0.57–1.12) 1.01 (0.72–1.42) 1.25 (0.81–1.94)

a The survey question was “In general, how do you feel about your time? Would you say…?” Response options included the following: “I always feel rushed,” “I only sometimes feelrushed,” and “I almost never feel rushed.” Responses were dichotomized as follows: rushed all the time (always feel rushed) versus sometimes or almost never feel rushed.b The survey question was “How satisfied are you with your share of responsibilities relative to others in your home?” Response options included the following: not at all satisfied, not verysatisfied, somewhat satisfied, very satisfied, completely satisfied, and not applicable. “Not applicable” responses were removed from analysis. Responses were dichotomized as follows:completely satisfied or very satisfied versus somewhat satisfied, not very satisfied, or not at all satisfied.c The survey question was “How successful do you feel at balancing your job and the other areas of your life?” Response options included the following: not at all successful, not verysuccessful, somewhat successful, and very successful. Responses were dichotomized as follows: very successful versus somewhat successful, not very successful, or not at all successful.* P # .05.

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TABLE 2 Challenges to Balancing Personal and Work Responsibilities and Tips From Participants

Themesa Illustrative Quotes Describing Challengesb Illustrative Quotes Describing Suggested Tipsc

TimeNot enough time in the day for all

responsibilities“Not enough hours in the day. Between workresponsibilities, chores and caring for our 2 and4 year old there is little to no time left for coupletime with my husband or alone time for me.”

“Online family calendar (google calendar) to keeptrack of all the appointments and obligations –EVERYTHING goes in there.”

Expectations and/or perfectionismExpect to be perfect in all facets of life and

to be there for everyone; feelings of guiltwhen one cannot be there for family orpatients

“It is very hard to be there 100% for each aspect of mylife – I feel like I am always splitting my time/energy/attention between the different facets of mylife and nothing ever gets done fully or completely.”

“Learning to say ‘no’ to projects and recognizing mylimitations. We haven’t been taught to turn downopportunities in the medical field…”

“Expecting myself to do it all. It can’t be done to thelevel of perfection that I want without compromise.So learning to prioritize and let some things thatare not essential go & delegating other things.”

“Let it go. Sometimes minor things seem major andwe use up too much energy. Realize the biggerpicture and roll with it.”

Self-careEveryone’s needs are prioritized before one’s

own; too exhausted and short on time forown health and well-being

“Finding time for myself, I put everyone else before meand my needs.”

“(1) Give yourself permission to engage in SELF-CARE.If I can’t care for myself, then I can NOT be presentfor others. (2) It’s ok to have hired help and ask forhelp.”

Work and career requirements and doing work“after hours”Excessive work demands, including call,

documentation, and career requirements(CME, MOC); work-life bleed

“The pace of work is relentless. A bad day, duringwhich I am unable to complete enough charts orclinic extends translates into multiple evening andweekend hours away from my family. I like myjob...the issue is mainly the charting andadministrative side of things. I ALWAYS have chartsto do and could pretty much work continuous 12hour days if I wanted to...Sometimes you end upfeeling like no amount of effort is goodenough...nobody liked dinner AND you still havedelinquent charts.”

“I feel incredibly lucky to be able to work part time. Icannot imagine any kind of balance without thatoption.”

— “…I know that I need to create templates for myselfon the EMR to help me be more efficient.”

Personal responsibilities, relationships, andsupportDemands and support at home; delegating

household chores“Being a working mom, although rewarding, is tough.Expectations at work seem to grow along with yourchildren. Both need and want more of you as timegoes by. Our children are victims of their ownunconditional love, much more tolerant of ouroutside obligations than the reverse.”

“Essentially my tip would be to find a great spousewho isn’t going to be resentful of the division oflabor in a household.”

“I would say that balancing a happy married life withtruly shared responsibilities with my spouse hasbeen a great challenge. And finding time to spendwith my spouse given that he himself is alsoa physician and an extreme sport aficionado.”

“Hiring someone to help with laundry, cleaning anddriving. Also I have a very modern husband whohas a creative schedule and is willing to sharehome responsibilities equally.”

“Helping my spouse more with household activities &childcare. I am full-time and she is 70%, but [she]does a disproportionate share of home & childcare[tasks].”

“HIRED HELP!!! My husband doesn’t like spending themoney but he sees now that it takes some pressureoff me which makes me happier.”

— “What worked for me was leaving academic medicineand taking a job with very regular working hours. Ialso found the new job with its predictableschedule allowed me and my partner to moreequitably share our responsibilities at home andwith our children.”

Financial challengesEducation debt, salary, and lack of money to

hire help“We are a two doctor household, and both my husbandand I could use a 1950s era ‘wife.’ But we are tooburdened by [medical] school debt to have

No tips identified in comments.

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continue to spend more time in theseactivities than men.24 Interestingly, inour study, although personalresponsibilities, relationships, andsupport emerged as key themes relatedto work-life balance, only a fewparticipants identified the need formore equitable sharing of householdresponsibilities and child care tasks withspouses and partners as a potentialsolution. It has been suggested thatpatterns of inequitable householdresponsibilities may start as early aschildhood,19 suggesting the possibilitythat inequitable responsibilities may beconsidered the norm.

Previous single-institution studies ofphysicians have revealed similarfindings of female faculty reportingthe devotion of more time tohousehold tasks and child care,4,16,17

yet our study is a national sample ofpediatricians, including thoseworking in primary, subspecialty, andhospital care. It is interesting to findthe persistence of these genderdisparities as they relate to the careof one’s own children, particularly inthe field of pediatrics in whichprofessionals dedicate their careersto caring for children. Identifyingways to ameliorate these disparitiesare particularly important becausemore perceived time spent inhousehold tasks, including child-rearing and housework, has beenassociated with psychologicaldistress, adverse physiologicoutcomes,4,16,17,27 and poor patientsafety outcomes.8–10,20

The frequency of women graduatingfrom medical school has increasedsignificantly over the last half-century(51% of matriculants in 2018),28 with

a concurrent increase in thepercentage of dual-profession anddual-physician relationships. Our datarevealed that of pediatricianrespondents who were married orpartnered, two-thirds (80% ofwomen and 40% of men) reportedhaving a full-time working spouse orpartner. Dual-professionalrelationships are known to beparticularly prone to work-homeconflicts, which are a key contributingfactor to burnout, depression, and jobdissatisfaction.29,30 Challenges withwork-life balance have been cited asobstacles for women in leadershiproles in medicine.16,31 Although wedo not examine leadership roles inour study, our findings of genderdisparities in home responsibilitiesand work-life balance in a broadsample of pediatricians reveal thatsuch factors may contribute to genderdisparities in leadership rolesat work.

Our study has several limitations,including that all data are self-reported. Second, we did not collectdata from respondents’ spouses and/or partners in our study. Previousstudies that include both individualsin a partnership revealed agreementbetween partners on reports of theextent of division of householdresponsibilities.21 Third, our studywas limited to early- and mid-careerpediatricians; therefore, thegeneralizability of the findings toother specialties or career stagesremains unclear. Fourth, although theresponse rate among PLACESparticipants who completed the studysurvey was high, the initial projectsign-up rate was lower at 41%.

However, efforts were made toaccount for nonresponse bias byusing a data-weighting procedure,and the sign-up rate is similar to orhigher than that of other longitudinalstudies reported in the literature.12

Fifth, in our survey, we asked ifparticipants were married orpartnered but did not ask if they weresame- or different-sex couples.Previous reports have revealed thatsame-sex couples were more likely toshare household responsibilities.21

Sixth, although our survey wasfocused primarily on execution ofconcrete tasks related to householdduties, we did not examine the extentto which some of the more “invisible”activities related to the work of childcare and household maintenance (eg,the mental, emotional, andinformation-processing work of childcare, which has previously beenshown to occupy women to a greaterextent than men) might furtherexacerbate the identified genderdiscrepancies.32,33 Seventh, althoughwe were able to control forpediatrician income in our models,we did not have data on spouse orpartner income, which might impactthe division of responsibilities.Finally, the data reported in thisarticle are cross-sectional andtherefore do not permit anunderstanding of the temporal natureof how factors associated withphysician health and wellness mighthave an impact over time, which willbe possible with future PLACES data.

CONCLUSIONS

Work-life balance remains a priorityfor pediatricians and is known to be

TABLE 2 Continued

Themesa Illustrative Quotes Describing Challengesb Illustrative Quotes Describing Suggested Tipsc

discretionary income to ‘hire out’ the tasks thatmight help ease the pressure.”

CME, continuing medical education; EMR, electronic medical record; MOC, Maintenance of Certification .a Predominant themes were identified in review of open-ended comments on the following question: “What has been your greatest challenge in trying to balance your work and personalresponsibilities?”b Open-ended comments on challenges.c Open-ended comments on tips: “Please share a tip that has helped you achieve a higher level of work-life balance.”

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associated with career satisfactionand productivity. In this study, weidentify significant genderdisparities of distribution ofactivities in the home that maycontribute to work-life balancedissatisfaction for physicians.Focused attention on programsthat develop skills to negotiatethe balance of responsibilities inthe home as well as in theworkplace setting may have thepotential to ameliorate thesedisparities and contribute to

increased work-life balance andsatisfaction.

ACKNOWLEDGMENTS

We thank the pediatriciansparticipating in PLACES who are allgiving generously of their time tomake this project possible. Membersof the AAP PLACES Project AdvisoryCommittee include the following:Bobbi J. Byrne, MD, FAAP,Chairperson; Gary L. Freed, MD, MPH,FAAP; Shesha Kalyan Katakam, MD,

MPH, FAAP; Laurel K. Leslie, MD,MPH, FAAP; Ashley A. Miller, MD,FAAP; and Amy J. Starmer, MD, MPH,FAAP.

ABBREVIATIONS

AAP: American Academy ofPediatrics

aOR: adjusted odds ratioCI: confidence intervalPLACES: Pediatrician Life and

Career Experience Study

Dr Matos’ current affiliation is People Science Practice, Culture Amp, New York, New York.

DOI: https://doi.org/10.1542/peds.2018-2926

Accepted for publication Jul 8, 2019

Address correspondence to Amy J. Starmer, MD, MPH, FAAP, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail:

amy.starmer@childrens.harvard.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2019 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

FUNDING: Supported by the American Academy of Pediatrics.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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DOI: 10.1542/peds.2018-2926 originally published online September 10, 2019; 2019;144;Pediatrics 

Bobbi J. ByrneAmy J. Starmer, Mary Pat Frintner, Kenneth Matos, Chloe Somberg, Gary Freed and

ResponsibilitiesGender Discrepancies Related to Pediatrician Work-Life Balance and Household

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DOI: 10.1542/peds.2018-2926 originally published online September 10, 2019; 2019;144;Pediatrics 

Bobbi J. ByrneAmy J. Starmer, Mary Pat Frintner, Kenneth Matos, Chloe Somberg, Gary Freed and

ResponsibilitiesGender Discrepancies Related to Pediatrician Work-Life Balance and Household

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