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Family Responsibilities and Domestic Activities of US Women Physicians
Erica Frank, MD, MPH;
Lynn Harvey, PhD;
Lisa Elon, MPH
Arch Fam Med. 2000;9:134-140.
ABSTRACT
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Background Women physicians may have a multiplicity of domestic roles (eg, cook, housekeeper, child care provider) that are of inherent interest and that may affect their professional lives, but are largely unstudied.
Design, Setting, Participants, and Main Outcome Measures We report data from respondents (N=4501) to the Women Physicians' Health Study, a cross-sectional, questionnaire-based study of a stratified random sample of US women MDs.
Results Women physicians with children aged 0 to 17 years spent a median of 24.4 hours per week on child care. Women physicians typically spent half an hour per day cooking, and another half-hour per day on other housework. Little time was spent on gardening: a median of 0.05 hours (3 minutes) per week. Those performing more domestic tasks are likely to work fewer hours outside the home and to be on call less often. Women physicians who are married or widowed, have more children, have lower personal incomes, and have more highly educated and higher-earning spouses perform more domestic activities. We found no significant adverse relationship between time spent on any domestic activity and career satisfaction or mental or physical health.
Conclusions Women physicians spend little time on domestic activities that can be done for them by others, including cooking, housework, and especially gardening. Women physicians spend somewhat less time on child care and substantially less time on housework than do other US women. Despite abundant editorializing about role conflicts of women physicians, our measures of career satisfaction and mental health were not adversely affected by time spent on domestic obligations.
INTRODUCTION
WOMEN ARE becoming physicians in record numbers, comprising 42% of current medical school students.1 Yet physicians may also retain other roles, including domestic roles such as that of child care provider, housekeeper, cook, and gardener.
Knowing about these nonprofessional roles can help with calculating physician workforce needs, producing a satisfactory work environment, and understanding the sociology of medicine. Yet, although anecdotes are plentiful about role conflicts of women physicians, to our knowledge no one has quantified the time spent on these roles by women physicians, nor the extent to which this time varies by such factors as age, marital status, spouse's educational level, sexual orientation, number of children, specialty, income, work hours and call nights, stress, career satisfaction, health risk behaviors, or health status.
This article will explore these unanswered questions using respondents (N=4501) to the Women Physicians' Health Study (WPHS). The WPHS is a cross-sectional, questionnaire-based study of a stratified random sample of US women physicians. The population database is the American Medical Association's Physician Masterfile, a record of all US physicians.
MATERIALS AND METHODS
The design of WPHS and the basic characteristics of the population have been more fully described elsewhere.2-4 The WPHS surveyed a stratified random sample of US women MDs; the sampling frame is based on the American Medical Association's Physician Masterfile, a database intended to record all physicians residing in the United States and possessions. Using a sampling scheme stratified by decade of graduation from medical school, we randomly selected 2500 women from each of the last 4 decades' graduating classes (1950-1989). We oversampled older women physicians, a population that would otherwise have been sparsely represented by proportional allocation because of the recent increase in numbers of women physicians. We included active, part-time, professionally inactive, and retired physicians, aged 30 to 70 years, who were not in residency training programs in September 1993 when the sampling frame was constructed. In that month, the first of 4 mailings was sent out; each mailing contained a cover letter and a self-administered 4-page questionnaire. Responses were accepted until October 1994 (final N=4501).
Of the potential respondents, an estimated 23% were ineligible to participate because their addresses were wrong or because they were men, deceased, living out of the country, or interns or residents. Our response rate was 59% of physicians eligible to participate. We compared respondents and nonrespondents in 3 ways. We used our telephone survey (comparing our telephone-surveyed random sample of 200 nonrespondents with all the written survey respondents), the American Medical Association's Physician Masterfile (contrasting all respondents with all nonrespondents), and an examination of survey mailing waves (all respondents, from waves 1 through 4) to contrast respondents' and nonrespondents' outcomes for key variables. From these 3 investigations, we found that nonrespondents were less likely than respondents to be board certified. However, respondents and nonrespondents did not consistently or substantively differ on other tested measures, including age, ethnicity, marital status, number of children, alcohol consumption, fat intake, exercise, smoking status, hours worked per week, frequency of being a primary care practitioner, personal income, or percentage actively practicing medicine.
Based on these findings, we weighted the data by decade of graduation (to adjust for our stratified sampling scheme), and by decade-specific response rate and board-certification status (to adjust for our identified response bias). The analysis weights (within decade) for board-certified and non–board-certified respondents, respectively, are 3.4 and 5.5 (1950s), 9.3 and 17.7 (1960s), 17.9 and 36.5 (1970s), and 28.3 and 63.9 (1980s). Using these weights allows us to make inference to and draw conclusions about the entire population of 86,000 women physicians who graduated from medical school between 1950 and 1989.
Time spent in domestic activities was queried by number of times (never or 1-6); frequency (per day, week, or month); and typical duration (14 categorical choices from >0 to <10 minutes to  8 hours) for each of our queried activities (child care, cooking, gardening, and housekeeping). SUDAAN5 was used to calculate medians and perform median split tests. Unless otherwise noted, only results significant at P .01 are described.
RESULTS
Table 1 examines US women physicians' domestic activities stratified by demographic characteristics. Table 2 stratifies by professional characteristics, and Table 3 stratifies by personal health characteristics. Hours currently spent on child care were examined in those with children aged 0 to 17 years at the time of the survey; such physicians spent a median of 24.4 hours per week on child care. More hours were spent caring for children by those who were younger, were married to a physician, had more-educated parents, worked less than 40 hours per week, were professionally inactive, had lower personal income, or had partners with higher income. Fewer child care hours were reported by Asian physicians, those born outside the United States, and those having only 1 child. Smokers and those reporting worse health status spent less time providing child care. Only 2.6% of these 1297 women younger than 60 years with children younger than 18 years stated that they were professionally inactive (this was only slightly higher than the 1.3% inactivity rate of women younger than 60 years with no children younger than 18 years (data not shown). There were no significant differences (P.01) in child care hours associated with exercise habits, marital status, partner's educational level, sexual orientation, stress at home or at work, specialty, career satisfaction, practice locale, number of call nights, or days lost to bad physical or mental health.
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Table 1. US Women Physicians' Demographic Characteristics and Their Relationship to Various Domestic Activities
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Table 2. US Women Physicians' Relationship of Professional Characteristics to Selected Domestic Activities
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Table 3. US Women Physicians' Personal Characteristics and Their Relationship With Various Domestic Activities
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Women physicians typically spent a half-hour per day cooking. Physicians who were older, Asian, born outside the United States, widowed or married, married to more-educated husbands (including physicians), professionally inactive, had more children, and those not taking call cooked more. Less cooking was reported by those in solo or 2-physician practices, those working more hours, those earning more, and by those who were the only household wage earner. Among specialties, surgical subspecialists cooked the fewest hours per week, while anesthesiologists, emergency medicine specialists, and general practitioners cooked the most. Cooking more was somewhat associated with a greater likelihood of severe home stress (P=.03) and light work stress (P=.02); it was not associated with career satisfaction. Nondrinkers and those who exercised more also spent more time cooking. Sexual orientation was modestly associated with time spent cooking; heterosexuals cooked 1 hour more per week than nonheterosexuals (P=.02). Practice locale, maternal and paternal education, smoking status, and health status were not associated with cooking.
Women physicians also spent another half-hour per day on other housework. More hours were spent by nonwhites, those married or widowed, those foreign-born, heterosexuals, those with more-educated spouses (P.05), the least- and most-educated mothers, those with more children, those who were professionally inactive or with fewer work hours, those with fewer nights on call, and those with lower personal income. Surgical subspecialists spent the fewest hours (1.2 per week) on other housework and general practitioners spent the most hours (5.0 per week). Spending more time on other housework was associated with more home stress; it was not related to work stress or career satisfaction, smoking, or health status.
Little time was spent on gardening: a median of 0.05 hours (3 minutes) per week. Older and widowed physicians and those practicing in rural environments spent more time gardening, but even these 3 groups only spent a median of one-third to one-half hour per week.
COMMENT
Women physicians spend little time on domestic activities that can be done for them by others, including cooking, housework, and especially gardening. Even those with young children are unlikely to be professionally inactive, although those doing more domestic tasks are likely to work fewer hours outside the home and be on call less often. Performing more domestic activities are those who are married or widowed, have more children, lower personal incomes, and more highly educated and higher-earning spouses. We found no significant adverse relationship between time spent on any domestic activity and career satisfaction or mental or physical health.
While Lorber6 found that women physicians often made specialty and practice-setting choices to accommodate children's needs, neither variable was related to time spent providing child care by women physicians in this study. There may, however, be qualitative areas we failed to measure, such as physicians feeling conflicted about spending time on professional socializing, or other professional compromises made to accommodate children's needs.
We did find that women physicians who cook more and do more housework report higher levels of stress at home (as noted earlier, they are also likely to have more children). While we do not know if this is also true of US men physicians (a major limitation of this study), this is consistent with findings among white-collar workers in Scandinavia. In those findings, primary responsibility for child care and household duties reflected traditional gender roles, with white-collar women reporting higher levels of work overload and stress than their male counterparts, and with stress increasing significantly with the number of children at home.7
Gardening was not common among women physicians in the United States; median time gardening is 3 minutes per week, compared with approximately 3 hours each for cooking and other housework and more than 24 hours per week of child care among those with children aged younger than 18 years. As Lorber6 found in interviews with some women physicians in her sample, it is often free time, not work, that is given up for children and other obligations; others have found that women have less leisure time than men.8 Gardening may be considered an activity that can be easily hired out, or it may be considered a low-priority leisure activity and hence dispensable.
Comparisons of these women physicians with other studied populations indicate that women physicians spend less time in child care and housework than do other women. Many published studies of household labor do not look separately at time mothers spend on child care, partially because it is difficult to separate the work and leisure components and partially because the effect of children shows up in the amount of other housework that has to be done.9 However, using diaries that tracked 7 different types of activities with children, Nock and Kingston10 provided some of the most complete figures available on time spent on child care. They found that employed US mothers of preschoolers in dual-parent households averaged 4 hours (251 minutes) on such activities on their longest workday of the week and about 8 hours (464 minutes) on Sunday. For dual-parent households with non–preschool-aged children at home, the average was 4 hours (230.4 minutes) on their longest workday and about 6 hours (382 minutes) on Sunday. Among women physicians, 88% with children younger than 18 years are in dual-parent households, and of these 49% have children younger than 6 years. These figures suggest that, with an average of 4 hours per day in child care activities, women physicians' time spent on child care is somewhat less than the hours spent by the average American mother.
Shelton,8 using data from the 1987 National Survey of Families and Households, found the mean number of hours per week preparing meals was 12.1 among homemakers, 10.9 among married women employed part-time, and 8.6 among married women employed full-time. The mean among women physicians is 5.1 hours cooking per week. Combining washing dishes, housecleaning, and washing and ironing (the other types of indoor tasks measured), homemakers spent a mean of 24.3 hours per week on other housework, compared with 20.7 hours among married women employed part-time, and 18.3 hours among married women employed full-time.8 The mean hours per week spent doing other housework by women physicians is 5.0. Thus, physicians apparently spend substantially fewer hours in all types of housework than do most US women.11-12
These differences between women physicians and other US women are not surprising. While some of the difference may be an artifact of reporting bias or of variations in question structure across surveys, as Shelton8 reports, education, occupational status, time spent in paid labor, and time spent in paid labor by one's spouse all reduce the amount of time women spend in household work. Similarly, Brayfield,13 using Canadian data, found that a "woman can reduce her responsibility for routine tasks to a greater degree as her personal level of workplace authority increases compared to other women and relative to her husband." Such advantages clearly accrue to women physicians.
Thus, this study suggests that women physicians share with other highly educated women in high-status occupations the ability to spend fewer hours than most women performing domestic activities. Although we did not directly assess related qualitative measures, our findings should also temper concerns about women physicians' role conflict: mental health and career satisfaction were unrelated to time spent with one's children or in other domestic activities.
These findings have implications for calculating physician workforce needs and establishing satisfactory work environments. Physicians, like other workers, have responsibilities and concerns beyond the workplace. While we found that most women physicians spend little time on domestic activities that can be done by others, we also found that some accept more domestic responsibilities and fewer work hours outside the home. Calculations of workforce needs should take into account the fact that many physicians want to experience the fulfilling aspects of home life, especially child rearing, as well as those of their profession. Administrators of settings where physicians work may need to be sensitive to the demands of different life-cycle stages if they are to maintain a working environment that physicians find satisfying. Such considerations might include flexible work schedules, part-time practice, and nontraditional on-call arrangements. While we only have data on women physicians, similar concerns may apply to many men in an era of changing parental and spousal roles. Understanding medical practice, in short, requires the context of the entirety of physicians' lives.
AUTHOR INFORMATION
Accepted for publication February 10, 1999.
Corresponding author: Erica Frank, MD, Department of Family and Preventive Medicine, Emory University School of Medicine, 69 Butler St SE, Atlanta, GA 30303-3219 (e-mail: efrank{at}fpm.eushc.org).
From the Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Ga.
REFERENCES
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1. Council on Graduate Medical Education. Women and Medicine. Rockville, Md: US Dept Health and Human Services; 1995.
2. Frank E. The Women Physicians' Health Study: background, objectives, and methods. J Am Med Wom Assoc. 1995;50:64-66.
3. Frank E, Rothenberg R, Brown V, Maibach H. Basic demographic and professional characteristics of US women physicians. West J Med. 1997;166:179-184.
ISI
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4. Frank E, Brogan D, Mokdad AH, Simoes EJ, Kahn HS, Greenberg RS. Health-related behaviors of women physicians vs other women in the United States. Arch Intern Med. 1998;158:342-348.
FREE FULL TEXT
5. Shah BV, Barnewell BG, Hunt PN, et al. SUDAAN User's Manual, Release 5.50. Research Triangle Park, NC: Research Triangle Institute; 1991.
6. Lorber J. Women Physicians: Career, Status, and Power. New York, NY: Tavistock Publications; 1984.
7. Lundberg U, Mardberg B, Frankenhaeuser M. The total workload of male and female white collar workers as related to age, occupational level, and number of children. Scand J Psychol. 1994;35:315-327.
ISI
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8. Shelton BA. Women, Men and Time: Gender Differences in Paid Work, Housework and Leisure. New York, NY: Greenwood Press; 1992.
9. Blair SL, Lichter DT. Measuring the division of household labor: gender segregation of housework among American couples. J Fam Issues. 1991;12:91-113.
10. Nock SL, Kingston PL. Time with children: the impact of couples' work-time commitments. Soc Forces. 1988;67:59-85.
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11. Hersch J, Stratton LS. Housework, wages, and the division of housework time for employed spouses. In: The American Economic Review: Papers and Proceedings of the Hundred and Sixth Annual Meeting. Nashville, Tenn: American Economics Association; 1994:120-125.
12. DeMeis DK, Perkins HW. Supermoms of the nineties: homemakers and employed mothers' performance and perception of the motherhood role. J Fam Issues. 1996;17:777-792.
13. Brayfield AA. Employment resources and housework in Canada. J Marriage Fam. 1992;54:19-30.
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