P2A041: Burden of Household "Invisible Work" on Louisiana Pediatricians: Cognitive Labor Variation by Gender

Background: Household cognitive labor (CL), unlike physical tasks, entails anticipating needs, identifying options for filling them, making decisions, and monitoring progress. Feeling disproportionately responsible for household management is associated with decreased life satisfaction. Studies demonstrate that women pediatricians bear more responsibility for physical tasks at home, but pediatricians’ household cognitive labor is not well-described.

We examined gender discrepancy in household CL among physicians in pediatric specialties practicing at five centers in Louisiana. This study aimed (1) to examine the extent to which physicians’ proportional responsibility for household CL varies by gender, as well as (2) to evaluate for association between greater responsibility for household CL and negative professional outcomes such as burnout, career dissatisfaction and sense of family-to-work conflict.

Methods: We performed a cross-sectional survey of physicians in pediatric specialties at five Louisiana centers associated with training programs. We dichotomized CL as high (primary responsibility in 6-11 domains) and low (0-5 domains).

We ran categorical analysis to determine associations between variables, using a Chi-square test. We assessed for association between gender and reported responsibility for household CL in 11 domains. Similarly, we assessed for association between “high” CL and outcomes related to professional well-being (burnout symptoms, dissatisfaction, and work-and-family conflict scale).

Results: Response rate was 39%. Of 208 analyzed respondents, 66% were women; mean time in practice was 16 years (IQR 9-22 years); mean work hours were 48 per week.

Women more often than men reported primary responsibility for CL in 9 of 11 domains of household/family work, including scheduling (e.g. coordinating family calendar), shopping (e.g. researching, choosing items), various cognitive aspects of childcare (e.g. managing activity enrollment, setting sleep schedule, awareness of school deadlines), and other domains (all p< 0.01).

Women more often than men reported monthly symptoms of burnout (69% vs 50%), increased callousness (45% vs 25%), and frequent distraction at work from home responsibilities (30% vs 13%). Those with high vs low CL were more likely to report these same outcomes (71% vs 57%; 51% vs 31%; 35% vs 17% respectively), as well as that their work performance suffered due to personal and family commitments (28% vs 12%) (all p< 0.05).

Conclusion: Gender disparity in household cognitive labor may contribute to gender disparity in professional well-being. This is relevant as discussions of healthcare improvement offer increasing consideration to equity and provider well-being.

In addition, this study contributes to the body of literature relating physicians' professional thriving to demands faced in their personal lives. To the extent that employers and administrators appreciate this relationship, they may be better able to design solutions to support long-standing employees and business longevity.