By Krisha J. Howell, MD, and Penny R. Anderson, MD

As health care providers pre-pandemic, we were all far too familiar with the 10-hour clinic days, parade of administrative documents, barrage of medical calls/emails/texts/pages inevitably delivered during “unplugged time” and the emergencies that pop up at 5:00 p.m. on a Friday. As parents, we each adapted as best we could with our own piecemeal childcare system to maintain the demands of burgeoning clinics and the needs of our family. Minor emergencies happened frequently: school lunches forgotten, pick-up times from sports practice missed. Then there was that one Christmas week when the family dog gulped down a box of chocolates ― that well-intended, beautifully gifted box of malt balls from Uncle Scott ― culminating into a 6:00 p.m. frenetic storm of family crisis and urgent childcare needs amid an on-going Tumor Board. But as unsatisfactory as it was, the system persisted. Conditioned from the moment of that first newborn cry, we gradually progressed into our own individual patchwork system of Dr. Mom/Dr. Dad.

In America, we profess a need for a robust infrastructure ― roads, utilities, communication systems are all worthy investments for the health of our economy. Yet it seems, as a culture, we remain married to the idea that the federal government only need to offer limited childcare assistance outside of the traditional kindergarten to high school model. Along with the nursing, therapy and administrative staff, women now constitute a large portion of our physicians and physicists. A more robust infrastructure would allow these women to make an even greater impact to our patients and our communities.

During the COVID-19 pandemic, we saw our health care workers report to work in the face of inadequate PPE, absent or under-resourced COVID testing and with the oncology cancer patient population quickly infiltrated by the disease. Not only were we consumed with our own safety but the probability of bringing the disease home to our families. One set of friends, both emergency physician parents, made matching living wills. Elsewhere, a physician mother quarantined at a hotel rather than go home to her family after an exposure.¹

The pandemic exposed the lack of a countrywide childcare infrastructure. Old sources of support became unavailable, less accessible, or, for many, executed the removal of an elderly family member as caregiver out of concern for their vulnerability. Many health care workers now found themselves in the triple role of essential worker/babysitter/teacher. Each, in itself, would constitute a full-time position. In turn, the daily act of raising children now required a greater investment in time and effort. A 101F degree fever in a baby during the era of COVID translated into an automatic two-week home quarantine from daycare. Baby’s doctor visit meant one parent had to take time off from work to stay home with siblings, as only a single guardian and no siblings were allowed to accompany an underage patient.

In dual income families, the typical parental dynamics may have altered. Many women conceded that it was no longer possible to be all roles at once. In general, women are more likely to be in part-time employment, more likely to be the lower earner in straight couples and likely to already have the greater expectation of doing household chores and meeting child-rearing obligations. If both parents had the pressure of working, then it more often than not resulted in women leaving the workforce.^2,3 Beyond this struggle, we do not even elaborate on those hurdles faced by single-parent households (9 out 10 headed by women) or those with separated households wherein child custody time may have been threatened by a parent’s role as a health care provider.

From a child’s perspective, understandably, the pandemic has caused a departure in their physical and social support. Their previous social outlets of friends, sports and school are not accessible or have been reimagined in a less intimate, virtual manner. Children of frontline health care workers have demonstrated increased anxiety and worrying. “The electronic media did come to their rescue during home confinement but not without its own drawback….”⁴ It is easy to imagine the paramount role a parent need play at this time as an accessible and reassuring figure to a child.⁵

A large-scale survey conducted by Athenahealth in 2017 found that the majority of physicians under age 44 were women.¹ Given the onset of COVID in early 2020, it would make sense that this population would be especially vulnerable to the aforementioned stresses. And, indeed, a drop in publications by female authors was demonstrated during the pandemic period.⁵

At our department, we realized early on many of these consequences and how they could impact our physicians. And, beyond them, the dosimetrists, physicists, nurses and therapists would experience similar, if not worse, upheaval in their lives at home. We set out to increase communication and strive to optimize safety and support throughout the department. As with the majority of health care clinics, we quickly integrated virtual days. This reduced risk of transmission and gave many parents greater freedom when children needed at-home care. A “buddy” system was created to optimize coverage so as not to compromise patient care and protect against surprise physician absences due to emergencies. This facilitated collaborative efforts regarding consents, simulations and SBRTs. Fortunately, our center already had in place an on-site daycare, similar to what companies did during World War II.⁶ Holidays were matched to the clinic holiday schedule, and the hours mirrored that of the clinic hours to optimize effective care. Furthermore, we tried, and ultimately succeeded, to honor all requested vacations despite months of upheaval. To take advantage of time away, we strove to improve communication among long-standing professional silos so that an attending’s physical clinic closure could translate to staffing the exact number of required support staff. Thus, a nurse with children being home-schooled could make appropriate plans to be home. Male colleagues, who in the past would rarely if ever admit to needing help, now approached me with requests for cross-coverage due to family needs or consideration of a father’s help being needed at home. This has caused a visible stress in my colleagues, culminating in an evident need for an improved work-life integration. Hopefully, this will continue to manifest into the future in a way to facilitate consideration and willingness to collaborate with other colleagues.

I wonder, were there ― and are there ― other solutions employed elsewhere? Going forward, as the pandemic subsides, will this awareness abate? And, finally, are there opportunities here that we will want to carry forward beyond the pandemic? Join us in this discussion on the ROhub.
 

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Dr. Krisha Howell is an assistant professor and clinical director of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. She is actively involved in ASTRO as the Gender Equity Community Champion and in the American Association for Women Radiologists (AAWR) along with other virtual platforms promoting mentoring in the space of gender equity.

References:

1. Dawar R, Rodriguez E. Chronicles of a Physician Mom in a Pandemic: When Doing It All Is No Longer Possible! Accessed January 25, 2021. https://connection.asco.org/blogs/chronicles-physician-mom-pandemic-when-doing-it-all-no-longer-possible

2. Lewis H. Don’t Build Roads, Open Schools. The Atlantic. Accessed January 25, 2021. https://www.theatlantic.com/international/archive/2020/06/child-care-infrastructure-britain-boris-johnson/613672/

3. Edwards K. Women Are Leaving the Labor Force in Record Numbers. The Rand Blog. Accessed January 25, 2021. https://www.rand.org/blog/2020/11/women-are-leaving-the-labor-force-in-record-numbers.html

4. Mahajan C, Kapoor I, Prabhakar H. Psychological Effects of COVID-19 on Children of Health Care Workers. Accessed January 25, 2021. Anesth Analg. 2020;131(3):e169-e170. doi:10.1213/ANE.0000000000005034

5. Andersen JP, et al. eLife. 2020;9:e58807. doi: 10.7554/eLife.58807

6. North A. Vox. Elizabeth Warren made a crucial point at the Democratic convention: Child care is “infrastructure for families”. Accessed January 25, 2021. https://www.vox.com/2020/8/20/21376792/elizabeth-warren-dnc-convention-child-care-biden