Can Telehealth Advance Professional Equity for Women in Medicine?

Occupational burnout is defined as the triad of emotional exhaustion, increased cynicism, and reduced feeling of personal accomplishment. ¹ Among female physicians, burnout has been estimated to occur at higher rates, with one national survey revealing a rate of 51% among women as compared with 39% among men. ² Numerous factors contribute to the gender gap in burnout, including lower pay, less institutional research funding, conflict between work and home life, conscious and unconscious gender bias, perceived inequity regarding control over workload, increased compassion fatigue, discrimination, workplace sexual harassment, and imposter syndrome. ^3,4 Childbearing and child-rearing also limit opportunities and advancement for women physicians who experience disproportionately greater familial responsibility, a phenomenon only amplified by the COVID-19 pandemic. ⁵ A 2017 study surveying the Physician Moms Group, an online community with >60,000 physician members in the United States who self-identified as mothers, found that 66% of respondents reported gender discrimination, whereas nearly 36% reported maternal discrimination. ⁶

Flexible weekday schedules are a desired workplace change to combat gender-based discrimination. ⁶ Although part-time work schedules are increasingly adopted as a means to achieve such flexibility, limited personal financial constraints, difficulty negotiating fair contracts, and negative perception from colleagues and superiors serve as impediments to this solution. ^{4 –6}

During the COVID-19 pandemic, the Centers for Medicare & Medicaid Services expanded telehealth coverage for all Medicare patients during the COVID-19 pandemic, effectively eliminating reimbursement, licensing restrictions, and Health Insurance Portability and Accountability Act barriers to widespread use of telemedicine. As a result, care delivery has rapidly incorporated telemedicine modalities, enabling continuity of care for patients and maintaining the safety of both patients and providers. Within academic medical centers, clinical care has not been the only form of work converted to a virtual medium. Administrative and committee meetings, supervision, and academic presentations have all transformed, with connectivity among colleagues and communication within teams all operationalized remotely.

An important dimension of remote work is its potential to improve physician burnout and boost professional fulfillment. Telehealth minimizes the work commute, resulting in time savings that facilitates work hours becoming more manageable. In addition, during a busy clinical shift, in contrast to a workplace setting requiring clinicians to constantly move between office space and examination rooms, telehealth simplifies the work schedule and further improves efficiency.

Flexibility is another advantage. Without the need for office space, physicians gain greater autonomy over scheduling hours. Improved flexibility and access to care for patients also adds to the doctor–patient relationship, further increasing meaningfulness of work for physicians. For all physician parents who struggle with the challenge of childcare due to unpredictable and long work hours, the flexibility permitted by the remote work environment may diminish work-life conflict.

The traditional model of work within the academic psychiatric setting has been for physicians to occupy clinical or laboratory workspace. Academicians fly across the country to present the findings of their research at outside institutions. Committees necessitate the physical presence of members to contribute in meaningful ways. Attending physicians supervise trainee's side by side. Visibility has been traditionally achieved through in-person engagement.

Recommendations from the American College of Physicians to promote academic advancement among female physicians include formal mentorship and sponsorship programs; coaching and personal development coursework; leadership and negotiation skills development opportunities; diversity on committees, councils, and boards; and flexibility in academic promotion and advancement criteria. ⁷ The general assumption is that participation take place through a physical presence. Two of the boundaries for successful implementation of such proposals during the childbearing and child-rearing years, however, will be time and flexibility. Time to participate in such opportunities outside of one's ongoing clinical and academic obligations is critical for engagement. Flexibility to attend meetings at more convenient times or contribute to conferences or presentations remotely through videoconferencing can enhance recruitment of female physician mothers to such initiatives. Without consideration for the constraints posed by these resources, interventions to address gender inequity in medicine cannot be perceived as sincere or authentic efforts to make a change.

The benefits conferred by the remote work environment and videoconferencing medium for both clinical care and participation in academic opportunities pose a significant advantage to physician mothers with limited time and seeking enhanced flexibility. Moreover, improving flexibility and control not only directly increases professional fulfillment but also provides physician mothers with much needed time and energy to engage in activities directed toward academic advancement. To advance gender equity in academic advancement will mean not only focusing on the need for such a goal but also disrupting the model for how academicians contribute to scholarly activities and removing physical attendance as a boundary for participation.

The advancement of women in academia will require a number of systems-based changes, including addressing the problems of implicit bias and gender stereotypes, the gender pay gap, and equitable representation at conferences and scholarly activities. However, nurturing a culture that promotes flexibility and tailoring workload expectations to the individual will also need to be an essential element of the strategy to retain and promote women physicians, particularly during the childbearing and rearing years. Availability of time is a critical constraint to participation in scholarly activities. Thus, making academic opportunities more widely available to female physician mothers is only the first step. An authentic effort toward gender equity in academic could mean utilizing the large-scale deployment of telehealth practice during COVID-19 as its own disruptive pilot program for the beneficial effects of the remote work environment on female physician burnout. Our hope is that such a pilot can serve as the foundation for promotion of remote work beyond the duration of COVID-19.