A research letter appearing in JAMA Internal Medicine suggests that women physicians, but not their physician husbands, decrease their work hours substantially after children are born. But as Dr. F. Perry Wilson discusses in this 150 Second analysis, there are a few ways to interpret this data.
This week, I'm looking at an incredibly narrow study appearing in JAMA Internal Medicine – a study that compares the hours worked by the men versus the women in dual-physician couples.
I often criticize studies with narrow inclusion criteria – so why bother with one that examines this highly specific segment of the population? Well, for one, I'm one of these poor suckers.
Actually, what's great about this study is that it allows us to examine the effect of child-rearing on hours worked in a way that is highly controlled. Dual-physician couples share a socioeconomic status, a location, a family structure, etc. If there is any place where we would find that men and women are balancing work and home hours equally, it would be here.
But that is not what was found by Anupam Jena and his team at Harvard. They used data from the American Communities survey - this is a Census Bureau-run survey that hits around 3.5 million addresses per year.
From this huge dataset, they found 4,934 heterosexual couples where both partners were physicians.
The results were pretty stark:
Here you see the male physician hours in blue and the women's in red, stratified by the age of the youngest child. Physician couples without kids worked roughly 60 hours a week, regardless of sex. But as soon as you introduce kids into the picture, women's hours go way down, by nearly 20 hours per week. This is true pretty much regardless of how old the kids are.
This was raw data, but even after adjustment for age, race, state of practice, and time period, women with kids worked about 10 hours a week less than women without kids. Men's work hours didn't change at all.
I asked Dr. Jena whether he saw temporal trends in the data – had the work hours gap narrowed at all as time went on?
According to him: "We looked at about a 20-year period and found that the reduction in work hours for women in dual-physician couples with the arrival of children did not change over this period." So the societal shift that has seen more sharing of child-rearing responsibilities between men and women is not so evident among physician couples.
Jena and his colleagues are quick to point out that they don't know the cause of the discrepancy. Perhaps it is due to societal norms that lead women to feel pressured to bear more of the burden of childcare. Or perhaps causality here is flipped, and women physicians who work less demanding hours are more likely to choose to have children.
To get some perspective, I spoke to Drs. Marika and Matt Russell – both ENTs, who are married with three young children in California. Marika told me she works fewer hours than Matt, but not because she chose that.
“I don’t think I actively chose it. I think I got lucky. I ended up in a situation where I am able to regulate a lot of my own schedule.â€
Of course, there is one other possible explanation for women working fewer hours:
“Matt is a much much more slower person and takes a lot more time to wind up his day. Whereas when I’m done I’m out of there, I’m much more efficient."
Maybe women just get more done.