Jobs in the health care industry often come with demanding hours and inflexible work scenarios. And with children involved in a range of hybrid schooling scenarios amid the pandemic, women are disproportionately taking on child care while serving on the frontline of the Covid-19 epidemic. The result? A workforce that at best is burned out—and at worst, exiting the industry entirely.

Resource library: Strategies for coping with the Covid-19 challenge

In this episode of Radio Advisory, host Rachel Woods talks with Advisory Board's Sarah Hostetter and Lauren Rewers to discuss how big a problem child care is for the health care workforce, how the Covid-19 epidemic has exacerbated existing workforce challenges, and how to embed flexibility in a way that works for everyone.

Read an edited excerpt of the interview below, and download the episode for the full conversation.

Rachel Woods: There are a lot of personal and professional reasons for anyone to seek a little bit of extra flexibility, but for the purposes of this conversation, let's just focus on child care. Lauren, how big of a problem is this for the health care workforce?

Lauren Rewers: Well, working parents around the country can tell you that child care is a huge issue nationally, but health care employees are disproportionately impacted by child care for a few reasons.

First of all, most of them are essential workers—they are clinicians who are having to come in every day. It's already hard enough for those who work at home, given the challenges of trying to work while watching your children, many health care workers don't even have the option, which is really difficult.

So at the beginning of the epidemic, the Center for American Progress estimated that around 4.6 million health care workers, which is about 30% of the total health care workforce, have children who are too young to be left home.

Measuring physician burnout

And I think it's also important to note that the health care industry is mostly women, and the epidemic is really disproportionately impacting working mothers. So that's also weighing very heavily on the health care industry as a whole.

Woods: I just want to underscore that for a moment, because the flexibility child care issue has always been something that has come back on women. And you're saying that, in a part of the economy that is mostly made up of women, this is something that's going to hit the health care industry harder than virtually any part of the American economy.

Sarah Hostetter: Yeah actually pre-Covid, 40% of women who became physicians went part-time or left medicine altogether within six years of completing residency. So it's been a problem pre-Covid that Covid has exacerbated and shined this whole other level of light on.

Woods: I think everyone listening to this podcast, and certainly the three of us, know someone or has a story about somebody who has dealt with this problem. Like you said, Sarah, this isn't actually something that's all that new. And it's also coming at a time when the epidemic was already disproportionately impacting working moms.

Rewers: Yeah, and I think it's also important to add that not all women who are health care workers are impacted equally by the child care burden.

So even though, certainly female physicians, are disproportionately impacted comparatively to their male colleagues by child care burdens, there's a whole segment of working moms who are health care workers who don't really have the resources to hire nannies and babysitters and who are really struggling.

So in addition to having a large proportion of working moms in the workforce, the health care industry also has a larger proportion of single parents, many of whom are working moms, and child care is a big burden on those parents.

For example, my own mom was a single mom when she just got out of nursing school, and luckily—and I think this is the case for many single moms who are working nurses or health care workers— she had family, her mom and her mother-in-law, to take care of my older brother at the time. But she didn't have the resources, if they were unavailable, to hire a nanny or a babysitter. So when she didn't have child care, she would take the nightshift, and then stay up all day with my brother and then go back to work and work another 12-hour shift.

Fight burnout by integrating self-care into clinician workflow

And the thing is, it's not ideal, but parents do stay up all night and don't get a lot of sleep with their kids, but I think what's happening now is that is just the reality for single parents and working moms right now who, day after day with no end in sight, are working their 12-hour shifts, and then coming home and staying up all day with their kids and also not only napping and keeping an eye on their kids, but also teaching, and taking on all these other responsibilities.

Woods: And so it's no wonder then that women in the workforce, whether they're physicians or nurses, faced with the incredible difficulty of balancing work and child care, sometimes decide to do what your mom did, Lauren, which seems so impossible to me.

And other times, they leave the workforce entirely, which creates its own problem. It's something that I think you and your team have defined as the nursing complexity challenge. Can you tell us a little bit about that?

Rewers: Yeah, so what we're finding in the nursing workforce is that the workforce is getting pretty polarized in terms of age and experience.

You have a big group of baby boomers who are exiting the workforce, because they're retiring and a big influx of novice staff who are new graduates right out of nursing school. But you see a dip in the middle of those pretty competent and expert staff who have between, say, seven to 10 years of experience, and that's an issue.

Even though some organizations are struggling with a nursing shortage across the board, most organizations in the country are facing a shortage of specialized staff, and I think importantly right now, of critical care staff. So when you think about the way child care impacts that shortage, what you're seeing is your specialized and experienced nurses exiting the workforce in droves, because the roles and times and schedules that are allotted to them are not working for the child care and other responsibilities they have at home.

Woods: So said another way, because we didn't have flexible roles for a core part of our health care workforce and they're forced to leave, when the industry is faced with an epidemic, we don't actually have the senior specialized expertise to deploy to combat that epidemic. So it's sort of a double whammy.

Rewers: That's right. And I think what is important to add—it's not that we're at this point where we don't have the staff that we need and that's scary enough, but that we're already so worried about retaining the staff that we've had who've been through an incredibly traumatic experience and who are now taking on additional childcare burdens.

So I think the big question is, if we aren't able to give this flexibility, are we going to see an ever-widening experience-complexity gap that will potentially impact quality and safety?