“We don’t know what to do,” says Catherine Jones, a registered nurse at a Boston-area community health center.
As the uncertainty surrounding covid-19 quickly mounted in recent weeks, 30-year-old Jones and her colleagues at their understaffed clinic had largely been left up to their own devices. They’d been forced to decide, ad hoc, when and where to don masks, gowns and gloves amid nationwide shortages — and to deliberate as to who among their largely low-income, immigrant patients was most in need of in-person care.
Covid-19 has arrived with a vengeance in Massachusetts as elsewhere, the initial trickle of patients intensifying into a deluge: As of Wednesday, the state had reported nearly 7,738 positive cases, including at least 122 deaths. These days, Jones, who is attending school to be a nurse practitioner, has found that her conversations with the center’s patients are an exercise in both triage and therapy. Work like this is why she went into nursing in the first place: “A lot of it falls back on good communication,” Jones says, “knowing how to listen and gather information” — how to provide “peace of mind” while making or contributing to high-stakes decisions.
Research shows that women are stronger empathizers than men, which helps explain why they make up nearly 9 in 10 of the country’s registered nurses and 3 in 4 of its health-care workers overall. But that context also hints at the pronounced emotional toll the coronavirus pandemic could have on female health-care professionals, who already suffer from higher rates of burnout than their male counterparts. A recent study found high rates of “depression, anxiety, insomnia, and distress” among workers on the front lines of covid-19 in China — problems that were especially pronounced among women.
As Jones put it, women in health care are being thrown into “a vicious cycle” as they strive to field questions they can’t answer, to provide reassurances they can’t give. “One of the worst things you can do to a health-care professional is to make them feel like they can't do their job,” says Megan Jones Bell, a clinical psychologist who oversees research for the mindful-meditation app Headspace.
The pandemic has saddled women in these professions with an exaggerated dose of emotional labor, particularly those in fields that already rely on the art and science of managing feelings, such as nursing and mental-health counseling. The stressors of being on or near the front lines, furthermore, are coupled with those of widespread gender biases in the workplace. Then there are the societal burdens placed on women as empaths, caregivers and multitaskers — responsibilities that many are internalizing more during the all-consuming threat of covid-19.
Women are “always thinking of other people, more than we think of ourselves,” suggests Rebecca Vermeulen, an executive with the biotech company Roche who serves as a vice chair of the Healthcare Businesswomen’s Association. That impulse was evident across interviews with nearly 20 female health-care workers, many of whom are feeling exasperated as they tend to the needs of both their loved ones and patients.
“I’ve also tried to inform my family, my friends, everybody who’s not in the medical field that [covid-19] is a serious issue,” says Iqra Kamal, a 28-year-old pediatrics student doing a clinical rotation at a hospital that serves nearly 1 million people in New York City, now the pandemic’s national epicenter. Kamal said in late March that she’d been entering and exiting her hospital through the back doors, using circuitous routes inside the building to mitigate her exposure. But she was struggling to get her parents, immigrants from Bangladesh who live with her elderly grandma and diabetic brother in Florida, to take similar precautions.
Some women in the coronavirus crucible now find themselves having to choose which other people to think about most. “There is this conflict right now between my passion for my work and for the people that I serve with needing to take care of their health and their safety and also my own,” says Katherine Sloman, 32, a Philadelphia-area licensed counselor who provides in-home therapy to disadvantaged families. “But also you have your own personal life, which is now compounded and contradicted by [your professional one].”
“We are making our wills,” says Elizabeth Leweling, a 39-year-old anesthesiologist in Billings, Mont. “We are planning ways to isolate ourselves from our families so they’re not exposed.”
A rise in demand for virtual mental-health tools offer a peek into the particular psychological burden of the pandemic. The number of Headspace subscribers who identify as health-care professionals, for example, has soared in recent weeks, in particular over the past few days. The app, which can cost up to roughly $160 a year, is now offering complimentary subscriptions to U.S. practitioners working in public-health settings and anyone working for the National Health System in the United Kingdom, “to address rising levels of stress and burnout.”
Talkspace, an app through which users can seek out licensed therapists with whom they meet virtually, has seen similar trends: Its user volume had, as of Friday, swelled by 65 percent since mid-February, with women accounting for the vast majority of new patients. Women already account for most of such site’s user bases, but initial data indicate a disproportionate growth in usage by female health-care professionals — many of them explicitly citing pandemic-induced stressors.
Women in health care already struggled to care for their own mental health before all this. A 2004 study found above-average suicide rates among physicians, with the gap especially pronounced among women. Some scholars suggest that among women in medicine, those who are suicidal tend to be more self-critical and to blame themselves for their psychological suffering. Separate research shows that nurses contend with heightened rates of job-induced stress, including depression and anxiety. Burnout is common among mental-health professionals, too, most of whom are women.
Some of the most immediate stressors are practical. Women tend to serve as their family’s “chief health-care officer,” says Jhaymee Tynan, 38, a health-care corporate strategist for one of the largest nonprofit health systems in the country. Many women are being forced onto double duty as they “[think] through the logistics of things,” says Roche’s Vermeulen, a role that, especially for single mothers and private-practice professionals, can come with pocketbook pressures. The median salary for the health-care practitioners and technical staff is about $66,000, less than what a Pew analysis last year deemed a middle-class income. The fields with the largest shares of women typically come with the lowest salaries; for instance, phlebotomists and nursing-home aides, roughly 9 in 10 of whom are women, respectively make just $34,500 and $24,000. Gender-based hiring biases and wage gaps are rampant within health-care fields, too. Women practitioners also tend to shoulder more student debt than do their male counterparts.
Exacerbating the financial pressures are those of working in hierarchical settings, which are common in health-care occupations. Female health-care workers are more likely than their male counterparts to contend with “role conflict, emotional labor, [and concerns] about medical errors and litigation,” according to a 2018 study, as well as with “verbal or physical abuse by patients and caregivers or bullying by colleagues.” Many female health-care workers interviewed said they are frequently scapegoated or doubted by patients and colleagues alike.
Crises like this pandemic put such biases under the microscope. Uncertainty in high-stakes situations can be uncomfortable, compelling people to react or finger-point. When medical faculty are well rested and calm, they’re more deliberate in their decision-making. “They know exactly how to run it, so they can kind of watch and make sure that things aren’t going wrong,” explains Erica Levine, 29, a resident in internal medicine at the University of Minnesota. Female trainees, research suggests, are far more likely than their male counterparts to be so wrongfully forced aside, and numerous doctors-in-training testified to that very experience in interviews.
Women enter the field aware of these obstacles. The work is simultaneously “rewarding while at times isolating, discouraging and difficult,” says Sasha Shillcutt, an anesthesiologist in Omaha. “You know you are saving people’s lives with your expertise and your knowledge, [even if] you may not be paid or promoted for doing so simply because of your gender.”
Ultimately, what makes this pandemic so unprecedented is also what makes life as a woman in health care right now so uniquely agonizing. Neil Leibowitz, Talkspace’s chief medical officer, described the current hysteria as “information overload and information absence in combat.” The upshot is that the helplessness felt by countless women on covid-19’s front lines isn’t just a matter of impostor syndrome, maternal instinct or visceral anxiety; it’s a function of the fact that the pandemic’s uncertainty is preventing them from leveraging their go-to triage tactics.
Their work is also jeopardizing their own safety, of course. And the stakes are universal, in part because patients’ physical health is incumbent on practitioners’ mental health. A body of research demonstrates that job-related stressors, including fatigue and a limited sense of self-efficacy, contribute to a greater likelihood of medical errors. Such stressors will worsen across the board for health-care workers during the pandemic — but women, as is tradition, will likely shoulder most of the burden.