Differences in Work-Life Experiences of Physicians by Parenting Status, Gender, and Training Level During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has presented new challenges for physicians, and physician-parents specifically. Few studies have focused on work-life changes in this population. The present study investigated work-life changes in a group of physicians during the first six months of the COVID-19 pandemic. METHODS: A survey was distributed electronically to physicians affiliated with a U.S. medical school inquiring about experiences during the first six months of the COVID-19 pandemic (March 2020 to September 2020). RESULTS: In logistic regression models adjusted for age, significantly more female physician- parents reported increased burnout, increased time with kids, and increased fear of going to work compared to male physician-parents. Around 1 in 2 attendings reported burnout, regardless of parenting status. CONCLUSION: While high rates of burnout were found across all groups in this study, differences were found by gender and parenting status. Further research is needed to understand burnout during the COVID-19 pandemic and to support physician-parents.

Changes in Sick Visits at an Academic Pediatric Primary Care Practice due to the COVID-19 Pandemic.

BACKGROUND/OBJECTIVE: The COVID-19 pandemic decreased pediatric patient volumes; however, details regarding patterns of use within primary care sick visits are not well understood. METHODS: We performed a retrospective chart review of sick visits in an academic primary care clinic from March-August 2019 and 2020 and recorded demographics and visit diagnoses. Descriptive statistics, Chi-square, and Fisher's exact tests were used to compare the two time periods. RESULTS: Patient age, gender, and insurance type were similar across years. In 2020, there were 1,868 sick visits (247 telehealth, 4%-36% of monthly visits) compared to 4,007 (0 telehealth) in 2019. The proportion of infectious diagnoses decreased (35% vs 48%); non-infectious diagnoses increased, including dermatological (25% vs 19%) and genitourinary/reproductive (9% vs. 6%) diagnoses.  Conclusion: Similar to pediatric emergency departments, we found decreased primary care sick visits. Telehealth increased in 2020 and varied with COVID-19 community prevalence. Visits for contagious illnesses decreased in 2020, likely related to mitigation measures.

Comparison of Resident and Faculty Screening for Social Determinants of Health in an Academic Pediatric Primary Care Practice.

BACKGROUND: Social determinants of health (SDH) have an important role in children's health and development and should be investigated in pediatric well child care. METHODS: A retrospective chart review of children aged 5-17 at well visits at an urban academic pediatric primary care practice was performed. Chi-square tests of independence and z-test for proportions were used to assess differences between residents and faculty SDH screening.  Results: Faculty screened for SDH more frequently than residents (P<0.05). Residents screened less frequently for food insecurity (P<0.05) and financial insecurity (P<0.05). Financial insecurity was endorsed less frequently by resident families (P<0.05), while school absence was endorsed more frequently by resident families (P<0.05). Referrals to the clinic's community resource desk did not differ between residents and faculty. CONCLUSIONS: Differences exist in screening and need between clinician groups. Despite these differences, there was no difference in community resource desk referrals.

Visits for Possible COVID-19 in a Pediatric Primary Care Practice Early in the Pandemic.

BACKGROUND: Children with COVID-19 usually present with mild symptoms. We characterize visits with respect to symptoms and testing in the outpatient setting. METHODS: A retrospective chart review of sick visits in a pediatric academic primary care clinic April-August 2020. We included possible COVID-19 cases, or "persons under investigation" (PUIs), recording symptoms, positive contacts, and COVID-19 testing. Descriptive statistics and Chi-square or Fisher's exact tests for comparisons were used. RESULTS: 32% (476/1,474) of sick visits were PUIs; 20% were telehealth. Symptoms most commonly reported were fever, congestion/rhinorrhea and cough. 76% of PUIs were tested for COVID-19. Only presence of COVID-19 contacts and loss of taste/smell were significantly associated with positive tests (p<0.001). CONCLUSION: Nearly a third of sick visits in an academic pediatric practice were seen for possible COVID-19 symptoms and most were tested. The majority with and without COVID-19 had fever, congestion and/or cough. Our findings suggest low thresholds for testing in children.

Work-Life Balance and Career Experiences of Part-Time Versus Full-Time Faculty at the Warren Alpert Medical School of Brown University.

INTRODUCTION: Part-time faculty are an important part of the academic medical workforce, comprising 11-21% of faculty in some institutions. OBJECTIVE: To describe the part-time faculty experience at a single institution across four domains: work-life balance, work environment, leadership and advancement, and mentorship. METHODS: Faculty from the Division of Biology and Medicine at Brown University were invited to participate in an electronic survey. The authors compared responses between full-time and part-time faculty across the four domains.   Results: Survey response rate was 43% (437/1025). Of the 363 who answered the question about employment status, 333 (92%) were full-time and 30 (8%) were part-time. Part-time faculty were less likely to report forgoing personal activities for professional responsibilities, that work conflicted with personal life, that their division director took interest in their careers, and having a leadership position was important to them. CONCLUSION: Part-time and full-time faculty reported significant differences in perception of work impact on personal life, division director support, and desire for leadership positions.

Use of Pediatric Primary Care Telephone Advice by Families Whose Usual Language Spoken at Home Is Not English.

Language barriers and access to telephone advice have been shown to affect patient care. Less is known about access to telephone advice for families whose usual language is not English. The objective was to characterize the use of pediatric primary care telephone advice by families based on usual language spoken at home. A total of 277 surveys were completed by families presenting for sick visits at an academic pediatric primary care practice. No meaningful differences in the use of telephone advice when a child was sick were found by language category. Overall, 80.5% reported calling the clinic first when the clinic was open, but 77.6% went to the emergency department when the clinic closed. In conclusion, use of telephone advice was similar among families regardless of usual language. Most families reported going to the emergency department when the clinic was closed. More research is needed to identify barriers to the use of telephone advice, particularly after hours.

Use of Language Services for Telephone Advice by Limited English Proficiency Families in a Pediatric Primary Care Setting.

BACKGROUND: Families limited in English proficiency (LEP) often do not receive appropriate medical language services, resulting in health disparities. Little is known about the use and effectiveness of language services provided via telephone when families call for medical advice. OBJECTIVE: To characterize language service provision to LEP families calling for medical advice in a pediatric primary care setting. METHODS: A self-administered survey was given to parents of children presenting for sick visits at an urban academic pediatric primary care practice. RESULTS: 277 out of 300 surveys were completed, 92% in English and 8% in Spanish. 7% (19/271) of those who answered the language proficiency question reported LEP (spoke English "not well," or "not at all"). Among LEP parents, 68% calling for advice during clinic hours received appropriate language services (a trained interpreter or a bilingual provider). 53% received these services when calling after hours. CONCLUSIONS: Over half of LEP families seeking telephone advice from their pediatric primary care office received adequate language services. Future research should identify barriers to providing telephone language services to LEP families.

Mammographically Occult Breast Cancers.

A small percentage of breast cancers are not visible on mammography. Since mammographically occult malignancies may be more difficult to diagnose, we hypothesized that the lack of visualization would cause a delay in detection, more aggressive surgical and adjuvant therapy, and poorer outcome. Patients with mammographically occult malignancies were compared to patients with cancers visible on mammogram. The significance of mammographic visibility for treatment and local and distant recurrence rates were evaluated. Ninety-one of the 813 (11%) cancers were mammographically occult. Patients with mammographically occult malignancies were significantly younger, of lower body weight, and had fewer pregnancies than patients with cancers visible on mammography: age, body weight, and parity were statistically significant (p < 0.001) in stepwise logistic regression. Ductal carcinoma in situ was significantly more frequently diagnosed in patients with mammographically visible malignancies (14% versus 4%, p = 0.0163) and nodal involvement was significantly more frequent in patients with mammographically occult malignancies (35% versus 24%, p = 0.0391). Diagnostic delays exceeding 3 months were experienced by 24% of patients with mammographically occult malignancies compared to 13% of patients with tumor visible on mammography (p < 0.0001). Adjuvant chemotherapy was given to 63% of patients with occult malignancies compared to 41% of patients with mammographically visible cancers (p = 0.0027). The use of breast-conserving therapy and adjuvant radiation and tamoxifen were comparable. Survival free of local recurrence and distant metastases for the 403 patients followed for 5 years or more was not related to mammographic visibility.