Mid-March. New York City. I can recall the moment when the otherwise ordinary sound of a patient coughing in an exam room unexpectedly became emblematic of my own risk of mortality and the emerging risk I might pose to my kids.

As the COVID-19 pandemic unfolds day by day at an exponential rate, we as doctors have been called to duty in unprecedented ways.  Speak with any physician in the last few weeks, and you will be hard-pressed to find one who didn’t feel an intrinsic obligation- indeed, wish- to rise to the occasion with an all-hands-on-deck attitude, despite the taxing and indefinite toll this will take.  Speak with any physician mother, and you will quickly see that our intense drive to lead on the frontlines is matched with an equally intense anxiety about protecting and preserving the wellbeing of our families. Indeed, for most of us, the conflict between being a physician and mother has never felt greater.

The recent pressures of parenthood and professional work are not exclusive to physician mothers, and the hardship of this virus will take its toll on each physician, indeed each person, in different forms. While physician-fathers are facing their own emotional challenges in terms of career demands and family responsibilities during this pandemic, existing evidence suggests that physician-mothers will absorb a unique burden. For example, a recent study examining the self-reported domestic workload of 1,700 physician-mothers in the United States, found that overall, respondents had sole responsibility for the majority of domestic tasks including; childcare planning, cooking, shopping, and laundry. Another study compared the domestic responsibilities of young physician-researchers and found that females with children spent, on average, nine hours more per week on domestic tasks than their male peers with children, even after adjustment for total hours worked and spousal employment status.

It should come as no surprise then that this inequitable division of domestic labor impacts physician mothers in different ways from physician fathers, complicating career trajectories.  For example, a study examining full-time employment of early-career physician-parents found that within six years of completing training, 30% of female physicians with children had reduced their work hours compared with 5% of the male physicians with children.  Similarly, the physician-mother survey study mentioned earlier revealed that for the subset of respondents in procedural specialties, the greater their domestic work burden, the more likely they were to report a desire to change careers altogether.

And herein lies the conflict; in recent weeks, physician mothers have been forced to rapidly reconcile our dual responsibilities within a system that has historically lacked adequate support for either.  Our instinct of working doubly hard to master both is no longer an option given how acute this crisis is and how indefinite its duration will be. With an unpredictable and limited health care workforce, our hospitals have made it clear that they need us now more than ever.  And yet when, in our lifetimes, have the stakes for our families been higher?

So imagine for a minute, that you are a physician-mother at the dawn of the COVID-19 pandemic.  Since statistically, you are likely carrying the domestic mental load of your family, even with a supportive and well-intentioned partner, this will be your problem to solve.

My own self-talk went something like this: I feel an immediate duty to serve in the trenches of this crisis, so who will watch my children now that they are home?  If I serve on the frontlines, how can I possibly protect my children? Should I isolate from them now?  What if my partner gets sick?  Should we continue to use external childcare support?  How do I structure their day now so as to optimize their education and wellbeing during this uncertain time? How much screen time is too much for them? Where can I buy Clorox wipes? Can my children have playdates?  Can I have a grandparent watch them? What if my children become sick?

As communities shutter and hospitals seek much needed extra staff support, physician mothers are rapidly facing unique, albeit not unfamiliar, challenges.  Indeed, most physician-mothers are accustomed to teetering between these roles, trying to convince others (and ourselves) that we have this under control.  But without warning, we have been exposed.  The façade has crumbled. Perhaps, as commentator and professor Anne Marie Slaughter notably wrote: “Women can’t have it all.” And maybe, that’s OK.  But maybe, we can use this moment to move toward a more equitable system that values our professional, as well as our personal, caregiving work.

I have received numerous emails from my institution in recent weeks about the availability of wellness resources such as short-term counseling, spiritual care, and “emotional first aid.” While such services are welcome, optimal wellness necessitates having the system-wide support to manage our lives outside of the hospital, thus allowing us to be better doctors and, in turn, benefitting the institution.

Indeed, the urgency of this situation has unmasked a necessary truth; to optimally support physicians, health care institutions must seek to understand our needs beyond the hospital and clinic environments.  I was impressed that within the first week of the pandemic, my institution swiftly facilitated back-up childcare options for employees, instituted free hospital parking, provided volunteer grocery-runs, and developed telehealth infrastructure to help our patients and physicians stay safe.  Will these initiatives be temporary in the setting of our current crisis? Or will they serve as a new foundation from which innovative solutions to longstanding challenges can blossom?

We must hold our leaders accountable in recognizing, valuing, and actualizing continued support to physician mothers long after this crisis has abated.  Lip service will no longer do. Such provisions should include enacting optimal paid parental leave policies, providing subsidized on-site and back-up childcare options, ensuring adequate lactation accommodations, creating innovative pathways to promotion, and offering flexible and predictable hours.

Systems don’t change because they want to; they change because they have to.

Tamara Goldberg is an internal medicine physician.

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