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We read the rapid response from Dr Ravat titled “Sex Discrepancies in Work Life Balance” (3 January 2022), and thank them for their interest in this work. We shall address the points raised in turn.
Firstly, this rapid response states that “the authors conclude by suggesting a follow-up study to examine the impact of the COVID-19 pandemic on doctors’ reported work-life balance and home-life satisfaction.” This was merely a point made in the discussion. The main conclusion was that it is imperative that steps are taken to promote the wellbeing of doctors, as our study identifies a lack of work-life balance and identifies important barriers to this.
Secondly, this rapid response discusses the possibility of selection bias in surveys of this nature – this was already acknowledged in the limitations of the paper. The lead authors of this study worked extremely hard to conduct and publish this work in adverse circumstances, including the COVID-19 pandemic, and successfully achieved 417 responses representing a wide variety of demographics (i.e. sex, age, professional grade, region of the UK, relationship status). Other such studies may only involve 20 respondents, and still provide useful data. Through studying the responses of 417 doctors across the UK, the authors have identified important barriers to work-life balance and home-life satisfaction that should be addressed to improve recruitment and retention of the medical workforce.
Thirdly, this rapid response appears to have confused statistical significance with qualitative significance. We have not once claimed statistical significance in this qualitative study.
Fourthly, this rapid response suggests pre-determining content to search within the free-text responses/thematic analysis. This goes against the methodology we adopted for the thematic analysis and could introduce bias. Instead, the themes arose from the data, as stated in the methods, “Familiarisation of the data was achieved by reading and rereading the responses before open coding was performed. The codes were then combined or contrasted to identify relevant themes. This was an inductive and cyclical process, with extra care taken not to overlay professional judgements onto those of the respondents.” This analysis revealed seven key themes, each with examples provided: unsocial working, rota issues, training issues, less-than-full-time working, location, leave and childcare.
Fifthly, this rapid response has implied that the authors were not mindful of framing bias when composing the survey questions. Many of the survey questions were neutral. In fact, the Likert-scale question of major importance was positively framed: “To what extent do you agree with the following statement? My training programme/job plan is associated with a satisfactory work-life balance.” We accept that perhaps sections of negatively and positively framed statements/questions could have been alternated to help offset framing bias. However, we do not think this has led to any false conclusions in this study.
To the best of our knowledge, this represents the first study assessing how the stresses of working life affect the personal lives and relationships of British doctors. Our study identified important barriers to work-life balance. Whilst we acknowledge the limitations of this study, we believe our conclusions are sound. We hope that this work serves as useful evidence to affect positive change, for the benefit of doctors, our families and loved ones, and our patients.
1. Parida S, Aamir A, Alom J, Rufai TA, Rufai SR. British doctors' work-life balance and home-life satisfaction: a cross-sectional study. Postgrad Med J. 2021 Dec 17:postgradmedj-2021-141338.
2. Morse JM. Qualitative Significance. Qual Health Res. 2004 Feb;14(2):151-2.
3. Chapman AL, Hadfield M, Chapman CJ. Qualitative research in healthcare: an introduction to grounded theory using thematic analysis. J R Coll Physicians Edinb 2015;45:201–5.
The pandemic is known to have exacerbated the pre-existing sex inequalities amid healthcare workers. Prominent findings included the marked decline in female authored publications during the pandemic (1-3), concerns regarding the static pay gap (4) and higher levels of burnout for female frontline staff (5). Equal sex representation is difficult to achieve when the disproportionate strain on female trainees, often due to childcare burden, is regarded with relative apathy.
Parida et al. explored the barriers to work-life balance and home-life satisfaction through a cross-sectional study of 417 survey responses from UK doctors (6). The majority of respondents were found to hold negative views regarding work-life balance and home-life satisfaction. Female doctors, in particular, were more likely to switch specialty, enter less-than-full-time training, and delay buying a home, or having children. The authors conclude by suggesting a follow-up study to examine the impact of the COVID-19 pandemic on doctors’ reported work-life balance and home-life satisfaction. This would certainly be of great interest. However, it is important to consider the biases that manifest in survey-based study designs.
Surveys were distributed amongst a Facebook group, 'The Consulting Room', comprised of 7031 members. The authors acknowledged the likely inflating effects of selection bias, 'the inherent nature of a survey predisposes to respondents be...
Surveys were distributed amongst a Facebook group, 'The Consulting Room', comprised of 7031 members. The authors acknowledged the likely inflating effects of selection bias, 'the inherent nature of a survey predisposes to respondents being a self-selecting group'. Respondents already concerned with work-life balance and home-life satisfaction may have been more likely to complete the survey.
The presumption of mutual independence is also erroneous. Facebook suggests groups based on friends and family. It is likely that members of the ‘The Consulting Room’ shared social circles, and some may have even shared households. This shared outlook may have further selected for particular responses.
Most importantly, authors ought to be mindful of framing bias when composing survey questions. Leading statements can heavily influence respondent views e.g. ‘My working pattern has caused difficulties in my personal relationships’. This can be challenging to avoid when using Likert scales to agree/disagree with given statements, but can be offset by interspersing contrasting, ‘positively framed’ statements/questions.
In spite of these biases, the free-text questions were a useful means of establishing particular barriers faced by doctors, and potential solutions. It would be interesting to ascertain whether the themes drawn from the responses varied depending on age and sex.
Finally, medical literature should avoid colloquial use of the term ‘significance’. Parida et al. wrote that a ‘significant proportion of respondents reported delaying major life event’ and that ‘there was no significant difference in leaving training positions or satisfactory work–life balance between the two sexes’. In the absence of statistical analyses, such conclusions may be vulnerable to misinterpretation.
1. Squazzoni F, Bravo G, Grimaldo F, García-Costa D, Farjam M, Mehmani B. Gender gap in journal submissions and peer review during the first wave of the COVID-19 pandemic. A study on 2329 Elsevier journals. PLOS ONE. 2021;16(10):e0257919.
2. Muric G, Lerman K, Ferrara E. Gender Disparity in the Authorship of Biomedical Research Publications During the COVID-19 Pandemic: Retrospective Observational Study. Journal of Medical Internet Research. 2021;23(4):e25379.
3. Viglione G. Are women publishing less during the pandemic? Here’s what the data say. Nature. 2020;581(7809):365-6.
4. Woodhams C, Dacre J, Parnerkar I, Sharma M. Pay gaps in medicine and the impact of COVID-19 on doctors' careers. The Lancet. 2021;397(10269):79-80.
5. Rimmer A. Covid-19: Female doctors felt compelled to step up during the pandemic, says BMA. BMJ. 2021;372:n658.
6. Parida S, Aamir A, Alom J, Rufai TA, Rufai SR. British doctors’ work–life balance and home-life satisfaction: a cross-sectional study. Postgraduate Medical Journal. 2021:postgradmedj-2021-141338.