Caregiving, Organizational Culture, and Burnout Among Primary Care Clinicians and Staff During the COVID-19 Pandemic

Context: Two out of five adults in the United States care for a child, elder, or adult with a disability. The COVID-19 pandemic amplified inequities around caregiving responsibilities.

Objective: 1. To understand how caregiving responsibilities affect work experience in the context of the pandemic and to what degree a supportive culture may mitigate burnout or stress. 2. To examine how emotional exhaustion and job stress changed between 2020-2021 for people with varying levels of caregiving responsibilities.

Study Design and Analysis: Longitudinal work experience survey, matching data from February 2020 and May 2021. Developed linear regression models, stratified by clinicians versus staff, clustering by site and controlling for years in the system.

Setting or Dataset: One county-based and one university-based health system in a large urban area.

Population Studied: Primary care clinicians and staff

Intervention/Instrument: Single item measures of hours per week “spent on caregiving responsibilities for dependent children, elders, or persons with disability” (0, 1-5, 6-10, 11-20, 20+ hours) and perceived organizational support: “In the past year, I have felt supported by my workplace in balancing work and responsibilities outside of work” (1 Completely disagree to 10=Completely agree).

Outcome Measures: Single item validated measures of emotional exhaustion and job stress

Results: The survey response rate was 73%, including 167 primary care clinicians and 154 staff. Two- thirds of respondents reported caregiving, with 29% reporting more than 20 hours per week of caregiving. In regression analyses, greater caregiving hours were associated with more emotional exhaustion for clinicians but not for staff, while feeling supported by the workplace was associated with lower emotional exhaustion for both groups. A supportive work culture (but not hours of caregiving) was associated with lower job stress for both clinicians or staff. Between February 2020 - May 2021, clinicians with more caregiving hours experienced increases in emotional exhaustion; however, for staff, increases in emotional exhaustion were not associated not with caregiving hours but with organizational support.

Conclusions: During a time when the COVID pandemic amplified caregiver demands at home for many health care workers, organizational support for caregivers appears to have mitigated some of the job stress and emotional exhaustion associated with caregiver responsibilities.