We found high rates of both caregiving and caregiving-related strain among late-career faculty members in medical schools. In this report, we found that nearly one-fifth (19%) of the full-time faculty members age 55 or older reported providing care for someone on an on-going basis. This rate is somewhat higher than the overall national average of 16%  and the 12% rate found in a previous national epidemiologic survey that used a similar caregiving status question . Interestingly, we also found that a sizeable proportion of men in our study (17.3%) reporting caregiving roles compared to 22.4% of women faculty members. Caregiving is often characterized as a role predominantly taken by women , but this gender difference may be diminishing. Indeed, Wolff et al.  found in longitudinal national samples, that more men are taking on family caregiving roles in more recent surveys, especially for non-dementia caregiving. This trend should inform our traditional caregiving services and programs as we evaluate their acceptance among male caregivers, as well as medical school faculty members.
We also found that 90% percent of the caregivers reported experiencing some or a lot of mental or emotional strain providing care. This rate of caregiving strain is also higher than the reported rate in a previous national epidemiologic survey  − 33% of 5,159 caregivers in the Roth et al. (2009) study reported no caregiving-related strain compared to 10% reporting no strain in our sample.
Caregiving and caregiving strain in particular, are known to have negative effects on caregiver physical, mental, and social health [14–19]. For example, in the Roth et al. (2009) study of 43,099 community-dwelling adults (average age 65.5, SD = 9.8), those who reported high caregiving strain had poorer quality of life than less-strained caregivers and non-caregivers . Similarly, we also found that caregiving faculty members were less likely to report: excellent health; adequate social and emotional support; and very good quality of life than their non-caregiving counterparts. In secondary analyses (not reported here), we found that the faculty caregivers who reported a lot of strain were nearly twice as likely to report depression as caregivers who reported only some strain and that more caregiver strain was also inversely associated with happiness, social and emotional support, good quality of life.
We also observed that caregivers in our study were statistically more likely to report finding comfort in their religion or spirituality every day compared to their non-caregiving peers. There was a similar trend for reporting every day comfort in religion or spirituality among the no strain group, although not statistically significant. There is literature showing association between daily spiritual experiences and better self-rated health and social networks  and a known association between religiosity/spirituality and life satisfaction . Further exploration of this topic may generate innovative faculty development interventions around caregiving, social support, and coping.
There are several limitations to this study. First, our findings are from a convenience sample of faculty from only 14 of the 145 LCME-accredited U.S. medical schools and may not be generalizable to faculty at any individual medical school. Second, these cross-sectional data were collected during a snapshot in time in 2017, and the response rate was only 41%. Third, our well-being items were self-report, single-item questions and our caregiving and caregiving strain items were similarly brief. Furthermore, we did not examine the nature or intensity of the faculty members’ caregiving experiences, which is very important. For example, in their recent analysis of national trends in family caregiving between 1999 and 2015, Wolff et al. (2017) found that the primary caregivers were overwhelmingly spouses and adult children . They observed that caregiving arrangements lasted four years or longer on average and that primary caregivers provided approximately 30 hours of care per week. Although untested, we may hypothesize that faculty members’ caregiving efforts are equally significant. Similarly, we did not examine the association of the caregiving experience with the work experience, other than correlating caregiving with thinking about retirement. For example, in their systematic review of the international research on unpaid caregivers and labor market choices, Lilly, Laporte, and Coyte (2007) found that ‘heavily-involved/intensive’ caregivers were more likely to withdraw from the labor market than their counterparts . Although the data vary, in general, most studies have shown a moderate reduction in the number of hours worked per week among caregivers and an inverse association between caregiving intensity and hours worked per week.
Our findings illuminate the necessity for more in-depth investigation of older faculty members’ needs, particularly as these needs impact work performance or as the needs either hasten or impede career transition decisions, including retirement. For example, are older, caregiving faculty members with increasing caregiving strain less likely to: submit grant applications; conduct research; spend time in clinic; spend time mentoring junior faculty members? Are older, caregiving faculty members with increasing strain more likely to: retire; have worse mental or physical health; abuse substances; behave badly toward colleagues, trainees, or patients; make more clinical errors? These questions and more require further research.
The caregiving responsibilities and associated caregiving-related strain experienced by a sizeable proportion of our faculty population present ample opportunity for collaboration between human resource offices, wellness programs, and faculty development offices to address current and future employee caregiving-work conflicts and responsibilities. Many of our institutions already offer a variety of resources and there are myriad programs in the community; for example: respite care; sitter/companion programs; home health/visiting nurses; meal preparation; shopping services; chore/task services; financial planning; caregiver-focused web-based interventions ; and online/virtual support groups (e.g., Facebook, Instagram, Twitter). However, there is little evidence documenting the utilization and impact of these programs on faculty outcome measures, such as well-being and burnout or institutional outcomes, such as recruitment, retention, faculty satisfaction, promotion, or retirement. Efforts to develop new programs, tailor existing programs, and then market them specifically to late-career faculty who are caregivers may help to normalize the aging experience, minimize perceived stigma, and increase the likelihood of utilization and positive outcomes.