The past few years have been a time of intense stress for many health care workers, and the effects are beginning to show: 40% of nurses and nearly 25% of physicians surveyed have said they expect to leave their practice within the next two years (“I Quit,” Summer 2022). Although the causes of burnout are complex, childcare is a frequent worry. Could better options help turn the tide for some? 

The question predates the COVID-19 crisis. In one pre-pandemic study, medical center employees who were parents of young children reported that finding and retaining childcare was their biggest source of stress. Another survey found that more than 60% of residents and fellows with children had difficulty arranging childcare. 

Rachel Apple, an internist and pediatrician at Vanderbilt University Medical Center in Nashville and lead author of the first study, says she wasn’t surprised. “In my own experience, I can’t go to work if my children are not safely cared for,” Apple says. “So this is something I think about on a daily basis.” 

The situation got worse during the pandemic, with one study finding that stress about childcare affected more than 20% of all health care workers, including some who didn’t have children. Worries about childcare were associated with an increased risk of anxiety or depression, burnout and intent to resign. 

Elizabeth Harry, an internal medicine specialist, senior medical director of well-being at UCHealth in California and lead author of that study, says that typical childcare arrangements may not be adequate for many in health care. “Our profession cares for people around the clock,” she says. “We may need childcare at atypical hours.”

Having childcare at work may be one potential solution. Apple’s pre-pandemic study found that having children in institution-affiliated childcare reduced employees’ childcare-related stress and overall stress levels. And a growing number of hospitals and universities are taking heed. Wellstar Kennestone Hospital in Georgia built a 17-classroom childcare center that also provides care for mildly sick children. Mass General Brigham, which already offered childcare, expanded those services during the pandemic. Many other medical centers, including Stanford University and Vanderbilt University, offer childcare on-site.

“Many more hospitals now want to do on-premises childcare,” says Priya Krishnan, chief client and experience officer at the childcare company Bright Horizons. “Conversations about establishing care have increased multifold for us in the past year and a half.” 

Yet having a place for children at work is still far from the norm at medical centers. According to an Association of American Medical Colleges report, fewer than half of responding institutions provided childcare options prior to the pandemic, and of these, only about 60% had expanded childcare options since the start of the pandemic.

Even when on-site childcare exists, many employees aren’t able to use it. About 20% of health center-affiliated childcare locations had waitlists of more than a year, and some are even longer. At the University of Washington, the wait for infant spots can be as long as three years, for example.

Cost is also a major factor. Infant care at academic health care centers is commonly between $200 and $400 per week, while nurses and residents, on average, make about $1,500 and $1,200 per week, respectively.

Despite such barriers, however, offering convenient and affordable childcare not only helps reduce stress for those who have access, but also helps hospitals and other medical facilities attract and retain diverse groups of workers. Providing that core benefit may be a strong draw for women and people of color. Multiple studies have shown that female physicians have more childcare responsibilities than male physicians, and childcare stress is more prevalent in health care workers who are racial minorities.

“If we say we want a diverse workforce, but can’t relieve childcare stress for groups that disproportionately experience it, then the system is perpetuating inequities,” says Harry. “We need to look at the policies that drive some of these inequities. In this sense, childcare couldn’t be more important.”