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  • Writer's pictureDaniel Puskin

Mothers Might Need TelePT

Updated: Dec 14, 2020

Mothers might need telePT both as providers and as patients.

Recessions generally hit men’s labor market prospects hardest. However, this is no ordinary recession - this is a pandemic driven recession. Why might a pandemic driven recession be different? First, many of the industries that are affected most by a virus like this have a high share of female employment. Second, women have been disproportionately impacted by increased childcare responsibilities as daycare centers closed and schooling moved online.

In what some are calling a “she-cession” or a “fem-cession,” the impacts on women are significant. According to the National Women’s Law Center, roughly 80 percent of those who left the workforce in September were women (approximately 865,000 versus 216,000).

A Census report from the summer, found “of those not working, women ages 25-44 are almost three times as likely as men to not be working due to childcare demands”.

What does this mean for women as providers of physical therapy and consumers of physical therapy? With this pandemic driven recession, women face barriers to providing and receiving care. TelePT may be able to help. In this article, I discuss the gendered recession, the impact on the physical therapy industry, and the potential of telePT.

Women’s careers suffering: Leaving the workforce and scaling back professional ambition

This pandemic driven recession appears to disproportionately hurt women. Patricia Cohen’s New York Times article notes that industries where women are concentrated most were hit hardest economically. “[The] parts of the economy that were smacked hardest and earliest by job losses were ones where women dominate” - e.g. restaurants, retail businesses, health care, and the public sector. This recession is different from classic recessions that “usually start by gutting the manufacturing and construction industries, where men hold most of the jobs” quotes University of Michigan professor of economics and public policy Betsey Stevenson.

Asymmetries in household division of labor furthers these issues. Cohen notes that closings of child care centers and the move to virtual schooling has “saddled working mothers, much more than fathers, with overwhelming household responsibilities”. As economist Julie Nelson says in the same article, “the big ticket to inequality in the home is that the men can usually assume that because the mom loves the kids she will not let the ball drop….And it doesn’t quite go so well in the other direction. The men are still able to plead incompetence, if nothing else.”

Women with children had labor force participation rates in September were 3 percentage points lower for women than in January (that drop was under 2 percentage points for their male counterparts). A recent Census Department study found thirty-two percent of working women not working cited childcare demands as the reason (compared to just 12 percent for men). These gender gaps might have narrowed somewhat in October, but “there were still 4.5 million fewer women employed in October than there were a year ago, compared with 4.1 million men.”

2020 Change in Labor Force Participation of Women and Men 18–55 Who Have Children in the Household

Leaving the labor force is a major issue, but even a slowing down of careers furthers the gender gap. A Mckinsey study found that 1 in 4 women are considering leaving the workforce or downshifting their career (by scaling back hours). The National Bureau of Economic Research working paper argues that the gendered impacts of the recession would persist and would be expected to increase the gender wage gap by 5 percentage points.

Physical Therapists are feeling these strains too. Could telehealth help?

Women physical therapists are sadly not immune to these issues. A recent Washington Post article, “Working Moms are not Okay” cites a couple examples of physical therapy professionals having to give up their work for family needs. One pediatric physical therapist, Katie Loeb “absolutely cannot work now. Not with her two older kids doing school from home and her toddler needing constant attention. Loeb ends most days with a headache, which sometimes becomes a full-on migraine.” Caroline Owens, a Seattle area PT assistant, featured in that same Post article was furloughed at the beginning of the pandemic, but was later offered her dream position, `“I couldn’t take it,” she said. Both she and her husband have made sacrifices this year, but Owens’s role as caregiver seemed inevitable. “It’s not that men don’t have stresses,” she says, “but I have no choices.”

Some women have been finding a small silver lining on this COVID cloud - more flexibility in therapy delivery and the potential to pursue more entrepreneurial paths while working more from home. For those Physical Therapy professionals featured in the Washington Post article, perhaps utilizing telehealth would be viable. It would allow for flexible hours (including squeezing in appointments when one’s children have a gap in the school day or even after they go to bed). The flexibility of hours and ability to do appointments from home provide ways of staying tapped into the field and ramp up intensity more easily. Women who are struggling to stay as part of the workforce due to pandemic pressures might better be able to work with their existing practice and sustain appointments more easily with telePT. We should note that while telePT does make it easier to work from home and perhaps find more flexible hours to work, it does not ultimately solve the issue of having the time to do so if childcare is unfairly foisted on women. It also does not address the root issue of gendered norms of childcare which needs to be addressed. For those providing the care more independently, there is potential to have more autonomy and target new types of clients and experiment with new treatments. With spikes in COVID rates, the ability to work from home for the safety of physical therapists and their patients would be particularly appealing.

Female patients’ health suffering: Pushing off appointments

While women’s careers are taking a backseat because of the virus, so is their health maintenance. A Kaiser Family Foundation study in June found that 49% of women postponed a medical or dental visit because of the virus compared to just 33% for men. Is this just heightened concern for the virus, more visits to medical professionals by women, nature of their jobs requiring avoidance of such interactions, or is it also about the strains at home making such commitments more difficult? It would make sense that some of this stems from the inability to free up time with any certainty.

Telehealth makes a lot of sense for women because of these uncertainties at home. Before the pandemic, roughly 63% of telehealth users were female. A JAMA Network featured article suggests similar results. It appears that this continued into the beginning of the pandemic. Preventative appointments and maintenance appointments are the first to decline. Mammograms in April were down roughly 75 percent from the 2019 levels and were 20 percent in August from levels 12 month earlier (see chart below). An Avalere and Community Oncology Alliance study found that breast cancer screenings dropped even more than prostate cancer screenings. This phenomenon is clearly not all being driven by working mothers with younger children (given that the overwhelming share of mammograms are for women over 50).

Usage of various health services pre and during the pandemic

Martin, Katie, Daniel Kurowski, Phillip Given, Kevin Kennedy, Elianna Clayton. “The Impact of COVID-19 on the Use of Preventive Health Care” Health Care Cost Institute. November 9, 2020.

PT at home?

Obviously, screenings such as mammograms and colonoscopies cannot be done at home. However, physical therapy evaluations and treatment sessions can be performed at home very effectively. As highlighted by a Hospital for Special Surgery study conducted this year that included postoperative and non-operative patients, evidence suggests physical therapy patients are quite satisfied.

In September (before the recent spike in cases), PT visits had returned to roughly 90 percent of their pre-pandemic levels. However, there would be a considerable backlog of skipped physical therapy appointments since visits dropped by more than half during certain times of the pandemic. There is a lot of PT to catch up with. For those struggling to squeeze in the time, tele physical therapy for evaluation and treatment might be a really good option. For those that feel uncomfortable being in a doctor’s office, especially given that 32 percent of U.S. documented cases occurred in November, telePT might be a good option for patients and PTs to stay safe.

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