My good friend and colleague, Dr. Sydney De Angelis, gave a great talk at the American Association of Women Emergency Physicians meeting at ACEP24. The talk was about the “sandwich generation” and how it affects physicians, particularly female physicians, which inspired me to write this article.

For those unfamiliar, the term “sandwich generation” encompasses people typically in their 30s to 50s, who will most likely be “sandwiched” between raising their kids and helping support aging parents.¹ Sometimes, particularly with physicians, this generation stretches even into our 60s and beyond, as many physicians delay starting their families until after residency or later. One study conducted by a team from the University of Michigan estimated that there are at least 2.5 million caregivers in the United States that fall into the sandwich generation, with nearly 25 percent of adults caring for at least one parent older than 65 while also looking after at least one child younger than 18.²

For many emergency physicians in this situation, the dual role of caregiver presents unique challenges that can affect their careers and family life as they deal with increased stress because of competing demands. Given the intense work and demanding hours of an emergency medicine career, physicians may have additional stressors that increase feeling overwhelmed, making it essential for health care organizations to recognize and identify these caregivers to provide needed support. In an age of growing discussions on wellness and how to avoid burnout, understanding the emotional and logistical burdens emergency physicians face in the sandwich generation is key to helping medical organizations implement better support systems that promote well-being and resilience, ultimately benefiting caregivers and patients.^1,3

As we all know, emergency medicine is a demanding specialty with many high pressure situations where physicians must quickly diagnose and treat patients with potentially life-threatening conditions. This fast-paced environment requires rapid actions and decision-making skills while still having the ability to remain calm under stress. Further compounding these challenges are our profession’s irregular hours and shift work.⁴ These demands create time pressures that can disturb family functioning, parental sense of connectedness, and emotional wellness in physicians navigating the complexities of their roles as partners and parents alongside work obligations.⁵

Juggling Act

These demands and challenges for emergency physicians in the sandwich generation are magnified as they juggle caregiving responsibilities for their children, aging parents, and a high-pressure career. As they wear both hats, these physicians experience considerable emotional, psychological, and even financial burdens associated with higher levels of stress and burnout in this group.³ Many physicians in this situation feel guilty and inadequate and question their ability to meet their families’ needs and demanding jobs.²