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

Deep-seated gender norm expectations add another layer of complexity. Across cultures, women in medicine often feel pressure to “do it all,” balancing physician and caregiver roles.⁵ This is only exacerbated by the disparities in gender representation and the responsibilities of domestic care, with two out of every three caregivers being female; this added pressure makes life even more difficult for female emergency physicians, and it leads to higher attrition rates among women in the workplace.⁶ This raises the importance of health care organizations focusing on multi-layered support systems that recognize these distinctive pressures to create a healthier work-life balance for all sandwich-generation emergency physicians.⁷

Solutions

Emergency physicians in the sandwich generation can use different coping strategies and solutions to help navigate the complexities of balancing work and home life. Time management and prioritizing are critical skills that help these physicians create a more manageable schedule. It is also essential to set clear boundaries between work and home life for quality time with their children and aging parents without feeling overwhelmed.^8,9 Finally, creating a solid social support system is critical, as your family, friends, and peers can offer emotional and practical support. Professional resources, including mentorship, counseling, and even executive coaching, can also guide stress and wellness management.^8,10

On a broader scale, health care organizations can support emergency physicians in excelling at work and feeling satisfied with their lives outside of work by creating a culture that understands the sandwich generation.⁸ In August 2024, U.S. Surgeon General Dr. Vivek Murthy released an advisory highlighting parents’ and caregivers’ mental health and well-being. In the report, he noted that this group is “struggling” and called for workplace policy improvements and employer programs that support caregivers.¹¹

One suggestion is to have employers offer “paid parental, medical, and sick leave, flexible and equitable work schedules, and access to childcare (either in the community or onsite)” for their employees. Additionally, Dr. Murthy recommended that employers implement training programs for managers focusing on stress management and work-life balance. This training should help managers recognize indications of stress and mental health challenges among caregivers and provide strategies for promoting work-life integration.¹¹

Other ways to create a supportive organizational culture would be offering comprehensive and affordable mental health resources such as therapy and support groups, providing financial planning assistance, and training emergency department chairs and directors to understand the unique needs of these physicians.^8,11

Ultimately, the issues important to emergency physicians in the sandwich generation are complex and require a multifaceted approach to support and promote well-being. As these professionals balance their medical careers with caregiving roles for children and aging parents, hospitals and health care organizations must recognize and address their unique needs.

Emergency physicians can thrive in their personal and professional lives with appropriate coping strategies, robust support systems within the workforce, and organizational advocacy for work-life balance. In the end, caring for these caregivers will have a ripple effect: improving their quality of life, eventually reflecting on better care at the bedside. Therefore, we must continue raising awareness about the sandwich generation’s challenges and work collectively towards solutions that empower emergency physicians to achieve a healthier balance in their demanding lives.

Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. She is the chair of the USACS diversity, equity, and inclusion committee, the social issues and equity in medicine committee co-chair, and leads physician leadership development for USACS.

References

1. Mental Health America. Caregiving and the sandwich generation. Mental Health America. Accessed January 16, 2025.
2. University of Michigan. Sandwich generation study shows challenges of caring for both kids and aging parents. Published December 9, 2022. Accessed January 16, 2025.
3. Kennedy M, Abbate L, Davenport K, et al. Doctoring in the sandwich generation. Society for Academic Emergency Medicine. Accessed January 16, 2025.
4. Milne K, Fischer L. Sandwich generation: an interview with Ken Milne and nutritional advice. Emottawablog. Published January 30, 2019. Accessed January 16, 2025.
5. Henry TA. Higher physician burnout risk for moms in the sandwich generation. AMA. Published June 3, 2019. Accessed January 16, 2025.
6. O’Connor A. The Impact of Caregiving on the Sandwich Generation- and Employers. Updated October 17, 2023. Accessed January 16, 2025.
7. Maynerd J. The Sandwich Generation Needs Workplace Support. Here’s How Leaders Can Help. Spring Health. Published November 6, 2024. Accessed January 16, 2025.
8. Collins J. Navigating the challenges of the sandwich generation for healthcare professionals. Yourebbflow. Published July 19, 2024. Accessed January 16, 2025.
9. Watt W. How ‘Sandwich Generation’ Healthcare Providers Can Balance Caring for Kids and Parents. GoodRx. Published December 20, 2021. Accessed January 16, 2025.
10. Brown-Worsham S. Tips for managing sandwich generation stress. Care.com. Published December 11, 2024. Accessed January 16, 2025.
11. Murthy V. Parents Under Pressure: The U.S. Surgeon General’s Advisory on the Mental Health and Well-being of Parents. U.S. Public Health Service. 2024.
12. American Psychological Association. The sandwich generation. 2008. Accessed Dec 2024. APA.
13. DeRigne L, Ferrante S. The Sandwich Generation: A Review of the Literature. Florida Public Health Review. 2012. Vol. 9, Article 12. (biotechnology)