Female health care workers were more likely to leave or intend to leave the profession compared to male health care workers during the COVID-19 pandemic, according to a report published recently in the journal PLOS ONE.

The study analyzed survey data from the Healthcare Worker Exposure Response and Outcomes (HERO) registry, a national registry with more than 55,000 participants that captured the experiences of health care workers starting in 2020 and at periodic times during the pandemic. Participants were recruited largely from academic medical centers and self-enrolled online.

Although some studies have examined the relationship between the COVID-19 pandemic and health care worker attrition, few have addressed the impact of gender or assessed intention to leave by role.

“We sought to address this knowledge gap related to the longitudinal effects of the pandemic on the health care workforce,” said Rachel Apple, MD, MPH, assistant professor of Medicine at Vanderbilt University Medical Center and lead author of the study. The study team included Russell Rothman, MD, MPP, and Christianne Roumie, MD, MPH, at VUMC and collaborators from Duke University School of Medicine, University of Cincinnati College of Medicine and the University of Minnesota.

After baseline enrollment in the HERO registry, two “hot topic” surveys in May and December 2021 ascertained intent to leave health care, defined as having already left, actively making plans, or considering leaving health care.

The researchers analyzed 4,165 responses to either the May or December surveys and found that females were 36% more likely to report intent to leave compared with males and that nurses had 74% higher odds of intent to leave compared to most other health professionals.

Among those who expressed intent to leave, about three-quarters reported job-related burnout as a contributor. One-third reported moral injury, defined as “a state of psychological distress as a result of acting or witnessing behaviors that go against your values and/or moral beliefs.” Burnout and moral injury rates were similar for males and females.

“The health care workforce experienced a worker exodus at the onset and throughout the pandemic,” Apple said. “Our study advances what is known about the impact of gender among a geographically diverse population and across multiple roles within the health care field.

“Health care workers are continuing to leave, and it’s important to understand and address the contributing factors.”

Apple also noted that the 2021 surveys may not have adequately captured the multiple stressors that may contribute to intention to leave.

“Important variables such as ages of children in the household were not available and may be in the causal pathway between female gender and intention to leave health care,” she said.

“As a result of the COVID-19 pandemic, the health care system remains under stress,” said Roumie, professor of Medicine and senior author of the study. “The downstream impacts of the exodus of health care workers from both academic medical centers and other parts of the workforce are still being realized and remain areas in need of ongoing research.”

The HERO registry is funded through a Patient-Centered Outcomes Research Institute award. It is coordinated by the Duke Clinical Research Institute and leverages PCORnet, the Patient-Centered Clinical Research Network.