PONE-D-21-10949

Dilemma of physician-mothers faced with an increased home burden and clinical duties in the hospital during the COVID-19 pandemic

PLOS ONE

Dear Dr. Nishida,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 14 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Yoshihiko Hirohashi, M. D., Ph. D.

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

1. For more information on PLOS ONE's expectations for statistical reporting, please see https://journals.plos.org/plosone/s/submission-guidelines.#loc-statistical-reporting. Please update your Methods and Results sections accordingly

3. Thank you for stating the following financial disclosure:

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

At this time, please address the following queries:

a)              Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b)              State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c)              If any authors received a salary from any of your funders, please state which authors and which funders.

d)              If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

Additional Editor Comments :

Dear Authors,

In the study from authors Sachiyo Nishida et al. entitled ‘Dilemma of physician-mothers faced with an increased home burden and clinical duties in the hospital during the COVID-19 pandemic.’, the authors analyzed the survey of physicians regarding to treatments of patients and domestic burden under COVID-19 pandemic. The authors found that domestic burden have been increased especially in female and having child physicians and they suffer dilemma between increased home burden and clinical duties under COVID-19. This study raises significant problem of Japanese social system and this must be discussed intensively now. Some major and minor points have been raised by the reviewers. Please consider answering the comments.

Yours sincerely,

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I have reviewed the Manuscript ID PONE-D-21-10949 entitled "Dilemma of physician-mothers faced with an increased home burden and clinical duties in the hospital during the COVID-19 pandemic". The following concerns are listed below:

1) General comments

The authors evaluated the burdens on physicians in Sapporo Medical University, which managed by Hokkaido's prefectural government in Japan during coronavirus disease 2019 (COVID-19) pandemic, and concluded physician-mothers are caught in a dilemma between an increased home burden and clinical duties in the hospital.

It seems an unique and interesting and informative study during the COVID-19 pandemic.

2) Specific comments for revision

A) Major

1. Please mention the gender distribution of all 622 medical and dental physicians and researchers working in Sapporo Medical University.

2. The general background in your institution is well written in Introduction. However, please mention what kind of physician take care for COVID-19, how to share the work, and the role of researcher in your institution.

3. Please mention regarding the social support system in Japan in Discussion.

4. You have to provide proof number of ethical approval in the institution even though the board chairman’s judgement in your institution.

B) Minor

5. None

Reviewer #2: This paper investigates the effects of the coronavirus pandemic on physicians' lives at university hospitals having responsibility as a central role in medical care in Hokkaido, Japan. The COVID-19 impact resulted in an increase in the burden of housework of female doctors compared with male doctors, and a female doctor burdened the care of children in a working couple. Although the number of questionnaires is limited, the impact on physicians' daily lives under emergencies in groups with matching work environments has become clear, and it can be said that it is an important paper in Japan that is promoting work style reforms.

abstract

The purpose, method, and result are briefly described. Among the results, there is a risk factor for the increase in housework as treating patients, but it is inferr from the text that it is the treatment of Covid-19 patients. It is easier to use treating Covid-19 patient in the abstract. The conclusion suggests a warning about the gender gap and delayed systems of child care in Japan.

introduction

Information on Hokkaido, which is medical area of university hospitals and sudden school or childcare service closures during a pandemic, and the status of the accepting of COVID-19 patients at the university hospitals studied are shown.

Materials & Methods

The research design is excellent.

Outcome

Increase of domestic burden associated with the pandemic according to gender

The percentage of physicians who say they have increased house burden is 30% (including slightly and markedly), proving the big impact of COVID-19 emergencies on physicians' lives.

Factors for increasing domestic burden

Female doctors, having children, and COVID-19 patients care is a factor in the increase in domestic burden. These results suggest female physicians are more effected than male physician, because female physicians are always do house burden and child care.

Physician-mothers’ dilemma: work in and outside of home

In Table. 4, was there an investigation into the changes in those responsible for caring for children before and after the pandemic?

The reasons for the increase in the domestic burden

Of the 83 people who said they had to spent times for more housework, how many doctors had children? I think the impact of daycare centers and school closures is significant, but is there a link between children's age and the burden of housework?

Discussion

Line 252:treating patient to treating COVID-19 patient

Reviewer #3: I've pointed out some words that should be changed so check it out.

Conclusion: ”This suggests that we have to redress this inequality as soon as possible to avoid such problems in the event of another such social crisis, which could occur at any time. ”

This does not fit the content, so I think it should be changed as follows.

Other than this, please refer to the attached file.

In order for female doctors to continue their careers and take responsible positions in the same way as male doctors, it is necessary to improve the delay in gender equality in Japanese society.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Review Comments to the Author.docx

Dilemma of physician-mothers faced with an increased home burden and clinical duties in the hospital during the COVID-19 pandemic

PONE-D-21-10949R1

Dear Dr. Nishida,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Yoshihiko Hirohashi, M. D., Ph. D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors addressed concerns.

Reviewers' comments: