Dear Dr Soham Bandyopadhyay, Dear reviewers,

Thank you very much for the opportunity to submit a revised version of our manuscript entitled “Work-life balance in physicians working in two emergency departments of a university hospital: Results of a qualitative focus group study”.

Foremost, we would like to express our sincerest gratitude for the thoughtful reviewer comments and helpful recommendations. We carefully revised the manuscript with respect to all the points raised by the reviewer. Please find below a point-by-point statement of the changes we made to the manuscript. Our responses are inserted in italics. Changes to the previous version are highlighted in red font in the marked-up copy of the manuscript.

Regarding your remark about data availability, we would like to point out that our focus group transcripts contain person-related sensitive information. Due to the low number of participants, a possible identification cannot be fully ruled out, also after pseudonymization of data. Moreover, since one study objective was to reflect critically on current working conditions, the prospect of publishing the interview recordings would have significantly limited willingness to participate. Further, the participants did not agree with sharing fully transcribed texts in their informed consent and our ethic approval does not allow the release of all transcripts. However, data excerpts can be shared upon reasonable request by contacting anna.schneider@charite.de and medsoz@charite.de as described in our revised data availability statement.

We sincerely hope that we have adequately addressed all of the issues raised and that the revised manuscript now meets your as well as the reviewer’s approval. We are looking forward to your feedback.

With best regards,

Samipa Pudasaini, Liane Schenk, Martin Möckel, Anna Schneider

Journal Requirements:

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Authors: We have applied all style requirements based on the PLOS ONE template and hope to now meet the journal’s demands on this matter.

2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

Authors: Thank you for this note. As described in our response letter, legal as well as ethical restrictions both apply to our study and prohibit the publishing of full transcripts. First, the participants did not agree to that in their informed consent. Also, the ethical approval only allows us to share parts of the transcribed material since a full anonymization of the participants cannot be guaranteed due to the small group size. Based on this, we would be grateful if you could update our data availability statement to the following:

“Data cannot be shared publicly because of legal and ethical restrictions. Our focus groups contained person-related sensitive information and the anonymization of participants in full transcripts cannot be fully guaranteed due to a small group size. On this account, our ethic approval does not allow the release of full transcripts. Further, the participants themselves did not agree in their informed consent with data sharing of full transcribed texts. However, data excerpts can be accessed upon reasonable request by contacting anna.schneider@charite.de and medsoz@charite.de.”

In your revised cover letter, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings as either Supporting Information files or to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories.

Authors: We thank you for this remark. In point two, we have explained in detail the legal and ethical restrictions that prohibit the publishment of full transcripts. Certainly, researchers can send data sharing requests to anna.schneider@charite.de and medsoz@charite.de if interested.

We will update your Data Availability statement on your behalf to reflect the information you provide.

Authors: We thank you very much for this offer. We would be grateful if you could update our data availability statement as described in point two.

Reviewer’s comments:

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: Partly

Authors: We have carefully revised the detailed comments of the reviewer and hope that the conclusions we have drawn are now more traceable and coherent.

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

Reviewer #1: N/A

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: No

Authors: The data used includes potentially sensitive information and person-related data and based on the participants’ informed consent and the ethical approval, does not allow full publishment. In our revised data availability statement (see point two), we have now described this matter in detail and hope for your understanding.

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

Authors: We thank you very much for this positive evaluation.

5. Review Comments to the Author

Reviewer #1:

5.1. This study comprehensively highlights the various facets of work life balance among ED physicians. A few suggestions to improve this paper are given.

Authors: We thank you for the positive response and the given suggestions for improvement. Based on these remarks, we have revised our manuscript and hope to now fully meet the criteria for publication.

5.2. In the methodology, it is not necessary to mention as first author etc. Simply mentioning that a medical student, a Post grad trainee is enough.

Authors: We agree with the reviewer and have corrected the respective sections in the methodology by removing this information (see lines 91-94).

5.3. In line 175, it is not necessary to mention which author did the process. Instead mention that transcribed speeches were divided according to similar content and so on.

Authors: As suggested, we have changed this sentence by removing the information about who transcribed the material (see lines 172-178).

5.4. It would be good if a paragraph containing the demography of each focus group was mentioned along with whether discussion was initiated with scenario 1 or 2.

Authors: We fully understand the relevance of including this information. Therefore, in the method section, we have now inserted an additional paragraph with a general description of which stimulus was used for groups with specialized or senior doctors versus assistant doctors (see lines 152-154). More precise quantitative information on the professional position, gender and child status of each individual focus group can unfortunately not be provided since statements listed in Supplementary tables 1-3 are marked with the focus group number (FG 1-4) they were obtained from. Based on that and due to the low number of participants, a retracing of statements to specific doctors could not be ruled out when listing the detailed demography of all focus groups separately. We hope for your understanding in this matter.

5.5. The results are very descriptive and lengthy but reflect valuable points. It would be good if some measure (proportion or percentage) could be included to salient points highlighting how many of the focus groups mentioned a particular factor. This would demarcate more important widely mentioned points from points which were mentioned by one or two people.

Authors: We thank you for this remark. Our work focuses on depicting valuable statements and experiences shared by the participating doctors by choosing a qualitative approach. Unfortunately, neither the nature of the sample construction nor the sample size allow for quantifying statements. We share the curiosity about the statistical relevance of the statements, but this must be reserved for future research. Methodologically, we assume to reconstruct typical orientations that are not represented by only one individual. Further, weighing the statement in a quantitative manner does not follow the standardized protocol of explorative qualitative research, as e.g. described by Tenny et al. (1). In our discussion, additionally to our past statement regarding the quantification of results (see lines 556-559), we have now embedded an additional sentence highlighting the major importance of analyzing this topic in a quantitative manner in future research (see lines 545-547).

5.6. Perhaps sentences could be shortened with more paragraph breaks to facilitate better understanding (making discussion and results a bit more concise).

Authors: As marked in the revised manuscript, we have shortened sentences throughout the results and discussion section. With that, we hope to have significantly improved the readability of our work.

References cited in the response to reviewers

1. Tenny S, Brannan GD, Brannan JM, Sharts-Hopko NC. Qualitative Study. StatPearls. Treasure Island (FL)2022.