July 30, 2021, 2:45 p.m. News Staff ― Well, here’s something you don’t see every day.
Regarding the effects of factors such as systemic racism on the well-being of physicians who are members of racial/ethnic minority groups, new research findings in the Annals of Family Medicine seem downright counterintuitive.
Case in point: Although it stands to reason that such factors could adversely affect the well-being of these clinicians, in a study that examined the intersection of physician race/ethnicity and measures of burnout, family physicians from racial and ethnic groups underrepresented in medicine were less likely than their non-underrepresented peers to report emotional exhaustion and depersonalization.
The researchers suggested that this result may stem from the fact that certain characteristics more commonly seen among underrepresented physicians than their non-underrepresented counterparts may mitigate the likelihood of experiencing burnout. Specifically, underrepresented physicians were more likely to practice in racially and ethnically diverse communities, and they were less likely to practice obstetrics.
The cross-sectional study used data from the 2017 ABFM Family Medicine Continuing Certification Examination Registration questionnaire and the 2017 National Family Medicine Graduate Survey. For each survey, respondents answered a core set of questions that included items on self-designated race and ethnicity. In keeping with the definition established by the Association of American Medical Colleges, respondents were categorized as underrepresented in medicine if they self-reported any of the following races and/or ethnicities: Black/African American, American Indian/Alaskan, Native Hawaiian/Pacific Islander, and Hispanic/Latino. Data on demographic factors and practice characteristics also was collected.
All NGS respondents and a subset of respondents to the continuing certification exam questionnaire weighed in on single-item measures of emotional exhaustion and depersonalization that are considered valid predictors of Maslach Burnout Inventory scores on these domains. Although each measure is considered a distinct dimension of burnout, with distinct triggers and effects, either can be used to assess burnout.
Response options for these items were “never,” “a few times a year or less,” “once a month or less,” “a few times a month,” “once a week,” “a few times per week,” and “every day.” Physicians who responded “once a week” or more frequently were classified as having a high level of burnout.
The researchers used practice address to geocode each physician to a county and link them to a county-level database on population diversity capable of distinguishing whether a given county has a predominant race-ethnicity group among its residents or, rather, has a relatively even distribution of race-ethnicity groups.
Burnout measures data was acquired from 1,510 ABFM recertification applicants and 1,586 NGS respondents. Of this total, 450 family physicians were identified as underrepresented in medicine.
Compared with their non-underrepresented peers, underrepresented physicians were significantly more likely to be women, speak Spanish, and have an M.D. rather than a D.O. degree. In addition, a relatively smaller proportion of the underrepresented physicians group provided obstetrical care.
As for comparative community diversity, residents of counties in which underrepresented physicians practiced were more likely to have a predominant race-ethnicity group than to have evenly distributed race-ethnicity groups.
After evaluating outcomes across multiple models, including those adjusted for various mediators and covariates, the researchers found that overall, family physicians underrepresented in medicine were less likely than their non-underrepresented counterparts to report suffering from emotional exhaustion and depersonalization, and that the total protective effects of underrepresented status on the two measures was statistically significant in all models tested.
The independent direct effect of being an underrepresented physician on emotional exhaustion did not reach statistical significance in the adjusted models, but the total effect of underrepresented status on emotional exhaustion was significant after accounting for mediation by county diversity.
“Individuals from underrepresented backgrounds may face unique challenges in their life experiences and professional careers because of the adverse effects of interpersonal and structural racism and other forms of social inequity,” wrote the authors, noting that minority medical students are more likely than their non-underrepresented peers to report that racial discrimination and prejudice, feelings of isolation, and different cultural experiences adversely affected their medical school experience.
“Although it might be expected that stress related to these same social factors would result in underrepresented physicians being more likely than non-underrepresented peers to experience burnout, we found that, to the contrary, underrepresented physicians had comparatively lower frequencies of emotional exhaustion and depersonalization,” they added.
The report’s authors suggested that underrepresented individuals who have succeeded in securing their medical degree may have a particularly high level of resilience related to a sense of social mission or related personal characteristics that protects against burnout.
“We also found that underrepresented family physicians were one-half as likely as their non-underrepresented counterparts to practice obstetrics,” the authors noted. In contrast to one study that found a protective effect of obstetrical practice on burnout among recent family medicine residency graduates, the current study sample, which included more-experienced family physicians among those who practiced obstetrics, reported more frequent depersonalization.
This difference, said the researchers, “suggest that scope of practice may have a different meaning for physician satisfaction with work and sense of personal accomplishment, depending on the developmental stage of a family physician’s career.”
Finally, the authors contended that their findings have a number of potential policy implications. Perhaps most notable among them: “Understanding the attributes of underrepresented physicians that may protect against burnout, such as a greater social mission orientation and empathy born from experiences of discrimination, may provide insights for developing a physician workforce more resilient to the many forces predisposing to burnout.”