White Docs on the Short End of One Racial Disparity

Survey data showed non-Hispanic white physicians were more likely than others to suffer from burnout, while non-Hispanic Black physicians are more likely to be satisfied with work-life balance than physicians of other ethnicities.

Their study is “the first to examine the association between physician race/ethnicity and occupational burnout in physicians using a large, national sample,” the authors wrote in JAMA Network Open.

Researchers at Stanford University School of Medicine in California led by medical student Luis Garcia, MS, conducted a cross-sectional secondary analysis of survey data from 4,424 physicans who reported Hispanic/Latinx or non-Hispanic white, Black, or Asian ethnicity.

Burnout rates, as established via scores on the Maslach Burnout Inventory (≥27 for emotional exhaustion or ≥10 for depersonalization), were as follows:

• White: 44.7%
• Black: 38.5%
• Hispanic/Latinx: 37.4%

• Asian: 41.7%

Translated to odds ratios with white physicians as the reference, chances of experiencing burnout among the other groups were:

• Black: OR 0.49 (95% CI 0.30-0.79; P=0.004)
• Hispanic/Latinx: OR 0.63 (95% CI 0.47-0.86; P=0.004)
• Asian: OR 0.77 (95% CI 0.61-0.96; P=0.02)

“In supplemental analyses, this difference appeared to be associated with lower odds of experiencing emotional exhaustion among physicians in minority racial/ethnic groups,” the authors wrote.

Black physicians were also more likely to express work-life balance satisfaction than white physicans (OR 1.69; 95% CI 1.05-2.73; P=0.03). This was established with survey answers of “agree” or “strongly agree” with a statement saying “My work schedule leaves me enough time for my personal/family life.”

Rates of career satisfaction and depression symptoms, however, showed no significant differences by race/ethnicity.

Skepticism and questions

In an accompanying commentary, Joel C. Cantor, ScD, and Dawne M. Mouzon, PhD, both of Rutgers University, were skeptical of the results, suggesting that the Stanford group perhaps didn’t dig deep enough.

“Prior work has shown that primary care physicians experience more burnout than specialists and that physicians of minority racial/ethnic groups are more likely to practice primary care,” they wrote. “Therefore, it could be that controlling for specialty in the multivariate model masks the extent of burnout experienced by physicians from underrepresented groups compared with their white counterparts.”

Cantor told MedPage Today that the results surprised him.

“Their finding might not hold up to greater scrutiny,” said Cantor, a health services researcher who has studied minority physicians in the workforce. While the dataset was national and representative, he added, he suggested examining the associations of specialty/primary care with well-being by ethnicity.

For their part, the Stanford researchers had hypothesized that minority physicians would be more at risk of burnout than white physicians.

“Given previous studies demonstrating that physicians in minority racial/ethnic groups experience social exclusion, bias, and increased professional burden serving as diversity ambassadors, the results of this study may be considered counterintuitive,” they wrote.

“Possible explanations for these results could include stigma associated with decreased disclosure of burnout symptoms, poor retention of medical students in minority racial/ethnic groups and residents who experience burnout (ie, survival bias), differences in personal resilience by race/ethnicity, or a selection process that favors resilience among minority racial/ethnic groups during medical training.”

Although Cantor and Mouzon didn’t explicitly mention systemic racism, they alluded to it in acknowledging racial differences in expectations from a medical career. “Those from more privileged backgrounds may lament that medicine is ‘not your father’s profession’ more than the slowly growing diverse new generation of physicians,” they wrote.

Minority physicians may have different intrinsic motivations, Cantor said, adding that he would like to see this hypothesis tested. “The business of medicine makes it that much harder to achieve [a comfortable life] these days. There’s just so much economic pressure on physicians now.”

In addition to excluding some ethnicities, the researchers noted study limitations including: the proportion of minority physicians in their population was lower than national rates, and they could not count response rate by race/ethnicity.

They called for a similar study of ethnicities excluded from this study — American Indian, Alaskan Native, Native Hawaiian, Pacific Islander, and multiracial — and for long-term studies of burnout and resilience at medical school matriculation, and throughout training and practice.

“It is critical that future studies use large data sets with modeling approaches like nesting, stratification, or interaction terms to disentangle” critical associations, the editorialists wrote, adding, “How pressures from new ownership relationships may drive levels and disparities in physician burnout is an area ripe for future research.”

Other study details

Most respondents completed the survey via email, while some were mailed surveys. Out of the 30,456 physicians who received a survey, 5,197 issued responses.

The population’s mean age was 52.5, while 61.5% were male and 78.7% were white.

Nearly one-quarter practiced primary care (23.6%). The most popular specialty was an internal medicine subspecialty (12.2%) — followed by psychiatry (8.1), family medicine (7.7), general internal medicine (7.7), and general surgery subspecialty (7.5).

They worked an average 51.2 hours per week. Nearly half (49.4%) worked in a private practice setting, while 27.7% worked in an academic medical center.

The majority (82.2%) were married, while another 4.2% reported being partnered.