A recent survey of physicians in the United States finds high levels of occupational burnout — with white physicians more likely to report burnout than those from marginalized ethnic or racial groups.

Feeling emotionally exhausted and unable to cope are common signs of burnout, a response to a prolonged period of stress.

The issue is often occupational; the World Health Organization (WHO) define burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”

Burnout is particularly common among physicians, who regularly face long hours and high-pressure situations. In the U.S., levels of burnout are consistently higher in this group than in the general population of employed people.

Yet there is limited understanding of how burnout varies among physicians, particularly among people who are marginalized due to race or ethnicity, and who therefore face the additional challenges of exclusion and discrimination.

In light of this, a recent study explored how various aspects of a physician’s experience, including burnout, varied according to race and ethnicity.

The survey investigated levels of burnout, depression, career satisfaction, and work-life balance among more than 4,000 physicians in the U.S. The respondents were white, Asian, “Hispanic/Latinx”, or Black.

The odds of reported burnout were significantly lower among Asian, Hispanic/Latinx, and Black physicians, compared with white counterparts. Black physicians were also more likely to report satisfaction with their work-life balance than white physicians.

The authors of the study suggest that stigma surrounding these marginalized communities may be preventing these physicians from disclosing symptoms of burnout. They also point to a selection process that promotes resilience among physicians from these racial and ethnic groups.

The study paper now appears in the journal JAMA Network Open.

The survey

The findings are based on a survey of 4,424 physicians in the U.S. who were listed in the American Medical Association’s Physician Masterfile. The team conducted the survey in 2017–2018.

The team assessed race and ethnicity using the methodology of the U.S. Census Bureau. The majority of respondents were white (78.7%), followed by Asian (12.3%), Hispanic/Latinx (6.3%), and Black (2.8%).

To measure burnout, the researchers used a survey called the Maslach Burnout Inventory (MBI), which can be specialized for medical personnel.

The survey assesses feelings of emotional exhaustion, personal accomplishment, and depersonalization — the latter of which might involve viewing patients impersonally, as if they were objects.

Less burnout among marginalized groups

Almost half — 43.7% — of the physicians who responded to the survey reported occupational burnout.

Burnout was highest among the white respondents, 44.7% of whom reported it, according to the MBI assessment. Meanwhile, 41.7% of Asian respondents reported burnout, followed by 38.5% of Black respondents and 37.4% of Hispanic/Latinx respondents.

Even after controlling for factors that may influence burnout, such as age, clinical specialty, and hours worked per week, white physicians were still more likely to report it than physicians of other races and ethnicities.

Black physicians were 51% less likely to report symptoms of burnout, while Hispanic/Latinx and Asian physicians were 37% and 23% less likely to do so, respectively.

Compared with the white physicians, the others were less likely to report symptoms of emotional exhaustion. However, there were no significant differences in measures of depersonalization among the groups.

The survey also showed that Black physicians were almost 70% more likely to report being satisfied with their work-life balance than white physicians. The researchers assessed this by asking the respondents to rate the statement “My work schedule leaves me enough time for my personal/family life.”

Concerning overall career satisfaction and depression, the team found no significant differences among the groups.

Why the differences?

The authors suggest some reasons why physicians from marginalized racial and ethnic groups were less likely to report symptoms of burnout.

They pointed to a greater stigma associated with burnout among these groups making it less likely for the physicians to disclose their experiences.

They also noted that medical schools may not retain as many marginalized students who experience burnout, generating survivor’s bias. Similarly, there may be a selection process that favors resilience among candidates from marginalized groups.

The authors acknowledge that corroborating their hypotheses and better understanding their findings will require further research.

They also highlight the importance of reducing burnout, which jeopardizes the health and well-being of physicians and affects the quality of care that patients receive.

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