Sexist and Racial/Ethnic Microaggressions Contribute to Physician Burnout, Study Finds

The new study corroborates earlier research that found sexism and racial/ethnic bias are common in surgical settings.

Sexist and racial/ethnic microaggressions against female and racial/ethnic minority surgeons and anesthesiologists are common and linked to physician burnout, a new study finds.

Burnout is one of the most vexing challenges facing physicians and other healthcare workers nationwide. Research published in September 2018 indicates that nearly half of physicians nationwide were experiencing burnout symptoms. Female physicians tend to experience burnout more than their male counterparts—a Medscape report published in January found that 51% of female physicians were burned out and 36% of male physicians were burned out.

The new study, which was published by JAMA Surgery, is based on survey data collected from nearly 600 surgeons and anesthesiologists at Southern California Permanente Medical Group. The study includes several key data points.

• 94% of female survey respondents reported experiencing sexist microaggressions
   
• 81% of racial/ethnic survey respondents reported experiencing racial/ethnic microaggressions
   
• 47% of survey respondents reported physician burnout
   
• The odds of experiencing physician burnout were high for female physicians (odds ratio 1.60) and racial/ethnic minority physicians (odds ratio 2.08)
   
• The likelihood of burnout was high for female physicians who experienced sexist microaggressions (odds ratio 1.84 for racial/ethnic minority female physicians and odds ratio 1.99 for White female physicians)
   
• The likelihood of burnout was high for racial/ethnic minority female physicians who experienced racial microaggressions (odds ratio 1.86)
   
• The likelihood of burnout was high for racial-ethnic minority female physicians who experienced both sexist and racial/ethnic microaggressions (odds ratio 2.05)

"In this survey study, there was a high prevalence of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists. Racial/ethnic minority female physicians, specifically [Black, Hispanic, and Hawaiian/Pacific Islander] physicians, experience the highest prevalence and severity. Furthermore, sexist and racial/ethnic microaggressions were associated with physician burnout," the researchers wrote.

Interpreting the data

The lead author of the new study told HealthLeaders that sexist and racial/ethnic microaggressions are one of several factors that contribute to physician burnout.

"The cause of physician burnout is multifactorial and has been described as chronic work-related stress that leads to a constellation of emotional exhaustion, depersonalization, and low personal achievement. We know that microaggressions negatively impact one's morale and psychological well-being. The extra energy required to address these microaggressions, the responsibilities of being a physician, and our essential roles directly contribute to burnout," said Neha Sudol, MD, a member of the Department of Obstetrics and Gynecology at Southern California Permanente Medical Group and UC Irvine Medical Center.

Sexist and racial/ethnic microaggressions likely impact all three dimensions of physician burnout, she said. "We hypothesize that repetitive microaggressions in the workplace specifically contribute to emotional exhaustion and, perhaps, the other components of burnout to a lesser degree."

With sexist and racial/ethnic microaggressions, there is an intersection of sex, race/ethnicity, and physician burnout, Sudol said. "We found that female and all racial/ethnic-minority surgeons and anesthesiologists were more likely to experience burnout compared to White, male colleagues. We then identified an intersection between microaggression experience and physician burnout whereby female racial/ethnic-minority physicians who experienced microaggressions were more likely to experience burnout compared to their White, male colleagues."

Sexist and racial microaggressions contribute to pervasive workplace inequity faced by female and racial/ethnic surgeons and anesthesiologists, she said. "Workplace inequity, by definition, is rooted in bias and unfair circumstance. Microaggressions are acts of discrimination toward marginalized groups and, thus, directly contribute to inequity. Our findings, that female and racial/ethnic minority surgeons and anesthesiologists experience microaggressions at a high prevalence, corroborate previously published reports that surgical environments are wrought with sexism and racial/ethnic bias."

The are actions that can be taken at the individual and institutional levels to address sexist and racial/ethnic microaggressions, Sudol said. "At an individual level, value and respect should be placed on addressing microaggressions in a non-accusatory manner and holding each other accountable. From a larger institutional standpoint, the data highlights the importance of establishing codes of conduct and other initiatives that empower marginalized groups and encourage allyship."

Related: Resilience Is Not the Key to Addressing Physician Burnout, Researchers Find