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Burnout tied to racial bias in resident physicians

Symptoms of burnout were tied to racial bias among resident physicians, which could potentially lead to disparities in care, according to a study published in JAMA Network Open.

“Physicians’ negative emotional states have been shown to be associated with greater explicit racial bias in medical decision-making,” Liselotte Dyrbye, MD, MHPE, of the division of community internal medicine in the department of medicine at the Mayo Clinic, and colleagues wrote. “Negative emotions, like those characterized by burnout and depression, also can impede cognitive performance making implicit biases more likely to play a role in behaviors and decision-making.”

“Burnout, as a negative emotional state, could activate bias, reduce cognitive capacity leading to inappropriate application of heuristics, or have negative consequences in mindful decision making in other ways,” they continued.

To assess burnout and racial bias among resident physicians, researchers conducted a cohort study using medical student and resident physician responses to the Cognitive Habits and Growth Evaluation Study. Participants completed questionnaires during their fourth year of medical school, and at the second and third year of residency.

Burnout was evaluated through two single-item measures from the Maslach Burnout Inventory. In questionnaires completed during the second and third year of residency, a “feeling thermometer” was used to measure explicit bias by establishing individual feelings towards black and white people on a 100-point scale. A higher score on the feeling thermometer was tied to warmer or more favorable feelings. Implicit bias was measured during the second year of residency questionnaire through a racial Implicit Association Test, which had scores ranging from –2 to 2, with a positive score indicating stronger prowhite bias.

Only nonblack physicians were included in analyses due to the lack of evidence of racial bias towards black patients among black physicians.

A total of 3,392 nonblack resident physicians were included in the study, 2,362 (69.9%) of whom were white. Among 3,380 respondents, 1,529 (45.2%) had symptoms of burnout, 1,203 (35.6%) had high emotional exhaustion, and 1,179 (34.9%) had high depersonalization.

Both implicit and explicit bias tests indicated that participating resident physicians had preferences for white people over black people. The mean feeling thermometer scores among respondents were 77.9 towards black people and 81.1 towards white people, and the mean racial Implicit Association Test score was 0.4.

Burnout reported during the second year of residency questionnaire was associated with the highest rates of both explicit and implicit bias.

After adjusting for feeling temperature scores towards white people, depression, specialty and demographics, resident physicians with burnout had greater scores for both explicit bias (difference in score = –2.4; 95% CI, –3.42 to –1.37) and implicit bias (difference in score = 0.05; 95% CI, 0.02-0.08).

“If the association between burnout and bias toward black people is present among physicians in practice or after residency, it may be a factor in the explicit use of race in medical decision-making,” Dyrbye and colleagues wrote. “As the prevalence of burnout symptoms among practicing physicians exceeds 40%, the implications for the quality of care provided to black people, as well as to other disadvantaged groups, could be substantial.” – by Erin Michael

Disclosures: Dyrbye reported royalties for the Well-Being Index licensed by the Mayo Clinic to CWS Inc. Please see study for all other authors’ relevant financial disclosures.