IMPORTANCE Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency. OBJECTIVE To explore factors associated with symptoms of burnout and career choice regret during residency. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016. EXPOSURES Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school. MAIN OUTCOMES AND MEASURES Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again). RESULTS Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, ophthalmology, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.23 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.19 [95% CI, 1.09 to 1.29]; risk difference [RD], 7.6% [95% CI, 3.8% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.10]; RD, 1.7% per 1-point increase [95% CI, 1.5% to 1.9%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 1.00]; RD, −0.5% per 1-point increase [95% CI, −0.5% to −0.2%]). Reported symptoms of burnout (RR, 3.46 [95% CI, 2.83 to 4.23]; RD, 15.2% [95% CI, 12.8% to 17.5%]) and clinical specialty (range of RRs, 1.60 to 2.96) were both significantly associated with career choice regret. CONCLUSIONS AND RELEVANCE Among US resident physicians, symptoms of burnout and career choice regret were prev...

Key Points Question Are symptoms of burnout associated with resident physicians’ implicit and explicit biases toward black people? Findings In this cohort study of 3392 second-year resident physicians who self-identified as nonblack, symptoms of burnout were associated with greater explicit and implicit racial biases. Recovery from burnout in the third year of residency was associated with the greatest reduction in explicit bias toward black people. Meaning Given the high prevalence of burnout among resident physicians and the negative association between bias and suboptimal medical care, symptoms of burnout may be factors in disparities in care; the implications for the quality of care provided to black people and other disadvantaged groups could be substantial.

This article presents a systematic review of qualitative studies focusing on the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) among Black men who have sex with men (BMSM) in the United States. We reviewed studies that were published between 1980-2014. Qualitative methods employed in the studies reviewed include: in-depth interviews, focus groups, participant observation, and ethnography. We searched the following databases: PubMed, PsychINFO, JSTOR, ERIC, Sociological Abstracts, and Google Scholar for relevant articles using the following broad terms: “Black men” and/or “BMSM,” and “qualitative” and/or “ethnography.” Seventy studies were included in this review. The key themes observed across studies were: (1) heterogeneity, (2) layered stigma and intersectionality, (3) risk behaviors, (4) mental health, (5) resilience, and (6) community engagement. The review suggests that sexual behavior and HIV-status disclosure, sexual risk-taking, substance use, and psychological well-being were contextually situated. Interventions occurring at multiple levels and within multiple contexts are needed to reduce stigma within the Black community. Similarly, structural interventions targeting religious groups, schools, and health care systems are needed to improve the health outcomes among BMSM. Community engagement and using community-based participatory research methods may facilitate the development and implementation of culturally appropriate HIV/AIDS interventions targeting BMSM.

Although scholars have long studied circumstances that shape prejudice, inquiry into factors associated with long-term prejudice reduction has been more limited. Using a 6-year longitudinal study of non-Black physicians in training ( N = 3,134), we examined the effect of three medical-school factors—interracial contact, medical-school environment, and diversity training—on explicit and implicit racial bias measured during medical residency. When accounting for all three factors, previous contact, and baseline bias, we found that quality of contact continued to predict lower explicit and implicit bias, although the effects were very small. Racial climate, modeling of bias, and hours of diversity training in medical school were not consistently related to less explicit or implicit bias during residency. These results highlight the benefits of interracial contact during an impactful experience such as medical school. Ultimately, professional institutions can play a role in reducing anti-Black bias by encouraging more frequent, and especially more favorable, interracial contact.

Congress passed the Health Professions Educational Assistance Act of 1976 to address the crisis in primary care supply in rural and inner-city locations of the United States. This legislation created primary care Health Professional Service Areas (HPSAs), which help states and communities increase their primary care supply through eligibility for loan repayment, technical assistance, increased reimbursement through Medicare, Federally Qualified Health Center (FQHC), and Rural Health Clinic designation. This study examines the degree to which persistence of primary care HPSA designation in rural counties is associated with lower population socioeconomic status and deficiencies in access to health care services.