Association of Racial Bias With Burnout Among Resident Physicians

Abstract

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.

Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth

“…Clinician burnout is characterized by depersonalization, emotional exhaustion, and a reduced sense of personal accomplishment [68]. Clinicians who experience burnout rely more heavily on implicit and explicit biases during periods of stress and increased cognitive workload, as their capacity to regulate biases may be reduced during these times [68,69].…”

Health care disparities, provider bias, and provider burnout

“…Specifically, higher levels of emotional exhaustion, depersonalization, or depression were associated with more negative attitudes toward black people (i.e., increased explicit bias). In contrast, only higher levels of depersonalization and overall burnout were associated with higher levels of implicit bias (Dyrbye et al, 2019).…”

“…Studies have shown that providers show fewer “patient‐centered behaviors” when interacting with black patients (Dyrbye et al, 2019). Cumulatively, this type of provider behavior results in a negative patient experience, less trust in the medical system, and less adherence to treatment recommendations, and decreases the likelihood of a patient following up (Dyrbye et al, 2019).…”

“…Of note, the group that showed the greatest degree of change was residents who had recovered from burnout. Specifically, residents who experienced improvements in feelings of depersonalization showed decreased explicit bias (Dyrbye et al, 2019). The authors hypothesized that this change “may be associated with positive experiences with black people (colleagues, coworkers, patients), graduate medical education efforts to reduce racial biases, changing signals of contextual anti‐bias norms, and other factors” (Dyrbye et al, 2019).…”

Capsule Commentary on Neto et al.: Effects of a Required Large-Group Mindfulness Meditation Course on First-Year Medical Students’ Mental Health and Quality of Life: a Randomized Controlled Trial

“…For instance, as demonstrated by Dyrbye, residents with increased symptoms of burnout demonstrated increased implicit and explicit racial bias, which could drive disparities in delivery of patient care. 2 Neto et al contribute to the growing literature exploring whether required interventions to prevent or treat stress can improve mental wellbeing among medical students. 3 [Mindfulness-based interventions come in a variety of forms (for instance, mindfulness-based cognitive therapy, mindfulnessbased stress reduction, and mindfulness meditation) and are evidence-based treatments for conditions such as depression, anxiety, and stress.]…”