Burnout Affects Bias Through Changes in Internal Motivation in a Sample of Healthcare Providers

Abstract

Burnout is a prevalent issue among healthcare providers and is known to affect patient care (e.g., through increased mistakes). Burnout is also known to affect bias against minoritized patients, which could contribute to disparities in diagnoses and quality of care. Here we hypothesize that burnout is linked to greater bias through reduced internal motivations to respond without prejudice (IMS). Physicians, advanced practice providers, and residents (N = 185) were recruited from multiple emergency medicine and internal medicine departments in the US. Participants completed an online survey. We found that burnout was a significant negative predictor of IMS (b=-0.46, t=-2.50, p<0.05). Burnout was also associated with multiple measures of bias against a fictional Central African group. We also found a significant mediation effect, whereby burnout was linked with greater bias through reduced IMS values (e.g., greater bias against patients who don’t speak English, b=-3.32, 95% CI [-5.95, -0.78]). These findings support our hypothesis that burnout affects internal motivational states with downstream effects on unconscious biases against outgroup members, although further work is needed to link these outcomes with compromised care. Additionally, these findings highlight the need for system-level efforts to reduce and otherwise mitigate burnout in healthcare providers.