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Research ArticleORIGINAL RESEARCH

Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups

Montgomery Douglas, Emil Coman, Aimee R. Eden, Suleiman Abiola and Kevin Grumbach
The Annals of Family Medicine July 2021, 19 (4) 342-350; DOI: https://doi.org/10.1370/afm.2696
Montgomery Douglas
1Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
MD
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  • For correspondence: Montgomery.Douglas@downstate.edu
Emil Coman
2Health Disparities Institute, University of Connecticut School of Medicine, Farmington, Connecticut
PhD, PStat
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Aimee R. Eden
3American Board of Family Medicine, Lexington, Kentucky
PhD, MPH
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Suleiman Abiola
1Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
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Kevin Grumbach
4Department of Family and Community Medicine, University of California, San Francisco, California
MD
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  • Figure 1.
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    Figure 1.

    Potential mediating effect of county diversity index on the effect of underrepresented status on emotional exhaustion.

    DO = doctor of osteopathic medicine; MD = doctor of medicine.

    a Indicates P <.05.

    Notes: Values are odds ratios, with the exception of +0.089, which is a β coefficient. Single lines denote direct effects, double lines denote indirect effects, and interrupted lines indicate P >.05.

  • Figure 2.
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    Figure 2.

    Mediating effects of county diversity index and practicing obstetrics on the effect of underrepresented status on depersonalization.

    DO = doctor of osteopathic medicine; MD = doctor of medicine.

    a Indicates P <.05.

    Note: Values are odds ratios, with the exception of +0.089, which is a β coefficient. Single lines denote direct effects, and double lines denote indirect effects.

Tables

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    Table 1.

    Characteristics of Family Physicians, Comparing Those Underrepresented vs Not Underrepresented in Medicine

    CharacteristicAll Physicians (N = 3,096)Underrepresented in Medicine
    No (n = 2,646)Yes (n = 450)P Value
    Survey respondent group, No. (%).08
    Recertification1,510 (48.8)1,308 (86.6)202 (13.4)
    Graduate1,586 (51.2)1,338 (84.4)248 (15.6)
    Female, No. (%)1,598 (51.6)1,343 (50.8)255 (56.7).02
    Ethnicity: Hispanic, No. (%)231 (7.5)0 (0)231 (51.3)<.001
    Race, No. (%)
    Black204 (6.6)0 (0)204 (45.3)<.001
    American Indian/Alaskan Native30 (0.9)0 (0)30 (6.7)<.001
    Speaks Spanish, No. (%)324 (10.5)222 (8.4)102 (22.7)<.001
    Degree: MD (vs DO), No. (%)2,655 (85.8)2,234 (84.4)421 (93.6)<.001
    International medical graduate, No. (%)807 (26.1)641 (24.2)166 (36.9)<.001
    Age, mean (SD), y43.443.543.3.73
    (10.5)(10.6)(10.0)
    Practice size, No. (%)
    Solo264 (8.5)210 (7.9)54 (12.0).006
    2-5 clinicians2,063 (66.6)1,759 (66.5)304 (67.6)
    6-20 clinicians462 (14.9)411 (15.5)51 (11.3)
    ≥21 clinicians307 (9.9)266 (10.1)41 (9.1)
    Pediatric inpatient care, No. (%)492 (15.9)446 (16.9)46 (10.2)<.001
    Obstetric care, No. (%)390 (12.6)361 (13.6)29 (6.4)<.001
    Adult inpatient care, No. (%)896 (28.9)780 (29.5)116 (25.8).11
    County diversity index, mean (SD)0.460.440.53<.001
    (0.18)(0.18)(0.16)
    Emotional exhaustion, No. (%)
    Dichotomous: more than once a week1,289 (41.6)1,118 (42.3)171 (38.0).09
    Categorical.07
        Never177 (5.7)147 (5.6)30 (6.7)
        A few times a year421 (13.6)340 (12.9)81 (18.0)
        Once a month or less421 (13.6)364 (13.8)57 (12.7)
        A few times a month788 (25.5)677 (25.6)111 (24.7)
        Once a week399 (12.9)352 (13.3)47 (10.4)
        A few times per week654 (21.1)565 (21.4)89 (19.8)
        Every day236 (7.6)201 (7.6)35 (7.8)
    Depersonalization, No. (%)
    Dichotomous: more than once a week634 (20.5)559 (21.1)75 (16.7).03
    Categorical.001
        Never908 (29.3)738 (27.9)170 (37.8)
        A few times a year631 (20.4)542 (20.5)89 (19.8)
        Once a month or less484 (15.6)430 (16.3)54 (12.0)
        A few times a month439 (14.2)377 (14.3)62 (13.8)
        Once a week231 (7.5)207 (7.8)24 (5.3)
        A few times per week316 (10.2)278 (10.5)38 (8.4)
        Every day87 (2.8)74 (2.8)13 (2.9)
    • DO = doctor of osteopathic medicine; MD = doctor of medicine.

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    Table 2.

    Odds Ratios for Emotional Exhaustion and Depersonalization, From Ordinal Logistic Models

    Emotional ExhaustionDepersonalization
    Model and PredictorsOR (95% CI)P ValueOR (95% CI)P Value
    Unadjusted regression model
        Underrepresented in medicine (referent: not underrepresented)0.83 (0.69-0.99).040.70 (0.58-0.84)<.001
    Adjusted regression model
        Underrepresented in medicine (referent: not underrepresented)0.85 (0.71-1.02).080.74 (0.62-0.90).002
        Practices obstetrics1.28 (0.99-1.52).061.38 (1.11-1.71).004
        DI (per 10%)0.97 (0.93-1.00).0580.93 (0.90-0.97).000
        Age (per 10 years)0.89 (0.84-0.95)<.0010.65 (0.61-0.70).000
        Female (referent: male)1.43 (1.26-1.63)<.0011.10 (0.96-1.25).17
        MD (referent: DO)1.06 (0.89-1.27).510.96 (0.80-1.15).64
        Practices pediatric care1.09 (0.88-1.34).431.13 (0.92-1.40).25
        Practices adult hospital care0.79 (0.68-0.93).0040.83 (0.71-0.98).03
    Path model testing for mediation
        Indirect effects mediated by under-represented physicians being less likely to practice obstetrics……0.77 (0.62-0.95).02
        Indirect effects mediated by under-represented physicians practicing in counties with higher DI0.97 (0.94-1.00).060.94 (0.91-0.97)<.001
        Total effect of underrepresented status (direct + indirect effects)0.82 (0.69-0.99).030.54 (0.41-0.71)<.001
    • DI = diversity index; DO = doctor of osteopathic medicine; MD = doctor of medicine; OR = odds ratio.

Additional Files

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  • The Article in Brief

    Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups

    Montgomery Douglas, and colleagues

    Background More than 40% of physicians in the United States reported at least one symptom of burnout, which is particularly high among family physicians. This study examined a nationally-representative sample of family physicians to determine whether physician race-ethnicity was associated with burnout among a nationally-representative sample of family physicians. Of the 3,096 physicians studied, 450 (15%) were from racial-ethnic groups underrepresented in medicine (UIM), which include Blacks/African Americans, Hispanics/Latinos, American Indians and Pacific Islanders who together comprise 30-35% of the general population yet account for only 12.4% of family physicians.

    What This Study Found Study findings support the researchers’ hypothesis that UIMs were significantly less likely than their non-UIM counterparts to report emotional exhaustion and depersonalization. This may be attributed to practicing in more racially-diverse counties and being less likely to practice obstetrics, both of which partially mediated the protective effect of UIM status on depersonalization. The mediating effect of working in more racially and ethnically diverse counties is consistent with evidence of the beneficial effect of cultural diversity on health outcomes for minorities and better overall self-rated health among adults.

    Implications     

    • Understanding the attributes of UIMs that may prevent burnout could also provide insights for developing a more resilient physician workforce.


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The Annals of Family Medicine: 19 (4)
The Annals of Family Medicine: 19 (4)
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1 Jul 2021
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Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups
Montgomery Douglas, Emil Coman, Aimee R. Eden, Suleiman Abiola, Kevin Grumbach
The Annals of Family Medicine Jul 2021, 19 (4) 342-350; DOI: 10.1370/afm.2696

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Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups
Montgomery Douglas, Emil Coman, Aimee R. Eden, Suleiman Abiola, Kevin Grumbach
The Annals of Family Medicine Jul 2021, 19 (4) 342-350; DOI: 10.1370/afm.2696
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    • Professional practice
  • Other topics:
    • Racism
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