RE: Lower LIkelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups

Lower Likelihood of Burnout Among Racial and Ethnic Minority Family Physicians
A Commentary
Jeannette E. South-Paul, MD, DHL (Hon), FAAFP
8 3 2021

Douglas and colleagues’ recently completed a cross-over observational survey of applicants from the 2017 American Board of Family Medicine recertification exam and those responding to the 2017 National Graduate survey. They noted a lower likelihood of burnout among family physicians from underrepresented racial-ethnic groups. They used structural equation models to test the effects of underrepresented status on measures of emotional exhaustion and depersonalization. Family physicians underrepresented in medicine were significantly less likely than their non-underrepresented counterparts to report emotional exhaustion and depersonalization, to practice in more racially and ethnically diverse counties and to practice obstetrics.
Studies such as this must focus on the data that are available and associated with the study participants. Nonetheless, professional factors influencing individual physician experiences necessarily layer upon personal characteristics and environment as well as historical experiences which are not available in databases. The epidemic of burnout among health care professionals has prompted ongoing analysis of these factors in the hope of interrupting the stressors that have devastated not only individual practitioners but their colleagues and the patients for whom they care.
Furthermore, the job stress and psychological strain of one individual impacts others in the same social environment. This ‘crossover phenomenon’ was described by Bolger and colleagues in 1989 and amplified by Bakker and colleagues almost 20 years later in relation to the impact of stress on the family partner. They called for further research of this crossover impact (e.g. depression, anxiety, exhaustion) among work partners. Bakker and Demerouti (2007b) later tested Westman and Vinokut’s (1998) hypothesis that empathy moderates the crossover of work engagement – the direct opposite of burnout.
Minorities are more likely to be attracted to and thrive in organizations that have substantial minority representation – a workforce situation that has been difficult to achieve at this time. As a result a number of programs such as those sponsored by the Association of American Medical Colleges have been instituted to bring minorities underrepresented in medicine and science together to nurture a sense of community and empathy while building skills to effectively compete in primarily majority institutions.
Meaning of life
More recent efforts by Hooker and colleagues to identify stressors as well as protective factors against burnout have resulted in the introduction of conceptual models spotlighting awareness of life meaning, or ‘meaning salience’, as anchors to improved stress and coping, and potentially reduced experience of burnout. They note this as another area under-researched with respect to burnout. A study of health care workers laboring during the SARS CoV2 pandemic noted the fear of exposure to the virus that was prevalent among nursing assistants and Black and Latinx workers, while housekeepers and Black and Latinx workers most often experienced enhanced meaning and purpose. In multilevel models, odds of burnout were 40% lower in those feeling valued by their organizations.
Moral resilience
In addition to recognizing the importance of finding meaning in life, health care professionals face a complexity of ethical challenges on a daily basis bringing attention to an awareness of the value of moral resilience in a challenging professional environment. Antonsdottir, Rushton and colleagues examined domains of moral resilience and their contribution to burnout over and above work and demographic variables. Moral resilience is described as the ability to preserve or restore integrity in response to moral adversity. The importance of assessing moral resilience is that it may be modifiable and provide an opportunity to intervene to achieve empowerment and growth.
One’s Journey
Above all, an area not measured in any of the current databases is an assessment of the journey faced by URM physicians as they pursue careers in medicine. Differential experiences of URMs on the journey into medicine have been documented for years but are only now getting more visibility. The well-known 1910 Flexner report (promoted as increasing the quality of medical education) resulted in the closure of all but two black medical schools – Meharry and Howard who educated the majority of black physicians at that time. There was limited access for underrepresented minority (URM) students to majority medical schools up until the last 40 years to include having fewer black males matriculating in medical schools in 2014 than occurred in 1978 and they experienced isolation and stereotypical behaviors.
Furthermore, little research has focused on the impact of faith-based institutions in anchoring success in the black community. Historically black colleges and universities were largely launched by the United Methodist Church and a few by other denominations. Campaigns for freedom, civil and voting rights, and safety and liveable communities were largely led by black and later LatinX clergy. Thus, most black, LatinX, and indigenous citizens were raised with a respect and comfort in a faith anchor for the journey of life. This spiritual lens has allowed many minorities to position the stressors of life – both personal and professional – as stages of a journey that may result in detours but will ultimately result in success. Until these critical factors undergirding the experiences of those racial and ethnic groups underrepresented in medicine are explored further and understood, appropriate steps for reducing burnout will be inadequate.

References
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