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ROCHESTER, Minn. ― Mayo Clinic researchers have found an association between increased symptoms of burnout and heightened racial bias in medical residents. The study appears in JAMA Network Open.
"When physicians aren't operating in an optimal mental and emotional state, they may find it harder to push back against their own biases," says Liselotte Dyrbye, M.D., who led the study. "If burnout contributes to disparities in care, perhaps fighting burnout can help narrow that gap."
The results of the study suggest it can. Over 3,000 physicians from across the country who are not black were surveyed for symptoms of burnout. They were then given tests of explicit racial bias, a direct rating of how warmly they feel toward a person, and implicit racial bias, which is based on descriptive word association. Researchers conducted these surveys in the second and third years of residency to assess changes over time. Physicians experiencing high symptoms of burnout in the second year tended to respond with more racial bias, explicit and implicit. At follow-up in the third year, racial bias decreased across the board. The greatest reduction in bias, however, occurred in those physicians who experienced burnout in the second year but had recovered from burnout by the third year. This suggests that treating burnout could make a tangible improvement in racial bias in the clinic.
Health disparities between ethnic groups in the U.S. are well-documented. The Centers for Disease Control and Prevention reports a higher incidence of many health conditions among black Americans, including stroke, heart disease, infant mortality, obesity and diabetes. Many studies have investigated the ways in which differences in physician care contribute to this effect, but little previous research has explored how a physician's mental state can trigger these disparities. Rates of burnout — a condition marked by emotional exhaustion, cynicism and negative feelings toward one's job — are nearly doubled in physicians, compared to the general population. The researchers on this study wanted to know if burnout affects the manifestation of bias in medical residents.
While the differences in scores between the groups in the study are small, the authors suggest that further studies could better explore whether the relationship between burnout and racial bias truly is one of cause and effect and if so, foster solutions.
The study was performed in collaboration with Yale University, the University of Minnesota, Syracuse University, and Oregon Health & Science University. It was funded by the National Institutes of Health and Mayo Clinic.
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