Burnout Among Physicians With Disabilities
Research Letter | Equity, Diversity, and Inclusion | May 9, 2024
Lisa M. Meeks, PhD1,2; Sarah S. Conrad, MS3; Zakia Nouri, MA3; et alChristopher J. Moreland, MD, MPH4; Zoie C. Sheets, MD, MPH5,6; Xiaochu Hu, PhD3; Michael J. Dill, MA3
JAMA Netw Open. 2024;7(5):e2410701. doi:10.1001/jamanetworkopen.2024.10701
Burnout among physicians and health care practitioners is a national crisis. It affects the health and well-being of physicians, health care costs, health care quality, and physician attrition.1–3 Mistreatment is a known correlate of burnout,4 and physicians with disabilities (PWDs), an integral part of the physician workforce, are at an increased risk for mistreatment, placing them at higher risk for burnout.5 Despite known stressors for this population, burnout in PWD has not been studied. To address this gap, we investigated the burnout experiences among PWDs in the US.
We analyzed the Association of American Medical College’s 2022 National Sample Survey of Physicians (NSSP) data (eMethods in Supplement 1). This dataset contains information on nationally representative physicians (eMethods in Supplement 1) who completed the NSSP between May and November 2022 and consented for their data to be included in research. Physicians were asked whether they had a disability and, if so, to indicate their disability (ie, attention-deficit/hyperactivity disorder, chronic health issue, hearing impairment, learning disability, mobility disability, psychological disability, vision impairment, or other). The American Institutes for Research Institutional Review Board deemed this survey study exempt from review. We followed the AAPOR reporting guideline.
Burnout was measured using 2 dimensions from the Maslach Burnout Inventory: depersonalization and emotional exhaustion. Physicians used a 7-point scale (never, a few times a year or less, once a month or less, a few times a month, once a week, a few times a week, and every day) to report the frequency with which I have become more callous toward people since I took this job and I feel burned out from my work.
We ran 2 multivariate ordered logistic regressions to assess the likelihood of PWDs to experience emotional exhaustion and depersonalization, controlling for demographic variables (age group, gender identity, sexual orientation, marital and parental status, and race and ethnicity), workplace characteristics (work settings, weekly work hours, specialty group, academic affiliation, and time use), and international medical graduate status. We set significance levels at P < .05. Data analysis was performed with Stata SE/17 (StataCorp LLC).
A total of 5917 physicians (3722 males [62.9%], 2195 females [37.1%]; mean [SD] age, 51.98 [11.78] years) completed the NSSP. Of these physicians, 185 (3.1%) reported having a disability. The most frequently selected disabilities were chronic health (60 [32.4%]) and mobility (46 [24.9%]). For PWDs, the odds of reporting daily depersonalization were higher (adjusted odds ratio, 1.45; 95% CI, 1.11-1.91; P = .007) than for their peers (Table 1). Additionally, PWDs reported emotional exhaustion more frequently than physicians without disability, but the difference was not statistically significant (Table 2).
Compared with peers, PWDs were significantly more likely to experience depersonalization at least once during the previous year, but not emotional exhaustion. This finding suggests PWDs have some protective qualities against exhaustion. However, it simultaneously amplifies growing concerns about the structural environments in which PWDs work, including lack of protections against mistreatment, harassment, and pay inequity.5,6
The sustainability of entering and remaining in the health care workforce without structural-level intervention is tenuous for PWDs. Health care systems must develop a multifaceted approach to decreasing mistreatment, increasing a sense of belonging, promoting pay equity, and ensuring psychological and physical safety for PWDs. Strategies may include antiableist training, sharing successes, pay equity evaluations, and robust reporting options for disability-related mistreatment.
Study limitations include the self-reported nature of survey data and potential underreporting of disability due to fear of stigma. Additionally, physicians with high levels of burnout may opt out of surveys.
Future research may include qualitative studies to identify factors in burnout among PWDs. Additionally, studies that investigate the effectiveness of mechanisms focused on mistreatment reduction, pay equity, increased access (including accommodations), and intent to leave the workforce would provide valuable information to initiatives for retaining this physician population.
Accepted for Publication: March 9, 2024.
Published: May 9, 2024. doi:10.1001/jamanetworkopen.2024.10701
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Meeks LM et al. JAMA Network Open.
Concept and design: Meeks, Conrad, Nouri, Moreland, Hu, Dill.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Meeks, Conrad, Nouri, Sheets, Hu.
Critical review of the manuscript for important intellectual content: Meeks, Nouri, Moreland, Sheets, Hu, Dill.
Statistical analysis: Meeks, Nouri, Hu.
Obtained funding: Meeks.
Administrative, technical, or material support: Meeks, Conrad, Nouri, Hu, Dill.
Supervision: Meeks, Moreland, Dill.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported, in part, by grant 142636 from the Ford Foundation (Dr Meeks); Rehabilitation, Research, and Training Centers Equity grant 90RTHF0005 from the National Institute on Disability, Independent Living, and Rehabilitation Research (Dr Meeks); and grant 80317 from the Robert Wood Johnson Foundation (Dr Meeks).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 2.
Additional Contributions: We thank each participant for their time and willingness to share their experiences.
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