Burnout Among Physicians With Disabilities

This survey study examines reported experiences of burnout, including emotional exhaustion and depersonalization, among physicians with disability.


Introduction
Burnout among physicians and health care practitioners is a national crisis.[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. 5Despite 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.

Methods
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).

+ Supplemental content
Author affiliations and article information are listed at the end of this article.

Discussion
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. 5,6e sustainability of entering and remaining in the health care workforce without structurallevel 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.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.c Race and ethnicity were secondary reported and merged from multiple AAMC surveys in which respondents self-reported race and ethnicity.
d No further information was available.
e Respondents described their current primary employment arrangement from a list and were allowed to choose more than 1.
f Other specialty group included anesthesiology and psychiatry, among others.
g Respondents were asked to give an estimate of the percentage of total weekly work hours they spent in each of the given activities; the total added to 100%.

Table 1 .
Adjusted Odds Ratios (AORs) for Physicians Feeling Depersonalized a b Other gender identity included agender and genderqueer/gender nonconforming, among others.cd No further information was available.ef Other specialty group included anesthesiology and psychiatry, among others.g Respondents were asked to give an estimate of the percentage of total weekly work hours they spent in each of the given activities; the total added to 100%.JAMA Network Open | Equity, Diversity, and Inclusion JAMA Network Open.2024;7(5):e2410701.doi:10.1001/jamanetworkopen.2024.10701(Reprinted) May 9, 2024 2/4 Downloaded from jamanetwork.comby guest on 05/20/2024

Table 2 .
Adjusted Odds Ratios (AORs) for Physicians Feeling Emotional Exhaustion a a Analyses of the 2022 Association of American Medical College (AAMC) National Sample Survey of Physicians data (N = 5546).b Other gender identity included agender and genderqueer/gender nonconforming, among others.