MEZIESBLOG

Key Points

Question: How frequently do physicians experience mistreatment and discrimination by patients, their families, and visitors; how does this vary by physician characteristics; and what is the association between having such interactions and experiencing burnout?

Findings: In this cross-sectional study of 6512 US physicians, mistreatment and discriminatory behaviors by patients, families, and visitors within the previous year were common, especially for female and racial and ethnic minority physicians, and associated with higher burnout rates.

Meaning: The findings suggest that efforts to mitigate risk of physician burnout and improve the work experience of female and racial and ethnic minority physicians should include strategies that promote patient, family, and visitor civility.

Abstract

Importance: Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout.

Objective: To examine the occurrence of mistreatment and discrimination by patients, families, and visitors by physician characteristics and the association between such interactions and experiencing burnout.

Design, Setting, and Participants: This cross-sectional survey was conducted from November 20, 2020, to March 23, 2021, among US physicians.

Exposures: Mistreatment and discrimination were measured using items adapted from the Association of American Medical College’s Graduation Questionnaire with an additional item querying respondents about refusal of care because of the physicians’ personal attributes; higher score indicated greater exposure to mistreatment and discrimination.

Main Outcomes and Measures Burnout as measured by the Maslach Burnout Inventory.

Results Of 6512 responding physicians, 2450 (39.4%) were female, and 369 (7.2%) were Hispanic; 681 (13.3%) were non-Hispanic Asian, Native Hawaiian, or Pacific Islander; and 3633 (70.5%) were non-Hispanic White individuals. Being subjected to racially or ethnically offensive remarks (1849 [29.4%]), offensive sexist remarks (1810 [28.7%]), or unwanted sexual advances (1291 [20.5%]) by patients, families, or visitors at least once in the previous year were common experiences. Approximately 1 in 5 physicians (1359 [21.6%]) had experienced a patient or their family refusing to allow them to provide care because of the physician’s personal attributes at least once in the previous year. On multivariable analyses, female physicians (OR, 2.33; 95% CI, 2.02-2.69) and ethnic and racial minority physicians (e.g., Black or African American: OR, 1.59; 95% CI, 1.13-2.23) were more likely to report mistreatment or discrimination in the previous year. Experience of mistreatment or discrimination was independently associated with higher odds of burnout (vs score of 0 [no mistreatment], score of 1: OR, 1.27; 95% CI, 1.04-1.55; score of 2: OR, 1.70; 95% CI, 1.38-2.08; score of 3: OR, 2.20; 95% CI, 1.89-2.57). There was no difference in the odds of burnout by gender after controlling for experiencing mistreatment and discrimination score and other demographic factors, specialty, practice setting, work hours, and frequency of overnight call.

Conclusions and Relevance In this study, mistreatment and discrimination by patients, families, and visitors were common, especially for female and racial and ethnic minority physicians, and associated with burnout. Efforts to mitigate physician burnout should include attention to patient and visitor conduct.

Introduction

Burnout is an occupational phenomenon characterized by emotional exhaustion, cynicism related to one’s work, and reduced sense of professional efficacy that is prevalent among physicians. Studies have linked burnout to detrimental professional and personal consequences.1,2

Burnout occurs due to high work stress3 and may be caused, in part, by negative interactions with patients, families, and visitors. Prior studies have shown that physicians experience verbal and physical mistreatment and discrimination at work due to their visible personal attributes.4-12 These studies have primarily focused on the perpetrator of mistreatment being another health care worker, have been conducted in a single specialty or outside the United States, or did not differentiate the potential impact of the experience by the type of perpetrator (institutional employee vs patient, family member, or visitor).6,9,13-19

Little is known about mistreatment and discrimination experiences of physicians by personal characteristics (e.g., gender and race) and professional characteristics (eg, specialty, practice setting) or the potential professional impact of mistreatment and discrimination by patients, families, and visitors.5 Therefore, we studied the prevalence of physicians experiencing mistreatment and discrimination originating from patients, their families, and visitors and explored the association between such experiences and occupational burnout.

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