Almost 30% of physicians report experiencing mistreatment or discrimination from patients, families, and visitors, according to a new study conducted in collaboration with the American Medical Association.

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Study details and key findings

For the study, researchers surveyed 6,512 physicians nationwide about their experiences with burnout, mistreatment, and discrimination between Nov. 20, 2020, and March 23, 2021.

Of the responding physicians, 37.6% were female, and 70.5% were non-Hispanic white. The median age of the respondents was 54 years, and 56.9% worked in private practice. Respondents worked a median of 50 hours per week and were on call a median of one night per week.

Overall, 29.4% of all respondents said they had experienced racially or ethnically offensive remarks from patients, families, or visitors at least once in the past year. Female physicians, as well as physicians of color, were more likely to report this type of mistreatment than male or white physicians.

Similarly, 28.7% of respondents said they experienced offensive sexist remarks, and 20.5% said they experienced unwanted sexual advances at least once in the past year. Female physicians were more likely to report these experiences than male physicians.

In comparison, fewer physicians (9.8%) reported experiencing offensive remarks related to their sexual orientation. However, more than 20% of female physicians identifying as two or more races and Indigenous female physicians reported such experiences.

In addition, 21.6% of physicians said a patient or their family refused to allow them to provide care because of the physician's gender or race/ethnicity at least once in the last year. Among female physicians, 27.5% reported having this experience, while more than 40% of Black male physicians and Indigenous female physicians reported the same.

Almost 15% of physicians said they had been physically harmed by patients, families, or visitors at least once in the last year. The group that reported the most cases of physical harm was male physicians of two or more races at 31.8%, which was almost twice that of other groups.

Based on a multivariable analysis, the researchers found that factors associated with more frequent mistreatment and discrimination among physicians were female gender and non-white race or ethnicity. In addition, physicians in specialties that have less direct contact with patients, such as pathology or radiology, had a lower risk for mistreatment, while physicians in emergency medicine had a higher risk.

The researchers examined the association between mistreatment/discrimination and burnout. Overall, as the frequency of mistreatment increased, so did the percentage of physicians who reported high emotional exhaustion, depersonalization, and burnout. In a multivariable analysis, summative mistreatment and discrimination increased the odds of burnout among physicians by 27% to 120%, independent of several other factors, such as age, gender, race and ethnicity, or specialty.

Commentary

According to the study's authors, these findings suggest that more efforts, particularly those that help mitigate mistreatment and discrimination by patients, families, and visitors, are needed to reduce the risk of burnout among physicians.

"It's a ripple effect," said Lotte Dyrbye, senior associate dean of faculty and chief well-being officer at the University of Colorado School of Medicine and the study's lead author. "Burnout can lead to physicians cutting back on clinical time, which costs U.S. health care tons of money and magnifies workforce shortages, reducing access to care. Also, if physicians are burned out, they're more likely to have substance use issues, more likely to have thoughts of suicide. It's not only horrible by itself that these things are happening, but it's horrible because burnout has adverse consequences for patients and for society."

According to Dyrbye, health care organizations should take the initiative to protect their workers, through policies and procedures that reduce harassment and bias from patients and ensuring all clinicians feel supported. In addition, organizations can provide training on unconscious bias and stereotype threat, as well as help clinicians practice self-care.

"You certainly can't abandon patients and you're going to tolerate behavior more from patients who are delirious, demented, or not competent," Dyrbye says. "But for the rest of the world, we can have higher expectations."

"It's also important for the general public to understand how burnout can impact them," Dyrbye said.

"Why should they care that doctors are burned out? They should care because physician turnover and cutting back on hours directly attributable to burnout costs the U.S. health care system $4.8 billion every year. Burned out physicians reduce clinical time, they're twice as likely to leave practice, so then you're having to find a new doctor. Burned out physicians may also deliver more expensive and lower quality care. If we want high-quality, affordable health care, we must support physicians." (Gleeson, Becker's Hospital Review, 5/20; Sauer, CU Anschutz, 5/19; Dyrbye et al., JAMA Network Open, 5/19)