Differential burnout by race, sex, and sexual orientation in academic oncology.

Abstract

11000 Background: Burnout is a concern in medicine with negative effects on physician wellbeing, workforce retention, and patient outcomes. Research has shown that rising burnout can lead to medical errors, lower patient satisfaction, and decreased professional work effort. The presence of burnout in oncology is well documented, however it is unclear if burnout affects all groups equally in academic oncology. Methods: We obtained national faculty data from the Association of American Medical Colleges StandPoint Faculty Engagement Survey, conducted 2017-2020 (overall response rate 64%). Burnout was considered any response endorsing at least “one or more symptoms of burnout”. Self-reported workplace culture was assessed for key factors: collegiality, diversity, faculty wellness, and recruitment/retention of underrepresented in medicine (UiM) faculty. Faculty demographics included age, sex, race/ethnicity, sexual orientation (heterosexual, bisexual, lesbian/gay), rank, degree, and any department or institutional leadership role. Multivariate analysis (MVA) identified factors associated with faculty burnout. Results: A total of 724 academic oncologists were identified. Most were male (58%) and identified as heterosexual (95%). Race/ethnicity were mostly White (65%), with 29% Asian, 2% Black, and 3% Hispanic/Latino; 7% were considered UiM. Most (53%) were senior faculty; 37% had a leadership role. Overall, 22% reported burnout. Self-identified lesbian/gay/bisexual faculty had the highest rate of burnout (43% vs 21%, p = 0.0005) followed by female faculty (31% vs 16% men, p = < 0.0001). Asian faculty had the lowest burnout rates (12%) followed by White and Hispanic (both 26%), Black (33%), and multi-racial physicians (50%, p = 0.003 for comparisons). Pooled UiM had numerically higher burnout but this was not statistically significant (30% vs 22%, p = NS). On MVA, lesbian/gay/bisexual (OR = 3.56, 95%CI 1.55-8.18, p = 0.003) and female (OR = 2.32, 95%CI 1.51-3.56, p < 0.0001) faculty had increased odds of burnout. Most agreed that their institution cultivates collegiality (80%), diversity (73%), and faculty wellness (53%); men were more likely to endorse positive diversity (77% vs 68% women, p = 0.004). Most agreed their institution was successful in recruiting (63%) and retaining (58%) UiM faculty, however non-UiM were more likely to agree with this for recruitment (64% vs 46% UiM, p = 0.01) and retention (50% vs 42% UiM, p = 0.01). Conclusions: Nearly 1 in 4 oncologists report burnout with self-identified female and lesbian/gay/bisexual faculty at the highest risk. Additionally, in general, men and non-UiM faculty were more likely to feel their workplace culture was favorable. Urgent and tailored interventions at the institutional and departmental level will be critical to address both drivers of faculty burnout and the impact of burnout on attrition and career trajectory for marginalized and minoritized groups.