Gender-Based Discrimination Is Prevalent in the Integrated Vascular Trainee Experience and Serves as a Predictor of Burnout

Abstract

Trainee burnout is on the rise, and negative training environments may contribute. In addition, as the proportion of women entering vascular surgery increases, identifying factors that challenge recruitment and retention is vital as we grow our workforce to meet demand. This study sought to characterize the learning environment of vascular residents and to determine how gender-based discrimination and bias (GBDB) affect the clinical experience. A survey was developed to evaluate the trainee experience; demographics and a two-item burnout index were included. It was sent electronically to all integrated vascular surgery residents in the United States. Univariate analyses were performed and predictors of burnout identified. There were 284 residents who were invited and 208 (73%) who completed the survey. Participants were predominantly male (64%) and white (57%), with a mean age of 30.7 ± 3.2 years. Some form of negative workplace experience was endorsed by 79%, and 29% were at high risk for burnout. Personal experience of GBDB was endorsed by 38%, with a significant difference between men and women (14% vs 81%; P < .000). Whereas men were significantly more likely to witness GBDB than to experience it, women were still more likely to observe these occurrences (77% vs 56%; P = .003). Patients and nurses were the most frequently cited sources of GBDB (80% and 65%, respectively), with vascular surgery attendings cited by 42% of trainees. More than one in four female resident respondents indicated being sexually harassed during the course of training, with a significant gender difference (1% vs 26%; P < .001). Nearly half (46%) of trainees who witnessed or experienced GBDB thought that quality of patient care, job satisfaction, personal well-being, and personal risk of burnout were affected. GBDB was predictive of high risk of burnout (odds ratio, 1.9; 95% confidence interval, 1.1-3.6; P = .035), as were longer work hours (>80 h/wk; odds ratio, 2.6; 95% confidence interval, 1.1-6.7; P = .049). GBDB was experienced by 38% of integrated trainees, with women significantly more affected than men. GBDB is predictive of high risk of burnout, and this has significant implications for our specialty in the recruitment and retention of female physicians. Programs addressing these issues are needed to maintain a diverse workforce and to promote physicians’ well-being.