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Prevalence and Nature of Sexist and Racial/Ethnic Microaggressions Against Surgeons and Anesthesiologists

Educational Objective
To examine the prevalence and nature of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists who are female and/or racial/ethnic minority members and assess the association with physician burnout.
1 Credit CME
Key Points

Question  What are the prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists?

Findings  This survey study of surgeons and anesthesiologists in a large health maintenance organization found a 91% prevalence of sexist microaggressions and an 84% prevalence of racial/ethnic microaggressions, with a significant association between microaggressions and physician burnout.

Meaning  These findings suggest that a high prevalence of microaggressions exists that stigmatize female and racial/ethnic–minority physicians and contribute to unhealthful surgical workplaces and physician burnout.

Abstract

Importance  Workplace mistreatment can manifest as microaggressions that cause chronic, severe distress. As physician burnout becomes a global crisis, quantitative research to delineate the impact of microaggressions is imperative.

Objectives  To examine the prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists and assess the association with physician burnout.

Design, Setting, and Participants  This cross-sectional survey evaluated microaggressions and physician burnout within a diverse cohort of surgeons and anesthesiologists in a large health maintenance organization. A total of 1643 eligible participants were sent a recruitment email on January 8, 2020, 1609 received the email, and 652 replied, for a response rate of 41%. The study survey remained open until February 20, 2020. A total of 588 individuals (37%) were included in the study after exclusion criteria were applied.

Exposures  The Maslach Burnout Inventory, the Racial Microaggression Scale, and the Sexist Microaggression Experience and Stress Scale.

Main Outcomes and Measures  The primary outcomes were prevalence and nature of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists using the Sexist Microaggression Experience and Stress Scale and Racial Microaggression Scale. Secondary outcomes were frequency and severity of microaggressions, prevalence of physician burnout, and associations between microaggressions and physician burnout.

Results  Data obtained from 588 respondents (249 [44%] female, 367 [62%] racial/ethnic minority, 224 [38.1%] 40-49 years of age) were analyzed. A total of 245 of 259 female respondents (94%) experienced sexist microaggressions, most commonly overhearing or seeing degrading female terms or images. Racial/ethnic microaggressions were experienced by 299 of 367 racial/ethnic–minority physicians (81%), most commonly reporting few leaders or coworkers of the same race/ethnicity. Criminality was rare (18 of 367 [5%]) but unique to and significantly higher for Hispanic and Black physicians. Individuals who identified as underrepresented minorities were more likely to experience environmental inequities (odds ratio [OR], 4.21; 95% CI, 1.6-10.75; P = .002) and criminality (OR, 14.93; 95% CI, 4.5-48.5; P < .001). The prevalence of physician burnout was 47% (280 of 588 physicians) and higher among female physicians (OR, 1.60; 95% CI, 1.03-2.47; P = .04) and racial/ethnic–minority physicians (OR, 2.08; 95% CI, 1.31-3.30; P = .002). Female physicians who experienced sexist microaggressions (racial/ethnic–minority female physicians: OR, 1.84; 95% CI, 1.04-3.25; P = .04; White female physicians: OR, 1.99; 95% CI, 1.07-3.69; P = .03) were more likely to experience burnout. Racial/ethnic–minority female physicians (OR, 1.86; 95% CI, 1.03-3.35; P = .04) who experienced racial microaggressions were more likely to report burnout. Racial/ethnic–minority female physicians who had the compound experience of sexist and racial/ethnic microaggressions (OR, 2.05; 95% CI, 1.14-3.69; P = .02) were more likely to experience burnout.

Conclusions and Relevance  The prevalence of sexist and racial/ethnic microaggressions against female and racial/ethnic–minority surgeons and anesthesiologists was high and associated with physician burnout. This study provides a valuable response to the increasing call for evidence-based data on surgical workplace mistreatment.

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Article Information

Accepted for Publication: December 30, 2020.

Published Online: March 24, 2021. doi:10.1001/jamasurg.2021.0265

Corresponding Author: Neha T. Sudol, MD, Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Irvine Medical Center, 6650 Alton Pkwy, Medical Office Bldg 2, Third Floor, Irvine, CA 92618 (neha.t.sudol@kp.org).

Author Contributions: Dr Sudol had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sudol, Guaderrama, Honsberger, Weiss, Whitcomb.

Acquisition, analysis, or interpretation of data: Sudol, Guaderrama, Weiss, Li, Whitcomb.

Drafting of the manuscript: Sudol, Guaderrama, Whitcomb.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sudol, Li.

Obtained funding: Sudol, Whitcomb.

Administrative, technical, or material support: Sudol, Weiss.

Supervision: Guaderrama, Honsberger, Weiss, Whitcomb.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded by grant KP-RRC-20190504 from the Regional Research Committee of the Southern California Permanente Medical Group.

Role of the Funder/Sponsor: The funding source helped pay for the rights to the Maslach Burnout Inventory, RedCap, and statistical support.

Additional Contributions: Dana Pounds, MS, Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, for her contribution to data collection.

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