BURNOUT AMONG WOME N PHYSI CI ANS K im T e mple to n, MD Pa - PowerPoint PPT Presentation

BURNOUT AMONG WOME N PHYSI CI ANS K im T e mple to n, MD Pa st-pre side nt, Ame ric a n Me dic a l Wo me n’ s Asso c ia tio n Pro fe sso r o f Ortho pa e dic Surg e ry Unive rsity o f K a nsa s-K a nsa s City

 No t a ll studie s o f b urno ut e va lua te b a se d o n g e nde r  E xha ustio n a nd e mo tio na l e xha ustio n te nd to b e hig he r a mo ng wo me n  Do e s this ma ke it e a sie r to ide ntify b urno ut?  I s it mo re so c ia lly a c c e pta b le fo r wo me n to c o mpla in o f b urno ut?  Ge nde r diffe re nc e s in inc ide nc e o f b urno ut ne e d a dditio na l study BURNOUT AMONG WOME N PHYSI CI ANS

 Study o f 1 a c a de mic me dic a l c e nte r a nd its c o mmunity a ffilia te  100 me n a nd 98 wo me n  I nc o ming PGY-1 a nd PGY-1-4 I M re side nts  30% o f wo me n, 15% o f me n me t c rite ria fo r b urno ut  Wo me n we re mo re like ly to de mo nstra te e mo tio na l e xha ustio n (22% vs 9%) Spa ta ro e t a l 2016 I S T HE RE A DI F F E RE NCE ?

 T ho ug h no t q uite sta tistic a lly sig nific a nt, b urno ut is hig he r a mo ng PGY2 re side nts, e spe c ia lly fe ma le s (p=0.076, c hi-sq ua re te st) UNI VE RSI T Y OF K ANSAS DAT A BURNOUT , PGY1-3, AND GE NDE R

 Co mmunic a tio n style s/ inte rpe rso na l inte ra c tio ns  I mpo ste r syndro me / ste re o type pe rc e ptio n  Ge nde re d e xpe c ta tio ns/ e xte rna l de ma nds  Se xua l ha ra ssme nt/ (un)c o nsc io us g e nde r b ia s I SSUE S T HAT MAY BE T I E D T O WOME N PHYSI CI ANS AND BURNOUT

 Pro b le m so lve r, pe a c e ma ke r, kind  Diffic ultie s de le g a ting , fixe r, c a re ta ke r  Nurturing  Se lf a b ne g a ting Do e s this le a d to wo me n spe nding mo re time with pa tie nts? E xpe nding mo re e mo tio na l e ne rg y? Diffic ulty de le g a ting pa tie nt c a re o r fa mily re spo nsib ilitie s? “Mo the rly a ppro a c h to pa tie nt c a re is like ly to b e b e st fo r the pa tie nt, b ut pe rha ps c o uld b e pe rso na lly ‘ dra ining ’ to fe ma le (surg e o ns) o ve r time ” (Da hlke e t a l 2018) T HE “MOT HE R” T RANSF E RE NCE

 Physic a l/ e mo tio na l distre ss c a use d b y re pe a te dly c a ring fo r tho se e xpe rie nc ing tra uma  Use the Pro QOL  Distrib ute d b y ne wsle tte r to the Ame ric a n Co lle g e o f Surg e o ns  178 Surg e o ns c o mple te d surve y  F e ma le surg e o ns fro m a ll spe c ia ltie s e xhib ite d sig nific a ntly hig he r le ve ls o f b urno ut a nd c o mpa ssio n fa tig ue c o mpa re d to ma le surg e o ns  Wu, e t.a l, T he Ame ric a n Surg e o n, 2017 COMPASSI ON F AT I GUE I N F E MAL E SURGE ONS

 F irst de sc rib e d a mo ng wo me n b ut fo und in b o th wo me n a nd me n  T ho se suffe ring fro m impo ste r syndro me b e lie ve the mse lve s le ss inte llig e nt o r c o mpe te nt tha t pe rc e ive d b y o the rs  F e a r tha t the y a re inte lle c tua l fra uds, de spite e xc e lle nt e va lua tio ns a nd te st sc o re s  Pe rso na lity c ha ra c te ristic ? A re sult o f tra ining ? Pa rt o f pro fe ssio na l ide ntity de ve lo pme nt?  Ma y b e mo re mo tiva te d to pe rfo rm, b ut…  Also mo re like ly to suffe r fro m distre ss, de pre ssio n, a nxie ty I MPOST E R SYNDROME

 Surve y o f 181 fa mily me dic ine re side nts  90% tho ug ht tha t the y we re re c e iving a de q ua te tra ining  41% o f wo me n vs 24% o f me n sc o re d a s impo ste rs  60% o f wo me n(43% o f me n) wo rrie d a b o ut the ir a b ility to pra c tic e a fte r re side nc y  T ho se with hig h sc o re s o n the I mpo ste r Sc a le we re mo re like ly to b e de pre sse d, a nxio us, a nd ha d lo we r se lf-e ste e m Orie l e t a l 2004 I MPOST E R SYNDROME

 We b -b a se d surve y o f 138 me dic a l stude nts  Wo me n we re sig nific a ntly mo re like ly to suffe r fro m I S  Hig he r inc ide nc e a mo ng 4 th ye a r stude nts  T ho se with I S we re sig nific a ntly mo re like ly to de mo nstra te e mo tio na l e xha ustio n, c ynic ism, a nd de pe rso na liza tio n  Wo me n ma na g e d I S b y wo rking ha rde r, me n b y a vo iding a re a s o f vulne ra b ility  I nc re a se risks fo r b urno ut a mo ng wo me n? Villwo c k e t a l 2016 DO RE SI DE NT S ST ART T RAI NI NG WI T H I S?

 Ma y re fle c t de ve lo pme nta l pro c e ss during time s o f c ha ng ing o r c ha ng ing ro le s/ re spo nsib ilitie s  Do e s this re so lve with time ?  Whic h c o me s first, a nxie ty/ de pre ssio n o r I S?  Wha t is the impa c t o n b urno ut? I MPOST E R SYNDROME QUE ST I ONS

 F e a r o f c o nfirming a ne g a tive ste re o type b e c a use yo u b e lo ng to a g ro up (e .g ., fe ma le ), e ve n if the ste re o type is no t a c c ura te  Surve y o f 384 (189 fe ma le ) re side nts within a sing le me dic a l c e nte r  All re side nts (ma le a nd fe ma le ) tho ug ht tha t the pub lic a nd fa c ulty b e lie ve d me n we re b e tte r physic ia ns  Wo me n hig he r in ste re o type pe rc e ptio n ha d wo rse psyc ho lo g ic he a lth  Ste re o type pe rc e ptio ns did no t impa c t the he a lth o f me n Sa lle s e t a l 2016 ST E RE OT YPE PE RCE PT I ON/ T HRE AT

 “F e e l like (the y) do n’ t kno w a nything b ut a re re spo nsib le fo r… pa tie nts”  “T he y ha ve to lo o k like the y kno w e ve rything whe n the y do n’ t”  Didn’ t kno w ho w to ma inta in c re dib ility with a pa tie nt  “T he (wo ma n) re side nt is he ld re spo nsib le fo r e ve rything , fro m the e mo tio ns o f e ve ryb o dy to the b rig htne ss o f the ro o m”  “Whe n thing s a re n’ t do ne c o rre c tly, no ma tte r who se fa ult it is, wo me n ta ke it mo re pe rso na lly”  “Wo me n a re mo re like ly to ta ke c ritic ism to he a rt”  “We fe e l we ha ve to b e ‘ supe rwo ma n’ ”  “Ma ny de a l with impo ste r syndro me ”  Inte rna l o r e xte rna l pre ssure s? I MPOST E R SYNDROME / ST E RE OT YPE PE RCE PT I ON WOME N RE SI DE NT S

 Wo me n a re he ld to hig he r sta nda rds b y the mse lve s a nd o the rs  No ma tte r whe re the y we re (e a rlie r in the ir c a re e rs) the y we re e xpe c te d to b e so me whe re e lse (e .g ., wo rk vs ho me )  F e lt (a nd c o ntinue to fe e l) g uilty a b o ut no t do ing wha t o the r mo the rs did (e .g ., pic king up kids fro m sc ho o l, b a king c o o kie s)  Wo me n physic ia ns a re no t a llo we d to sho w e mo tio ns (“c a n’ t c ry in the o ffic e ”)  “Wo me n sho uld sta nd up fo r the mse lve s a nd the ir wo rk” I MPOST E R SYNDROME / ST E RE OT YPE PE RCE PT I ON SE NI OR WOME N PHYSI CI ANS

 Syste ma tic re vie w a nd me ta -a na lysis  177 a rtic le s re vie we d (1987-2011)  6 c o untrie s, inc luding the US a nd Ca na da  Hig he r pre va le nc e o f ha ra ssme nt a nd g e nde r disc rimina tio n a mo ng fe ma le physic ia ns  Ge nde r disc rimina tio n mo st c o mmo n fo rm o f a b use a mo ng re side nts (pre va le nc e 66.6%), fo llo we d b y ve rb a l a b use (58%), a nd se xua l ha ra ssme nt (36%)  Mo st c o mmo n pe rpe tra to rs we re se nio r physic ia ns  I nc re a se s risks fo r de pre ssio n a nd a nxie ty  Mo re “in-g ro up”/ ”o ut-g ro up”, ra the r tha n g e nde r-b a se d F na is e t a l 2014 HARASSME NT / DI SCRI MI NAT I ON

 Surve y thro ug h Assn o f Wo me n Surg e o ns  Mo st e xpe rie nc e d o r o b se rve d g e nde r-b a se d disc rimina tio n  60% fro m me n, 40% fro m wo me n  Supe rio rs, pe e rs, suppo rt sta ff, pa tie nts  Wo me n le ss like ly to spe a k up  De c re a se d c a re e r sa tisfa c tio n Bruc e e t a l 2015 GE NDE R-BASE D DI SCRI MI NAT I ON

 Na tio na l sa mple s o n the impa c t o f pe rc e ive d disc rimina tio n (PD) in the wo rkpla c e , b a se d o n ra c e , se x, a g e , fa mily o b lig a tio n, a nd se xua l o rie nta tio n  PD c o rre spo nde d with le ss e ng a g e me nt a nd mo re b urno ut  T his psyc ho lo g ic withdra wa l indire c tly re sulte d in physic a l withdra wa l (i.e ., la te ne ss, a b se nte e ism, a nd inte nt to q uit) Vo lpo ne e t a l 2013 DAT A OUT SI DE OF ME DI CI NE …

 “I t’ s still a ‘ ma n’ s wo rld’ , a nd wo me n ha ve to wo rk ha rde r to pro ve the mse lve s”  “Sta ff a ssume tha t the ma le is the mo re se nio r re side nt”  “I t’ s o fte n po inte d o ut to fe ma le re side nts if the y a re the o nly o ne in the ir pro g ra m-no t ne g a tive b ut sho uldn’ t ma ke a diffe re nc e ”  Re c o g nize d a s unc o nsc io us b e ha vio r, BUT  “I t’ s the little thing s tha t re a lly a dd up to c re a te stre ss” GE NDE R BI AS- WOME N RE SI DE NT S