Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians

Area of Science:

• Medical Education
• Military Medicine
• Occupational Health

Background:

• Physician recruitment, training, and retention in critical wartime specialties may be hindered by discrimination and abuse.
• The extent of discrimination and abuse experienced by US combat specialty physicians, intervention rates, and impact on career choices remain unclear.

Purpose of the Study:

• To investigate the prevalence of discrimination and abuse among US active duty physicians in critical specialties.
• To examine the association between negative experiences and burnout.
• To analyze the mediating role of these experiences in the relationship between gender and burnout.

Main Methods:

• Surveyed active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N=243; 21% response rate).
• Used generalized linear models to assess the relationship between negative/stigmatizing comments/events, gender, specialty, service, and burnout.
• Employed bootstrapped mediation analysis to evaluate the role of negative experiences in mediating gender and burnout.

Main Results:

• Most common negative comments/events related to pregnancy, parental leave, gender/assigned sex, lactation, and sexual harassment.
• Self-intervention and bystander intervention were reported, but nonintervention was also common.
• The number of witnessed/experienced negative comment/event types was associated with greater burnout, and this mediated the relationship between gender and burnout.

Conclusions:

• While confidence in intervention is high, its actual practice and impact on workplace climate require further investigation.
• Burnout differences between genders were explained by the number of negative experiences.
• Institutions need targeted policies and programs beyond annual training to optimize workplace climate and address discrimination.