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

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Discrimination and abuse in critical medical specialties negatively impact physicians, with the number of negative events mediating burnout. Targeted interventions are needed to improve workplace climate and retention.

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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.