Racist and Sexist MicroAggressions are a Common Cause of Physician Burnout

Posted by Dike Drummond MD

JAMASurgeryLogoI am a big, old, straight, American cis male physician, showered in white privilege and given a free pass in the realm of bias and discrimination. 

I have coached hundreds of burned out physicians over the last 12 years. Our conversations are intimate and authentic for a simple reason; there is no change without first telling the truth.

Whenever one of my coaching clients varies from my personal characteristics - in terms of race, ethnicity, gender, native language, sexual orientation or any other variable - we both know that bias and discrimination play some role in their burnout. They tell me the truth of what is going on. I tell them when I see subtle and obvious bias and discrimination from my position of privilege.

[I freely acknowledge I did not earn this position. It is only a reflection of the random combination of chromosomes that looks back at me from the mirror in the morning. As a coach it offers me the equivalent of a Litmus Test: I ask, "if it was me instead of my client in this situation, would I be treated the same way?" If the answer is NO, bias and discrimination is in play.]

For these physicians, each week contains a subset of words and deeds that hurt. The aggressors may be patients, staff, the general population or even leaders and physician colleagues.

  • Some hurt on purpose with looks, language and actions used deliberately to wound the physician as a human being.
  • Others are unconsciously woven into the fabric of our society and the healthcare system itself. 


TWO (obvious) QUESTIONS:

1) Just how often do physicians who are not white and not cis males experience these feelings of bias and discrimination in the course of their work life?

2) Is the frequency of these "microaggressions" associated with burnout in these doctors?

A recent study answers both.

  • 94% experienced sexist microaggressions
  • 81% experienced racist microaggressions
  • Each and both were linked to the physician's burnout risk

Let me show you why these results (which might seem shocking to you) are what I consider to be a best case scenario.

And ... let me ask you if this strikes you as important new information or an obvious "DUH of the Day"?


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

Neha T. Sudol, MD; Noelani M. Guaderrama, MD; Pamela Honsberger, MD; et al
JAMA Surg. 2021;156(5):e210265. doi:10.1001/jamasurg.2021.0265
Full PDF is available

Study Highlights

The study highlighted surgeons and anesthesiologists because of their known high frequency of burnout, especially among female surgeons. The study population came from Southern California Permanente Medical Group (SCPMG).

We have trained all physicians at SCPMG to recognize and prevent burnout previously. It is my experience that their physician staff is the most diverse and their geographic region and work environment one of the most progressive in the USA.

I personally consider this study of bias and discrimination to be a best case scenario.


All surgeons and anesthesiologists in SCPMG invited to participate in an anonymous electronic survey. Respondents received an $10 Amazon gift card.

The survey included demographics, the Maslach Burnout Inventory, the Racial Microaggression Scale (RMAS), and the Sexist Microaggression Experience and Stress Scale (Sexist MESS)


Sexist Microaggressions

A total of 245 of 259 female respondents (94%) experienced sexist microaggressions.
A total of 123 of 259 (47%) experienced cumulative microaggressions or microaggressions across all 7 survey subscales.

The most commonly experienced microaggression was overhearing or seeing degrading terms or images about females which occured in 86%.

The next most common was feeling pressure to overcompensate, hide emotions, or intentionally appear less feminine at work, which occurred in 73%.

Sexual objectification was reported by 114 (44%) and was highest for the following groups:
- Women who worked at SCPMG for less than three years
- Those who worked primarily with men
- Underrepresented minority physicians
- Divorced, separated, or widowed female physicians

Racial/Ethnic Microaggressions

Racial/ethnic microaggressions were experienced by 299 of 367 racial/ethnic–minority physicians (81%).

A total of 67 of 299 (18%) experienced cumulative microaggressions across all 6 RMAS survey subscales.
Within this subset, 47 of 67 individuals (70%) were female, and although these individuals were primarily Asian, 39% of all Hispanic and 61% of all Black respondents met the criteria for this group.

Female physicians experienced a significantly higher prevalence of all microaggressions compared with male physicians, except for criminality.

The criminality subscale, being perceived as scary or aggressive or being singled out by law enforcement because of race/ethnicity, had the lowest frequency (18 of 367 [5%]) but was unique to and significantly higher for Black (11 of 23 [48%]) and Hispanic (3 of 31 [10%]) physicians.

Racial/ethnic sexualization occurred in 58 of 267 racial/ethnic–minority physicians and was reported by 81% of female physicians in this cohort.

Physician Burnout

The overall prevalence of physician burnout was 47% (280 of 588 physicians).

Female physicians who experienced sexist microaggressions (racial minority group: P = .001; White group: P = .001) were more likely to experience burnout compared with White male physicians.

Racial/ethnic–minority female (P = .001) and male (P = .01) physicians who experienced racial/ethnic microaggressions were more likely to report physician burnout compared with White male physicians.
When adjusting for demographic variables, this finding only persisted for racial/ethnic–minority female physicians (OR, 1.86; 95% CI, 1.03-3.35; 
P = .04).

Racial/ethnic–minority female physicians who had the compound experience of sexist and racial/ethnic microaggressions were more likely to experience burnout compared with racial/ethnic–minority (P = .05) and White male physicians (P = .001).


The Author's Comments included:

Our high prevalence of microaggressions is consistent with published reports that surgical environments are wrought with sexism and racial/ethnic bias.

Although we are unable to assume causality, the association of physician burnout with sexist and racial/ethnic microaggressions provides a valuable response to the call to further investigate this intersection.


What can be done?

The article finishes with these recommendations:

"Individuals and medical organizations play an active role in mitigation of these experiences and associated burnout, and future research should assess both perpetrators and allies.

At an individual level, value and respect should be placed on addressing microaggressions in a nonaccusatory manner, as proposed by the GRIT (gather, restate, inquire, talk it out) mnemonic.

Systemic algorithms, such as the #BeEthical 6-step process of investigation, implementation, and publication of institutional efforts toward gender equity, should extend to racial inequity and be prioritized to the same degree as medical research.

As we continue our work on these important topics, we place a call to action to our medical community to prioritize this imperative."




  • Is this your experience of what the authors call MicroAggressions in your work week?
  • Do these findings strike you as new information or confirmation of something that everyone already understands?
  • What additional research would you like to see?
  • What additional actions would you like to see taken within your organization?



Tags: Physician Burnout, bias and discrimination in healthcare