URiMs and Imposter Syndrome: Symptoms of Inhospitable Work Environments?

BACKGROUND AND OBJECTIVES: Workforce diversity is associated with improved health outcomes. Currently, primary care physicians who are underrepresented in medicine (URiM) disproportionately work in underserved areas. Increasingly, URiM faculty describe experiencing imposter syndrome (IS), including a sense of not belonging in their work environment and a lack of recognition. Studies of IS among family medicine faculty are not prevalent nor are the factors most associated with IS among URiMs and non-URiMs. The objectives of our study were to (1) determine prevalence of IS among URiM faculty compared to non-URiM faculty; (2) determine factors associated with IS among both URiM and non-URiM faculty. METHODS: Four hundred thirty participants completed anonymous, electronic surveys. We measured IS using a 20-item validated scale. RESULTS: Among all respondents, 43% reported frequent/intense IS. URiMs were not more likely than non-URiMs to report IS. Factors independently associated with IS for both URiM and non-URiM respondents include inadequate mentorship (P<.05) and poor professional belonging (P<.05). However, inadequate mentorship, low professional integration and belonging, and racial/ethnic discrimination-based exclusion from professional opportunities (all P<.05) were more prevalent among URiMs than non-URiMs. CONCLUSIONS: While URiMs are not more likely than non-URiMS to experience frequent/intense IS, they are more likely to report racial/ethnic discrimination, inadequate mentorship, and low professional integration and belonging. These factors are associated with IS and may be reflective of how institutionalized racism impedes mentorship and optimal professional integration, which may be internalized and perceived as IS among URiM faculty. Yet, URiM career success in academic medicine is crucial for achieving health equity.

Contributors to disparities in postpartum readmission rates between safety-net and non-safety-net hospitals: A decomposition analysis.

BACKGROUND: Safety-net hospitals (SNHs) treat more maternal patients with risk factors for postpartum readmission. OBJECTIVE: To assess how patient, hospital, and community characteristics explain the SNH/non-SNH disparity in postpartum readmission rates. DESIGN: A linear probability model assessed covariates associated with postpartum readmissions. Oaxaca-Blinder decomposition estimates quantified the contribution of covariates to the SNH/non-SNH disparity in postpartum readmission rates. SETTING: Healthcare Cost and Utilization Project 2016-2018 State Inpatient Databases from 25 states. PARTICIPANTS: 3.5 million maternal delivery stays. MEASUREMENTS: The outcome was inpatient readmission within 42 days of delivery. SNHs had a share of Medicaid/uninsured stays in the top quartile. A range of patient, hospital, and community characteristics was considered as covariates. RESULTS: The unadjusted postpartum readmission rate was 4.2 per 1000 index deliveries higher at SNHs than at non-SNHs (19.1 vs. 14.9, p < .001). Adjustment reduced the risk difference to 0.65 per 1000 (95% confidence interval [CI]: -0.14, 1.44). Patient (66%), hospital (14%), and community (4%) characteristics explained 84% of the disparity. The single largest contributors to the disparity were race/ethnicity (20%), hypertension (12%), hospital preterm delivery rate (10%), and preterm delivery (7%). Collectively, patient comorbidities explained 31% of the disparity. CONCLUSION: Higher postpartum readmission rates at SNHs versus non-SNHs were largely due to differences in the patient mix rather than hospital factors. Hospital initiatives are needed to reduce the risk of postpartum readmissions among SNH patients. Improving factors that contribute to the disparity, including underlying health conditions and health inequities associated with race, requires enduring investments in public health.

Postpartum Health Care Use After Gestational Diabetes and Hypertensive Disorders of Pregnancy.

Objective: To examine postpartum health care utilization after a pregnancy complicated by gestational diabetes (GD) and hypertensive disorders of pregnancy (HDP) using nationally representative data. Materials and Methods: We examined longitudinal pooled panel data from the 1996-2007 Medical Expenditure Panel Survey with linked data from Pregnancy Detail Files on adult women (>18) with singleton pregnancies who reported an infant delivery. Multivariable weighted logistic regression analyses, including interactions, examined the associations between pregnancy complications (GD/HDP) and three postpartum health care utilization outcomes, adjusting for demographic characteristics. Results: The unweighted sample size included 304 women. Overall, 32% did not report an office visit within 12 weeks postpartum, and 15% did not report an office visit within 1 year postpartum. In addition, 15% had ≥1 emergency room (ER) visit 1 year postpartum. Women with GD/HDP compared with those with neither complication had more ER visits 1 year postpartum (unadjusted mean 4.9 vs. 2.3; p < 0.01). In multivariable analyses, GD and HDP were not independently associated with outcomes. However, education marginally modified the pregnancy complication-office visit 1 year postpartum relationship (p = 0.06). Other demographic characteristics were independently associated with each postpartum health care utilization outcome after adjustment. Conclusions: Women with GD/HDP did not differ from women with neither complication on postpartum utilization outcomes. Less educated women with GD/HDP were more likely to miss an office visit within 1 year postpartum than less educated women with neither complication. Certain subgroups of women were more likely to forego timely and appropriate postpartum care. Efforts to improve care coordination and insurance coverage access during the postpartum period are needed.

A Population-Based Study of School Readiness Determinants in a Large Urban Public School District.

Objectives We examined biologic and social determinants of school readiness in an urban population and whether childcare altered these associations. Methods A retrospective cohort study was conducted using school readiness data linked to birth certificates of first-time kindergarten students (n = 39,463) in a large, urban public-school district during 2002-2012. Multivariate linear regression models compared mean readiness scores (MRS) for students born low birthweight (LBW) or preterm (PTB) and by childcare type, adjusting for other student and parent risk factors. Results MRSs for moderately LBW (1000-2499 g), extremely LBW (< 1000 g), moderately PTB (28-36 weeks), early-term (37-38 weeks) and post-term (42 + weeks) students were significantly lower than scores for their normal weight or full-term peers, adjusting for childcare type and other student and parent characteristics. Childcare was an important predictor of MRSs. MRSs were highest for district prekindergarten (PK) students and for students of mothers with greater years of education. Conclusions for Practice Social and biologic differences in MRSs for children entering school in a large urban public-school district suggest the need for greater attention to family and child health backgrounds. Increased enrollment in formal childcare may improve school readiness in these settings.