Stanford Network for Advancement and Promotion: The impact of a community building-focused leadership development program on the success of underrepresented groups in academic medicine.

BACKGROUND: Leadership can be an isolating experience and leaders from underrepresented groups (URGs) may experience even greater isolation and vulnerability because of lack of representation. Given the collaborative nature of medicine, leadership programs for physicians need to address isolation. Social support is one mechanism to combat this isolation; however, most leadership programs focus exclusively on skills building. PURPOSE: The Stanford Network for Advancement and Promotion (SNAP) program was developed to reduce isolation among physician leaders from URGs in academic medicine leadership by building a supportive network of peers. METHODOLOGY/APPROACH: Ten women physicians from diverse racial/ethnic backgrounds were invited to participate in SNAP. Annual surveys were administered to participants to assess the effectiveness of SNAP on decreasing feelings of isolation and increasing professional leadership growth. The authors charted the expansion and adaptation of the program model across gender and in additional settings. RESULTS: SNAP effectively created a sense of community among the physician leaders. Participants also reported feeling challenged by the program and that they had grown in terms of critical thinking, organizational knowledge, and empowerment as leaders. Participants found community building to be the most valuable program component. Because of this success, the SNAP model has been adapted to create 10 additional cohorts. CONCLUSION: Leadership programs like SNAP that focus on reducing isolation are instrumental for retaining and promoting the career advancement of physicians from URGs. PRACTICE IMPLICATIONS: Developing a diverse workforce of academic physicians is essential to providing high-quality and equitable clinical care, research, and medical education.

Women physicians receive lower Press Ganey patient satisfaction scores in a multicenter study of outpatient gynecology care.

BACKGROUND: Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians. OBJECTIVE: This study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care. STUDY DESIGN: This was a multisite, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS: Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score. CONCLUSION: Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.

Career Advancement Among Women Physicians in Nine Academic Medicine Specialties.

Objective: Gender parity lags in academic medicine. We applied the Rank Equity Index (REI) to compare the longitudinal progress of women's academic medicine careers. We hypothesized that women have different rank parity in promotion by specialty based on the proportion of women in the specialty. Materials and Methods: Aggregate data by sex for medical students, residents, assistant professors, associate professors, and professors in nine specialties were obtained from the Association of American Medical Colleges for 2019-2020. Specialties were clustered into terciles based on the proportion of women in the field: upper (obstetrics and gynecology, pediatrics, psychiatry), middle (internal medicine, emergency medicine, anesthesia), and lower (surgery, urology, and orthopedic surgery). We calculated the percentage representation by sex by specialty and rank to calculate REI. Specialty-specific REI comparisons between each rank were performed to assess parity in advancement. Results: Only specialties in the upper tercile recruited proportionally more women medical students to residency training. All specialties advanced women for the resident-to-assistant professor with psychiatry, internal medicine, emergency medicine, anesthesia, urology, and orthopedic surgery that promoted women faculty at rates above parity. No specialty demonstrated parity in advancement based on sex for the assistant professor-to-associate professor or associate professor-to-professor transitions. Conclusion: Gender inequity in advancement is evident in academic medicine starting at the assistant professor-to-associate professor stage, regardless of overall proportion of women in the specialty. This suggests a common set of barriers to career advancement of women faculty in academic medicine that must be addressed starting at the early career stage.

Strategies to Increase Workforce Diversity in Pediatric Infectious Diseases.

The number of physicians who are underrepresented in medicine within the pediatric infectious diseases workforce remains disproportionate compared to the US population. Physician workforce diversity plays an important role in reducing health care disparities. Pathways to careers in pediatric infectious diseases require that a diverse pool of students enter medicine and subsequently choose pediatric residency followed by subspecialty training. Efforts must be made to expose learners to pediatric infectious diseases earlier in the education timeline. Along with recruitment and creation of pathways, cultures of inclusivity must be created and fostered within institutions of learning along the entire spectrum of medical training.

Disability Identity Among Diverse Learners and Employees at an Academic Medical Center.

This survey study evaluates representation of persons with disabilities across demographic characteristics at an academic medical center.

Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study.

Importance: Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care. Objective: To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report. Design, Setting, and Participants: This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information. Main Outcomes and Measures: This qualitative study had no planned outcome. Results: A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level. Conclusions and Relevance: In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.

Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care.

Objective: To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Methods: Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. Results: No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. "Confidence in care provider" was the communication skill most frequently identified in comments both pre- and post-training. Conclusion: Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. Innovation: This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact.

The effect of a relationship-centered communication program on patient experience and provider wellness.

OBJECTIVES: Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness. METHODS: 636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019. RESULTS: 104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTR CP significantly increased and persisted more than 7 months following program completion. CONCLUSIONS: The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience. PRACTICE IMPLICATIONS: Implementing a RCC course for providers may improve patient experience and provider wellness.

The Need to Mitigate Unconscious Bias to Improve Sponsorship Opportunities for Underrepresented Faculty in Academic Radiology.

Women physicians and those from racial and ethnic groups underrepresented in medicine face unique barriers to career advancement in academic medicine, especially in specialties that lack diversity such as radiology. One such barrier is the effect of unconscious bias on the ability of faculty from these groups to find effective sponsors. Given the central role of sponsorship in career advancement, departments are called on to implement formal sponsorship programs to address inequities stemming from bias.

Using the Rank Equity Index to measure emergency medicine faculty rank progression.

BACKGROUND: Faculty diversity is a high-priority goal for academic emergency medicine (EM). Most administrators currently monitor faculty diversity using aggregate data, which may obscure underrepresentation by rank. We apply the Rank Equity Index (REI) to EM faculty data to assess rank progression. METHODS: We calculated the REI (% faculty cohort higher rank/% faculty cohort lower rank) for EM faculty. We performed REI analyses by faculty gender (women, men) and race/ethnicity (White, Black, Hispanic/Latinx, Asian). We compared professor/assistant professor, professor/associate professor, and associate professor/assistant professor to establish rank parity for gender and race/ethnicity. Parity is an REI of 1.0. RESULTS: REI analysis by gender demonstrates that women faculty did not achieve parity at any rank comparison in any study year. REI analysis by race/ethnicity demonstrates that all faculty of color are below parity at the assistant to associate professor promotion. Latinx faculty are at parity for associate professor to professor, but Asian and Black faculty do not achieve parity in any comparison. Intersecting gender and race/ethnicity in the REI analysis demonstrates that Asian women have the lowest REIs among all faculty ranks and races/ethnicities. Men of all races/ethnicities achieved parity in two of three rank comparisons, except for Black men, who did not achieve parity in any comparison. CONCLUSIONS: REI analysis demonstrates EM women faculty and faculty of color are not achieving rank parity and are disadvantaged at the first tier of promotion. A preliminary longitudinal trend analysis suggests little progress. Asian women and Black men experience the most rank inequity. REI analysis identifies a need for focused faculty development to enhance our most vulnerable faculty's rank progression, suggesting that targeted recruitment and retention efforts of women faculty of all races/ethnicities and faculty of color, in particular, will improve diversity at every tier of faculty rank.

Effects of surgeon sociodemographics on patient-reported satisfaction.

BACKGROUND: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear. METHODS: This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. χ2 tests and generalized estimating equation regression models were run to assess correlation. RESULTS: In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making. CONCLUSION: Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.

Everyday Heroism: Maintaining Organizational Cultures of Wellness and Inclusive Excellence Amid Simultaneous Pandemics.

Health care professionals and the institutions in which they work are being stretched to their limits amidst the current COVID-19 pandemic. At the same time, a second longstanding pandemic has been brought to the fore: the entrenched system of racial injustice and oppression. The first pandemic is new, and to date, substantial resources have been allocated to urgently addressing its mitigation; the second has a long history with inconsistent attention and resources but has recently been spotlighted more intensely than at any time in the nation's recent past. The authors contend that these 2 simultaneous pandemics have brought forth the need for institutions in the United States to make a renewed commitment to respect, wellness, diversity, and inclusion. While investment and leadership in these domains have always been essential, these have largely been viewed as a "nice-to-have" option. The events of much of 2020 (most notably) have illustrated that committing to and investing in policies, programs, centers, and leadership to drive change in these domains are essential and a "need-to-have" measure. The authors outline the necessity of investing in the promotion of cultures of inclusive excellence at both individual and organizational levels to coordinate a united response to the simultaneous pandemics. It is in the interests of health care systems to consider the wellness of the workforce to overcome the longer-term economic, systemic, and social trauma that will likely occur for years to come at both the individual and institutional levels. Maintaining or augmenting investment is necessary despite the economic challenges the nation faces. Now is the time to cultivate resilience and wellness through a renewed commitment to cultures of respect, diversity, and inclusion. This commitment is urgently needed to support and sustain the health care workforce and maintain outstanding health care systems for future generations.

The Long "Race" to Diversity in Otolaryngology.

The number of health disparities disproportionately affecting minority communities continue to rise. Thus, it is imperative to assess whether equity within medical school enrollment and along the academic pipeline has mirrored this growth, especially among elite surgical specialties such as otolaryngology. Census and educational data from 2010 and 2018 were used to assess the current otolaryngology, surgery, and internal medicine physician and faculty workforce diversity across each stage of the academic medicine trajectory by race and ethnicity. We found that disparities exist in medical school enrollment for minority students such that Hispanic/Latinx representation was only 30% and Black representation only 50% of their respective proportions in the US population in 2018. Disparities in achieving full professorship were also observed across all 3 specialties but most prominently in otolaryngology, with 1% Black representation among otolaryngology professors in 2018. A collective strategy toward diversifying the otolaryngology workforce should be explored.

Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations.

Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.

Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores.

INTRODUCTION: Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the "topbox" score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). METHODS: We looked at PG surveys from January 2015-December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: "Likelihood of your recommending our ED to others"; and "Courtesy of the doctor." We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution. RESULTS: We analyzed a total of 3,038 surveys. For "Likelihood of your recommending our ED to others," topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03-1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70-0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60-0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54-0.93) and vertical areas (OR 0.71; 95% CI 0.53-0.95) compared to fast track. For "Courtesy of the doctor," topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06-1.14); less likely among Asian (OR 0.70; 95% CI, 0.58-0.84), Black (OR 0.66; 95% CI, 0.45-0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55-0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50-0.95) compared to fast track. CONCLUSION: Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.

Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine.

As educators, researchers, clinicians, and administrators, faculty serve pivotal roles in academic medical centers (AMCs). Thus, the quality of faculty members' experiences is inseparable from an AMC's success. In seeking new methods to assess equity in advancement in academic medicine, the authors developed the Rank Equity Index (REI)-adapted from the Executive Parity Index, a scale previously implemented within the business sector-to examine national data on gender and racial/ethnic equity across faculty ranks. The REI was employed on self-reported demographic data, collected by the Association of American Medical Colleges, from U.S. medical school faculty in 2017, to make pairwise rank comparisons of the professoriate by demographic characteristics and department. Overall results indicated that women did not attain parity at any pairwise rank comparison, while men were above parity at all ranks. Similar results were observed across all departments surveyed: women in the basic sciences had REIs closest to parity, women in pediatrics had the highest representation but had REIs that were further from parity than REIs in the basic sciences, and women in surgery demonstrated the lowest REIs. Nationally, REIs were below 1.00 for all racial/ethnic group rank comparisons except for White and, in one case, multiple-race non-Hispanic/Latinx. Across all analyzed departments, Black/African American, Asian, Hispanic/Latinx, and multiple-race Hispanic/Latinx faculty had REIs below parity at all ranks except in 2 cases. In a comparison of 2017 and 2007 data, REIs across both race/ethnicity and gender were lower in 2007 for nearly all groups. REI analyses can highlight inequities in faculty rank that may be masked when using aggregate faculty proportions, which do not account for rank. The REI provides AMCs with a new tool to better analyze institutional data to inform efforts to increase parity across all faculty ranks.

Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity.

Importance: Previous research suggests that the prevalence of occupational burnout varies by demographic characteristics, such as sex and age, but the association between physician race/ethnicity and occupational burnout is less well understood. Objective: To investigate possible differences in occupational burnout, depressive symptoms, career satisfaction, and work-life integration by race/ethnicity in a sample of US physicians. Design, Setting, and Participants: In this cross-sectional study, data for this secondary analysis of 4424 physicians were originally collected from a cross-sectional survey of US physicians between October 12, 2017, and March 15, 2018. The dates of analysis were March 8, 2019, to May 21, 2020. Multivariable logistic regression, including statistical adjustment for physician demographic and clinical practice characteristics, was performed to examine the association between physician race/ethnicity and occupational burnout, depressive symptoms, career satisfaction, and work-life integration. Exposures: Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status. Main Outcomes and Measures: Physicians with a high score on the emotional exhaustion or depersonalization subscale of the Maslach Burnout Inventory were classified as having burnout. Depressive symptoms were measured using the Primary Care Evaluation of Mental Disorders instrument. Physicians who marked "strongly agree" or "agree" in response to the survey items "I would choose to become a physician again" and "My work schedule leaves me enough time for my personal/family life" were considered to be satisfied with their career and work-life integration, respectively. Results: Data were available for 4424 physicians (mean [SD] age, 52.46 [12.03] years; 61.5% [2722 of 4424] male). Most physicians (78.7% [3480 of 4424]) were non-Hispanic White. Non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic Black physicians comprised 12.3% (542 of 4424), 6.3% (278 of 4424), and 2.8% (124 of 4424) of the sample, respectively. Burnout was observed in 44.7% (1540 of 3447) of non-Hispanic White physicians, 41.7% (225 of 540) of non-Hispanic Asian physicians, 38.5% (47 of 122) of non-Hispanic Black physicians, and 37.4% (104 of 278) of Hispanic/Latinx physicians. The adjusted odds of burnout were lower in non-Hispanic Asian physicians (odds ratio [OR], 0.77; 95% CI, 0.61-0.96), Hispanic/Latinx physicians (OR, 0.63; 95% CI, 0.47-0.86), and non-Hispanic Black physicians (OR, 0.49; 95% CI, 0.30-0.79) compared with non-Hispanic White physicians. Non-Hispanic Black physicians were more likely to report satisfaction with work-life integration compared with non-Hispanic White physicians (OR, 1.69; 95% CI, 1.05-2.73). No differences in depressive symptoms or career satisfaction were observed by race/ethnicity. Conclusions and Relevance: Physicians in minority racial/ethnic groups were less likely to report burnout compared with non-Hispanic White physicians. Future research is necessary to confirm these results, investigate factors contributing to increased rates of burnout among non-Hispanic White physicians, and assess factors underlying the observed patterns in measures of physician wellness by race/ethnicity.

The association between Asian patient race/ethnicity and lower satisfaction scores.

BACKGROUND: Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings. METHODS: Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N = 216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex. RESULTS: Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking. CONCLUSIONS: Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.