Symptoms of burnout among second-year resident physicians who self-identified as nonblack were associated with greater explicit and implicit racial bias toward black people, according to a study published in JAMA Network Open.

In this cross-sectional study, researchers used data from a cohort of nonblack resident physicians who completed a Cognitive Habits and Growth Evaluation Study (CHANGES) survey (n=3392). Symptoms of burnout were measured using the R2 questionnaire and the R3 questionnaire, adapted from the full 22-item Maslach Burnout Inventory. The R2 questionnaire was also used to assess implicit bias toward black people compared with an implicit bias toward white people.

Within the cohort, 35.6% of resident physicians had high emotional exhaustion (n=1203) and 34.9% had high depersonalization (n=1179), both of which were associated with more unfavorable attitudes toward black people. The mean feeling thermometer (FT) score toward black people was 77.9, compared with an FT score of 81.1 toward white people, and the mean racial implicit association test (IAT) score was 0.4, which indicates a preference for white people over black people. Compared with resident physicians without high emotional exhaustion, physicians with high emotional exhaustion had lower mean FT scores toward black people (75.9 vs 78.9; 95% CI, -4.5 to -1.5; P <.001). Resident physicians with at least 1 symptom of burnout had lower mean FT scores toward black people compared with those without symptoms of burnout (75.9 vs 79.5; 95% CI, -5.0 to -2.2; P <.001).

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This study was limited by the use of a limited number of factors that may be associated with explicit and implicit racial biases, as well as by its reliance on measures of bias rather than on observed behaviors. The magnitude of the observed associations was small to medium, and the researchers could not ascertain whether the associations were causal.

Long-term findings suggest that nonblack resident physicians’ feelings toward black patients can become more favorable over the course of a year, possibly due to positive experiences with black colleagues, coworkers, and patients; graduate medical education to reduce racial biases; changing signals of contextual antibias norms; and other factors. Adding to previous studies showing physician burnout as a threat to patient safety and quality of care, these data suggest symptoms of burnout may be associated with negative outcomes for black patients. Future studies are warranted to establish whether the association between burnout and racial bias persists among physicians in practice.


Dyrbye L, Herrin J, West CP, et al. Association of racial bias with burnout among resident physicians [published online July 26, 2019]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2019.7457