Physicians for a Healthy California (PHC), the charitable arm of the California Medical Association (CMA), has published a new study that presents crucial insights into the factors contributing to burnout and attrition among women physicians of color. The study—A Prescription for Change: Addressing Retention Among Women Physicians of Color in California—done in collaboration with University of California Health, evaluated the experiences of more than 1,150 women physicians, from various health care settings throughout California. 

“Within the first six years post-residency, women physicians are far more likely than their male counterparts to either work part-time or exit the profession altogether,” said Deena Shin McRae, M.D., co-principal investigator and Associate Vice President for Academic Health Sciences, University of California Health. “At the same time, California is facing a physician shortage, especially in rural and underserved population centers, and evidence tells us that improved health outcomes are linked to the shared racial and linguistic backgrounds of both patients and providers. Given the critical role women physicians of color play in California’s health care infrastructure, we sought out to learn why women physicians of color leave the medical field and explore ways to support and retain them.”

The study, which compared 2022 data with data previously collected for PHC’s 2018 study, found increased burnout among all women physicians, rising from 37.2% in 2018 to 45.8% in 2022 following the COVID-19 pandemic. Burnout is closely associated with intentions to leave the profession, posing significant implications for the already strained health care workforce, particularly in underserved areas. 

In focus groups, participants reported that moral injury, rather than personal characteristics, is an important driver of physicians’ desire to leave the workforce. Moral injury describes the psychological distress experienced by those operating within systems or under authorities when one’s moral code is challenged.

The study identified several significant drivers contributing to attrition among women physicians in California, particularly exacerbated by the COVID-19 pandemic. Key stressors included increased administrative burdens such as extensive electronic health record usage, overwhelming patient volume and staff shortages. Moreover, women physicians of color faced additional challenges, including inequities in work distribution and discrimination and bias. The pandemic highlighted issues of transparency and engagement from leadership, while the physical and mental toll of continuous personal protective equipment (PPE) usage added to the strain.

Despite these challenges, the study also revealed some protective characteristics such as experiences of community and belonging among women physicians of color, emphasizing the importance of supportive networks and representation in leadership. Overall, the findings underscore the urgent need for systemic changes and institutional support to improve retention and promote the well-being of women physicians in California.

"Our research reveals the alarming increase in moral injury and burnout among women physicians across California and it is imperative that we take immediate action to create a more inclusive and sustainable health care workforce,” said Lupe Alonzo-Diaz, MPA, co-principal investigator and PHC President and Chief Executive Officer. “Policy makers and organizations must implement comprehensive policies and practices that cultivate a health care environment that meets the diverse needs of California's population while ensuring the well-being and resilience of our healthcare workforce."

The study provides eight key recommendations to improve retention and address the challenges faced by women physicians of color in California. They emphasize understanding and addressing systemic issues influencing attrition, accommodating health care system changes, identifying meaningful outcome measures for Diversity Equity and Inclusion programs, as well as establishing transparency and accountability measures in those programs. Developing mechanisms for anonymous employee feedback, evaluating compensation and benefits for equity among genders and races, compensating for the diversity tax, and revitalizing employees' sense of meaning and community at work are also highlighted.

To see the full study, including the recommendations, click here.