Perspectives of female and under-represented physicians on well-being in medicine: a qualitative study from an academic medical centre in the USA

BMJ Open · 2026-03-01

BACKGROUND: Stress and burnout are pervasive among physicians. Academic physicians who are female and physicians who are under-represented in medicine (URM) face inequities in the workplace and beyond. Understanding their experiences is crucial for workforce sustainability and diversity, especially given the disproportionate effects on these individuals and overall workforce capacity. OBJECTIVE: To qualitatively explore the perspectives of academic female and URM physicians and identify key themes affecting their careers and well-being. DESIGN: Semi-structured interviews were conducted with 30 physicians at an urban academic health system. Interviews were audio-recorded, transcribed and thematically analysed using a general inductive approach. Interview guides were informed by prior literature and constructs. INTERVENTION: None. SETTING AND PARTICIPANTS: Female and URM physicians from a large, academic medical centre were recruited via email. Participants self-reported demographic information, including sex, race, ethnicity and tenure. OUTCOMES AND MEASURES: The primary outcomes encompassed the main themes identified through the analysis of interviews with female and URM physicians regarding their perspectives on well-being, mental health and academic medicine. RESULTS: 30 female or URM physicians were interviewed (27 (90%) female; 14 (47%) black, Asian or multi-racial). Thematic analysis revealed four key themes: physician identity (URM, female, family), well-being in the workplace (emotional health, staffing burden, non-clinical responsibilities), barriers to accessing well-being resources (workplace environment, culture, overgeneralisation) and facilitators to well-being (physician camaraderie, leadership support). Physicians discussed how their identities influenced their experiences of well-being. They highlighted emotional health challenges, staffing burdens and administrative tasks contributing to stress. Barriers to accessing resources included workplace culture and broad-based interventions, while supportive leadership and camaraderie were identified as facilitators of access. CONCLUSION: Female and URM physicians face systemic challenges impacting their well-being and careers. These findings underscore the need to address systemic changes and specifically design programmes focused on promoting the well-being and inclusivity of female and URM physicians. Tailored interventions to these individuals, supportive leadership structures and collaborative working cultures are crucial for addressing these issues and sustaining a diverse physician workforce.

Behavioral Interventions Improve Mailed Colorectal Cancer Screening Among Overdue Patients in a Randomized Trial

Clinical Gastroenterology and Hepatology · 2025-09-23 · 2 citations

BACKGROUND & AIMS: Mailed fecal immunochemical testing (FIT) can boost colorectal cancer screening (CRC) rates, but response rates remain limited. We evaluated if behavioral interventions increased response rates. METHODS: This pragmatic randomized trial with a 2 × 2 × 2 factorial design included primary care patients aged 50 to 74 years who were overdue for CRC screening. Patients were randomized 1:1 to receive a health system-branded blue box or a standard envelope. Patients were concurrently randomized 1:1 to receive or not receive text reminders. Patients were also concurrently randomized 1:1 to receive a reminder letter. The primary outcome was the proportion who completed a FIT within 4 months. RESULTS: Among 5244 patients included, the mean age was 59.6 years (standard deviation [SD], 7.3 years); 35.8% were Black and 53% were White. At 4 months, 17.8% (95% confidence interval [CI], 16.3%-19.2%) who received the box, compared with 18.0% (95% CI, 16.5%-19.5%) who received the standard envelope, completed FIT, an absolute difference of -0.2% (95% CI, -2.3 to 1.9%; P = .85). Among those who received text messaging, 21.2% (95% CI, 19.6%-22.8%) completed FIT compared with 14.6% (95% CI, 13.2%-15.9%) of those who did not, an absolute difference of 6.6% (95% CI, 4.6%-8.7%; P < .001). Among those that received the mailed reminder, 20.3% (95% CI, 18.7%-21.8%) completed FIT compared with 15.5% (95% CI, 14.1%-16.9%) of those who did not, an absolute difference of 4.8% (95% CI, 2.7%-6.9%; P < .001). CONCLUSIONS: Behaviorally informed text messaging and mailed reminders significantly increased screening completion, but the health system-branded box did not increase response rates. CLINICALTRIALS: gov, Number: NCT05341622.

A communication-efficient federated learning algorithm to assess racial disparities in post-transplantation survival time

Journal of the American Medical Informatics Association · 2025-08-02 · 1 citations

OBJECTIVE: Patients of different race have different outcomes following renal transplantation. Patients of different race also undergo renal transplantation at different hospitals. We used a novel decentralized multisite approach to quantitatively assess the effect of site of care on racial disparities between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in post-transplantation survival times. MATERIALS AND METHODS: In this study, we develop a communication-efficient federated learning algorithm to assess site-of-care associated racial disparities based on decentralized time-to-event data, called Communication-Efficient Distributed Analysis for Racial Disparity in Time-to-event Data (CEDAR-t2e). The algorithm includes 2 modules. Module I is to estimate the site-specific proportional hazards model for time-to-event outcomes in a distributed manner, in which the Poissonization is used to simplify the estimation procedure. Based on the estimated results from Module I, Module II calculates how long the kidney failure time of NHB patients would be extended had they been admitted to transplant centers in the same distribution as NHW patients were admitted. RESULTS: With application to United States Renal Data System data covering 39 043 patients across 73 transplant centers, we found no evidence suggesting the presence of site-of-care associated racial disparities in post-transplantation survival times. In particular, restricting to one year after transplantation, the counterfactual graft failure time would have been extended by only 0.61 days on average if NHB had the same admission distribution to transplant centers as NHW patients. DISCUSSION: The proposed approach offers a quantitative measure to evaluate site-of-care associated racial disparities. CONCLUSION: Our approach has the potential to be extended to investigate site-of-care related disparities in other time-to-event outcomes, thus promoting health equity and improving patient health in various fields.

Evaluating Risk-Adjusted Associations between Prenatal Care Utilization and Obstetric Outcomes in a Commercially Insured Patient Population

American Journal of Perinatology · 2025-03-17

Office prenatal care has followed a similar structure for the past century. It is largely unknown whether attendance at routine outpatient antenatal visits prevents major adverse maternal outcomes. This study examined associations between prenatal care utilization and adverse obstetric outcomes including severe maternal morbidity (SMM), preterm birth, and stillbirth in a large, commercially insured US patient population.This is a retrospective cohort study using an insurance claims database evaluating associations between prenatal care utilization and obstetric outcomes over 4 years (2017-2020). Prenatal care utilization was characterized based on the adequacy of prenatal care utilization (APNCU) index. The primary outcome was SMM (as per Centers for Disease Control). Secondary outcomes included preterm birth <37 weeks and stillbirth. Associations between exposure and outcome were investigated using logistic regression models in designated "low" and "medium" maternal risk groups, defined based on obstetric co-morbidity index (OB-CMI) scores modeled at the time of the first trimester and at delivery.A total of 297,453 patients were included: 78,100 in the sub-group who remained low-risk throughout pregnancy and 49,920 in the sub-group who remained medium-risk. The largest number of patients overall (29.9%) received "adequate plus" care, as defined by the APNCU index, while a plurality of low- and medium-risk patients received "intermediate" care (35.6 and 29.9%, respectively). One point seventy seven percent of patients experienced SMM, 8.63% delivered preterm, and 0.88% had stillbirth. Adjusted analysis comparing volume of prenatal care with these outcomes demonstrated no statistically significant associations, with the exception of preterm birth, which was positively associated with "adequate" and "adequate plus" care in low- and medium-risk patients. "Inadequate care" was not associated with any of the studied outcomes.Overall volume of prenatal care was not associated with a reduction in adverse obstetric outcomes. Clinical quality improvement and health policy efforts to improve prenatal care delivery models may need to bypass adherence to established guidelines in terms of gross visit number as a key metric and instead work to revise practices based on more meaningful clinical outcomes. · It is unknown whether receipt of routine prenatal care is associated with better pregnancy outcomes.. · There were no associations between amount of prenatal care and SMM or stillbirth.. · Preterm birth was associated with "adequate" and "adequate plus" care in low- and medium-risk patients.. · Likely suggesting higher utilization in the setting of concerning symptoms.. · "Inadequate" care was not associated with any of the studied adverse outcomes..

Evaluating Factors Associated with Suicidal Ideation Among Healthcare Workers: A Secondary Analysis

Journal of General Internal Medicine · 2025-04-24

A latent transfer learning method for estimating hospital-specific post-acute healthcare demands following SARS-CoV-2 infection

Patterns · 2025-01-23

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COLA-GLM: collaborative one-shot and lossless algorithms of generalized linear models for decentralized observational healthcare data

npj Digital Medicine · 2025-07-15 · 2 citations

Clinical insights from real-world data often require aggregating information from institutions to ensure sufficient sample sizes and generalizability. However, patient privacy concerns only limit the sharing of patient-level data, and traditional federated learning algorithms, relying on extensive back-and-forth communications, can be inefficient to implement. We introduce the Collaborative One-shot Lossless Algorithm for Generalized Linear Models (COLA-GLM), a novel federated learning algorithm that supports diverse outcome types via generalized linear models and achieves results identical to a pooled patient-level data analysis (lossless) with only a single round of aggregated data exchange (one-shot). To further protect aggregated institutional data, we developed a secure extension, secure-COLA-GLM, utilizing homomorphic encryption. We demonstrated the effectiveness and lossless property of COLA-GLM through applications to an international influenza cohort and a decentralized U.S. COVID-19 mortality study. COLA-GLM and secure-COLA-GLM offer a scalable, efficient solution for decentralized collaborative learning involving multiple data partners and diverse security requirements.

Payments to Physician Practices and Incentives to Serve Different Racial and Ethnic Groups

JAMA Health Forum · 2025-11-26

Importance: In the US, a physician can be paid very different amounts for treating different patients, even when providing identical services. Understanding physician practices' financial incentives to serve different racial and ethnic groups may help inform payment policies to reduce health disparities. Objective: To measure disparities across patient racial and ethnic groups in per-visit payment to physician practices from health insurers and other sources, adjusted for visit content, geographic market, and year, and to quantify the role of health insurance source and other factors in these disparities. Design, Setting, and Participants: A unique, nationally representative dataset of outpatient visits containing survey-obtained patient race and ethnicity and payment amounts to physician practices from health insurers and other sources was analyzed. Data were collected from 2014 to 2021. Main Outcomes and Measures: Payment disparities were defined as gaps between patient groups defined by race and ethnicity in total payments per visit to physician practices, adjusted for visit content, geographic market, and year. Kitagawa-Oaxaca-Blinder decompositions were used to estimate the magnitude of these disparities and to quantify the roles of factors like health insurance. Results: The sample included 38 722 patients and 152 336 outpatient visits for evaluation and management services; a total of 8126 (21.0%) were Hispanic, 6150 (15.9%) were non-Hispanic Black, and 24 446 (63.1%) were non-Hispanic White. A total of 152 336 outpatient visits were included for evaluation and management services. In adjusted analyses, outpatient payments were 8.8% (95% CI, 6.7-11.0) less for visits with non-Hispanic Black patients and 9.8% (95% CI, 7.2-12.4) less for visits with Hispanic patients compared with visits with non-Hispanic White patients. Payment gaps were largest for children (13.9% [95% CI, 11.8-16.0] for non-Hispanic Black children; 15.1% [95% CI, 12.8-17.4] for Hispanic children), smaller when adjusted for insurance source (4.9% [95% CI, 2.7-7.1] for non-Hispanic Black patients; 5.6% [95% CI, 3.0-8.3] for Hispanic patients), and absent among patients with fee-for-service Medicare (1.2% [95% CI, -1.5 to 3.9] for non-Hispanic Black patients; -0.6% [95% CI, -4.4 to 3.2] for Hispanic patients). Conclusions and Relevance: In this study, US physician practices were paid more for outpatient visits with non-Hispanic White patients than for outpatient visits with Hispanic or non-Hispanic Black patients. Payment disparities were larger in pediatrics and partly explained by insurance. Differential financial incentives to serve non-Hispanic White patients may worsen disparities in health care access, utilization, and quality.

Proactively Delivered Digital Mental Health Support for Health Care Workers: Usability and Acceptability Evaluation

JMIR Formative Research · 2025-12-09

BACKGROUND: Health systems are investing in mental health and well-being support tools and resources for health care workers (HCW). Considering the mental health strain facing HCWs, there is a need to optimize the current mental health delivery model. OBJECTIVE: This study aimed to evaluate the usability and acceptability of a proactive digital mental health approach (Cobalt+;Penn Medicine), which included services proactively sent to HCWs via text messaging, including (1) monthly automated text messaging reminders and links to Cobalt, and (2) bimonthly text-message-based measures of depression and anxiety. METHODS: This study used the System Usability Scale (SUS), Net Promoter Score (NPS), and open-ended questions to capture Cobalt+ participants who received proactive digital mental health tools and resources. Descriptive summary statistics were used for SUS and NPS outcome measures, and a chi-square test was used to detect group differences. Open-ended questions were analyzed using a qualitative open coding process by 2 coders. Research team members calculated interrater agreement (Cohen κ above 0.80). RESULTS: A total of 162 of 642 HCWs randomized to Cobalt+ (25.2%) visited Cobalt due to a proactive text message and completed usability and acceptability measures. The mean age was 38.9 years, most were female (90.7%), 56.8% White, 53.1% married or partnered, and 34.6% engaged in shift work. The mean SUS score was 74.43 (median score 72.5). Participants said they mostly "browsed" the online mental health platform. Cobalt+ received an NPS of 13.7. When asked to elaborate on their experience, 2 categories (eg, positive and negative experiences) with 13 subcategories were identified. Most participants noted the brief process that helped prioritize mental health: "Forget otherwise. Puts in forefront of my mind," and "Your texts do remind me to take stock of my current feelings." CONCLUSIONS: A proactive digital mental health approach may help overcome barriers in the uptake of services that are otherwise passively available to HCWs. This study demonstrated that the proactive approach is generally usable, modestly acceptable, and further supplemented by HCW feedback. These findings suggest the approach's viability and the need for additional research toward improvement and broader implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05028075; https://clinicaltrials.gov/study/NCT05028075.

Telemedicine Utilization Trajectories and Sociodemographic Differences, 2019-2024

medRxiv · 2025-03-26 · 1 citations

Abstract IMPORTANCE Telemedicine usage surged during the COVID-19 pandemic, shaping how patients access healthcare services. Its sustained role in post-pandemic healthcare may uncover long-term trends and variations in utilization. OBJECTIVE To characterize telemedicine utilization patterns from 2019 to 2024 and identify patient characteristics associated with telemedicine use. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed outpatient visits across five hospitals within the University of Pennsylvania Health System (Penn Medicine) from January 1, 2019, to September 30, 2024. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of visits conducted through telemedicine. Multivariable logistic regression models were employed to assess association between telemedicine use and patient characteristics including demographics, insurance type, patient portal use, and socioeconomic status. RESULTS The study included 46,149,734 visits among 2,248,341 patients. Following the declaration of the COVID-19 pandemic in March 2020, telemedicine surged from 1% to 17% of outpatient encounters by April 2020, stabilizing at 8-13% for the rest of the year. Usage declined in 2021 but remained at 4-6% from 2022 to 2024. In multivariable models, older adults were less likely to use telemedicine compared to those under 40 years (40-64 years: aOR, 0.67 [95% CI, 0.67-0.67]; ≥65 years: aOR, 0.46 [95% CI, 0.46-0.46]). Higher telemedicine use was observed among women (male: aOR, 0.91 [95% CI, 0.91-0.92]), unmarried individuals (aOR, 1.10, 95% CI, 1.10-1.11), patient portal users (aOR, 1.44 [95% CI, 1.43-1.45]), patients with fewer comorbidities (Charlson Comorbidity Index scores ≥3: aOR, 0.87 [95% CI, 0.87-0.88]), those living farther from the place of service (5-15 miles: aOR, 1.04 [95% CI, 1.04-1.04]; ≥15 miles: aOR, 1.44 [95% CI, 1.43-1.44]; reference: &lt;5 miles), lower-income individuals (&lt;$50,000: aOR, 1.06 [95% CI, 1.06-1.07]; ≥$100,000: aOR, 0.91 [95% CI, 0.91-0.92]; reference: $50,000-$100,000), and primary care compared to specialty care (aOR, 1.19 [95% CI, 1.18-1.20]). Return patients used telemedicine more than new patients (new: aOR, 0.47 [95% CI, 0.47-0.47]). Telemdicine use varied by race/ethnicity, with lower use among Non-Hispanic Black (aOR, 0.89 [95% CI, 0.88-0.89]), Hispanic (aOR, 0.95 [95% CI, 0.95-0.96]), and Asian (aOR, 0.83 [95% CI, 0.82-0.83]) patients compared to Non-Hispanic White patients. Patterns varied across visit types (e.g., diabetes, mental disorders, sleep disorders, heart failure, COPD, CAD, and GI disorders), though younger, female, and geographically distant patients consistently used telemedicine more. Non-Hispanic White patients with mental disorders exhibited disproportionately higher telemedicine use, underscoring racial/ethnic differences that persisted during and after the pandemic, likely influenced by differences in access and coverage. CONCLUSIONS AND RELEVANCE Telemedicine use is higher among tech-friendly populations, including, younger individuals, female, return patients, and those living farther from healthcare facilities. However, difference by age, socioeconomic status, and race/ethnicity persist, suggesting barriers in access, digital literacy, and coverage. Targeted policies are needed to ensure equitable telemedicine adoption and accessibility for all patients. Key Points Question What has been the trajectory of telemedicine usage since the COVID-19 pandemic, and which sociodemographic factors are associated with its persistent use? Findings Telemedicine visits to the University of Pennsylvania Health System (Penn Medicine) surged with the onset of the COVID-19 pandemic in 2020. While telemedicine has since remained a significant component of outpatient care, its use has been uneven. Younger adults, women, patient portal users, unmarried individuals, return patients, and those with lower Charlson Comorbidity Index scores, were more likely to use telemedicine services. Moreover, racial and ethnic minorities, as well as socioeconomically disadvantaged populations, displayed varying patterns of telemedicine access, highlighting differences in utilization. Meaning Persistent differences in telemedicine use across primary care and specialty services highlight factors influencing its adoption, suggesting opportunities for targeted strategies to improve equity in digital healthcare access.