A cross-sectional study of nearly 8,000 emergency medicine residents shows that among the many factors that can contribute to burnout among resident physicians, sexual orientation was linked to a higher risk of work-related and personal burnout.
The study, “Sexual Orientation and Burnout Among Emergency Medicine Residents,” was published earlier this year in JAMA Network Open. Researchers found that emergency medicine residents who identified as lesbian, gay, bisexual, queer, asexual or other type of what the study authors termed a “sexual minority” reported higher levels of internal burnout and burnout overall than did residents who identified as heterosexual. The differences found in the study reached statistical significance.
“All resident physicians deserve to learn and care for patients in an environment that protects their well-being and allows them to thrive. That must include LGBTQ+ residents,” said Heather Farley, MD, MHCDS, the AMA’s group vice president of professional satisfaction and practice sustainability. “Burnout remains a serious concern across medicine, and we must create training environments where every physician feels supported, valued and able to emerge from residency fulfilled and prepared to thrive in practice.”
As the leader in physician well-being, the AMA provides organizational solutions that help physicians and health systems optimize practice efficiency, reduce burnout and rediscover the Joy in Medicine®.
Many facets of resident burnout
The most recent study included the results of a survey of 7,852 emergency medicine residents who took the American Board of Emergency Medicine In-Training Exam between Feb. 27 and March 2, 2024.
In the study, 12% of the residents identified as a sexual minority. Of that total:
- 35% identified as bisexual.
- 34%—gay or lesbian.
- 11%—other.
- 10%—queer.
- 4%—asexual.
- 4%—pansexual.
The American Board of Emergency Medicine survey did not ask about gender identity.
Residents who identified as a sexual minority were 7% more likely to report internal burnout—which the study’s authors defined as being related to personal and work-related burnout. They were more likely to report external burnout—related to patient care—though the difference was not statistically significant. They were also 7% more likely than heterosexual residents to report having at least one type of burnout and 3% more likely to report having both types of burnout.
Residents who identified as a sexual minority also were more likely to answer that they at least sometimes or somewhat experienced feeling:
- Tired.
- Physically exhausted.
- Burned out because of their work.
- Worn out at the end of the day.
- It was hard to work with patients.
- Frustrated about working with patients.
They were also likelier to say they “always or to a very high degree” had all the experiences.
“Broader institutional and professional changes outside of wellness initiatives at the residency and hospital level are needed to address the profound mental health threats facing medical trainees,” the study says.
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Unique set of circumstances
Being a sexual minority in residency training brings with it unique challenges, said Mollie Marr, MD, PhD. Dr. Marr is a psychiatry PGY-4 in Massachusetts and serves as vice chair on the AMA LGBTQ+ Section Governing Council.
Dr. Marr wears rainbow lanyards and pins on her clothes while at work to communicate to patients that she’s comfortable discussing topics related to sexual orientation and gender identity. Though some patients appreciate her openness, she has experienced threatening and disparaging comments while working in the emergency department.
“I certainly don’t lead with my identity. It’s just a lanyard, but I have had patients verbally attack me for just having something rainbow on my person, which is unexpected and not something that my colleagues have faced,” she said. “When there have been comments by patients, they're often aggressive in a more sexualized way, I think because it's around a sexual orientation. That is certainly not something that anyone deserves to be exposed to in their workplace.”
Dr. Marr, who plans to pursue fellowship training in child and adolescent psychiatry, said there is also an element of “self-disclosure” inherent in her work and in residency training in general.
“You're working with patients, and they're asking questions. They're seeking information. And disclosing your identity is something that carries a lot of weight,” she said. “It also puts you in a position—if you're getting supervision from a faculty member—about having to make a choice about whether it's safe to disclose to that faculty member about your sexual orientation. And that's something where you don't necessarily know how it's going to be received.”
Dr. Marr said that her training institution has clear behavioral standards for patients, and though support from training programs is essential, there is only so much that can be done.
“It doesn't always work perfectly,” she said. “There are going to be instances where the patient needs to be treated because there are emergent situations. … It’s hard to provide protection in an imperfect world.”
Dr. Marr said her advice for others struggling in residency and fellowship training is to assess your values and determine how to cope in a way that fits your value system. The importance to you of advocacy, disclosure and educational excellence—these factors are different for everyone and may shift over time.
“Part of burnout is when you’re in positions where you are making decisions that don’t align with your own values,” Dr. Marr said. “I don't know that we talk frequently enough about our individual and core values and how they contribute to our moral orientation and ethical decision-making.”
Learn more about the AMA LGBTQ+ Section, which addresses many important issues of interest to LGBTQ+ medical students, residents and fellows, LGBTQ+ physicians, patients and allies.
Data shows lower burnout rates nationally
The JAMA Network Open study shows burnout rates for residents in emergency medicine who identified as a sexual minority at 54% compared with 47% for those who identified as heterosexual.
Data from the AMA has shown national burnout rates for all those in residency and fellowship training dropped by 8 percentage points from the 2023 findings, to 34.5% in 2024. The 2024 findings reported burnout for practicing physicians at 43.2% in comparison. Notably, there is continued variation in reported burnout by resident gender, program year and specialty.
The AMA has resources to serve as a collaborator in addressing the factors that cause resident burnout and stress, including the AMA STEPS Forward® toolkit, “Resident and Fellow Well-Being: Optimize Well-Being at Work for Physician Learners.” It is enduring material and designated by the AMA for a maximum of 0.25 AMA PRA Category 1 Credit™.
The module is part of the AMA Ed Hub™️, an online learning platform that brings together high-quality CME, maintenance of certification, and educational content from trusted sources, all in one place—with activities relevant to you, automated credit tracking, and reporting for some states and specialty boards.
Learn more about AMA CME accreditation.
