Patterns and Impact of Burnout among Women in the Urology Workforce

INTRODUCTION AND OBJECTIVE: Contemporary rates of burnout amongst urologists are reported to be 60-80%. These rates have significant implications on physician well-being and retention. We investigated predictors of burnout in female surgeons. METHOD(S): An electronic census survey was distributed to residents, fellows and practicing urologists by the Society of Women in Urology in the United States and territories via email and social media between February and May 2022. We assessed participant demographics, personal and professional characteristics, practice environment, compensation, and burnout with chi-square and t-test analyses. RESULT(S): There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cis-gendered heterosexual females (96%) and were practicing urologists (74%), while 10% were fellows and 15% residents/interns. Average reported time in practice was 9 years (SD 9 years). Most respondents reported burnout (273, 72%), with 87% agreeing COVID worsened burnout in the community. Those reporting burnout worked an average of 58 (SD 15) hours per week versus 49 (SD 18) hours (p<0.00001). Table 1 demonstrates significant personal and professional characteristics for participants who reported burnout. On multivariable logistic regression analysis, increased hours worked per week (OR 1.03, p=0.002), Relative Value Unit based pay versus salary (OR 4.4, p=0.007), correlated to burnout and feeling income is comparable to peers (OR 0.4, p=0.03) was inversely related. Common shared experiences included lack of staffing, reduced operating room time, lack of administrative support, predominance of non-operative referrals, gender and racial inequity or microaggressions, electronic health records with increased documentation demands, increased non-clinical administrative duties, and insufficient compensation or lack of financial advancement. CONCLUSION(S): A majority of women in urology report burnout with work-hours and compensation inequity as leading contributing factors. Concerns raised in this study such as lack of support staff, racial and gender inequity, and poor referral patterns should be further evaluated to determine a comprehensive plan to reduce burnout. (Figure Presented).

Lessons (Not) Learned: Chicago Death Inequities during the 1918 Influenza and COVID-19 Pandemics.

During historical and contemporary crises in the U.S., Blacks and other marginalized groups experience an increased risk for adverse health, social, and economic outcomes. These outcomes are driven by structural factors, such as poverty, racial residential segregation, and racial discrimination. These factors affect communities' exposure to risk and ability to recover from disasters, such as pandemics. This study examines whether areas where descendants of enslaved Africans and other Blacks lived in Chicago were vulnerable to excess death during the 1918 influenza pandemic and whether these disparities persisted in the same areas during the COVID-19 pandemic. To examine disparities, demographic data and influenza and pneumonia deaths were digitized from historic weekly paper maps from the week ending on 5 October 1918 to the week ending on 16 November 1918. Census tracts were labeled predominantly Black or white if the population threshold for the group in a census tract was 40% or higher for only one group. Historic neighborhood boundaries were used to aggregate census tract data. The 1918 spatial distribution of influenza and pneumonia mortality rates and cases in Chicago was then compared to the spatial distribution of COVID-19 mortality rates and cases using publicly available datasets. The results show that during the 1918 pandemic, mortality rates in white, immigrant and Black neighborhoods near industrial areas were highest. Pneumonia mortality rates in both Black and immigrant white neighborhoods near industrial areas were approximately double the rates of neighborhoods with predominantly US-born whites. Pneumonia mortality in Black and immigrant white neighborhoods, far away from industrial areas, was also higher (40% more) than in US-born white neighborhoods. Around 100 years later, COVID-19 mortality was high in areas with high concentrations of Blacks based on zip code analysis, even though the proportion of the Black population with COVID was similar or lower than other racial and immigrant groups. These findings highlight the continued cost of racial disparities in American society in the form of avoidable high rates of Black death during pandemics.

The COVID-19 pandemic and Asian American employment.

Recent studies have documented the disparate impact of the COVID-19 pandemic on labor market outcomes for different racial groups. This paper adds to this literature by documenting that the employment of Asian Americans-in particular those with no college education-has been especially hard hit by the economic crisis associated with the onset of the pandemic. This can only partly be explained by differences in demographics, local market conditions, and job characteristics, and it also cannot be entirely explained by possible different selection into education levels across ethnic groups. The burden on Asian Americans is primarily borne by those who are not US-born. Supplementary Information: The online version contains supplementary material available at 10.1007/s00181-022-02306-5.

Using Telehealth through the Mobile Channel to Reduce Health Inequality and Disparity: A Real-World Study Examining Patients with Type 2 Diabetes Mellitus

Background and Aims: COVID-19 led to digital acceleration, raising alarms that minorities (Black/Hispanic) would be left further behind. Did patients with type 2 diabetes (PwT2D) who rely on routine care change their use of health IT resources? Methods: Using longitudinal patient portal usage data of 55,548 PwT2Dfroman urban hospital in the U.S.,we examinedmobile-vsdesktop internet access before-and-after COVID-19. We constructed threemodels using the panel dataset: pooled Ordinary Least Squares (OLS), random effect (RE), and fixed effect (FE). Result(s): The interaction of COVID-PeriodxMinority across the three models (OLS/RE/FE) was significant and showed racial disparity is increasing for desktop use (beta= -0.052/-0.053/-0.054) and decreasing for mobile use (beta = 0.026/0.025/0.025). COVID- 19 has reduced the gap by 34% (0.025/0.073) according to the RE model. Table 1 shows that racial disparity shrinkage is largely driven by the use of mobile communication. Conclusion(s): COVID-19 is a natural experiment providing the opportunity to investigate whether accelerated digitization impacted health inequality and disparity among PwT2D. The effect is mostly driven by mobile device access and cannot be explained by pre-COVID-19 trends. First, COVID-19 has been cited as a ''great magnifier'' of pre-existing racial inequality in health;however, telehealth can become a ''great equalizer'' for reducing inequity. Second, in the U.S., much effort in combating the digital divide has focused on the broadband connectivity gap;the transformative potential of mobile health is overlooked. Third, the lack of access to patient portals has disadvantaged PwT2D minorities;so long as they have access, they can ''catch up.'' NIH Award 5UL1TR001425-03.

On race, human variation, and who gets and dies of sepsis

COVID-19 has highlighted a brutal reality known for decades, that Black, Indigenous, and People of Color bear a disproportionate burden of US annual sepsis cases. While plentiful research funds have been spent investigating genetic reasons for racial disparities in sepsis, an abundance of research shows that sepsis incidence and mortality maps to indicators of colonial practices including residential segregation, economic and marginalization sepsis, and denial of care. Here we argue that sepsis risk is an immunological embodiment of racism in colonial states, that the factors contributing to sepsis disparities are insidious and systemic. We show that regardless of causative pathogen, or host ancestry, racialized people get and die of sepsis most frequently in a pattern repeatedly reiterated worldwide. Lastly, we argue that while alleviation of sepsis disparities requires radical, multiscale intervention, biological anthropologists have a responsibility in this crisis. While some of us can harness our expertise to take on the ground action in sepsis prevention, all of us can leverage our positions as the first point of contact for in depth human biology instruction on most college campuses. As a leading cause of death worldwide, and a syndrome that exhibits the interplay between human physiology, race and environment, sepsis is at the nexus of major themes in biological anthropology and is a natural fit for the field's curriculum. In adopting a discussion of race and sepsis in our courses, we not only develop new research areas but increase public awareness of both sepsis and the factors contributing to uneven sepsis burden.Copyright © 2022 The Authors. American Journal of Biological Anthropology published by Wiley Periodicals LLC.

Covid, schooling and race in England: a case of necropolitics

In this paper, I focus on the UK government's Covid-19 pandemic response to schooling in England with regards to the impact on race inequality, an area which has received comparatively little attention. I review the existing research, drawing on work by academics, think tanks, lobbying organisations and media reports, conducted between spring 2020 and autumn 2021, and argue that this evidence suggests that the UK government's pandemic response firstly has increased existing racial disadvantage for Black, Asian and Minority Ethnic (BAME) pupils in education, and secondly, it has potentially increased the exposure of BAME households to illness and death. I further argue that not only can education policy in response to Covid be considered to be an example of white supremacy, but it is an example of necropolitics, defined as ‘the power and the capacity [of the state] to dictate who may live and who must die' (Mbembe 2013, 161). I conclude by making some recommendations for wide-reaching social and educational change. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Racial diversity and Black vascular surgeons in vascular surgery workforce.

OBJECTIVES: The precise number of actively practicing vascular surgeons who self-identify as Black American and the historical race composition trends within the overall profession of vascular surgery are unknown. Limited demographic data have been collected and maintained at the societal or national board level. Vascular surgery societal reports suggest that less than 2% of vascular surgeons identify as Black American. Black Americans comprise 13.4% of the U.S. population yet for disorders such as peripheral artery disease and end-stage renal disease, Black communities are disproportionately impacted, and the prevalence of disease is greater on an age-adjusted basis. A significant body of research shows that clinical outcomes such as medication adherence, shared decision-making, and research trial participation are positively impacted by racial concordance especially for communities in whom distrust is high as a consequence of historic experiences. This survey aims to characterize practice and career variables within a network of Black American vascular surgeons. METHODS: A cross-sectional survey was conducted via a questionnaire sent to all participants of the Society of Black Vascular Surgeons that began to convene monthly during the COVID-19 pandemic and experienced subsequent organic growth. The survey included 20 questions with variables quantified including the surgeon's demographics, clinical experience, practice setting, patient demographics, and professional society engagement. RESULTS: Fifty-nine percent of the Society of Black Vascular Surgeons members completed the survey. Males comprised 81% of the responding vascular surgeons. The majority (62%) of respondents were involved in academic practice. Less than 25% of the total medical staff were Black American in 77% of the respondents' current work practice. The patient racial composition within their respective practice settings was as follows: White (47%), Black (34%), Hispanic (13%), Asian (3%), Middle Eastern or North African (2%), and American Indian and Alaskan Natives (0.4%). Forty-three percent of respondents had a current active membership in the Society for Vascular Surgery, and 24% had a regional society membership. Fifty-eight percent of respondents reported that they experienced a workplace event that they felt was racially or ethically driven in the 12 months before the survey. CONCLUSIONS: This survey describes an under-represented in medicine vascular surgeon subgroup that has not heretofore been characterized. Racial and ethnic demographic data are essential to better understand the current demographic makeup of our specialty and to develop benchmark goals of race composition that mirrors our society at large. The patients of this group of Black American vascular surgeons were more likely to represent a racial minority. Efforts to increase race diversity in vascular surgery have the potential benefit of enhancing care of patients with vascular disease.

Are there racial disparities in the incidence of venous thromboembolism (VTE) in hospitalized cancer patients with COVID-19?

Background: Both cancer and COVID-19 have been reported to be associated with an increased risk of VTE. Severe disease needing hospitalization is also associated with an increased risk of VTE. There is a paucity of data evaluating the effects of race on this risk, with the limited available data suggesting that such a correlation exists. Given the increased prevalence of comorbidities and risk factors for VTE in African Americans (AA), we sought to evaluate if there are racial disparities in the incidence of VTE in the hospitalized subset of COVID-19 patients with cancer. Method(s): This was a retrospective chart review of unvaccinated cancer patients hospitalized with COVID-19 at a major tertiary health facility. Only cancer patients who were on active systemic chemotherapy were included. The primary study outcomes were development of DVT or PE (VTE) within 30 days of COVID-19 diagnosis. Secondary outcomes included mortality, hospital length of stay, mechanical ventilation, ICU admission, and need for vasopressors. Mean and standard deviation were reported for continuous variables;proportions were reported for categorical variables. To compare between races, the Chi-square test was used for categorical variables and the t-test was used for continuous variables. Multivariable logistic regression was then conducted to assess the relationship between race and selected factors. All statistical tests were 2-sided with an alpha (significance) level of 0.05. Result(s): A total of 73 patients were included in our analysis. The median age of the cohort was 70 years (interquartile range [IQR] 64-79). Gender breakdown: 58.9% males, 41.1 females. 31.5% were Caucasian, 64.4% African American, 1.4% Hispanic, and 2.7% other races/ethnicities. There were 8 DVT/PE patients in the cohort. Of 23 Caucasians in our cohort, 3 (13.0%) had VTE. Of 47 African Americans, 5 (10.6%) had DVT/PE. There was no significant difference between the incidence of VTE and race (p > 0.05). Multivariable logistic regression did not show a significant relationship between race and VTE, controlling for age, ICU stay, intubation, vasopressor use, serum ferritin and serum IL-6 levels. Notably, all patients included in this study were on enoxaparin prophylaxis for VTE. The only variable associated with DVT/PE was age and the presence of hemoglobinopathy. Incidence of VTE was significantly associated with increasing age (p < 0.03) and the presence of hemoglobinopathy (p < 0.01). Hemoglobinopathy was only seen in AA cancer patients with VTE (n = 4), and none in Caucasian patients. Conclusion(s): Contrary to what has been reported in the literature, we did not detect racial disparity in the incidence of VTE in hospitalized cancer patients with COVID 19. Prophylactic anticoagulation likely had a protective effect. However, racial disparity was observed in AA cancer patients with hemoglobinopathy with increased VTE risk despite prophylactic anticoagulation. This warrants further evaluation in future studies.

Effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding: a nationwide study.

The COVID-19 pandemic altered healthcare delivery in the United States. This study examined the effect of the COVID-19 pandemic on the epidemiological trends and outcomes of gastrointestinal bleeding. We compared the admission rate, in-hospital mortality rate, and mean length of hospital stay between 2019 and 2020 to estimate the pandemic effect. The study highlighted disparities in outcomes of gastrointestinal bleeding hospitalizations stratified by sex and race. We noted a 9.5% reduction in the total number of hospitalizations in 2020. We also observed a 13% increase in overall mortality during the pandemic (P < 0.001). There was a 15.8% increase in mortality among men (P = 0.007), compared to a 4.7% increase among women (P = 0.059). There was a significant increase in mortality among Whites in 2020 compared to Black and Hispanic populations. On multivariable logistic regression, admission during the COVID-19 pandemic was associated with increased length of stay when adjusted for age, sex, and race. Despite the direct COVID-19-related morbidity and mortality, the so-called indirect effect of the pandemic cannot be overlooked. For the remainder of the pandemic and future health emergencies, it is critical to balance mitigation of the spread of the contagion with clear public health messages to not neglect other life-threatening emergencies.

Reflections on the COVID-19 mortality among the Black population and racial inequality in Brazil

This literature critical analysis reflects on the social, political and historical background responsible for racial discrepancies in hospital mortality by COVID-19 among the Brazilian population. During the pandemic, the COVID-19 mortality among the Black population gained notoriety. Rather than an isolated fact, this finding has historical roots dating back to Brazil's foundation and draws on structural racism, which reveals degrading living and health conditions experienced by the Black population before the pandemic. This situation of vulnerability affecting the Black population is a recurring scenario that is treated with the neglect inherent to structural racism. COVID-19 mortality portrays one way in which racism impacts and reproduces itself in the life and death of Black people. Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.

COVID-19-Specific Mortality among World Trade Center Health Registry Enrollees Who Resided in New York City.

We examined the all-cause and COVID-19-specific mortality among World Trade Center Health Registry (WTCHR) enrollees. We also examined the socioeconomic factors associated with COVID-19-specific death. Mortality data from the NYC Bureau of Vital Statistics between 2015-2020 were linked to the WTCHR. COVID-19-specific death was defined as having positive COVID-19 tests that match to a death certificate or COVID-19 mentioned on the death certificate via text searching. We conducted step change and pulse regression to assess excess deaths. Limiting to those who died in 2019 (n = 210) and 2020 (n = 286), we examined factors associated with COVID-19-specific deaths using multinomial logistic regression. Death rate among WTCHR enrollees increased during the pandemic (RR: 1.70, 95% CL: 1.25-2.32), driven by the pulse in March-April 2020 (RR: 3.38, 95% CL: 2.62-4.30). No significantly increased death rate was observed during May-December 2020. Being non-Hispanic Black and having at least one co-morbidity had a higher likelihood of COVID-19-associated mortality than being non-Hispanic White and not having any co-morbidity (AOR: 2.43, 95% CL: 1.23-4.77; AOR: 2.86, 95% CL: 1.19-6.88, respectively). The racial disparity in COVID-19-specific deaths attenuated after including neighborhood proportion of essential workers in the model (AOR:1.98, 95% CL: 0.98-4.01). Racial disparities continue to impact mortality by differential occupational exposure and structural inequality in neighborhood representation. The WTC-exposed population are no exception. Continued efforts to reduce transmission risk in communities of color is crucial for addressing health inequities.