Mediating Factors and Well-Being Differences by Gender Among Academic Physicians.

Importance: A greater understanding of the factors associated with occupational distress for female physicians will allow organizations to more effectively realize the benefits of improving physician occupational well-being. Objective: To identify factors associated with occupational distress among female physicians. Design, Setting, and Participants: This survey study was conducted at 15 US academic medical institutions who participate in the Healthcare Professional Well-Being Academic Consortium. A cross-sectional, voluntary survey was administered to attending physicians from October 2019 to July 2021 to assess occupational well-being. Data were analyzed from April to September 2023. Exposure: Physician gender was used as the exposure variable. Main Outcomes and Measures: Burnout and professional fulfillment were measured using the Professional Fulfillment Index, which included subscales to assess leadership support, personal-organizational values alignment, control over schedule, electronic health record helpfulness, and self-valuation. A secondary data analysis was performed to describe markers of occupational well-being by gender. Mediation models were used to assess the degree to which contributing factors mediated the difference in occupational distress between female and male physicians. Results: The survey was completed by 19 088 of 37 511 attending physicians (response rate of 50.8%), among whom 16 731 self-identified as male or female and were included in the analysis (8197 female [43%] and 8534 male [45%]), and 2357 (12%) either did not report their gender or reported a gender other than male or female. Respondents' ages ranged from younger than 29 to older than 60 years, with 40 to 49 years being the most common age bracket for both female (2788 participants [34%]) and male (2448 participants [29%]) physicians. Compared with male physicians, female physicians experienced more burnout (3338 of 8052 participants [42%] vs 2769 of 8404 participants [33%]; P < .001) and less professional fulfillment (2786 of 8133 participants [34%] vs 3852 of 8463 participants [46%]; P < .001). In mediation models including 5 factors associated with occupational well-being, the direct association between burnout and gender was no longer significant (B = 0.04; 95% CI, -0.01 to 0.08; P = .14), while the gender difference in professional fulfillment remained significant (B = -0.09; 95% CI, -0.14 to -0.04; P = .001). The indirect association of gender with burnout through self-valuation (B = 0.27; 95% CI, 0.24 to 0.29; P < .001) accounted for the majority (63%) of the total difference in burnout between female and male physicians. Conclusions and Relevance: In this survey study of attending physicians, the gender difference in burnout was fully mediated by 5 factors associated with occupational well-being, with self-valuation being the largest mediator. These same factors did not fully explain the difference in professional fulfillment, suggesting that further research is needed.