Exploring the impact of ethno-racial trauma on the well-being of US physicians: A scoping review

Background/Purpose: Providers who identify as Underrepresented in Medicine (URiM) are disproportionately affected by the trauma resulting from systemic bigotry and injustice. This ethno-racial trauma (ERT) has been characterised by discrimination, obstacles to career advancement and leadership roles, and a lack of mentorship and representation. In this review, we sought to bring together the existing literature on ERT and its influence on the well-being of attending physicians in the USA, while also examining how different aspects of well-being are shaped using the PERMA (Positive emotions, Engagement, Relationships, Meaning and Accomplishment) conceptual framework for flourishing and well-being. Methods: This scoping review was conducted according to the JBI Manual for Evidence Synthesis: Scoping Reviews Chapter. A literature search of six bibliographic databases and one grey literature source was conducted in 2023 and updated in 2024, without time restriction applied. All English language studies conducted in the USA that assessed the impact of ERT on physicians and/or physician trainees were included. Results: Of the 4656 manuscripts identified for initial screening, 534 studies underwent full-text review, and 94 studies met inclusion criteria, with 29 studies focused on physicians alone and 18 focused on both physicians and physician trainees. Physicians most frequently described ERT in the form of devaluation of work, discrimination, explicit and implicit bias, inadequate support, professional isolation and microaggressions. Reported sources of ERT included patients, peers, other practitioners and institutional leadership. Also, ERT was consistently associated with heightened burnout, stress and isolation and was linked to diminished career advancement, reduced job satisfaction and impaired emotional well-being. Across studies in this review, all domains of the PERMA framework were adversely impacted. Conclusion: Current evidence demonstrates that ERT profoundly undermines physicians' well-being. Urgent interventional research is needed to identify, implement and evaluate strategies that mitigate ERT's effects and promote a more equitable professional environment.