Burnout has spiked in recent years, particularly among professionals pushed to their limits by the COVID-19 pandemic. Health care providers are nearly twice as likely to experience burnout as professionals in other fields, and Black health care professionals in particular face unique burdens that contribute significantly to higher rates of burnout and attrition.

This can have far-reaching consequences for the quality of care patients receive, as mounting evidence suggests physician burnout can contribute to racial bias and health disparities. Providers who care for pregnant people and newborns have faced especially high rates of burnout in recent years. This is troubling for Black women, whose maternal mortality rate is three times higher than that of white women. Burnout and attrition among Black health care professionals adds urgency to the Black maternal health crisis, given that research has documented better health outcomes among patients who receive racially concordant care (where the provider and patient share the same racial identity).

For a new study on developing and retaining the Black maternal health workforce in California, we spoke with Black obstetricians, midwives, and labor and delivery nurses to understand the difficulties they face and the support they need to thrive in their roles as medical students and professionals.

Discrimination Impedes Black Clinicians’ Career Growth

The study and practice of maternal health care are already demanding, but pervasive racism, microaggressions, and implicit bias pose additional challenges for Black clinicians.

The maternal health workers we spoke with described experiencing blatant discrimination throughout their education and career journeys. Their experiences included “pushout,” or when a person is intentionally unpleasant or unfair to dissuade someone from participating in an activity. Interviewees also noted instances when non-Black professors or colleagues actively tried to redirect them from their desired career by withholding advice and information about career pathways in maternal health care. These experiences align with evidence indicating that Black physicians either leave or are terminated from residency training programs at higher rates than their white counterparts.

Shortage of Racially Diverse Mentors Exacts Unique Toll

The maternal health workers we spoke with highlighted that racially concordant mentors, with whom they could share common lived experiences, often shaped their career paths and education. This parallels other research showing that students of color seek mentors of the same racial or ethnic background and often find their guidance more helpful than that of mentors from different backgrounds. But for our interviewees, a lack of racial diversity—whether in academic institutions or among available Black midwifery preceptors—limited their access to racially concordant mentors.

As clinicians advanced in their careers, the weight of being a sought-after mentor to numerous Black students and other students of color was heavy. The professionals we spoke with who also served as faculty members at predominantly white institutions mentioned the emotional toll of being one of the few people of color in their position and, as a result, being responsible for mentoring a larger number of students than their white counterparts. Their institutions also pressured them to shape diversity, equity, and inclusion initiatives, and interviewees often had to act as the primary advocates for institutional change. Interviewees handled these pressures on top of their traditional duties of teaching, conducting research, and publishing.

Support for Black Clinicians Enhances Patient Health Outcomes

Academia, hospitals, and other institutions can play a role in addressing burnout and improving the retention of Black maternal health clinicians.

A starting point is viewing diversity, equity, and inclusion initiatives as more than simply hiring a larger number of Black providers so students and professionals can see themselves reflected. These initiatives should also foster supportive learning and working environments that have accountability measures for discrimination and that prioritize cultural humility. Institutions can also provide mental health support to clinicians or encourage them to seek appropriate care when they face mental health challenges.

Providing emotional and mental health support to Black maternal health workers is critical when considering the Black maternal mortality crisis and evidence that racially concordant care can improve health outcomes and patients’ satisfaction with the care they receive.

Better supports may give Black clinicians what they need not only to survive but also to thrive as professionals and people — and health care may improve as a result.

This post was originally published on Urban Wire, the blog of the Urban Institute. 

Leandra Lacy

Leandra Lacy is a training and technical assistance specialist in the Research to Action Lab at the Urban Institute. She designs and delivers tailored technical assistance for community-based organizations that Urban supports through the Partnering for Vaccine Equity project, which is funded by the US Centers for Disease Control and Prevention. Lacy also supports the design of a train-the-trainer model for Urban’s Boosting Upward Mobility work, funded by the Bill & Melinda Gates Foundation. Read More

Lauren Fung

Lauren Fung is a research assistant in the Metropolitan Housing and Communities Policy Center at the Urban Institute. Their research focuses on guaranteed income, housing affordability, and maternal health. Read More