Sexual Orientation and Burnout Among Emergency Medicine Residents

Importance: Burnout is highly prevalent among emergency medicine (EM) residents and is associated with negative outcomes for physician well-being and patient care. Emerging evidence suggests sexual minority trainees may be at increased risk, but differences within EM residency are not well characterized. Objective: To determine if burnout prevalence among EM residents differs by sexual orientation after adjustment for key confounders. Design, Setting, and Participants: This cross-sectional study included US resident physicians who took the 2024 American Board of Emergency Medicine In-Training Exam (ITE) postexamination survey and answered the question on sexual orientation. Exposure: Sexual minority status (heterosexual or straight and sexual minority lesbian, gay, bisexual, queer or questioning, asexual, pansexual, or other sexual identity), adjusted for age, gender, race and ethnicity, postgraduate training year, program length, and region. Main Outcomes and Measures: The primary outcome was burnout, assessed with an abbreviated 6-item Copenhagen Burnout Inventory: internal (personal or work-related) and external (patient-related) burnout. Prevalence ratios (PRs) were estimated for burnout stratified by sexual orientation, utilizing Poisson regression with robust standard errors. Results: Of 9478 residents who took the ITE, 7852 respondents (median IQR age, 30 28-32 years; 4416 male 56%; 3364 female 43%; 56 nonbinary 1%) were included, with 928 (12%) identifying as a sexual minority and 6924 (88%) identifying as heterosexual. Compared with heterosexual residents, sexual minority residents had higher prevalence of any burnout prevalence (431 of 803 residents 54% vs 2786 of 5967 residents 47%; P < .001) and internal burnout (311 of 802 residents 39% vs 1902 of 5979 residents 32%; P < .001). After adjustment, sexual minority status was associated with higher prevalence of internal burnout (PR, 1.12; 95% CI, 1.02-1.24) and any burnout (PR, 1.09; 95% CI, 1.01-1.17). Among sexual minority subgroups, bisexual residents had the highest adjusted prevalence of any burnout (PR, 1.17; 95% CI, 1.05-1.30), and queer residents had higher prevalence of internal burnout (PR, 1.28; 95% CI, 1.02-1.62). Conclusions and Relevance: In this cross-sectional study of 7852 EM residents, those who identified as a sexual minority reported higher burnout, particularly internal burnout, compared with heterosexual peers. These findings indicate that targeted support for sexual minority trainees is needed to improve physician well-being, training experience, and patient care.