Document Type

Article

Publication Date

7-20-2026

Comments

This article is the author’s final published version in JAMA Network Open, Volume 9, Issue 7, 2026, Article number e2624047.

The published version is available at https://doi.org/10.1001/jamanetworkopen.2026.24047. Copyright © 2026 Rudolph D et al.

Abstract

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.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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PubMed ID

42475095

Language

English

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