Keywords
religiosity - religious accommodations - diversity - inclusion - healthcare workforce
Introduction
Providers' career satisfaction correlates with healthcare outcomes, patient satisfaction,
and providers' retention.[1]
[2] Career satisfaction is defined in many ways,[3]
[4]
[5]
[6] and is impacted by individual, occupational, and systemic factors. Career satisfaction
is defined as the overall contentment with one's choice of occupation and is often
used interchangeably with job satisfaction, where workplace conditions and dynamics
have a huge influence on that sense of contentment.[7] Career satisfaction is a worker's sense of achievement and success on the job and
the collection of feelings and beliefs that people have about their current job. It
is perceived to be directly linked to productivity and personal well-being.[6]
Career dissatisfaction and burnout are at their peak in our healthcare system during
the current pandemic leading to a great loss of practicing clinicians.[8]
[9] A growing body of research shows that burnout among healthcare providers is highly
prevalent. System changes, organizational support, workload, collegiality, and individual
physician-specific factors contribute to burnout.[10] In addition to higher morbidity and mortality in patients, physician burnout has
been linked to self-reported errors and high turnover.[11]
[12] Callousness is an advanced stage of burnout[13] in the clinical context, often used as an indicator of malignant burnout and associated
with poorer outcomes.[14]
[15]
Whereas 70% of individuals in the United States are religiously affiliated,[16] religiosity's effect on career satisfaction is inadequately studied.[17]
[18] Studies show that religious beliefs impact work and patient care attitudes, contribute
to a sense of personal accomplishment,[19] and build resilience among clinicians.[20] Muslim physicians are underrepresented in research,[21] though they comprise greater than 5% of the US healthcare workforce,[22] and religiosity impacts their professional life in many ways.[23] Moreover, in the past two decades, American Muslim clinicians have experienced more
racialization,[24] and discrimination in the workplace[25]
[26] hence, they may be at higher risk of burnout and scrutiny.[27]
To fill in critical gaps in the literature regarding religiosity, religious identity,
and how that impacts career satisfaction, burnout, and callousness, we examined predictors
of career satisfaction, burnout, and callousness among a national sample of Muslim
American physicians.
Materials and Methods
This study is a secondary data analysis of a national survey of Muslim American physicians
carried out by one of the authors (AIP) in 2013. Since study methods are described
in detail elsewhere,[28]
[29]
[30] only the most critical features are noted below. This study received human subjects
research approval from the Institutional Review Board of the Biological Sciences Division
at the University of Chicago.
Participant Recruitment and Data Collection
Since national databases of physicians, like the American Medical Association Masterfile,
do not collect data on religious affiliation, we drew upon the membership of the Islamic
Medical Association of North America (IMANA; n =1968 members in 2013) to draw a national cross-section of Muslim physicians. A random
sample of 746 members was selected for receiving a mailed questionnaire. Of these
120 were excluded due to nonworking addresses, decedent status, or those not practicing
medicine and no longer identifying as Muslim, leaving us with a sample size of 626
potential respondents. This group received up to three mailed survey questionnaires
with escalating fiscal and gift incentives for completion and intermittent postcard
and email reminders.
Survey Instrument and Key Measures
The questionnaire included extant validated measures as well as items created de novo.
The questionnaire underwent cognitive pretesting with a group of Muslim clinicians
and an expert panel review prior to finalization. Outcome domains were career satisfaction,
career burnout, and callousness toward people. The perceived career satisfaction was
assessed by adapting an item previously used by Nunez-Smith et al.[31] This item stated “thinking very generally about your satisfaction with your overall
career in medicine, would you say that you are currently…” with response categories
are appropriate Likert type scale from very dissatisfied to very satisfied. Burnout
and callousness were measured by items from West et al's work.[32] The items read “Thinking generally about your overall career in medicine, would
you say that currently i) I feel burned out from my work ii) I have become more callous
toward people since I took this job.” Each item had a 7-point frequency response scale
from never to every day.
The primary predictor domain was physician religiosity measured by different constructs.
Religious importance[33] was measured with the question “How important would you say your religion is in
your life?” with responses from “not important” to “the most important part of my
life.” This question has been used in multiple physician surveys assessing religion-associated
variations in physicians' clinical practices.[34]
[35] Religious practice was measured with five items. The first three assessed the frequency
with which participants (a) attended congregational worship (daily to less than once
per year), (b) performed Islamic ritual prayers (five times per day to never), and
(c) read the Qur'an (daily to never). The fourth item assessed the extent to which
the participant keeps the Ramadan fasts (strictly to not at all), while the fifth
item assessed adherence to Islamic legal injunctions regarding the consumption of
meat (participants reported whether they would eat meat slaughtered according to Islamic
law, kosher meat, any meat aside from pork, or did not eat meat). To assess their
religious appearance, we asked male respondents whether they wore a beard and female
respondents whether they wore a hijab. We also asked about sectarian affiliation within
Islam (Sunni, Shi'ite). Other predictor domains were perceived religious discrimination
at the workplace, religious accommodation at the workplace, and discrimination-related
job turnover.[30]
Finally, the questionnaire captured conventional sociodemographic descriptors (gender,
age, ethnic/racial background, country of medical school matriculation, and generational
status in the United States) and practice-level data (years in medical practice, medical
specialty, primary work setting, and the percentage of Muslim patients in each participant's
practice).
Data Analyses
Independent double data entry was performed in Research Electronic Data Capture (REDCap)
databases,[36] and cross-compared with original surveys to resolve discrepancies. Where possible,
variables were transformed for ease of interpretation in the following ways: (i) dichotomizing
agreement and satisfaction scales, (ii) collapsing response categories where responses
totaled less than 5% of the sample into adjacent categories, and (iii) dropping the
“other” response category if this category held less than 5% of the sample. A religious
practice variable was a summed score of the five items noted above. After generating
descriptive statistics, we used chi-squared tests and simple logistic regression to
test bivariate associations between each predictor and outcome variable. Given the
exploratory nature of assessing relationships between our variables of interest, bivariate
associations significant at the level of p-value less than 0.10 were moved forward into final multivariate logistic regression
models for each outcome measure, where the conventional p-value less than 0.05 threshold indicated a significant association.
Results
Participant Characteristics
We had 255 respondents (41% response rate) with a mean age of 52 years. Most were
male (172, 69.9%), of South Asian ethnicity (172, 69.9%), completed medical school
abroad (166, 69.3%), and had been in medical practice for over 20 years (137, 57.4%).
Most considered Islam as the most or a very important part of their life (226, 89.2%),
strictly fasted Ramadan (215, 85%), and most reported praying five times daily (158,
63%). Almost half wore a beard (44.4% of men) or hijab (43.7% of women; see [Tables 1] and [2]).
Table 1
Participants characteristics (n = 255)
|
Characteristic
|
n (%)
|
|
Age, n = 238
24–39
40–55
56–69
70–84
|
66 (27.7)
58 (24.4)
76 (31.9)
38 (16)
|
|
Gender, n = 246
Male
Female
|
172 (69.9)
74 (30.1)
|
|
Race/Ethnicity, n = 247
South Asian
Arab or Middle Eastern
White/Caucasian
Black/African American
|
172 (69.6)
54 (21.9)
10 (4.1)
2 (0.8)
|
|
Residency status, n = 244
Participant immigrated to the United States as an adult
Participant immigrated to the United States as a child
Participant born in the United States
|
158 (64.8)
39 (16)
47 (19.3)
|
|
Participant completed medical school in the United States, n = 243
|
77 (31.7)
|
|
Years of medical practice since completion of medical school, n = 239
0–10
11–20
21–30
32–41
42–57
|
66 (27.6)
36 (15.1)
48 (20.1)
58 (24.3)
31 (13)
|
|
Importance of religion in respondent's life, n = 254
“The most important part of my life”
“Very important in my life”
“Fairly important in my life”
|
136 (53.5)
90 (35.4)
25 (9.8)
|
|
Frequency of attendance at congregational worship services, n = 251
Daily
Less than daily but at least once a week
Less than weekly but at least once per month
Less than monthly but at least once per year
|
29 (11.6)
116 (46.2)
47 (18.7)
59 (23.5)
|
|
Frequency of prayer, n = 251
Five times per day
Less than five times a day but at least once per day
Less than once per day but at least once per week
Rarely or never
|
158 (63)
65 (25.9)
14 (5.6)
14 (5.6)
|
|
Frequency of reading the Quran outside of prayer, n = 251
Daily
Less than daily but on a weekly basis
2-3 times per month
On special occasions
Rarely or never
|
79 (31.5)
50 (19.9)
32 (12.8)
48 (19.1)
42 (16.7)
|
|
Keeping Ramadan fast, n =253
Strictly
Somewhat
Not at all
|
215 (85)
31 (12.3)
7 (2.8)
|
|
Dietary practices, n = 248
Most religious
Very religious
Fairly religious
Not religious
|
64 (25.8)
74 (29.8)
96 (38.7)
14 (5.7)
|
|
Religious appearance,
Keep a beard (male only), n = 171
Wear the hijab (female only), n = 71
|
76 (44.4)
31 (43.7)
|
Table 2
Summary of predictor variables, n = 255
|
Variable
|
Median, mean ± SD
|
|
Religious practice
|
2.0, 2.02 ± 0.47
|
|
**
|
n (%)
|
|
Religious appearance (hijab/beard)
|
|
|
No
|
135 (53.9)
|
|
Yes
|
107 (42.0)
|
|
Since completing medical school, how often have you personally experienced discrimination
at work because of your religion?
|
|
|
Never
|
79 (31.0)
|
|
Rarely
|
112 (43.9)
|
|
Sometimes to always
|
60 (23.5)
|
|
Have you personally experienced religious discrimination at your current workplace?
|
|
|
No
|
214 (83.9)
|
|
Yes
|
36 (14.1)
|
|
Have you ever reported concerns about religious discrimination to an employer or a
professional body?
|
|
|
No
|
239 (93.7)
|
|
Yes
|
11 (4.3)
|
|
My religion negatively influences my relationships with colleagues
|
|
|
Strongly disagree/disagree
|
229 (89.8)
|
|
Agree/strongly agree
|
23 (9.0)
|
|
My religion positively influences my relationships with colleagues
|
|
|
Strongly disagree/disagree
|
83 (32.6)
|
|
Agree/strongly agree
|
163 (63.9)
|
|
My religion places me under greater scrutiny than non-Muslim colleagues
|
|
|
Strongly disagree/disagree
|
132 (51.8)
|
|
Agree/strongly agree
|
117 (45.9)
|
|
I struggle to find time for prayer (salat/namaz) at work
|
|
|
Strongly disagree/disagree
|
123 (48.2)
|
|
Agree/strongly agree
|
125 (49.0)
|
|
My workplace accommodates my religious identity
|
|
|
Strongly disagree/disagree
|
68 (26.7)
|
|
Agree/strongly agree
|
179 (70.2)
|
|
Patients have refused my care because of my religious identity
|
|
|
Strongly disagree/disagree
|
227 (89.0)
|
|
Agree/strongly agree
|
22 (8.6)
|
|
Did Islamic values influence your choice of specialty?
|
|
|
No
|
178 (69.8)
|
|
Yes
|
71 (27.8)
|
Abbreviation: SD, standard deviation.
With respect to career satisfaction, 216 respondents (85%) were somewhat or very satisfied
with their overall career (see [Table 4]). In terms of burnout, there was a diversity of experiences, with 59 (23%) respondents
reporting feeling burnt out once a week or more, and 48 (19%) never experiencing it
(see [Table 5]). Similarly, there was a diversity of experiences with callousness, most (165, 65%)
never felt this way, but some (21, 8%) experienced it once a week or more (see [Table 6]).
Table 3
Respondent career satisfaction, n = 255
|
Variable
|
n (%)
|
|
Thinking very generally about your satisfaction with your overall career in medicine,
would you say that you are currently:
|
|
|
Very/somewhat dissatisfied
|
38 (14.9)
|
|
Somewhat/very satisfied
|
216 (84.7)
|
|
Thinking generally about your overall career in medicine, would you say that you are
currently burned out from your work?
|
|
|
Never
|
48 (18.8)
|
|
A few times a year
|
78 (30.6)
|
|
A few times a month or less
|
68 (26.7)
|
|
Once a week or more
|
59 (23.1)
|
|
Thinking generally about your overall career in medicine, would you say that you are
currently more callous towards people since you took your job?
|
|
|
Never
|
165 (64.7)
|
|
A few times a year
|
29 (11.4)
|
|
A few times a month or less
|
27 (10.6)
|
|
Once a week or more
|
21 (8.2)
|
Table 4
Bivariate associations between predictor variables and career satisfaction
|
Variable
|
Very/somewhat dissatisfied, n = 38
|
Somewhat/very satisfied, n = 216
|
|
|
Mean ± SD
|
p-Value
|
|
Religious practice
|
1.87 ± 0.54
|
2.05 ± 0.45
|
0.028
|
|
Age (years)
|
53.9 ± 15.8
|
51.7 ± 15.8
|
0.440
|
|
**
|
n (%)
|
p-Value
|
|
Religious appearance (hijab/beard)
|
|
|
0.506
|
|
No
|
23 (60.5)
|
111 (54.7)
|
|
Yes
|
15 (39.5)
|
92 (45.3)
|
|
Since completing medical school, how often have you personally experienced discrimination
at work because of your religion?
|
|
|
0.852
|
|
Never
|
12 (32.4)
|
67 (31.5)
|
|
Rarely
|
15 (40.5)
|
96 (45.1)
|
|
Sometimes to always
|
10 (27.0)
|
50 (23.5)
|
|
Have you personally experienced religious discrimination at your current workplace?
|
|
|
0.742
|
|
No
|
31 (83.8)
|
182 (85.9)
|
|
Yes
|
6 (16.2)
|
30 (14.2)
|
|
My religion negatively influences my relationships with colleagues
|
|
|
1.000
|
|
Strongly disagree/disagree
|
34 (91.9)
|
194 (90.7)
|
|
Agree/strongly agree
|
3 (8.1)
|
20 (9.4)
|
|
My religion positively influences my relationships with colleagues
|
|
|
0.067
|
|
Strongly disagree/disagree
|
17 (47.2)
|
66 (31.6)
|
|
Agree/strongly agree
|
19 (52.8)
|
143 (68.4)
|
|
My religion places me under greater scrutiny than non-Muslim colleagues
|
|
|
0.892
|
|
Strongly disagree/disagree
|
19 (54.3)
|
113 (53.1)
|
|
Agree/strongly agree
|
16 (14.7)
|
100 (47.0)
|
|
I struggle to find time for prayer (salat/namaz) at work
|
|
|
0.979
|
|
Strongly disagree/disagree
|
18 (50.0)
|
105 (49.8)
|
|
Agree/strongly agree
|
18 (50.0)
|
106 (50.2)
|
|
My workplace accommodates my religious identity
|
|
|
0.004
|
|
Strongly disagree/disagree
|
17 (47.2)
|
51 (24.3)
|
|
Agree/strongly agree
|
19 (52.8)
|
159 (75.7)
|
|
Patients have refused my care because of my religious identity
|
|
|
1.000
|
|
Strongly disagree/disagree
|
34 (91.9)
|
192 (91.0)
|
|
Agree/strongly agree
|
3 (8.1)
|
19 (9.0)
|
|
Did Islamic values influence your choice of specialty?
|
|
|
0.568
|
|
No
|
28 (75.7)
|
150 (71.1)
|
|
Yes
|
9 (24.3)
|
61 (28.9)
|
|
Percentage of patients who are Muslim
|
|
|
0.495
|
|
< 2%
|
16 (43.2)
|
72 (35.1)
|
|
2–4.99%
|
5 (13.5)
|
31 (15.1)
|
|
5–14.99%
|
14 (37.8)
|
73 (35.6)
|
|
> 15%
|
2 (5.4)
|
29 (14.2)
|
|
Community work setting
|
|
|
1.000
|
|
Urban
|
17 (46.0)
|
94 (46.1)
|
|
Suburban
|
17 (46.0)
|
94 (46.1)
|
|
Rural
|
3 (8.1)
|
16 (7.8)
|
|
Sex
|
|
|
0.200
|
|
Female
|
8 (21.1)
|
65 (31.4)
|
|
Male
|
30 (79.0)
|
142 (68.6)
|
|
Medical school completed in the United States
|
|
|
0.972
|
|
No
|
26 (68.4)
|
139 (68.1)
|
|
Yes
|
12 (31.6)
|
65 (31.9)
|
|
Ethnicity
|
|
|
0.927
|
|
South Asian
|
23 (76.7)
|
148 (75.9)
|
|
Arab
|
7 (23.3)
|
47 (24.1)
|
|
Years of medical practice
|
|
|
0.908
|
|
< 11
|
8 (22.2)
|
58 (28.7)
|
|
11–20
|
5 (13.9)
|
30 (14.9)
|
|
21–31
|
8 (22.2)
|
40 (19.8)
|
|
32–42
|
9 (25.0)
|
49 (24.3)
|
|
> 42
|
6 (16.7)
|
25 (12.4)
|
Abbreviation: SD, standard deviation.
Table 5
Bivariate associations between predictor variables and career burnout
|
Variable
|
Never, n = 48
|
A few times a year, n = 78
|
A few times a month or less, n = 68
|
Once a week or more, n = 59
|
|
|
Mean ± SD
|
p-Value
|
|
Religious practice
|
2.15 ± 0.41
|
2.04 ± 0.47
|
1.98 ± 0.47
|
1.94 ± 0.50
|
0.097
|
|
Age (years)
|
61.6 ± 14.4
|
56.6 ± 14.5
|
46.0 ± 13.4
|
44.8 ± 14.7
|
<0.001
|
|
**
|
n (%)
|
p-Value
|
|
Religious Appearance (hijab/beard)
|
|
|
|
|
0.866
|
|
No
|
26 (57.8)
|
39 (52.0)
|
37 (58.7)
|
32 (56.1)
|
|
Yes
|
19 (42.2)
|
36 (48.0)
|
26 (41.3)
|
25 (43.9)
|
|
Since completing medical school, how often have you personally experienced discrimination
at work because of your religion?
|
|
|
|
|
0.158
|
|
Never
|
18 (37.5)
|
25 (32.5)
|
22 (32.4)
|
13 (23.2)
|
|
Rarely
|
23 (47.9)
|
31 (40.3)
|
34 (50.0)
|
23 (41.1)
|
|
Sometimes to always
|
7 (14.6)
|
21 (27.3)
|
12 (17.7)
|
20 (35.7)
|
|
Have you personally experienced religious discrimination at your current workplace?
|
|
|
|
|
0.052
|
|
No
|
43 (89.6)
|
66 (85.7)
|
62 (91.2)
|
41 (74.6)
|
|
Yes
|
5 (10.4)
|
11 (14.3)
|
6 (8.8)
|
14 (25.5)
|
|
My religion negatively influences my relationships with colleagues
|
|
|
|
|
0.044
|
|
Strongly disagree/disagree
|
43 (91.5)
|
76 (97.4)
|
58 (85.3)
|
50 (87.7)
|
|
Agree/strongly agree
|
4 (8.5)
|
2 (2.6)
|
10 (14.7)
|
7 (12.3)
|
|
My religion positively influences my relationships with colleagues
|
|
|
|
|
0.175
|
|
Strongly disagree/disagree
|
11 (24.4)
|
24 (31.2)
|
22 (33.3)
|
25 (44.6)
|
|
Agree/strongly agree
|
34 (75.6)
|
53 (68.8)
|
44 (66.7)
|
31 (55.4)
|
|
My religion places me under greater scrutiny than non-Muslim colleagues
|
|
|
|
|
<0.001
|
|
Strongly disagree/disagree
|
27 (57.5)
|
49 (63.6)
|
39 (58.2)
|
16 (28.6)
|
|
Agree/strongly agree
|
20 (42.6)
|
28 (36.4)
|
28 (41.8)
|
40 (71.4)
|
|
I struggle to find time for prayer (salat/namaz) at work
|
|
|
|
|
0.007
|
|
Strongly disagree/disagree
|
30 (65.2)
|
42 (54.6)
|
33 (48.5)
|
18 (32.1)
|
|
Agree/strongly agree
|
16 (34.8)
|
35 (45.5)
|
35 (51.5)
|
38 (67.9)
|
|
My workplace accommodates my religious identity
|
|
|
|
|
0.913
|
|
Strongly disagree/disagree
|
12 (26.1)
|
23 (30.3)
|
18 (26.9)
|
14 (25.0)
|
|
Agree/strongly agree
|
34 (73.9)
|
53 (69.7)
|
49 (73.1)
|
42 (75.0)
|
|
Patients have refused my care because of my religious identity
|
|
|
|
|
0.989
|
|
Strongly disagree/disagree
|
43 (91.5)
|
71 (92.2)
|
60 (89.6)
|
51 (91.1)
|
|
Agree/strongly agree
|
4 (8.5)
|
6 (7.8)
|
7 (10.5)
|
5 (8.9)
|
|
Did Islamic values influence your choice of specialty?
|
|
|
|
|
0.154
|
|
No
|
37 (80.4)
|
53 (68.8)
|
50 (76.9)
|
37 (62.7)
|
|
Yes
|
9 (19.6)
|
24 (31.2)
|
15 (23.1)
|
22 (37.3)
|
|
Community work setting
|
|
|
|
|
0.754
|
|
Urban
|
22 (47.8)
|
36 (48.0)
|
24 (38.7)
|
28 (49.1)
|
|
Suburban
|
22 (47.8)
|
31 (41.3)
|
33 (53.2)
|
25 (43.9)
|
|
Rural
|
2 (4.4)
|
8 (10.7)
|
5 (8.1)
|
4 (7.0)
|
|
Sex
|
|
|
|
|
0.274
|
|
Female
|
9 (19.6)
|
23 (30.3)
|
19 (30.2)
|
22 (37.3)
|
|
Male
|
37 (80.4)
|
53 (69.7)
|
44 (69.8)
|
37 (62.7)
|
|
Medical school completed in the United States
|
|
|
|
|
0.038
|
|
No
|
39 (84.8)
|
51 (68.0)
|
37 (59.7)
|
37 (63.8)
|
|
Yes
|
7 (15.2)
|
24 (32.0)
|
25 (40.3)
|
21 (36.2)
|
|
Ethnicity
|
|
|
|
|
0.752
|
|
South Asian
|
36 (81.8)
|
50 (74.6)
|
44 (75.9)
|
40 (72.7)
|
|
Arab
|
8 (18.2)
|
17 (25.4)
|
14 (24.1)
|
15 (27.3)
|
|
Years of medical practice
|
|
|
|
|
<0.001
|
|
< 11
|
3 (6.4)
|
12 (16.4)
|
22 (36.1)
|
29 (51.8)
|
|
11–20
|
7 (14.9)
|
13 (17.8)
|
9 (14.8)
|
6 (10.7)
|
|
21–31
|
10 (21.3)
|
13 (17.8)
|
14 (23.0)
|
11 (19.6)
|
|
32–42
|
12 (25.5)
|
25 (34.3)
|
14 (23.0)
|
7 (12.5)
|
|
> 42
|
15 (31.9)
|
10 (13.7)
|
2 (3.3)
|
3 (5.4)
|
Abbreviation: SD, standard deviation.
Table 6
Bivariate associations between predictor variables and feelings of callousness
|
Variable
|
Never, n = 48
|
A few times a year, n = 78
|
A few times a month or less, n = 68
|
Once a week or more, n = 59
|
|
|
Mean ± SD
|
p-Value
|
|
Religious practice
|
2.06 ± 0.47
|
1.90 ± 0.49
|
2.00 ± 0.41
|
1.77 ± 0.48
|
0.034
|
|
Age (years)
|
56.8 ± 13.9
|
44.7 ± 15.8
|
34.9 ± 8.9
|
38.4 ± 11.1
|
<0.001
|
|
**
|
n (%)
|
p-Value
|
|
Religious appearance (hijab/beard)
|
|
|
|
|
0.374
|
|
No
|
85 (54.5)
|
16 (57.1)
|
14 (53.9)
|
15 (75.0)
|
|
Yes
|
71 (45.5)
|
12 (42.9)
|
12 (46.2)
|
5 (25.0)
|
|
Since completing medical school, how often have you personally experienced discrimination
at work because of your religion?
|
|
|
|
|
0.615
|
|
Never
|
54 (32.9)
|
7 (25.0)
|
9 (34.6)
|
6 (28.6)
|
|
Rarely
|
67 (70.9)
|
16 (57.1)
|
13 (50.0)
|
8 (38.1)
|
|
Sometimes to always
|
43 (26.2)
|
5 (17.9)
|
4 (15.4)
|
7 (33.3)
|
|
Have you personally experienced religious discrimination at your current workplace?
|
|
|
|
|
0.541
|
|
No
|
140 (85.4)
|
25 (89.3)
|
23 (88.5)
|
15 (75.0)
|
|
Yes
|
24 (14.6)
|
3 (10.7)
|
3 (11.5)
|
5 (25.0)
|
|
My religion negatively influences my relationships with colleagues
|
|
|
|
|
0.081
|
|
Strongly disagree/disagree
|
151 (92.1)
|
27 (96.4)
|
22 (81.5)
|
17 (81.0)
|
|
Agree/strongly agree
|
13 (7.9)
|
1 (3.6)
|
5 (18.5)
|
4 (19.1)
|
|
My religion positively influences my relationships with colleagues
|
|
|
|
|
0.871
|
|
Strongly disagree/disagree
|
54 (33.8)
|
9 (33.3)
|
7 (26.9)
|
8 (38.1)
|
|
Agree/strongly agree
|
106 (66.3)
|
18 (16.7)
|
19 (73.1)
|
13 (61.9)
|
|
My religion places me under greater scrutiny than non-Muslim colleagues
|
|
|
|
|
0.028
|
|
Strongly disagree/disagree
|
93 (56.7)
|
15 (55.6)
|
13 (48.2)
|
4 (21.1)
|
|
Agree/strongly agree
|
71 (43.3)
|
12 (44.4)
|
14 (51.9)
|
15 (79.0)
|
|
I struggle to find time for prayer (salat/namaz) at work
|
|
|
|
|
0.000
|
|
Strongly disagree/disagree
|
95 (59.0)
|
14 (50.0)
|
6 (22.2)
|
2 (9.5)
|
|
Agree/strongly agree
|
66 (41.0)
|
14 (50.0)
|
21 (77.8)
|
19 (90.5)
|
|
My workplace accommodates my religious identity
|
|
|
|
|
0.552
|
|
Strongly disagree/disagree
|
41 (25.8)
|
9 (32.1)
|
6 (22.2)
|
8 (38.1)
|
|
Agree/strongly agree
|
118 (74.2)
|
19 (67.9)
|
21 (77.8)
|
13 (61.9)
|
|
Patients have refused my care because of my religious identity
|
|
|
|
|
0.452
|
|
Strongly disagree/disagree
|
145 (90.1)
|
27 (96.4)
|
26 (96.3)
|
18 (85.7)
|
|
Agree/strongly agree
|
16 (9.9)
|
1 (3.6)
|
1 (3.7)
|
3 (14.3)
|
|
Did Islamic values influence your choice of specialty?
|
|
|
|
|
0.322
|
|
No
|
121 (75.2)
|
22 (75.9)
|
16 (61.5)
|
13 (61.9)
|
|
Yes
|
40 (24.8)
|
7 (24.1)
|
10 (38.5)
|
8 (38.1)
|
|
Community work setting
|
|
|
|
|
|
Urban
|
61 (39.4)
|
19 (65.5)
|
14 (53.9)
|
10 (52.6)
|
0.068
|
|
Suburban
|
82 (52.9)
|
9 (31.0)
|
8 (30.8)
|
8 (42.1)
|
|
Rural
|
12 (7.7)
|
1 (3.5)
|
4 (15.4)
|
1 (5.3)
|
|
Sex
|
|
|
|
|
0.228
|
|
Female
|
40 (25.5)
|
11 (37.9)
|
9 (34.6)
|
9 (42.9)
|
|
Male
|
117 (74.5)
|
18 (62.1)
|
17 (65.4)
|
12 (57.1)
|
|
Medical school completed in the United States
|
|
|
|
|
<0.001
|
|
No
|
118 (75.2)
|
17 (60.7)
|
10 (40.0)
|
9 (42.9)
|
|
Yes
|
39 (24.8)
|
11 (39.3)
|
15 (60.0)
|
12 (57.1)
|
|
Ethnicity
|
|
|
|
|
0.866
|
|
South Asian
|
112 (77.8)
|
20 (74.1)
|
18 (78.3)
|
14 (70.0)
|
|
Arab
|
32 (22.2)
|
7 (25.9)
|
5 (21.7)
|
6 (30.0)
|
|
Years of medical practice
|
|
|
|
|
<0.001
|
|
< 11
|
20 (12.9)
|
13 (46.4)
|
18 (75.0)
|
14 (70.0)
|
|
11–20
|
21 (13.6)
|
5 (17.9)
|
4 (16.7)
|
4 (20.0)
|
|
21–31
|
40 (25.8)
|
3 (10.7)
|
1 (4.1)
|
1 (5.0)
|
|
32–42
|
47 (30.3)
|
6 (21.4)
|
1 (4.1)
|
0 (0.0)
|
|
> 42
|
27 (17.4)
|
1 (3.6)
|
0 (0.0)
|
1 (5.0)
|
Abbreviation: SD, standard deviation.
Concerning the perceived impact of religious identity on relationships with colleagues,
9% of respondents felt that their religious identity negatively influenced relationships
with colleagues, while 68% felt it was a positive influence.
Predictors of Career Satisfaction
The strongest predictor of overall career satisfaction was the belief that one's workplace
accommodated their religious identity (odds ratio [OR]: 2.69, p <0.015). Respondents who had higher levels of religious practice also had higher
odds of career satisfaction (OR: 2.21, p < 0.049; (see [Table 7])
Table 7
Logistic regression model of physician predictors of career satistfaction,[a]
n = 240
|
Predictor
|
Odds ratio (95% confidence interval)
|
p-Value
|
|
Religious practice
|
2.21 (1.00, 4.87)
|
0.049
|
|
Workplace accommodates my religious identity
|
2.69 (1.21, 5.95)
|
0.015
|
|
Religion positively influences relationships
|
1.08 (0.47, 2.46)
|
0.853
|
a Thinking very generally about your satisfaction with your overall career in medicine,
rate your current satisfaction.
Predictors of Burnout and Callousness
Participants who were older (OR: 0.94, p < 0.000), US medical graduates (OR: 0.44, p < 0.011), and those who considered religious practice to be the most important part
of their lives (OR: 0.51, p < 0.016) had lower odds of burnout (see [Table 8]).
Table 8
Logistic regression model of physician predictors of career burnout,[a]
n = 221
|
Predictor
|
Odds ratio (95% confidence interval)
|
p-Value
|
|
Religious practice
|
0.51 (0.29, 0.88)
|
0.016
|
|
Age
|
0.94 (0.92, 0.95)
|
0.000
|
|
Discrimination at the current workplace
|
1.65 (0.75, 3.64)
|
0.208
|
|
My religion negatively influences relationships with colleagues
|
1.25 (0.48, 3.22)
|
0.637
|
|
My religion places me under greater scrutiny
|
1.50 (0.85, 2.65)
|
0.155
|
|
Struggle to find time for prayer
|
1.19 (0.71, 2.00)
|
0.506
|
|
Completed medical school in the United States
|
0.44 (0.23, 0.82)
|
0.011
|
a Thinking generally about your overall career in medicine, how often would you say
you feel burned out from your work?
With respect to callousness, respondents who considered religious practice to be the
most important part of their lives (OR: 0.42, p < 0.024) worked in suburban settings compared with those who worked in urban settings
(OR: 0.42, p <0.017) and older participants (OR: 0.91, p < 0.001) had lower odds of callousness. While those whose religion negatively influenced
their relationships with colleagues had greater odds to experience callousness (OR:
2.25, p <0.003). Of marginal statistical significance, those who reported struggling to find
time for prayer were at higher odds of callousness than those who did not (OR: 1.45,
p < 0.066; see [Table 9]).
Table 9
Logistic regression model of physician predictors on feelings of callousness,[a]
n = 211
|
Predictor
|
Odds ratio (95% confidence interval)
|
p-Value
|
|
Religious practice
|
0.42 (0.20, 0.89)
|
0.024
|
|
Age
|
0.91 (0.89, 0.94)
|
<0.001
|
|
My religion negatively influences relationships with colleagues
|
2.25 (1.31, 3.86)
|
0.003
|
|
My religion places me under greater scrutiny
|
1.17 (0.76, 1.80)
|
0.485
|
|
Struggle to find time for prayer
|
1.45 (0.98, 2.16)
|
0.066
|
|
Community setting
|
1.61 (0.86, 3.03)
|
0.139
|
|
Urban
|
REF
|
REF
|
|
Suburban
|
0.42 (0.21, 0.86)
|
0.017
|
|
Rural
|
1.02 (0.29, 3.62)
|
0.979
|
|
Completed medical school in the United States
|
0.61 (0.29, 1.31)
|
0.207
|
a Thinking generally about your overall career in medicine, would you say that you
are currently more callous towards people since you took your job?
Discussion
Our national survey shows that religiosity boosts career satisfaction and guards against
career burnout and callousness that echo the extant literature as well.[37]
[38]
[39] It is no surprising that workplace accommodation of physicians' religious identity
contributed to the highest odds of career satisfaction for American Muslim physicians.
The importance of religiosity to healthcare workers is not alike for all religious
backgrounds. Muslim physicians were found to value religiosity most and deem it as
foundational to their well-being compared to physicians from other religious affiliations.[40] This inherent individual construct comes at no cost to the healthcare system, and
while these findings are intuitive to interpret, it appears challenging to implement
in healthcare systems.[41]
Providing the opportunity to Muslim physicians to practice their faith fosters career
satisfaction and well-being. Our participants' struggle to find time for prayers predicted
career burnout as well as career satisfaction that reflects the interconnectedness
of both burnout and satisfaction even if they may not fall on a linear spectrum.[42]
Younger age with fewer years in clinical practice significantly predicted career burnout
among Muslim physicians. Physician's age was not a consistent predictor of burnout
in the literature but when it was associated, younger age and fewer years in clinical
practice were likely to coincide with career burnout.[43]
[44] This could be a result of the increased administrative load, being on the learning
curve to acquire expertise and accomplish tasks, and longer working hours negatively
impacting work–life balance.[45] For Muslim physicians, it can be rather confounded by inadequate mentorship, sponsorship,
or equitable support from workplaces compared to their physician counterparts.
Those who graduated from US medical schools were less likely to experience career
burnout, which may be attributed to their acquaintance with the healthcare system,
mentorship networking, and English proficiency with no accent. However, our finding
is not consistent with the literature reviewed[46] international medical graduates' experiences may need further research to unpack.[47] It is worth reading about how Muslim international medical graduates may share their
equivocal experiences in cultural exchange.
Workplace camaraderie and collegiality can manifest in many ways; Muslim physicians
who reported religiosity positively influenced their work relationships were more
satisfied in their careers compared to those who reported that their religiosity places
them under greater scrutiny. Those who reported being under greater scrutiny are more
likely to experience career burnout, and those who reported that their religiosity
negatively influenced their work relationship were more prone to callousness. Active
involvement and inclusion of Muslim clinicians in organizational cultures,[48] providing professional growth and development resources,[49] and examining the diversity and inclusivity of performance evaluation strategies
can improve their workplace experiences.[50]
Majoritarianism prevails in the healthcare ecosystem as it does in policymaking, which
is palpable in the underrepresentation of Muslim healthcare workers and what may exclusively
matter to them. One of the Healthy People 2030 goals is to strengthen the workforce
by promoting health and well-being as a high-priority public health issue that does
not yet have evidence-based interventions developed to address it.[51] Our study findings suggest that workplace accommodations of religious practice would
boost Muslim clinicians' well-being and career satisfaction.[52]
[53] Given the biases and discrimination pressures that Muslims now face in the United
States, focusing policy attention on accommodating Muslim physicians' religiosity
is important to enhance their career satisfaction and counteract burnout.
We have developed cutting-edge technology in biomedicine but have had less success
in addressing our spirituality. Looking at the issue of physician burnout through
the prism of rational problem-solving will highlight that the problem needs to be
tackled by incorporating preventative strategies such as mentorship, inclusion, and
embracing diversity in addition to developing curative strategies. More importantly,
the interventions need to be introduced early in careers rather than at the breaking
point.[54]
Limitations
As with any survey-based research, our findings should be interpreted in light of
the limitations of the measures used. In particular, the measure of practice-based
religiosity represented a summed score of different Islamic practices with variable
significance. We acknowledge other practices could have been measured, yet our measure
mirrored existing practice-based religiosity measures used in other population research.
Further research should explore how various practices associate with career satisfaction,
callousness, and burnout.
Implications
Our national survey of Muslim physicians shows that religiosity positively influences
career satisfaction, and potentially reduces career burnout. Workplace accommodations
of their religiosity highly predict career satisfaction, whereas being exposed to
scrutiny at work and being alienated due to their religiosity predispose them to career
burnout and callousness. The Healthcare system should aim toward inclusive workplaces
through accommodating religious identity, counteracting occupational scrutiny, and
offering cultural training. Although this cross-sectional study cannot be used to
make definitive causal inferences, physicians who consider themselves religious are
more likely to embrace their careers when workplaces cater for them and are rooted
in an inclusive environment that would shield them from burnout and callousness.
