First-generation health professionals report burnout

When Bernadette Williams-York began her master’s degree work in physical therapy, she was the first member of her family to attend college and the only Black student in the program. She experienced an unexpected level of stress for reasons she didn’t understand at the time.

In the years since, she’s learned more about the experiences of students with similar backgrounds.

“I've been in physical therapy education now for over 20 years, and I've noticed that students from underrepresented backgrounds experience more stress and more burden,” said Williams-York, a UW Medicine physical therapist and associate professor in the Department of Rehabilitation Medicine’s Division of Physical Therapy. 

“It’s my own personal experience, as well. When I was a graduate student, there were no other students of color, so there was that stress of not having anyone who could understand you or someone you could have an allegiance with.”

Williams-York and research colleagues decided to study this issues facing first-generation college students, students from underrepresented minority groups, and those who met both criteria. Their findings were recently published in the Physical Therapy & Rehabilitation Journal. 

They found that first-generation college students pursuing nursing, dentistry and other allied health professions experience burnout and exhaustion at significantly higher rates than their peers. 

The paper lays out a series of recommendations from study respondents, who also represented training programs in occupational therapy, pharmacy, and physical therapy. 

The findings are concerning because of the level of burnout that already exists in medical professions, said Bianca Frogner, the study’s senior author and a professor of family medicine at the University of Washington School of Medicine. She directs the UW Center for Health Workforce Studies, through which the study was funded. 

“I think the key question is: Are we burning out the future healthcare providers of America before they even get to the workplace?” asked Frogner. “What we hope this study shows is that there are things that can be done to support students.”

The researchers initially sought to assess the extent of burnout, exhaustion, stress and experiences of discrimination among these allied-health students, who tend to come from more diverse backgrounds than medical school students. Often these students and their perspectives are not included in research. Many reported more significant signs of exhaustion, family stress and financial stress than did peers with a family history of college attendance, according to the study findings.

As an example, Frogner said, many first-generation students work to support themselves.

“Sometimes a faculty member may say glibly, ‘Don't take a job while you're doing school, just concentrate on school,’” Frogner said. “That's not a very helpful statement and shows a lack of understanding of the background of first-generation students. As a result, the workload may not be commensurate with what time they actually have available.”   

The study participants also expressed the need for more moral support.

“Students are saying that they want their advisors to reach out to them and check in on them and say, ‘How are you doing?’” Frogner said. “You can't just wait for the student to say, ‘Hey, I'm tired and burned out.’ There needs to be a recognition that we need to create an environment that's supportive by checking in regularly with students.”

The study authors reported these additional recommendations:

• Assemble a faculty that mirrors diverse student populations. “Students might not feel like they belong because they don't see people who look like them,” Frogner said. “Therefore, students assume that maybe faculty don't understand where they're coming from.”
   
• Prioritize support. Medical and health professionals often do not prioritize their mental health, despite the extreme stressors in their field. “I think we need to make sure that counselors and mental health providers are available at low cost or free for students, to manage the realities of managing both school and life,” Frogner said. 
  
  Similarly, she said, institutional support from programs and universities is as necessary as support from faculty instructors. “It should not only fall on teachers and professors to solve the problem. The faculty also need institutional support to support their students.”
   
• Destigmatize mental health concerns. A culture of silence exists toward mental health needs  in medical professions, Frogner said. Until this changes, students won’t feel comfortable sharing their true feelings.
  
  “People don't want to talk about their health problems because they don't want to admit that they're weak,” Frogner said.  “We need to create a safe environment for students to be able to talk about their mental health needs, but that means also addressing the culture within the health professions.”

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