BURNOUT BEYOND WORKLOAD: RACIALIZED-GENDERED SCRUTINY AND THE CUMULATIVE STRAIN ON THE PROFESSIONAL SELF AMONG BLACK WOMEN PHYSICIANS

Abstract

Dominant approaches to physician burnout treat the phenomenon chiefly as a function of workload, administrative burden, and individual coping, leaving less well specified how institutional inequality organizes chronic stress exposure, interpretation, and career consequences. This dissertation examined burnout among Black women physicians as a cumulative social process unfolding through the professional self within medicine, a racialized and gendered institution. Drawing on Black feminist thought and intersectionality, the stress process model, life course perspectives, symbolic interactionism, and racialized organizations theory, the study asked how Black women physicians described the power dynamics, organizational culture, and medical culture that organized harassment and discrimination, bullying, and microaggressions at work; how those experiences shaped training, career trajectories, job opportunities, and decisions about remaining in or leaving medical practice; how self-esteem, mattering, mastery, and the management of professional self-presentation mediated the accumulation of burnout; and how physicians assessed diversity, equity, and inclusion efforts as institutional responses to inequality. The study employed an interpretivist qualitative design grounded in in-depth, semi-structured interviews with 30 Black women attending physicians recruited nationally through purposive snowball sampling across specialties, career stages, and institutional contexts. Analysis proceeded through meaning-centered thematic analysis oriented to how workplace events acquired meaning across time, settings, and reputational systems. Burnout developed through repeated encounters in which authority, credibility, and comportment remained open to challenge despite formal role and credential. Participants described persistent scrutiny, selective second-guessing, complaint circulation, and institutional nonresponse as conditions that converted workplace mistreatment into chronic strain. Repetition stabilized interpretation and generated anticipatory rulework, a learned and portable set of decision logics governing tone, disclosure, participation, documentation, escalation, and withdrawal under predictable scrutiny. Strategies developed for self-protection were repeatedly recast through organizational evaluation as attitude, tone, collegiality, or professionalism problems, permitting reputational labeling to travel across units and institutions and exposing physicians to heightened monitoring, restricted opportunity, and employment loss. Over time, continuous self-monitoring accumulated into emotional containment and narrowing, fatigue, mistrust, and constrained help-seeking, and downstream health and functional impairment, ultimately redirecting many careers through pulling back, pivoting, and exit. Where institutions acknowledged dysfunctional or racially charged environments while directing remedial attention toward the conduct of physicians who raised concerns, they institutionalized the self-management labor participants had already been performing privately, codifying individual regulation as official support while leaving the conditions producing that labor intact. Burnout also injured the social self through sustained damage to esteem, mastery, and mattering. Mattering operated on two sides. Institutions relied upon Black women physicians' labor while withholding durable concern for their welfare and obstructing the conditions under which their work could become authority, influence, and legacy. Participants judged DEI efforts by whether they altered the decision systems through which scrutiny, credibility, and retaliation were organized. Where DEI remained symbolic, optional, or detached from enforcement, it did not function as protection. The dissertation contributes a processual account of burnout that locates explanation in the institutional organization of interpretive risk, reputational vulnerability, and blocked reciprocity in professional life, and introduces anticipatory rulework and institutionalized self-management as analytic concepts developed from the data. Future research should follow cumulative career injury longitudinally across training and practice, examine whether analogous forms of blocked mattering and conditional authority operate in other high-status professions and differently positioned physician groups, and specify which accountability mechanisms, resource distributions, and organizational audits distinguish symbolic equity commitments from protective institutional change.