Moral Distress and Burnout Among Hematologists in Mexico: Results of a National Survey
Authors: Orta-Martínez Rubí Alejandra A , Medina-Olivares Fernando J , Abel Gregory , Revette Anna , Kelkar Amar H. , Koranteng Erica O , del Campo-Martinez Maria , Montano Figueroa Efreen , Acosta Maldonado Brenda Lizeth , Aquino-Fernandez Efrain , Villela Martinez Luis Mario , Gomez-De Leon Andres 
Published: December 2024

Background: Moral distress arises from systemic barriers to providing ideal patient care, and can eventually lead to burnout for medical professionals. Moral distress and subsequent burnout are potentially of particular concern in lower- and middle- income countries where there are often poorly resourced public health systems and better resourced private ones. We aimed to characterize this issue in Mexico leveraging the membership of the Agrupación Mexicana para el Estudio de la Hematología (AMEH).
Methods: A Spanish-language electronic survey was developed for practicing hematologists and hematology fellows, capturing sociodemographic, career-level, and clinical practice characteristics. There were 82 questions, most of which were presented with five-item Likert scales. In addition to sociodemographic questions, respondents were asked about both the frequency and intensity of specific concerns with respect to moral distress (e.g., “I provide less than optimal care because of pressures from administrators or insurers to reduce costs”) and burnout (e.g., “I have become more callous to people since I have started this job”). The survey underwent pilot testing with expert assessments and cognitive interviews and reached saturation before distribution in July 2024. For these analyses, responses were dichotomized; descriptive statistics were presented with Chi-square analyses for subgroups (e.g., hematologists vs hematology fellows and exclusive private vs other practice setting).
Results: Of 205 surveys sent nationally, 91 have been returned so far, a 44.4% response rate. Respondents were predominantly women (62%), with a median age of 38 years (range, 26 to 72). 44% of respondents were married, and most were practicing hematology in Mexico City (24%), with geographic representation from 25 of the 32 Mexican states. 23% worked exclusively in the private sector, and 33% in the public sector; the rest reported a mixed practice setting.
Overall, 46% of respondents reported experiencing moral distress, and 48% burnout. The highest scored items for moral distress included lack of access to diagnostic tests that impact care (median=12 [IQR 4-16]); insufficient healthcare facilities (median=9 [IQR 3-16]); lack of patient access to healthcare (median=9 [IQR 3-12]); and conditions of overwork (median=9 [IQR 4-16]). Burnout items reported to occur at least once per week or more included feeling physically exhausted at the end of the day (44%), feeling emotionally exhausted (43%), feeling worn out (37%), spending too much time at work (36%), and becoming more callous (35%).
On the other hand, most respondents reported to have positive work-related experiences, including easily understanding their patients (88%); creating a positive environment for them (87%); feeling stimulated after working closely with patients (86%); feeling efficient in solving patients' problems (87%); influencing the lives of others positively (87%); achieving rewarding objectives in their work (75%); and feeling full of energy (63%).
No differences in self-reported moral distress or burnout were observed between hematologists vs. hematology fellows, nor comparing age or years of experience. Respondents with an exclusively private practice reported numerically lower levels of burnout (25 vs. 52%; p=.059) and moral distress (38% vs. 51%; p=.2) without statistical significance.
Conclusion: Moral distress and burnout are prevalent among hematologists in Mexico, but most hematologists also report high levels of several positive job-related experiences. These findings underscore an urgent need for support systems and awareness to address these issues for Mexican hematologists.