We evaluated the demographic measurement equivalence of the MBI-HSS subscales in a series of multi-group item response theory- (IRT-) based differential item functioning (DIF) analyses (Additional file 1: Appendix 1). The aim of this study was to examine whether demographic disparities in US physician burnout are explained by differences in the MBI-HSS’s functioning across physician age, gender, and specialty groups. However, no studies, to our knowledge, have evaluated the demographic measurement equivalence of the MBI-HSS in US physicians. Establishing the measurement equivalence of an instrument is a key aspect of construct validity and, consequently, is required for the unbiased comparison of physician burnout across demographic groups. For example, female physicians may have higher observed burnout scores than male physicians because they are more willing than male physicians to report their symptoms, despite both groups having the same latent burnout levels. However, when a measure lacks equivalence across respondents who differ demographically, subscale score differences may actually reflect systematic differences in the way the demographic groups interpret items or in their willingness to endorse items, as opposed to true differences in the groups’ latent (unobserved) burnout symptom levels. Ī measure is equivalent when it functions the same way across groups of respondents who might differ in gender, age, or other personal characteristics that may influence their responses to a self-reported measure. However, it is unclear whether the observed disparities are explained by differences in the MBI-HSS’s functioning, or what is known as a lack of measurement equivalence, across demographic groups. In response, the National Academy of Medicine has recommended that healthcare organizations monitor and intervene on demographic disparities within their institutions. Physicians who are younger, female, and practicing in front-line specialties (e.g., emergency medicine, family medicine, and general internal medicine) have generally reported higher rates of burnout compared to their older, male colleagues practicing in non-front-line specialties. Disparities in US physician burnout rates across age, gender, and specialty groups as measured by the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS) are well documented.
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