Publications

Linos, E., Lasky-Fink, J., Halley, M., Sarkar, U., Mangurian, C., Sabry, H., Linos, E. and Jagsi, R., 2022. Impact of Sexual Harassment and Social Support on Burnout in Physician Mothers. Journal of Women's Health.

Abstract

Background: Burnout affects >50% of physicians, especially women. This study aimed to examine how negative workplace interactions can predict burnout, and whether positive social interactions can mitigate risk. Materials and Methods: In a study of 1627 physician mothers who responded to a survey by the Physician Moms Group, an online Facebook group, we first examined the association between workplace sexual harassment and burnout. In an embedded experiment, we then measured the causal impact of priming perceived social support and connectedness on the three dimensions of employee burnout.Results:Two-thirds of respondents reported having experienced sexual harassment in the past year. Sexual harassment by patients was associated with 0.27 points higher emotional exhaustion, one dimension of burnout (95% confidence interval [CI] 0.12–0.41), equivalent to the predicted impact of an additional 22 weekly work hours on emotional exhaustion. Sexual harassment by patients was also associated with 0.40 points higher patient depersonalization, another dimension of burnout (95% CI 0.27–0.53). Sexual harassment by colleagues was associated with 0.16 points higher emotional exhaustion (95% CI 0.02–0.30), but not other dimensions of burnout. We found no significant relationship between experiences of sexual harassment and levels of personal accomplishment (the third dimension of burnout) among this sample. Priming physician mothers to reflect on their connectedness with other physician mothers significantly increased their sense of personal accomplishment. The priming intervention did not yield a significant effect on emotional exhaustion or depersonalization.   Conclusions: Negative and positive social interactions each affect different dimensions of burnout. Sexual harassment—a pervasive type of negative social interaction—strongly predicts emotional exhaustion and depersonalization. Reflecting on social connectedness—a type of positive social interaction—can improve one's sense of personal accomplishment with an effect similar in magnitude to more intensive in-person interventions, suggesting that social connectedness through online groups merits further consideration as a tool to mitigate burnout.
Sciepura, B. and Linos, E., 2022. When Perceptions of Public Service Harms the Public Servant: Predictors of Burnout and Compassion Fatigue in Government. Review of Public Personnel Administration, p.0734371X221081508.

Abstract

Public servants’ mental health can impact how, how well, and to whom services are delivered. In this article, we extend the Job Demands-Resources (JD-R) framework to consider whether employees’ perceptions of themselves, their co-workers, and beneficiaries predict higher psychological distress during the COVID-19 pandemic. Through a survey of state and local public servants (n = 3,341), we report alarming rates of psychological distress: one in three employees are burnt out and one in five are experiencing compassion fatigue. Those who view government as the place to make a difference, and those who perceive co-workers as competent, are less likely to report distress. Those who attribute poverty to systemic factors, and not to individual flaws of beneficiaries, experience higher distress. These findings suggest an urgent need to prioritize public servant mental health, and show that individual perceptions of self and others can predict variation in psychological distress, even in periods of widespread crisis.

Linos, E., Reddy, V. and Rothstein, J., 2021. Demystifying college costs: how nudges can and can't help. Behavioural Public Policy, pp.1-22.

Abstract

As US college costs continue to rise, governments and institutions have quadrupled financial aid. Yet, the administrative process of receiving financial aid remains complex, raising costs for families and deterring students from enrolling. In two large-scale field experiments (N = 265,570), we test the impact of nudging high-school seniors in California to register for state scholarships. We find that simplifying communication and affirming belonging each significantly increase registrations, by 9% and 11%, respectively. Yet, these nudges do not impact the final step of the financial aid process – receiving the scholarship. In contrast, a simplified letter that affirms belonging while also making comparable cost calculations more salient significantly impacts college choice, increasing enrollment in the lowest net cost option by 10.4%. Our findings suggest that different nudges are likely to address different types of administrative burdens, and their combination may be the most effective way to shift educational outcomes.
Lasky-Fink, J. and Linos, E., 2022. It’s Not Your Fault: Reducing Stigma Increases Take-up of Government Programs. Available at SSRN 4040234.

Abstract

Government programs provide a critical safety net for millions of low-income Americans, but their success depends on who accesses benefits. This research examines the role of stigma, an often-cited, but understudied barrier to take-up of safety net programs. Across two field experiments (N = 117,073) and two online experiments (N = 1,258), we show that subtle changes to the language used to describe one highly stigmatized benefit—emergency rental assistance—can reduce the internalized stigma associated with the program and, in turn, yield meaningful gains in take-up. A one-time communication that used de-stigmatizing language increased interest in rental assistance by 36% compared to providing information only, and increased program applications by about 11%, with likely larger effects for Black and African-American renters. This research offers some of the first causal evidence of the impact of stigma on participation in critical safety net programs, and demonstrates that internalized stigma can be reduced even in the presence of pervasive societal stigma.

Linos, E., Ruffini, K. and Wilcoxen, S., 2022. Reducing burnout and resignations among frontline workers: a field experiment. Journal of Public Administration Research and Theory, 32(3), pp.473-488.

Abstract

Government agencies around the world struggle to retain frontline workers, as high job demands and low job resources contribute to persistently high rates of employee burnout. Although four decades of research have documented the predictors and potential costs of frontline worker burnout, we have limited causal evidence on strategies that reduce it. In this article, we report on a multicity field experiment (n = 536) aimed at increasing perceived social support and affirming belonging among 911 dispatchers. We find that a 6-week intervention that prompts dispatchers to share advice anonymously and asynchronously with their peers in other cities reduces burnout by 8 points (0.4 standard deviations) and cuts resignations by more than half (3.4 percentage points) 4 months after the intervention ended. We provide supporting evidence that the intervention operates by increasing perceived social support and belonging in an online laboratory experiment (n = 497). These findings suggest that low-cost belonging affirmation techniques can reduce frontline worker burnout and help agencies retain workers, saving a mid-sized city at least $400,000 in personnel costs.

Linos, E., Prohofsky, A., Ramesh, A., Rothstein, J. and Unrath, M., 2020. Can nudges increase take-up of the EITC?: Evidence from multiple field experiments (No. w28086). National Bureau of Economic Research.

Abstract

The Earned Income Tax Credit (EITC) distributes more than $60 billion to over 20 million low-income families annually. Nevertheless, an estimated one-fifth of eligible households do not claim it. We ran six pre-registered, large-scale field experiments to test whether “nudges” could increase EITC take-up (N=1million). Despite varying the content, design, messenger, and mode of our messages, we find no evidence that they affected households’ likelihood of filing a tax return or claiming the credit. We conclude that even the most behaviorally informed low-touch outreach efforts cannot overcome the barriers faced by low-income households who do not file returns.
Linos, E. and Riesch, N., 2020. Thick red tape and the thin blue line: A field study on reducing administrative burden in police recruitment. Public Administration Review, 80(1), pp.92-103.

Abstract

Police departments struggle to recruit officers, and voluntary drop-off of candidates exacerbates this challenge. Using four years of administrative data and a field experiment conducted in the Los Angeles Police Department, the authors analyze the impact of administrative burden on the likelihood that a candidate will remain in the recruitment process. Findings show that reducing friction costs to participation and simplifying processes improve compliance, as behavioral public administration would predict. Applicants who were offered simpler, standardized processes completed more tests and were more likely to be hired. Later reductions to perceived burden led to an 8 percent increase in compliance, with a 60 percent increase in compliance within two weeks. However, removing steps that would have allowed for better understanding of eligibility kept unqualified candidates in the process for longer, reducing organizational efficiency. These results extend the field’s understanding of how administrative burden can impact the selection of talent into government.

Halley M., Rustagi A., Torres J., Linos E., Plaut V., Mangurian C., Choo E., Linos E. 2018. Physician Mothers’ Experience of Workplace Discrimination: A Qualitative Analysis. British Medical Journal (BMJ). 363:k4926

Abstract

Design Qualitative analysis of physician mothers’ free-text responses to the open question: “We want to hear your story and experience. Please share” included in questions about workplace discrimination. Three analysts iteratively formulated a structured codebook, then applied codes after inter-coder reliability scores indicated high concordance. The relationships among themes and sub-themes were organized into a conceptual model illustrated by exemplary quotes.
Participants Respondents to an anonymous, voluntary online survey about the health and wellbeing of physician mothers posted on a Facebook group, the Physician Moms Group, an online community of US physicians who identify as mothers.
Results We analyzed 947 free-text responses. Participants provide diverse and vivid descriptions of experiences of maternal discrimination. Gendered job expectations, financial inequalities (including lower pay than equally qualified colleagues and more unpaid work), limited opportunities for advancement, lack of support during the pregnancy and postpartum period, and challenging work-life balance are some of the key themes identified. In addition, participants’ quotes show several potential structural drivers of maternal discrimination and describe the downstream consequences of maternal discrimination on the physician herself, her career, family, and the healthcare system.
Conclusions These findings provide a view of maternal discrimination directly from the perspective of those who experience it. Women physicians report a range of previously uncharacterized ways in which they experience maternal discrimination. While certain aspects of these experiences are consistent with those reported by women across other professions, there are unique aspects of medical training and the medical profession that perpetuate maternal discrimination.

Riano N.S., Linos E., Accurso E.C., Sung D., Linos E., Simard J.F. and Mangurian, C., 2018. Paid Family and Childbearing Leave Policies at Top US Medical Schools. Journal of the American Medical Association (JAMA), 319(6), pp.611-614.

Abstract

Retaining women in academic medicine is challenging, despite gender parity in medical training. Child-rearing and differential preferences on work-life balance may contribute to sex differences in retention in medicine.1 Retaining women during childbearing years is central to gender parity, as even short workforce interruptions can have long-term consequences—and may partially explain the gender wage gap. Our goal was to examine variations in childbearing and family leave policies at top US medical schools.

Linos E., Reinhard J., and Ruda S., 2017. Levelling the playing field in police recruitment: Evidence from a field experiment on test performance. Public Administration, 95(4), pp.943-956.

Abstract

How to increase diversity in the police is an unanswered question that has received significant political and media attention. One area of intervention is the recruitment process itself. This study reports the results of a randomized controlled trial (RCT) in a police force that was experiencing a disproportionate drop in minority applicants during one particular test. Drawing on insights from the literatures on stereotype threat, belonging uncertainty and values affirmation exercises, we redesigned the wording on the email inviting applicants to participate in the test. The results show a 50 per cent increase in the probability of passing the test for minority applicants in the treatment group, with no effect on white applicants. Therefore, the intervention closed the racial gap in the pass rate without lowering the recruitment standard or changing the assessment questions.

Linos, E., 2018. More than public service: A field experiment on job advertisements and diversity in the police. Journal of Public Administration Research and Theory, 28(1), pp.67-85.

Abstract

There is a human capital crisis looming in the public sector as fewer and fewer people show interest in government jobs. At the same time, many public sector organizations struggle with increasing the diversity of their workforce. Although many institutional forces contribute to the challenge, part of the solution is in how government recruits. This study presents the results of a field experiment aimed at attracting more and different people to apply to a police force by varying job advertisements in a postcard. The results suggest that focusing on public service motivation (PSM) messages is ineffective at attracting candidates that would not have applied anyway. Rather, messages that focus on the personal benefits of applying to the job—either emphasizing the challenge of the job or the career benefits—are three times as effective at getting individuals to apply as the control, without an observable loss in applicant quality. These messages are particularly effective for people of color and women, thereby supporting a key policy goal of the police to increase diversity of applicants.

Policy Briefs and Reports