With the many challenges affecting healthcare providers since the onset of coronavirus disease 2019 (COVID-19), some clinics have the burden of dealing with the various forms of discrimination and harassment that can be ‘ g contribute to a counter workplace (HWE). Findings from 2 recent studies explain the magnitude of these internal issues in the field of cardiology.
In the first paper published today in Journal of the American College of Cardiology, the researchers investigated the prevalence of HWE in medicine, which addressed not only gender discrimination but also including emotional harassment.1 Cardiologists from around the world were surveyed (n = 5931, 77% men and 23% women). Survey respondents identified themselves as White (54%), Asian (17%), Hispanic (17%), and Black (3%). In addition, 73% of the responding physicians were aged ≤54.
More than 40% of respondents reported experiencing HWE, with the highest rate reported among women (68% vs. 37%; P <.001 probability ratio [OR], 3.58; 95% CI, 3.14–4.07) and Black cardiologists (53% vs 43%; O, 1.46 vs Whites). Specific components of HWE more often affected women than men: Emotional harassment (43% vs. 26%), discrimination (56% vs. 22%), and sexual harassment (12% vs. 1%). The most common causes of discrimination were gender (44%), age (37%), race (24%), religion (15%), and sexual orientation (5%). Multivariate analysis showed the highest probability of experiencing HWE in women (OR, 3.39; 95% CI, 2.97–3.86; P <.001) and early career cardiologists (O, 1.27; 95% CI, 1.14–1.43; P <.001) compared with other physicians surveyed.
Factors that independently protected against HWE were associated with working in a physician-owned practice (O, 0.75; 95% CI, 0.63–0.88; P = .001), married (O, 0.81; 95% CI, 0.71–0.92; P = .001), and White race (OR, 0.88; 95% CI, 0.79–0.98; P = .017). Respondents reported that HWE had a negative impact on interactions with patients (53%) and colleagues (75%), as well as many aspects of career satisfaction.
In the second study published in the journal Heart2, London -based researchers examined the frequency and variability of sexism affecting female and male cardiologists in the United Kingdom. Of the 174 cardiologists (24% female, 76% male) who completed a validated online survey, 61.9 female doctors experienced discrimination – often focused on gender and parenting – compared with 19.7% in male doctors. Survey responses also showed that 35.7% of female cardiologists (vs. 6.1% of male cardiologists) had “experienced unwanted sexual comments, attention or advances from a superior or partner. ” Sexual harassment had a greater negative impact on women’s professional confidence compared to male cardiologists (42.9% vs. 3.0%), and 33.3% of female cardiologists (vs. 2.3% of men) reported that sexism negatively affects opportunities for career advancement.
The results of 2 studies are consistent with previous findings, including the American College of Cardiology’s third decennial Professional Life Survey published in 2017, which showed 65% of female cardiologists (vs. 23% of men) ) experienced workplace harassment or discrimination.3 “Women are particularly vulnerable to gender-based harassment, which includes both verbal and non-verbal behavior that treats women or men inferiorly through anger, opposition, harassment, or segregation. “, according to the researchers The JACC study.1
Given the potential impact of these findings on providers and their patients, it is necessary to examine the organizational structure and system processes to optimize patient care. We spoke with Laxmi Mehta, MD, lead author of the study The JACC study and professor to divide heart medicine, director of the Lipids Clinic, and director of Preventative Cardiology and Cardiovascular Health in Women at The Ohio State University Wexner Medical Center in Columbus on how to address these findings.
What are some factors believed to drive high levels of hostility in the cardiology workplace?
Women and minorities are not described in cardiology. Organizational and individual actions and beliefs can contribute to the attack on the work environment. Micro- and macro-aggressions also contribute to irritability in the workplace.
What are the potential impacts of HWE on patient care and provider well-being?
Working with an HWE can negatively affect the professional activities of colleagues and patient care. HWE can also result in unemployment and burnout for some people if they feel discriminated against or threatened.
What actions are needed at the institutional and employer level to reduce HWE?
There should be a zero-tolerance policy for serious acts of discrimination and harassment. For serious incidents of such conduct, human resources and legal interventions are necessary to prevent acts. People should feel safe to express their concerns and seek help in a non-threatening manner, and victims should not be blamed. External review of complaints can alleviate internal suspicion of favoritism. It is important to create a culture of workplace health.
What are the suggestions for clinicians regarding support and encouragement for colleagues who may have experienced HWE?
The American College of Cardiology and the American Heart Association have just published an online Professionalism and Ethics document outlining recommendations to address bias, structural racism, and sexual structure.4 Everyone in the community with heart disease has a responsibility and must do their part to identify and eradicate structural racism and sexism.
- Sharma G, Douglas PS, Hayes SN, et al. Globalization and the impact of hatred, discrimination, and harassment in the cardiology workplace. J Am Coll Cardiol. 2021; 77 (19): 2398-2409.
- Jaijee SK, Kamau-Mitchell C, Mikhail GW, Hendry C. Sexism experienced by consultant cardiologists in the United Kingdom. As much as. 2021; 107 (11): 895-901. doi: 10.1136 / heartjnl-2020-317837
- Lewis SJ, Mehta LS, Douglas PS, et al; American College of Cardiology Women’s Cardiology Leadership Council. Changes in the professional life of cardiologists over 2 decades. J Am Coll Cardiol. 2017; 69 (4): 452-462. doi: 10.1016 / j.jacc.2016.11.027
- Executive Committee, Benjamin IJ, Valentine CM, Oetgen WJ, et al. The 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: a consensus conference report. Published online May 5, 2021. J Am Coll Cardiol. doi: 10.1016 / j.jacc.2021.04.004
This article originally appeared The Cardiology Advisor