With myriad challenges affecting healthcare providers since the coronavirus disease 2019 (COVID-19) pandemic began, some physicians are burdened with dealing with various forms of discrimination and harassment that contribute to a hostile work environment (HWE). can do. The findings of two recent studies illustrate the extent of these issues in the field of cardiology.
In a recently published first paper Journal of the American College of CardiologyIn this study, the researchers examined the prevalence of HWE in medicine, addressing not only gender discrimination but also 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 54 years of age.
Over 40% of respondents reported experiencing HWE, the highest rate among women (68% versus 37%; p <.001 odds ratio [OR], 3.58; 95% CI, 3.14–4.07) and Black cardiologists (53% versus 43%; OR, 1.46 versus Whites). Specific components of HWE affected women more frequently than men: emotional harassment (43% vs. 26%), discrimination (56% vs. 22%), and sexual harassment (12% vs. 1%). The most common reasons for discrimination were gender (44%), age (37%), race (24%), religion (15%), and sexual orientation (5%). Multivariate analysis demonstrated the highest odds of experiencing HWE among women (OR, 3.39; 95% CI, 2.97–3.86; p <.001) and early-career cardiologists (OR, 1.27; 95% CI, 1.14–1.43; p <.001) compared to other physicians surveyed.
Factors that independently protected against HWE included working in a physician-owned practice (OR, 0.75; 95% CI, 0.63–0.88; p = .001), being married (OR, 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 an adverse effect on patients (53%) and co-workers (75%) as well as on several aspects of career satisfaction.
In another study published in the journal heart2, London-based researchers examined the frequency and types 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 physicians experienced discrimination – most often focused on gender and parenting – compared to 19.7% of male physicians . Survey responses also showed that 35.7% of female cardiologists (versus 6.1%) male cardiologists “have experienced unwanted sexual comments, attention, or advances from a superior or colleague.” Sexual harassment had a more negative effect on professional confidence in female versus male cardiologists (42.9% versus 3.0%), and 33.3% of female cardiologists (versus 2.3% of males) reported that sexism negatively impacted career advancement opportunities. Impressed.
The results of these 2 studies are consistent with previous findings, including the American College of Cardiology Third Decade Professional Life Survey published in 2017, which indicated that 65% of female cardiologists (versus 23%) experienced workplace harassment or discrimination. has done.3 “Women are particularly likely to experience gender harassment, which includes both verbal and nonverbal behavior that perceives women or men as inferior through hostility, objectivity, humiliation or exclusion”, noted researchers. JACC Study.1
Given the potential impact of these findings on providers and their patients, the organizational structure and system processes to optimize patient care should be examined. We spoke with Laxmi Mehta, MD, lead study author of JACC Studies and Professor in the Division of heart disease medicineHow to address these findings, director of the Lipid Clinic, and of Preventive Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus.
What are some of the factors driving high levels of hostility in the cardiology workplace?
Women and minorities are under-represented in cardiology. Organizational and personal practices and beliefs can contribute to a hostile work environment. Subtle- and macro-aggression also contribute to hostility in the workplace.
What are the potential effects of HWE on patient care and provider well-being?
Working in HWE can have a negative impact on professional activities with coworkers and patient care. HWE can also result in disenchantment and irritation for some people who 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 behavior, human resource intervention and legal intervention are necessary to stop the acts. People need to feel that it is safe to express their concerns and seek help in a non-threatening fashion, and not to blame the victims. External review of complaints can reduce internal suspicion of favoritism. Creating a culture of workplace wellbeing is essential.
What are some tips for clinicians in terms of support and support from colleagues who have experienced HWE?
The American College of Cardiology and the American Heart Association have just published an online professionalism and ethics document that outlines recommendations for addressing prejudice, structural racism and structural sexism.4 Everyone in the cardiovascular community is responsible and must do their part to recognize and eliminate structural racism and sexism.
- Sharma G, Douglas PS, Hayes SN, et al. Global prevalence and impact of hostility, discrimination and harassment in the cardiology workplace. J Am Col Cardiol. 2021;77(19):2398-2409.
- Jazzi SK, Kamau-Michel C, Mikhail GW, Hendry C. Sexism experienced by consultant cardiologists in the United Kingdom. heart. 2021;107(11):895–901. DOI: 10.1136/heartjnl-2020-317837
- Lewis SJ, Mehta LS, Douglas PS, et al; American College of Cardiology Women in Cardiology Leadership Council. Changes in the professional lives of cardiologists over 2 decades. J Am Col Cardiol. 2017;69(4):452-462. doi:10.1016/j.jacc.2016.11.027
- Executive Committee, Benjamin IJ, Valentine CM, Otgen WJ, et al. 2020 American Heart Association and American College of Cardiology consensus conference on professionalism and ethics: a consensus conference report. Published online on 5 May 2021. J Am Col Cardiol. doi:10.1016/j.jacc.2021.04.004
This article originally appeared on cardiology consultant
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