Along with the myriad challenges affecting healthcare providers since the coronavirus disease 2019 (COVID-19) pandemic began, some clinicians have the burden of dealing with various forms of discrimination and harassment that may contribute to a hostile work environment (HWE). Findings from 2 recent studies elucidated the extent of these issues within the field of cardiology.

In the first paper recently published in the Journal of the American College of Cardiology, researchers investigated 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). The survey responders self-identified as White (54%), Asian (17%), Hispanic (17%), and Black (3%). In addition, 73% of responding physicians were ≤54 years of age.

Over 40% of respondents reported experiencing HWE, with the highest rates reported among women (68% vs 37%; P <.001 odds ratio [OR], 3.58; 95% CI, 3.14-4.07) and Black cardiologists (53% vs 43%; OR, 1.46 vs Whites). Specific components of HWE affected women more often 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 with other physicians surveyed.


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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 adverse effects on interactions with patients (53%) and colleagues (75%), as well as several aspects of career satisfaction.

In the second 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 of female physicians had experienced discrimination – most often focused on gender and parenting – compared with 19.7% of male physicians. The 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 colleague.” Sexual harassment had a greater negative impact on professional confidence in female vs male cardiologists (42.9% vs 3.0%), and 33.3% of female cardiologists (vs 2.3% of males) reported that sexism negatively affected opportunities for career advancement.

The results of these 2 studies are consistent with previous findings, including the American College of Cardiology third decennial Professional Life Survey published in 2017, which indicated that 65% of female cardiologists (vs 23% of males) experienced workplace harassment or discrimination.3 “Women are especially likely to experience gender harassment, which includes both verbal and nonverbal behaviors that treat women or men as inferior through hostility, objectification, disparagement, or exclusion”, noted researchers in the JACC study.1

Given the potential effects of these findings on providers and their patients, organizational structure and system processes should be examined to optimize patient care. We spoke with Laxmi Mehta, MD, lead study author of the JACC study and professor in the division of cardiovascular medicine, director of the Lipids Clinic, and director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus about how to address these findings.   

What are some of the factors believed to be driving the high levels of hostility in the cardiology workplace?

Women and minorities are underrepresented in cardiology. Organizational and individual practices and beliefs can contribute to the hostile work environment. Micro- and macro-aggressions also contribute to hostility in the workplace.

What are the potential effects of HWE on patient care and provider well-being? 

Working in a HWE can negatively impact professional activities with colleagues and patient care. HWE may also result in disengagement and burnout for some people when they feel discriminated against or threatened.

What actions are needed on the institutional and employer level to reduce HWE? 

There should be a zero-tolerance policy for egregious acts of discrimination and harassment. For serious incidents of such behavior, human resources interventions and legal interventions are necessary to curb the acts. People need to feel that it is safe to voice their concerns and seek help in a non-threatening fashion, and victims should not be blamed. External review of complaints can mitigate internal suspicion of favoritism. Creation of a culture of workplace wellbeing is essential.

What are suggestions for clinicians in terms of supporting and advocating for colleagues who may be experiencing HWE?  

The American College of Cardiology and the American Heart Association just published an online Professionalism and Ethics document that outlines recommendations to address bias, 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.

References

  1. Sharma G, Douglas PS, Hayes SN, et al. Global prevalence and impact of hostility, discrimination, and harassment in the cardiology workplace. J Am Coll Cardiol. 2021;77(19):2398-2409.
  2. Jaijee SK, Kamau-Mitchell 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
  3. 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 Coll Cardiol. 2017;69(4):452-462. doi:10.1016/j.jacc.2016.11.027
  4. Executive Committee, Benjamin IJ, Valentine CM, Oetgen WJ, et al. 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