Discrimination and harassment are a common experience among those working in cardiology, according to the findings from a global survey carried out by the American College of Cardiology (ACC), which have been published in the Journal of the American College of Cardiology (JACC). Responses suggest that as many as 44% of cardiologists report experiencing a hostile work environment (HWE) including being subject to emotional or sexual harassment, or discrimination.
Authors concluded that a renewed focus on organisational structure, processes, and practices to mitigate these problems in cardiology across the globe is critical to ensuring workforce wellbeing and optimal patient care.
The report is the culmination of a 50-item online survey conducted by the ACC in September to October 2019, reaching 5,931 cardiologists in Africa, Asia, the Caribbean, Europe, the Middle East, Oceana, and North, Central, and South America. Questions covered demographic information, practice environment, academic rank, discrimination, and harassment, with a particular focus placed on the professional and personal challenges of cardiologists.
Author Garima Sharma (Johns Hopkins School of Medicine, Baltimore, USA) noted that the incidences of HWE were more commonly reported among female (68%), Black (53%) and North American (54%) respondents. Gender was the most frequent cause of discrimination (44%), the study found, followed by age (37%), race (24%), religion (15%), and sexual orientation (5%).
Of the participants 77% were men (n=4,584), and 23% (n=1,347) were women. Survey participants predominantly identified as white (54%), followed by Asian (17%), Hispanic (17%), and Black (3%); and 73% were ≤54 years of age. Most were married (75%); 12% were single, 7% were living with a partner, 3% were divorced, and 1% were separated.
Cardiologists from the European Union represented the largest group of respondents (32%), followed by respondents from South America (18%), the Middle East, Eastern Europe and Asia (all 9%), Africa (8%), North America (7%), Central America (6%), and Oceana (2%).
According to Sharma, the survey results indicate thatthere is a high level of professional dissatisfaction among the 44% who had experienced harassment or discrimination. Of those who reported HWEs, 30% felt dissatisfied with their financial compensation, 23% reported being treated unfairly, and 16% felt undervalued. Furthermore, 64% said it had some effect and 21% said it had a significant effect on the work environment.
A HWE also adversely affected professional activities with colleagues, where 62% of those experiencing HWEs reported some impact and 13% reported a significant impact. HWEs also adversely affected patient care, where 46% who experienced a HWE reported some impact on their activities with patients, and 6% reported a significant impact.
“HWE defined here as emotional harassment, discrimination, or sexual harassment, is experienced by nearly one-half of cardiologists globally, including across all regions, races or ethnicities, and both sexes and all gender identifications,” Sharma writes.
“Specific groups are at higher risk, including being a woman and being at an early career stage, whereas working in a physician-owned practice, being married, or being white conferred protection. Interestingly, there is significant intersectionality among the three subgroups, where experiencing one type of HWE greatly increased the odds of experiencing either of the others. HWE has a pronounced and pervasive adverse effect on professional satisfaction and professional activities, a finding suggesting that HWE is both a professional issue and a patient care issue. Our findings have important implications for organisations and individuals seeking to optimise clinical wellbeing.”
Looking at each subset of the hostile work environment in detail, Sharma details that emotional harassment was experienced by nearly one-third of cardiologists. This can take the form of microaggressions, which are characterised as microassaults, microinsults, microinvalidations, or more overt “macroagressions”, representing institutional and structural biases.
The survey results indicate that at least one form of discrimination was experienced by 30% of cardiologists, an outcome that was found to be three times higher among women than men. Although women experienced more gender-based discrimination, men experienced more age-based discrimination, Sharma reports.
“Our study also uniquely investigated the perpetrators of discrimination, and this also differed by gender of the targeted group,” Sharma goes on to add. “Women were especially targeted by colleagues and patients, whereas men were most commonly targeted by administrators. This difference may have important implications for the impact on the target. This also means that solutions should target not just peers but also ancillary staff, administrators, and patients.”
Incidences of sexual harassment were more commonly reported by women than men, the results indicate, also showing that 42% of respondents had experienced more than one type of sexual harassment. The study authors say this consistent with reports that targets of sexual harassment often face repeated harassment rather than one single incident.
“These data come at a crucial time when harassment and the culture of discrimination in medicine are being openly challenged,” Sharma writes. “These findings support the need to improve the culture within medicine greatly and raise a call to action to address harassment and discrimination.”
In an editorial comment accompanying the study in JACC, Javed Butler (University of Mississippi Medical Center, Jackson, USA) and Ileana Piña (Central Michigan University, Midlands, USA), write that the importance of the research “cannot be underestimated”, although caution against drawing conclusions about whether the findings apply uniquely to the practice of cardiology, or would be generalisable across many medical specialties. “It needs to be understood that cardiology has been traditionally a white male-dominated specialty and thus some of these observations may have this underlying feature. Further data are needed to understand and compare the workplace culture in medicine as a whole, and to learn from each other,” they write.
Butler and Piña go on to state: “When people feel threatened, undervalued, or discriminated against, it can affect productivity at work. It is unlikely, however, that the impact of such dynamics stops in the workplace and may affect individuals’ personal life and relationships with a potential to escalate into bigger problems with more dire consequences.
“Thus, there are both ethical and practical considerations why these results should be taken seriously. Lack of awareness by leadership coupled with a sense of not belonging may force the recipient of the hostility to leave the workplace. This loss of talent and dedication should be concerning to all.”
Other contributors to the study included Laxmi Mehta (Ohio State University Wexner Medical Center, Columbus, USA) and Pam Douglas (Duke University, Durham, USA).
