Perception of discrimination common among cardiologists
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More than 50% of cardiologists from historically underrepresented racial or ethnic groups reported experiencing discrimination during their career, according to results from a survey.
In addition, women were more likely than men to report experiencing discrimination, according to the 2015 American College of Cardiology Professional Life Survey, which was conducted by the ACC Diversity & Inclusion Task Force and the ACC Women in Cardiology Section and published in the Journal of the American College of Cardiology.
“Despite calls for racial and ethnic diversification in medicine or cardiology, there has been little change. Putting into place methods to support those who are underrepresented in medicine is critical moving forward,” Kevin L. Thomas, MD, FACC, associate professor of medicine at the Duke University Research Institute, said in a press release.
The survey included responses from 2,245 cardiologists (58% men; 83% to 85% adult cardiologists). Among the cohort, 1,447 identified as white, 564 as Asian/Pacific Islander, 37 as multiracial and 197 as a member of an historically underrepresented racial or ethnic group. Of the latter group, 80 were Black, 113 were Hispanic and four were Native American.
Reports of discrimination
Compared with white respondents (36.4%), more respondents from historically underrepresented racial or ethnic groups (52.3%) and Asian/Pacific Islander respondents (45.5%) reported they experienced discrimination (P for both < .001), according to the survey.
In addition, women (range by racial/ethnic group, 57% to 69.2%) were more likely to report experiencing discrimination than men (range by racial/ethnic group, 13.9% to 44.6%), Thomas and colleagues found.
Among male respondents, those from historically underrepresented racial or ethnic groups (44.6%) and Asian/Pacific Islander respondents (36.2%) were more likely to report experiencing discrimination than white respondents (13.3%; P for comparison across all racial/ethnic groups < .001).
However, among female respondents, white women (69.2%) were more likely to report they experienced discrimination compared with those from historically underrepresented racial or ethnic groups (62.7%) and Asian/Pacific Islander respondents (57%; P for comparison across all racial/ethnic groups < .001), according to the researchers.
Regarding types of discrimination reported, men were most likely to report race- or religion-based discrimination, whereas women were most likely to report sex-based discrimination, followed by parenting-based discrimination, the researchers wrote.
Among the cohort, 53% reported discrimination affected relationships with colleagues and 22% reported it affected relationships with patients; those results were consistent across races/ethnicities.
Three-quarters of respondents reported they had a mentor during training, and Asian/Pacific Islander respondents were more likely than white respondents to report their mentor had a positive influence on career planning and decision-making (74% vs. 67%), according to the researchers.
Compared with white cardiologists, those from historically underrepresented racial or ethnic groups were less likely to prioritize salary (13.6% vs. 20.6%), benefits (10.9% vs. 23.3%) or work hours (19.3% vs. 31.3%) in their first job after training (P for all < .02), Thomas and colleagues wrote.
In negotiations for subsequent jobs, compared with white cardiologists, those from historically underrepresented racial or ethnic groups were more likely to prioritize salary, benefits and work hours, whereas those from historically underrepresented racial or ethnic groups and Asian/Pacific Islander cardiologists were more likely to prioritize travel benefits, diversity, mentoring, workspace, time to promotion advancement, academic rank and roles with recognition (P for all < .01), the researchers wrote.
Rates of burnout were higher among white cardiologists (30.3%) compared with those from historically underrepresented racial or ethnic groups (22.4%; P = .02) and Asian/Pacific Islander cardiologists (20.1%; P < .01), and white cardiologists were more likely than those from other backgrounds to report that their job caused “a great deal of stress,” Thomas and colleagues wrote.
Recommendations for improvement
The authors issued four recommendations in response to the results:
- Collect sex and racial/ethnic identity using classifications similar to those in the 2020 U.S. Census.
- Partner with racial- and ethnic-specific organizations on strategies to improve racial and ethnic diversity and inclusion in cardiology.
- Implement training on implicit bias and antiracism for leaders of institutions and organizations.
- Develop leadership pathways for women and those from historically underrepresented racial or ethnic groups.
Reference:
- American College of Cardiology. Survey: More Work Needed to Combat Discrimination, Inequity in Cardiovascular Workforce. Published and accessed Oct. 18, 2021.
Perspective
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Amber E. Johnson, MD, MS, MBA, FACC
I find the results and the authors’ interpretation of them to be very interesting. Based on the survey responses, 40% of American cardiologists have personally experienced discrimination from colleagues or patients. But despite these negative interactions, the survey respondents were presumably able to persist in their careers and have a high level of job satisfaction and low burnout rates. Dr. Thomas and his co-authors attribute the low levels of burnout to psychosocial resilience, especially among underrepresented minorities.
Overall, these findings align with our paper on race-based disparities in the CV workforce (Johnson AE, et al. Circulation. 2021;doi:10.1161/CIRCULATIONAHA.121.053566.) The survey results show that the experience of discrimination is higher for respondents from underrepresented minority groups. The recommendations by Thomas and colleagues are also similar to ours, especially the importance of partnering with professional organizations and formation of career development pathways for underrepresented groups (their recommendations 2 and 4).
The observations regarding career motivation are mostly consistent with our review findings. Data show that Black, Latinx and Indigenous physicians are more likely to work in community-based practices. Such settings are likely to have relatively lower pay and higher proportion of patients from racial minority backgrounds. Together, these findings suggest that cardiologists from underrepresented minority groups appear to be driven by motives other than finance primarily. And that community activism/outreach is a central driver for physicians of color.
The authors also underscore the importance of mentorship for career success.
Our findings differ regarding career advancement. In Dr. Thomas’ study, survey respondents reported satisfactory rates of career advancement irrespective of race. These findings counter the available objective data. As Dr. Thomas acknowledges, rates of promotion and tenure are not equitable across races. Perhaps the survey findings are reflective of the large proportion of fellows in the sample, who would be expected to progress from year to year so long as educational requirements are met.
Coming back to the idea of mentorship, it really is critical for underrepresented cardiologists to find mentors and sponsors who can help them navigate career success and council them on strategies for advancement. While this won’t overcome discrimination, mentorship may help to buffer against discriminatory situations so that one’s career does not get derailed.
Discrimination in the clinical setting is challenging to navigate in the moment. It’s time for health care systems to start normalizing physicians and staff of color. Patients of all races should not be surprised that cardiologists can come in any skin tone. Along those lines, it is important that our hospital leadership support diversity. Allyship among practice managers and administration can foster collegial environments to prevent discrimination from occurring in patient care areas.
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