Survey suggests many health care workers are not speaking out against racism
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Most physicians and trainees who were surveyed agreed that racism has an impact on health; however, less than half of respondents reported speaking out against a racist encounter or policy.
Adults aged 50 years and older were more likely to report speaking out against racism compared with younger physicians, according to survey results published in the Journal of General Internal Medicine.
“It is anxiety provoking to discuss bias, and it is something that our National Academy of Medicine has clearly described as one of the three root causes of health disparities,” Sherri-Ann Burnett-Bowie, MD, MPH, an assistant professor of medicine at Harvard Medical School and a chair of the Diversity and Inclusion Board in the department of medicine, told Healio. “We need to be willing to both acknowledge the discomfort but also not let it prevent us from moving forward and being a part of that change.”
Burnett-Bowie and colleagues conducted an anonymous, cross-sectional survey of interns, residents, fellows and faculty within the department of medicine at Massachusetts General Hospital. In total, 948 participants responded to the survey between August 3, 2020, and October 26, 2020. They rated their attitudes on a five-point Likert scale about the impact of racism on health and health care, the impact of racism on other areas in society and the likelihood of reporting racist encounters or policies.
Most participants were aged 30 to 39 years (39%), followed by those aged 40 to 49 years (20%) and those aged 50 to 59 years (15%). Also, 44% were cisgender female and 49% were cisgender male; 64% identified as white, 20% as Asian and 4% as Black. In total, 68% of respondents were faculty and 20% were trainees. In addition, 80% of participants conducted clinical work while 43% conducted research.
Odds of speaking out
A majority of those surveyed agreed or strongly agreed that racism impacts society and health, yet a lower proportion accepted that the higher rate of pregnancy-related mortality among Black women has not been improving, according to Burnett-Bowie. Between 45.8% and 64% of participants reported a neutral stance towards the likelihood of intervening during a racist encounter or policy. Based on “disagree” and “strongly disagree” responses, 8.3% to 24.4% reported that they had not spoken up when they witnessed a racist encounter or policy. Conversely, based on “agree” and “strongly agree” responses, 21.7% to 40.5% reported having spoken up.
Addressing racism directly
The researchers reported that participants were least likely to speak to someone in leadership about a racist policy but most likely to speak to someone not in leadership about observing a racist encounter. Attitudes regarding the impact of racism on society and health were associated with participant race, with higher levels of endorsement of the impact of racism on health among Black respondents (OR = 1.97; 95% CI, 1.07-3.65) compared with other racial and ethnic groups. Male participants and those older in age were less likely to endorse the impact of racism on health and in society. Burnett-Bowie and colleagues reported that higher levels of endorsement regarding the impact of racism on health were associated with a greater likelihood of intervening, including speaking with the source of a racist statement (OR = 1.26), speaking with leadership about a racist encounter (OR = 1.29), speaking with someone else about a racist encounter (OR = 1.18), speaking with leadership about a racist policy (OR = 1.3), and speaking with someone else not in leadership about a racist policy (OR = 1.39).
Overall, the likelihood of speaking up following an observed racist encounter or policy did not differ substantially by race, ethnicity or gender identity. However, Burnett-Bowie and colleagues reported that female participants were more likely to speak to someone about a racist encounter or policy compared with other gender identities. Also, participants aged 50 years and older were more likely to address the source of racist behavior or to report a racist policy to leadership. Trainees aged 20 to 29 years were more likely to speak with others about racist experiences yet hesitant to speak with the source of the racist encounter or with leadership.
The root cause of this reluctance towards speaking out against racism is multifaceted, according to Burnett-Bowie. It is often very difficult to be the one to speak out since racism is a sensitive subject, she said. Older participants were more likely to speak out possibly because they have learned from past regrets, Burnett-Bowie said. Meanwhile, she expects younger participants and trainees were less likely to speak out in fear of it distracting from their clinical responsibilities or possible negative consequences to their careers.
“The fact that less than half of respondents endorsed speaking up after observing a racist encounter or learning of a policy or procedure that reinforces racism, and around half of the respondents chose the neutral option for these items, may reflect lack of awareness of the presence of racism in health care or lack of skills with which to address racism,” the researchers wrote.
Burnett-Bowie encouraged practices to implement an anonymous reporting system so that physicians may feel more comfortable speaking out against racist encounters and policies. Also, practices should have clear behaviors and actions prepared in order to take concerns seriously and act on them, she said.
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