ABSTRACT
BACKGROUND
Promoting racial/ethnic diversity within the physician workforce is a national priority. However, the extent of racial/ethnic discrimination reported by physicians from diverse backgrounds in today’s health-care workplace is unknown.
OBJECTIVE
To determine the prevalence of physician experiences of perceived racial/ethnic discrimination at work and to explore physician views about race and discussions regarding race/ethnicity in the workplace.
DESIGN
Cross-sectional, national survey conducted in 2006–2007.
PARTICIPANTS
Practicing physicians (total n = 529) from diverse racial/ethnic backgrounds in the United States.
MEASUREMENTS AND MAIN RESULTS
We examined physicians’ experience of racial/ethnic discrimination over their career course, their experience of discrimination in their current work setting, and their views about race/ethnicity and discrimination at work. The proportion of physicians who reported that they had experienced racial/ethnic discrimination “sometimes, often, or very often” during their medical career was substantial among non-majority physicians (71% of black physicians, 45% of Asian physicians, 63% of “other” race physicians, and 27% of Hispanic/Latino(a) physicians, compared with 7% of white physicians, all p < 0.05). Similarly, the proportion of non-majority physicians who reported that they experienced discrimination in their current work setting was substantial (59% of black, 39% of Asian, 35% of “other” race, 24% of Hispanic/Latino(a) physicians, and 21% of white physicians). Physician views about the role of race/ethnicity at work varied significantly by respondent race/ethnicity.
CONCLUSIONS
Many non-majority physicians report experiencing racial/ethnic discrimination in the workplace. Opportunities exist for health-care organizations and diverse physicians to work together to improve the climate of perceived discrimination where they work.
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References
Peterson NB, Friedman RH, Ash AS, et al. Faculty self-reported experience with racial and ethnic discrimination in academic medicine. J Gen Intern Med. 2004;19:259–65.
Corbie-Smith G, Frank E, Nickens HW, et al. Prevalences and correlates of ethnic harassment in the U.S. Women Physicians’ Health Study. Acad Med. 1999;74:695–701.
Palepu A, Carr PL, Friedman RH, et al. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000;75:157–60.
Fang D, Moy E, Colburn L, et al. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA. 2000;284:1085–92.
Palepu A, Carr PL, Friedman RH, et al. Minority faculty and academic rank in medicine. JAMA. 1998;280:767–71.
Institute of Medicine. In the Nation’s Compelling Interest: Ensuring Diversity in the Healthcare Workforce. In: Smedley BD, Bulter AS, Bristow LR, eds. Washington DC: National Academies Press; 2004.
Nickens HW, Ready TP, Petersdorf RG. Project 3000 by 2000. Racial and ethnic diversity in US medical schools. N Engl J Med. 1994;331:472–6.
The Sullivan Commission on Diversity in the Healthcare Workforce. Missing Persons: Minorities in the Health Professions. 2004. Available at: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1141. Last accessed July 23, 2009
Chan L, Ahmad Y. Diversity in Medicine-Diversity and equity issues in medical education. Univ Tor Med J. 2005;82:172–4.
Cohen JJ. Time to shatter the glass ceiling for minority faculty. JAMA. 1998;280:821–2.
Nickens HW. The rationale for minority-targeted programs in medicine in the 1990s. JAMA. 1992;267:2390–5.
Powe NR, Cooper LA. Diversifying the racial and ethnic composition of the physician workforce. Ann Intern Med. 2004;141:223–4.
Smith LH, Bridges K. Minority medical faculty fellows credit program with fostering their academic careers. 1996. Available at: http://www.rwjf.org/reports/grr/027395s.htm. Last accessed July 23, 2009
Tekian A. A thematic review of the literature of underrepresented minorities and medical training, 1981–1995: securing the foundations of the bridge to diversity. Acad Med. 1997; 72: S140–6.
Thomson WA, Denk JP. Promoting diversity in the medical school pipeline: a national overview. Acad Med. 1999;74:312–4.
Price EG, Gozu A, Kern DE, et al. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med. 2005;20:565–71.
Coombs AA, King RK. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005;97:467–77.
Nunez-Smith M, Curry LA, Bigby J, et al. Impact of race on the professional lives of physicians of African descent. Ann Intern Med. 2007;146:45–51.
American Medical Association. AMA Physician Masterfile. Available at: http://www.ama-assn.org/ama/pub/category/2673.html. Last accessed July 23, 2009
National Medical Association. Available at: http://www.nmanet.org/. Last accessed July 23, 2009
Cook DA, Beckman TJ. Current concepts in validity and reliability for psychometric instruments: theory and application. Am J Med. 2006;119:166 e167–116.
Krause N. A comprehensive strategy for developing closed-ended survey items for use in studies of older adults. J Gerontol B Psychol Sci Soc Sci. 2002;57:S263–74.
Bobo LD, Suh SA. Surveying racial discrimination: analyses from a multiethnic labor market. In: Bobo LD, Oliver ML, Johnson JHJ, et al, eds. Prismatic Metropolis: Inequality in Los Angeles. New York: Russell Sage Foundation; 2000.
Essed P. Understanding Everyday Racism: an interdisciplinary theory. Thousand Oaks: Sage; 1991.
Burkard A, Boticki M, Madson M. Workplace Discrimination, Prejudice and Diversity Measures: a review of instrumentation. J Career Assess. 2002;10:343–61.
Hosmer DJ, Lemeshow S. Applied Logistic Regression. New York: John Wiley and Sons Inc.; 1989.
Austin PC, Mamdani MM, Juurlink DN, et al. Testing multiple statistical hypotheses resulted in spurious associations: a study of astrological signs and health. J Clin Epidemiol. 2006;59:964–9.
American Medical Association. Physician Characteristics and Distribution in the US, 2008 Edition. Available at: http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-consortium/physician-statistics/total-physicians-raceethnicity-2006.shtml. Last accessed July 23, 2009
Alderfer C. An inter-group perspective on group dynamics. In: Lorsch J, ed. Handbook of Organizational Behavior. Englewood Cliffs, NJ: Prentice-Hall; 1987.
Cox TJ. Cultural Diversity in Organizations: Theory, Research, and Practice. San Francisco: Berrett-Koehler; 1994.
Akinola M, Thomas D. Defining the attributes and processes that enhance the effectiveness of workforce diversity initiatives in knowledge intensive firms. 2008 Working Paper. Available at: http://www.hbs.edu/research/pdf/07-019.pdf. Last accessed July 23, 2009
Coker N. Racism in Medicine: An Agenda for Change. London: King’s Fund; 2001.
Kaiser Family Foundation. National Survey of Physicians Part I: Doctors on Disparities in Medical Care. 2001. Available at: http://www.kff.org/minorityhealth/20020321a-index.cfm. Last accessed July 23, 2009
Nunez-Smith M, Curry LA, Berg D, et al. Healthcare workplace conversations on race and the perspectives of physicians of African descent. J Gen Intern Med. 2008;23:1471–6.
National Research Council, ed. Measuring Racial Discrimination. Washington DC: The National Academies Press; 2004.
Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–36.
Campbell EG, Gruen RL, Mountford J, et al. A national survey of physician-industry relationships. N Engl J Med. 2007;356:1742–50.
Curlin FA, Lawrence RE, Chin MH, et al. Religion, conscience, and controversial clinical practices. N Engl J Med. 2007;356:593–600.
Gruen RL, Campbell EG, Blumenthal D. Public roles of U.S. physicians: community participation, political involvement, and collective advocacy. Jama. 2006;296:2467–75.
McCormick D, Woolhandler S, Bose-Kolanu A, et al. US physicians’ views on financing options to expand health insurance coverage: a national survey. J Gen Intern Med. 2009;24:526–31.
Sharma R, Kostis WJ, Wilson AC, et al. Questionable hospital chart documentation practices by physicians. J Gen Intern Med. 2008;23:1865–70.
Acknowledgments
Conception and design (MNS, EHB); data acquisition (MNS, NP, MW, CB); data analysis and interpretation (NP, MMD, MNS, EHB); manuscript drafting (MNS); manuscript revisions (MNS, NP, MW, MMD, CB, EHB, BJ, HMK). MNS had full access to all of the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. Thank you to Emily Bucholz for her assistance in the data collection phase of this project for which she was reimbursed as a research assistant. EHB is supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation Investigator Award (grant no. 02–102). MNS was supported, in part, by a grant through the Yale Center for Clinical Investigation. The funders did not contribute to the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
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None of the authors have any conflicts of interest to disclose.
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Nunez-Smith, M., Pilgrim, N., Wynia, M. et al. Race/Ethnicity and Workplace Discrimination: Results of a National Survey of Physicians. J GEN INTERN MED 24, 1198–1204 (2009). https://doi.org/10.1007/s11606-009-1103-9
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DOI: https://doi.org/10.1007/s11606-009-1103-9