Racial and ethnic minority cardiologists are underrepresented in the workforce, and continue to face discrimination and missing representation, analyses of the American College of Cardiology’s (ACC) 2015 Professional Life Survey show.
The findings – published Monday online ahead of the Oct. 26 issue of the Journal of the American College of Cardiology – show that, “despite calls for racial and ethnic diversification in medicine or cardiology, there has been little change,” the study’s lead authors, Kevin Thomas, MD, Duke University Research institute, said in an accompanying press statement.
“Putting into place methods to support those who are underrepresented in medicine is critical moving forward,” Thomas urged.
The survey was the third of its kind, conducted every 10 years, some of the few data available detailing professional and personal experiences of people working in cardiology, as well as racial and ethnic information, the researchers noted. It included 2,245 respondents in the cardiology field who provided their racial/ethnic data.
Of the cohort, 1,447 identified as white, 564 Asian or Pacific Islander, while those identifying as either Black (80 respondents), Hispanic (113 respondents) or Native American (4 respondents) – jointly categorized as “underrepresented racial and ethnic minorities” (URMs) – accounted for just 197 of the respondents. A further 37 identified as multiracial.
For the entire group, 58% were men and most were adult cardiologists (83% to 85%), followed by pediatric cardiology (6% to 10%) and cardiovascular surgery (1% to 2%), while 12.4% were fellows in training.
URMs were more likely to be clinical cardiologists (55.8%) compared to whites (49.4%) (P = 0.11). URMs were also more likely to be in solo practice than whites (8.2% URMs vs. 3.2% whites; P < 0.01), whereas Asians and Pacific Islanders were more likely to work in physician-owned practices (19% vs. 14.3% whites; P = 0.010), or government hospitals and agencies (7.1% vs. 4.8%; P = 0.04).
The researchers then assessed factors such as career satisfaction and advancement, discrimination, job negotiations, mentoring, burnout rates, and personal and family issues in the 197 URM respondents compared to those in other racial and ethnic groups.
The majority of URMs (52.3%) and many Asian/Pacific Islanders (45.5%) said they had experienced discrimination, compared to 36.4% of whites who said the same (both P < 0.01).
Furthermore, women across the groups (57% to 69.2%) were more likely to report discrimination than men (13.9% to 44.6%), and in particular, discrimination in white men was low (13.9%) relative to URM (44.6%) and Asian/Pacific Islander (35.2%) men (P < 0.01 comparison across all racial and ethnic groups).
“Men were more likely to experience race- and religion-based discrimination, whereas nearly all women reported sex discrimination, with parenting as an important second reason,” the researchers noted.
“Race-based discrimination was frequently experienced by URM and Asian/PI women but less commonly than men in these groups.”
Notably, white women were more likely to report discrimination (69.2%) than women in other groups (URMs 62.7%, Asian/Pacific Islanders 57%; P < 0.01 for comparison across racial and ethnic groups).
“There were several challenges of examining discrimination in the workplace, including its subjective nature, difficulty in quantitating severity or overtness, and fear of retaliation,” the researchers lamented.
Meanwhile for mentoring, both the URM and Asian/Pacific Islander groups reported more favorable experiences with mentors than white cardiologists, “perhaps because these individual relationships are more critical to success among otherwise disadvantaged or less visible groups.”
Unlike previous findings that URMs were at a disadvantage for job and financial advancement, the current study found that over 91% of URM respondents said they were satisfied with their career – slightly more respondents than those who were satisfied from Asian/Pacific Islander (90%) and white (89.1%) backgrounds.
Similarly, most URMs (64.1%) were satisfied with their financial compensation, in line with other races and ethnicities (Asian/Pacific Islanders at 63.8% and whites 65.8%), and most cardiologists across groups believed their level of advancement was similar to their peers and were satisfied with career opportunities.
Nevertheless, URM cardiologists were less likely to prioritize salary, benefits and work hours in their first job after completion of training, the researchers noted.
“Interestingly, there are data that report higher salaries for White men compared with Black physicians,” the researchers added.
URM and Asian/Pacific Islander respondents also reported lower burnout rates (22.4%and 20.1%, respectively) compared with white colleagues (30.3%; P = 0.02 and P < 0.01, respectively).
Although this finding was unexpected, the life experiences and ongoing professional challenges for URMs and Asian/Pacific Islanders may result in “greater resiliency,” which could account for lower burnout, “or perhaps challenges of institutional racism deters less resilient URM and Asian/PI physicians from cardiology careers,” the researchers speculated.
They added that: “In subsequent job negotiations, URMs relative to White cardiologists placed more importance on multiple work domains, including salary benefits and work hours, whereas both URMs and Asians/PIs highlighted a greater importance for travel benefits, diversity, mentoring, workspace, time to promotion or advancement, academic rank, and roles with community, institutional, or national recognition (all: P < 0.01).”
URM and Asian/Pacific Islander prioritization of more factors in job negotiations could indicate a greater need to overcome systemic barriers, the analysts added.
Although the current study has limitations – including having a response rate of 21%, which could hinder representativeness of each group – “few studies have examined the significance and impact of discriminatory behavior on practicing physicians,” the researchers said.
“How these experiences may influence care delivery, scholarly productivity, and well-being among clinicians in a variety of care settings is poorly understood and warrants further investigation.”
They added that addressing discrimination is both a “priority and a necessity” for the profession, while Thomas stressed that the results are “very revealing about how much work there is still left to do”.
The researchers went on to call for zero tolerance policies and processes for discriminatory acts, with accountability, remediation and restorative justice to produce substantive change.
They concluded with four key recommendations for professional organizations and health systems:
- That sex, racial and ethnic data be systematically collected similarly to the 2020 U.S. Census
- That partnerships with racial and ethnic-specific professional organizations be made to develop and implement diversity and inclusion efforts
- To implement bias and antiracism training among leadership
- To develop leadership pathways for women and URM members
Thomas KL, Mehta LS, Rzeszut AK, et al. Perspectives of Racially and Ethnically Diverse U.S. Cardiologists: Insights From the ACC Professional Life Survey. J Am Coll Cardiol 2021;78:1746–1750.
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