LGBTQ+ Worker Protections: Implications for Academic Medicine Today and in the Future

Workplace Mistreatment in U.S. Cardiology: A Comprehensive Analysis of Experiences and Implications

BACKGROUND

Discrimination and harassment are common in cardiology but data on its impact are limited.

OBJECTIVES

This study sought to identify the prevalence and impact of workplace mistreatment among U.S. cardiologists overall and when engaged in clinical and academic work.

METHODS

The American College of Cardiology conducted an online survey of 1,583 U.S. cardiologists in 2022. Demographics, types of mistreatment, professional experiences, and impact were self-reported. Multivariable logistic regression analyses were used to determine the predictors of "negative professional impact" defined as a composite of any of the following outcomes: being less productive, taking sick time, leaving a position, leaving cardiology, or leaving medicine.

RESULTS

Three-quarters of cardiologists experienced workplace mistreatment, including incivility (34%), discrimination (62%), emotional or physical harassment (32%), and sexual harassment (13%). Unfair treatment was reported by 54% working in any clinical setting, including issues related to professional advancement (31%), clinical work expectations (27%), and compensation (23%). Unfair treatment was reported by 58% during academic work. Consequently, 20% avoided training, employment, or promotion opportunities, 20% felt silenced, and 16% reported social avoidance; 11% considered leaving medicine. Predictors of negative professional impact included type of mistreatment (harassment [OR: 10.01; 95% CI: 5.25-19.10], discrimination [OR: 3.03; 95% CI: 1.56-5.80]), identification as homosexual (OR: 5.60; 95% CI: 1.87-16.78), and woman gender (OR: 1.57; 95% CI: 1.19-2.07).

CONCLUSIONS

Three of 4 U.S. cardiologists report workplace mistreatment, including two-thirds reporting discrimination and/or harassment. Mistreatment negatively impacts professional lives, career trajectory, well-being, productivity, workforce retention, and ultimately impacts the delivery of patient care. These data highlight the need to improve the climate within cardiology.

Equity, diversity, and…exclusion? A national mixed methods study of "belonging" in Canadian undergraduate medical education

Equity, diversity, and inclusion remain a prominent focus in medical schools, yet the phenomenon of "belonging" has arguably been overlooked. Little is known regarding how belonging is experienced by medical students from groups that face systemic oppression and exclusion. We employed a sequential explanatory mixed methods design to explore how students from equity-deserving groups (EDGs) experience belonging during medical school, including those who are women, racialized, Indigenous, disabled, and 2SLGBTQIA+. First, we conducted a national cross-sectional survey of medical students (N = 480) measuring four constructs: belonging, imposter syndrome, burnout, and depression. Belonging scores were overall lower for students from EDGs and, more specifically, significantly lowest amongst racialized students. Structural equation models show that poor sense of belonging precedes imposter syndrome and further exacerbates burnout and depression. Next, we sampled and interviewed students (N = 16) from the EDG whose belonging scores were significantly lowest. Participants described the essence of belonging as being able to exist as one's "true self" while emphasizing feelings of acceptance, comfort, and safety as well as being valued and seen as an equal - yet described how routine experiences of "othering" inhibited a sense of belonging, often due to differences in social identity and structural privilege. Poor sense of belonging negatively affected learners' well-being and career trajectory. We illuminate the range of psychological and professional consequences associated with diminished sense of belonging and highlight the need to expand traditional notions of equity, diversity, and inclusion to consider structural barriers to belonging.

Someone Like Me-The Importance of Visible Sexual and Gender Minority Health Care Professionals

This Viewpoint proposes ways to promote safe spaces for sexual and gender minority health care professionals and patients.