The views and experiences described by our physician participants shed light on the tensions and challenges that healthcare organizations may face as they attempt to promote healthy dialogues about race in the workplace. We found that physicians of African descent in our study often had early and powerful healthcare experiences that were influenced by race. Participants described healthcare organizations as settings in which racial/ethnic discrimination still occur. In addition, participants primarily relied on support networks external to their workplace and were hesitant to discuss race-related experiences within their work environment. This apprehension was reinforced by the perception that their non-minority colleagues would not want to discuss race. Furthermore, participants were concerned that their non-minority colleagues would dismiss the potential contribution of race if the participant found an interaction racially offensive. Participants also expressed fears of damaging their work relationships, being labeled as hypersensitive, and hurting their chances for advancement if they openly discussed race in their work settings.
Our findings build upon an existing literature documenting reports of racial/ethnic discrimination experienced by physicians and physicians-in-training. Prior qualitative studies of racial/ethnic minority high school students, medical students, residents, and practicing physicians described their perceptions and experiences of discrimination within healthcare organizations4,15,24,25
. Surveys of practicing physicians found that racial/ethnic discriminatory experiences extend post-medical training for significant numbers of racial/ethnic minority physicians1,2,6,7
. We extended the previous work with practicing physicians of African descent4
by characterizing the challenges and potential consequences that may arise as healthcare organizations respond to recommendations for open dialogue about race.9–11
The perspectives offered by the physicians of African descent in this study highlight both the importance of workplace conversations about race and the challenges organizations may face when trying to promote a healthy dialogue in the workplace. Our findings have several important implications for healthcare organizations focused on the recruitment and retention of a diverse workforce. Given that our findings and management literature identify challenges when engaging racial/ethnic minority and non-minority individuals in such dialogue,26–28
healthcare organizational leadership must proactively raise awareness and foster organizational climates that support dialogue about race relations and diversity. Our findings are similarly consistent with the literature that notes minority business professionals are less likely to network within their workplace.12–14
Although seeking support outside of the organization may be effective for the immediate resolution of individual difficulties, this pattern of diverted race-related conversations delays the organization’s recognition of any problems and does not promote longer-term changes within the organization. This pattern may also have career consequences for minority physicians since external networking hinders the career advancement of racial/ethnic minorities in the business professions.12–14
To address these potential difficulties, safe environments should be created before initiating race-related dialogue. Safe environments are workplaces in which individuals can express personal experiences without fear of dismissal or punishment, where differences across perspectives are explored respectfully, and where confidentiality is assured to prevent subsequent career consequences. Creating a safe physician workplace for race-related conversations will require a cohesive, coordinated initiative with input from members across racial identities, given that race and ethnicity influence the interpretation of shared experiences and shape the professional identity of all physicians and healthcare providers. Although we found that race is an important dimension of physician identity, it is critical to recognize the inherent risk of stereotyping based on this study’s findings. Therefore, the insights presented here are intended as a starting point, not a substitution, for an exploratory process within individual organizations.
It is important to consider the limitations of the study. Our sample was purposefully limited to physicians of African descent living and practicing in the six New England states. Therefore, these findings may not fully characterize the experiences of all physicians of African descent, physicians from other racial/ethnic backgrounds or physicians in other geographic areas. We developed a sample that was nevertheless diverse in terms of potentially relevant characteristics, including a range of academic and nonacademic work settings, clinical specialties, and age groups. Despite this diversity, these physicians shared common views on how race shapes their professional identity and perspectives that may affect their participation in workplace conversations about race. Other strengths of the project include a 100% participation rate, research and coding team diversity, and racial concordance with a physician interviewer. In addition, we used several recommended strategies to ensure scientific rigor, including consistent use of the discussion guide, audio-taping interviews, professional transcript preparation, standardized coding and analysis of the data, participant confirmation of findings, and maintenance of an audit trail to document analytic decisions.18,21,29,30
Creating a healthcare work environment that successfully supports diversity is as important as recruiting diversity across the workforce. In addition to the fundamental creation of a safe place for open dialogue, close attention should also be paid to the development and enforcement of specific institutional policies that target discriminatory experiences. Larger initiatives can utilize existing institutional incentives, such as the accreditation and licensure process, to support change.31
Raising awareness and drafting policy recommendations at the national level can also result in important regulatory and protective guidelines as attempted by other health systems.32
Developing constructive ways to discuss race and race relations among colleagues in the workplace is a key step towards creating a supportive environment for employees and patients from all backgrounds.