Despite recent efforts to foster racial/ethnic diversity within the physician workforce, a majority of non-Hispanic black physicians reported experiencing discrimination in their current workplace even after adjusting for years in practice, age, gender, specialty, region of the country and other factors. These findings are similar to those from national surveys conducted more than a decade ago,1,2
suggesting that significant numbers of non-majority physicians continue to experience discrimination at work. However, the experience of perceived discrimination does not appear to be static over the career course of individual physicians. Although most non-majority physicians in our sample reported having specifically experienced racial/ethnic discrimination at work at least sometimes during their careers, fewer non-majority physicians reported current workplace discrimination than reported career racial/ethnic discrimination. Notably, physician views on how race, ethnicity, and discrimination affect their current professional experiences varied significantly by the respondent’s self-identified race/ethnicity. The dramatic racial differences in physician responses suggest that many non-majority physicians encounter a work environment where they perceive specific, discrimination-related challenges.
Our findings are consistent with observations made in the business literature describing the challenges associated with increasing workplace or workforce diversity, such as intergroup conflict and strained communication, without concurrent strategies to counteract these challenges.29,30
The business literature further suggests that specific core elements characterize successful diversity initiatives including: (1) recruiting racial/ethnic minorities into the organization, (2) promoting racial/ethnic minorities within the organization, (3) capturing the perspectives of employees regarding the race-related climate, and (4) emphasizing the relevance of diversity to the mission of the organization.31
The United Kingdom’s response to physician-experienced discrimination may also provide the US medical profession with some guidance. The British Medical Association launched a national campaign to inform National Health System patients and providers that racial harassment would not be tolerated. They further trained all NHS employees, not just racial/ethnic minority providers, regarding the knowledge, new structures, and skills necessary to respond to workplace discrimination.32
Leadership engagement, the development of policies that support professional equity, and physician participation in decision-making are principles that can be generalized to the US medical profession. For example, additional research can focus on addressing differential experiences such as difficulty finding mentors, being asked to take on certain responsibilities because of race/ethnicity, and patient refusal of provider.
To place these findings in perspective, it is important to recognize that they do not set the medical profession apart from the rest of American society. They reflect the fact that racism and discrimination have created a broad-based legacy of vastly differing world views.33
As organizations aim to recruit and retain a racially/ethnically diverse health-care provider workforce, it is necessary that organization leadership explicitly recognizes that differences in employee experiences and perceptions will inevitably affect the conversations about race within health-care settings,34
and should inform the development of formal and informal mechanisms for communication and conflict resolution.
Our study extends prior work and augments our understanding of the physician workplace experience, but it also has some limitations. First, although our cross-sectional study design demonstrated statistically significant associations between race and reports of experienced discrimination, caution should be used when drawing conclusions regarding causality. We found trends toward increased reports of discrimination among Hispanic/Latino(a) physicians, but our sample size provided limited power to assess the statistical significance of these associations. Finally, survey non-respondents may have had different views from respondents. However, we found no differences between respondents and non-respondents on observable characteristics such as specialty, age, or geographical region. The inclusion of the NMA membership roster in our sampling frame potentially introduces bias towards increased reports of discrimination if current or former members are more likely than non-members to report discrimination. We did not, however, find that physicians of African descent identified via the NMA were more likely than those identified via the AMA Masterfile to report discrimination, so we believe this potential sampling bias is not substantial. Furthermore, previous data35
have identified a tendency for individuals of African descent to underreport workplace discrimination, suggesting bias towards the null in our sample. Given our research objectives, it was imperative to explicitly recruit practicing physicians of African descent; the NMA membership roster remains the most comprehensive repository of contact information for this group. Despite our inability to describe the NMA membership roster non-responders, our response rates (53.1% from the AMA Masterfile, at worst 46.6% overall) are consistent with other recent national surveys of physicians on potentially sensitive topics (43%–53%).36–41
Non-majority physicians in the US, regardless of specialty, geographic region, gender, years in practice, or age, continue to report high rates of workplace discrimination, comparable to rates reported over a decade ago. These findings suggest that efforts to address workplace discrimination have not been entirely successful, and new initiatives will be needed to achieve the goal of professional equity in medicine. Increasing and successfully supporting physician workforce diversity may reduce existing racial/ethnic health-care inequities and improve the quality of health-care for all patients. It may be cause for optimism that fewer respondents reported current workplace discrimination than reported career discrimination, although job turnover or other undesired factors may account for this finding. Still, opportunities exist for health-care organizations and diverse physicians to work together to improve the climate of racial discrimination where they work. Understanding the different experiences and perceptions of a diverse workforce is fundamental to creating health-care work environments that successfully support diversity.