More work needed to combat discrimination, inequity in cardiovascular workforce

American College of Cardiology

Underrepresented racial and ethnic minorities in the cardiovascular workforce continue to experience a lack of representation and face discrimination, inequitable job negotiations and burnout in their professional lives, according to an analysis of the 2015 Professional Life Survey conducted by the American College of Cardiology. The analysis published today in the Journal of the American College of Cardiology.

“Despite calls for racial and ethnic diversification in medicine or cardiology, there has been little change. Putting into place methods to support those who are underrepresented in medicine is critical moving forward,” said Kevin Thomas, MD, FACC, associate professor of medicine at the Duke University Research Institute and lead author of the study.

The ACC’s third decennial Professional Life Survey was conducted by the ACC Women in Cardiology Section and on behalf of the ACC Diversity and Inclusion Task Force to assess the professional experience of cardiologists. The survey included 2,245 respondents who provided racial/ethnic data. Of the respondents, 1,447 identified as white, 564 as Asian or Pacific Islander and 37 as multiracial. Underrepresented racial and ethnic minorities (URMs), those identifying as Black, Hispanic or Native American, counted for 197 of the respondents.

The researchers looked at the 197 URM respondents to assess career satisfaction and advancement, personal and family issues, discrimination, mentoring, job negotiations and burnout rates compared with the other racial and ethnic groups.

“This particular group has never been singled out in analyzing the data from the 2015 Professional Life Survey, and the results are very revealing about how much work there is still left to do,” said Thomas.

Over 91% of URM respondents were satisfied with their career and felt their level of advancement and career opportunities were similar to their peers. Along the same lines, 85% of URMs were satisfied with their family lives outside of work. These results are at odds with previous research and data showing URMs are at a disadvantage for job and financial advancement. The researchers said that prior studies have focused on advancement and leadership in academic settings, whereas this study included cardiologists in private practice and academics who may have different experiences.

However, over half (52.3%) of URMs reported experiencing discrimination, compared with 36.4% of white respondents. Women of all racial and ethnic groups were more likely than men to report discrimination (57-69.2% compared with 13.9-44.6%, respectively). When broken down, men were more likely to report race and religion-based discrimination, whereas nearly all women reported gender discrimination, and URM women in addition reported frequently experiencing race-based discrimination in the workplace.

Compared with white cardiologists, URM cardiologists were less likely to negotiate or prioritize salary, benefits and work hours in their first job (white cardiologists reported 20.6%, 23.3%, 31.3% in each category respectively, versus 13.6%, 10.9%, 19.3% respectively from URM cardiologists). As their careers advanced, URMs placed more emphasis on salary, benefits and work hours compared with white cardiologists, which according to researchers is potentially a marker that URMs are placed at a disadvantage in these categories at the start of the careers and showcasing there is a greater need to overcome systemic barriers.

White cardiologists were more likely than URMs to report higher rates of burnout, however URMs experienced more isolation and non-inclusive work environments. The researchers said greater learned resiliency over their lifetime from URMs may contribute toward reporting lower rates of burnout.

The authors offered four recommendations for professional organizations and health systems based on their findings:

  • Collect gender and racial and ethnic identities of members using classifications similar to the 2020 U.S. Census
  • Partner with racial and ethnic-specific professional organizations to develop and implement diversity and inclusion efforts
  • Implement bias and antiracism training among leaders
  • Develop leadership pathways for women and URM members

This study had several limitations, including a response rate of 21% which may limit representativeness of each group. Similarly, combining Black, Hispanic and Native American individuals into one group obscures the unique experiences between each of these groups, and comparing URMs to whites can perpetuate the idea of white race being the standard. Finally, the 2015 Professional Life Survey was not specifically designed to assess racial/ethnic diversity topics.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

The ACC’s family of JACC Journals rank among the top cardiovascular journals in the world for scientific impact. The flagship journal, the Journal of the American College of Cardiology (JACC) — and family of specialty journals consisting of JACC: Advances, JACC: Asia, JACC: Basic to Translational Science, JACC: CardioOncology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, JACC: Case Reports, JACC: Clinical Electrophysiology and JACC: Heart Failure — pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.

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