Background: Under-representation of women and people of color (POC) in leadership positions has recently gained significant attention, and there are ongoing efforts to enhance their recruitment and advancement. The same intensity of work must be applied to also improve their workplace experiences. Discrimination, bias, and microaggressions are common day-to-day experiences among both POC and women in medicine. These experiences are often under-measured and under-reported. There are limited tools to collect data on the workplace experiences of POC and women physicians. In this study, we surveyed faculty physicians and residency or fellowship trainees who had worked at the Veterans Affairs Healthcare System of Connecticut (VACHS) over the past five years about discrimination they had experienced or witnessed firsthand in the workplace.

Methods: A survey was designed and validated, and results were anonymously collected via Red Cap. In total, 1359 employees were emailed with the survey link and asked to respond if they had worked at VACHS over the past 5 years. Of these, 429 faculty and trainees met these criteria. The survey asked about experiences including verbal, physical, or emotional offenses based on group identity that caused distress or a loss of learning opportunity, how often the offense occurred, who the offender was (patient/physician etc.), and whether they had witnessed any offenses. If they did not experience discrimination, they were asked why they thought they did not have this issue. We used descriptive statistics, chi-square, to compare survey factors and analyses were performed using SAS 9.4.

Results: Of 429 eligible email recipients, 276 (64%) responded. Of the 276, 64.5% were trainees, 53.4% women, 56.5% White, 5% Black; 42% identified as people of color and 4.4% as LGBTQ. The most common offenses reported were microaggressions (58%), hurtful and offensive language (47%), and inappropriate compliments (46%). In addition, 30% reported their suggestions were not heard because of their group identity, and 31% reported emotional and psychological distress from these experiences. The offenses ranged from verbal insults to unwelcome physical contact, from both patients and faculty. Faculty formed a major offender group for not hearing suggestions and causing loss of opportunities and psychological distress. The percentage of reported experiences closely matched the percentage of witnessed reports in each category of insults. Women, especially women of color were the most significantly impacted: 90% of White women and 95% of women of color reported having experienced any of the surveyed offenses, as compared to 50% of White men and 67% of men of color. Open-ended questions provided rich qualitative data (Table 1).

Conclusions: Our study demonstrated that women and POC physicians and trainees experienced identity-based offenses at a greater rate than White men. Reported incidents matched witnessed reports in frequency, suggesting the need for and value of bystander training and other resources. The results helped us establish several tools to prevent and address identity-based offenses at our institution. Our hope is that this survey can be widely administered at healthcare sites to collect data to help monitor and drive solutions to improve workplace culture to assure a safe work environment, and faculty retention.

IMAGE 1: Identity based offenses: Gender and race distribution (Panel 1); Source of offense (Panel 2)

IMAGE 2: Illustrative quotations about offenses