Medical Technology

Survey Spotlights Double-Edged Sword for Minority Cardiologists

Survey results paint a stark picture of discrimination among racial minorities in the cardiology workforce but also a strong sense of belonging.

Among respondents to the 2015 American College of Cardiology (ACC) Professional Life Survey, which is the most recent survey, over half (52.3%) of underrepresented racial and ethnic minorities (URMs) and 45.5% of Asian or Pacific Islanders reported experiencing discrimination compared with 36.4% of whites (both P < .01).

Nevertheless, 91.2% of URMs reported being satisfied with their career, as did 90% of Asians or Pacific Islanders and 89.1% of whites.

Satisfaction with financial compensation also did not differ between groups and most cardiologists believed their opportunities for advancement were similar to their peers.

One possible explanation is that the respondents may simply be people who’ve had better experiences, lead author Kevin L. Thomas, MD, Duke Clinical Research Institute, Durham, North Carolina, and colleagues told | Medscape Cardiology. A second hypothesis looks more to sheer determination, or grit.

“Perhaps along the sometimes circuitous pathway to being a cardiologist — which is a lot of training, a lot of standardized testing, a lot of applications — that maybe you sub-select a group of individuals who are simply more resilient based on their life experiences and things that they’ve overcome to get where they are,” he said.

Interestingly, rates of burnout were lower among URMs (22.4%) and Asians/Pacific Islanders (20.1%) than whites (30.3%; P = .02 and P < .01, respectively). The finding is unexpected but in line with a recent report of more than 4400 US physicians finding lower odds of burnout among Asian, Hispanic/Latinx, and Black physicians.

The new study, published today in the Journal of the American College of Cardiology, however, affirms that women of all racial and ethnic groups face significant headwinds in the white, male-dominated cardiology workforce.

Just 13.9% of white men reported experiencing discrimination, compared with 44.6% of URM men and 36.2% of Asians/Pacific Islander men. In comparison, 69.2% of white women reported discrimination, as did 62.7% of URM women and 57% of Asian/Pacific Islander women (both P <.01).

“When you look specifically at white men versus white women, there is a large discrepancy there and it just shows us, I think, for a lot of different groups, we still have a long way to go in terms of trying to achieve equity and to try to be inclusive in the workplace,” Thomas said.

Men were more likely to experience race- and religion-based discrimination in the workplace, whereas nearly all women reported sex discrimination, with parenting an important second. Approximately 85% of cardiologists reported being satisfied with their family lives, although unpublished data suggest URMs were less likely to be married and to have fewer children, Thomas said.

During job negotiations, URM cardiologists were less likely to prioritize salary, benefits, and work hours for their first job (13.6%, 10.9% 19.3%) than white cardiologists (20.6%, 23.3%, 31.3%; P < .02 for all).

In subsequent negotiations, URMs placed more emphasis on salary, benefits, and work hours than whites, whereas both URMs and Asians/Pacific Islanders placed a greater importance on travel benefits, diversity, mentoring, workspace, time to promotion, academic rank, and roles with community, institutional, or national recognition, which the authors say, “might indicate a greater need to overcome systemic barriers.”

Three-fourths of all cardiologist respondents had a mentor during training, which can take many shapes, Thomas noted. “Within my own section as an electrophysiologist, which is a very subspecialized category, we have four Black electrophysiologists, and I think it was because many of us mentored each other as we came along and it inspired us.”

URMs are more apt to experience the so-called “minority tax” of being tapped for added responsibilities in the name of inclusivity efforts, he said, and called on individuals from the dominant culture to mentor or sponsor cardiologists from other racial groups and to carve out leadership pathways for women and minorities so they “can use their gifts to benefit the profession at large,” leading clinical trials or steering committees and serving in high-profile roles.

Although the events of 2020 sharpened attention on the issue of diversity in America, Thomas and colleagues say that more work needs to be done defining the problem and that professional organizations and health systems also should systematically collect sex, racial, and ethnic identifies of members using classifications similar to the 2020 US Census.

The study was based on 2245 respondents to the 2015 Professional Life Survey, which was not specifically designed to assess racial/ethnic diversity topics and had a response rate of 21%, which limited representatives of each group.

In all, 197 were from URMs (80 Blacks, 113 Hispanics, 4 Native Americans), 564 were Asians/Pacific Islanders, 1447 were whites, and 37 listed multiracial/other. More than half (58%) were men, and most were adult cardiologists (83% to 85%), followed by pediatric cardiology (6% to 10%) and cardiovascular surgery (1% to 2%).

“Further research is needed to understand these findings and their significance, because ongoing efforts within ACC and other organizations to increase diversity will fail unless this is successfully addressed,” the authors conclude.

To that end, Thomas said they are looking to develop a new survey that taps other groups like the Association of Black Cardiologists and members of the LGBTQ community.

“I’m really excited about the opportunity to develop a survey that specifically has the objective of trying to understand the experiences of systematically disadvantaged, historically marginalized groups to see if we can see the same information, but maybe through a clear lens and then be able to develop strategies to mitigate some of the challenges that we see” he said. “So we can increase the numbers and also have a workforce that is reflective of the populations that we take care of and the nation as a whole.”

The study was funded by the American College of Cardiology. The authors have disclosed no relevant financial relationships.

J Am Card Cardiol. 2021;78:1746-1750. Abstract

Follow Patrice Wendling on Twitter: @pwendl. For more from | Medscape Cardiology, join us on Twitter and Facebook.

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