Toxic Cardiology Culture Pervasive Worldwide, ACC Survey Finds

Workplace harassment and discrimination were highly prevalent in cardiology, with certain groups in particular bearing the brunt of these challenges, an international survey found.

The American College of Cardiology (ACC) surveyed cardiologists in the fall of 2019. Of the more than 5,000 respondents across the globe, 44% reported experiencing a hostile work environment on at least one occasion -- namely emotional harassment, discrimination, and sexual harassment -- according to Garima Sharma, MD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

Workplace hostility was reported by groups across all regions, races or ethnicities, and both sexes and all gender identifications. However, it was significantly more likely in women (68% vs 37% for men; adjusted OR 3.39, 95% CI 2.97-3.86) and early-career doctors in practice for 2 to 5 years (54% vs 36% for those in practice over 20 years; adjusted OR 1.27, 95% CI 1.14-1.43), they reported in the Journal of the American College of Cardiology.

"These findings support the need to improve the culture within medicine greatly and raise a call to action to address harassment and discrimination," they said. "Proven approaches include instituting stronger organizational policies and creating a safe and fair process to report HWE [hostile work environment] incidences without fear of repercussion."

Gender and age were the most frequent causes of discrimination in particular, according to study participants. Women reported being targeted mainly by colleagues and patients, whereas men were most commonly targeted by administrators.

"This difference may have important implications for the impact on the target. This also means that solutions should target not just peers but also ancillary staff, administrators, and patients," Sharma's group said.

Most survey respondents noted that their HWE ultimately had adverse effects on their patients and professional activities.

"The results of this survey are disturbing, to say the least," said Javed Butler, MD, MPH, MBA, of University of Mississippi Medical Center in Jackson, and Ileana Piña, MD, of Central Michigan University in Detroit, in an accompanying editorial.

"Sharma et al. deserve deep gratitude from the cardiovascular community to shed light on this pervasive under-recognized problem. This is a call for recognition and a call for leadership. We need both," the duo urged.

Butler and Piña suggested, for example, that institutions take the "necessary first step" of giving employees the ability to report incidents without fear of retaliation and of hostility at the workplace, and supervisors the chance to review and respond as appropriate.

On top of that, a "zero-tolerance" policy should be enforced for egregious infractions such as forced sexual behavior, they said.

The ACC survey had been sent to more than 70,000 member and nonmember cardiologists listed in the ACC database. With a survey response rate of 8%, there were 5,931 participants in the end (77% men, 54% white, 73% ages 54 or younger).

Respondents most commonly resided in the EU (32%), followed by South America (18%); the Middle East, Eastern Europe, and Asia (all 9%); Africa (8%); North America (7%); Central America (6%); and Oceania (2%).

"Although there were significant variations by region, the prevalence and consistency of reporting HWE by diverse countries and regions are disturbing. Given that cardiologists' demographics, expectations, and practice settings environments can vary by region, there may be a pervasive, unchecked negative culture in medicine that supersedes local customs and culture," the authors suggested.

Characteristics associated with less reporting of a hostile workplace included the respondent working in physician-owned practice, being married, and being white.

The authors acknowledged that the possibility of selection bias was a concern given the study design. Additionally, limiting their sample to people with connections to the ACC meant the results may not be generalizable to other cardiologists.

"How do we interpret and generalize these results?" asked Butler and Piña. "Is it that the other 92% of those who did not respond are perfectly satisfied with their workplace culture and hence this survey suffers from responder bias resulting in an overestimation of the problem?"

"Or is it that a large proportion of the cardiologists who did not respond were concerned about confidentiality and being potentially identified if they reported concerns and retaliated against, and hence the survey underestimates the problem?" they stated.

The truth may never come to light, but that's no reason to ignore this survey, Butler and Piña said. "Why should we care about any of this? The normative answer is obvious. We do not need any other reason to create a better work environment other than it is the right thing to do!"

"Lack of awareness by leadership coupled with a sense of not belonging may force the recipient of the hostility to leave the workplace," they pointed out. "This loss of talent and dedication should be concerning to all."

Comment