Yale School of Medicine, Yale University, New Haven, CT, USA.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06511, USA.
J Gen Intern Med. 2022 May;37(6):1475-1483. doi: 10.1007/s11606-021-07143-3. Epub 2021 Sep 24.
Racial and ethnic diversity of healthcare workers have benefits on team functioning and patient care. However, a significant barrier to retaining diverse providers is discrimination.
To assess the predictors, perpetrators, and narratives of racial discrimination among healthcare workers.
Survey study.
Healthcare workers employed at academic hospitals.
We assessed prevalence and perpetrators of racial and ethnic discrimination using the General Ethnic Discrimination Scale. We included an open-ended question asking respondents to recount experiences of discrimination and analyzed responses using grounded theory.
Of the 997 participants, 12.2% were females from backgrounds underrepresented in medicine (URM), 4.0% URM males, 10.1% Asian females, 4.7% Asian males, 49.1% non-Hispanic White females, and 19.8% non-Hispanic White males. Among healthcare workers of color, 85.2% reported discrimination. Over half of URM females (51.4%), URM males (52.6%), and Asian females (62.5%) reported discrimination by patients. About 20-25% of URM females, URM males, and Asian females reported discrimination by teachers, supervisors, co-workers, and institutions. In adjusted binary logistic models, URM females had 10.14 odds (95% confidence interval [95%CI]: 5.13, 20.02, p<.001), URM males 6.23 odds (95%CI: 2.59, 14.98, p<.001), Asian females 7.90 odds (95%CI: 4.07, 15.33, p<.001), and Asian males 2.96 odds (95% CI: 1.47, 5.97, p=.002) of reporting discrimination compared with non-Hispanic White males. Needing more support was associated with 2.51 odds (95%CI: 1.54, 4.08, p<.001) of reporting discrimination. Our qualitative findings identified that the murder of George Floyd intensified URM healthcare workers' experiences of discrimination through increased fear of violence and requests for unpaid diversity work. Asian healthcare workers reported that pandemic-related anti-Asian violence shaped their experiences of discrimination through increased fear of violence and care refusal from patients.
Our findings provide insights into experienced discrimination among healthcare workers and opportunities for hospitals to create programs that improve inclusivity.
医疗保健工作者的种族和民族多样性对团队运作和患者护理有益。然而，保留多元化提供者的一个重要障碍是歧视。
评估医疗保健工作者中种族歧视的预测因素、实施者和叙述者。
调查研究。
在学术医院工作的医疗保健工作者。
我们使用一般族裔歧视量表评估了种族和族裔歧视的流行率和实施者。我们还包括了一个开放式问题，要求受访者讲述歧视经历，并使用扎根理论分析了回答。
在 997 名参与者中，有 12.2%是医学背景代表性不足的女性（URM），4.0%是 URM 男性，10.1%是亚裔女性，4.7%是亚裔男性，49.1%是非西班牙裔白人女性，19.8%是非西班牙裔白人男性。在有色人种的医疗保健工作者中，有 85.2%报告了歧视。超过一半的 URM 女性（51.4%）、URM 男性（52.6%）和亚裔女性（62.5%）报告说他们受到了患者的歧视。约 20-25%的 URM 女性、URM 男性和亚裔女性报告说，她们受到了教师、主管、同事和机构的歧视。在调整后的二元逻辑模型中，URM 女性的歧视报告几率为 10.14 倍（95%置信区间[95%CI]：5.13，20.02，p<.001），URM 男性为 6.23 倍（95%CI：2.59，14.98，p<.001），亚裔女性为 7.90 倍（95%CI：4.07，15.33，p<.001），亚裔男性为 2.96 倍（95%CI：1.47，5.97，p=.002），与非西班牙裔白人男性相比，他们报告说受到歧视。需要更多支持与报告歧视的几率增加 2.51 倍（95%CI：1.54，4.08，p<.001）有关。我们的定性研究结果表明，乔治·弗洛伊德遇害事件通过增加对暴力的恐惧和对无偿多样性工作的要求，加剧了 URM 医疗保健工作者的歧视经历。亚裔医疗保健工作者报告说，与大流行相关的反亚裔暴力通过增加对暴力的恐惧和患者拒绝护理，影响了他们的歧视经历。
我们的研究结果提供了医疗保健工作者中经历歧视的深入见解，并为医院提供了改善包容性的机会。
