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Disclosures: The authors and Piña report no relevant financial disclosures. Butler reports he consults for Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk and Vifor.
May 10, 2021
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ACC survey: Nearly half of cardiologists report hostile work environment

Disclosures: The authors and Piña report no relevant financial disclosures. Butler reports he consults for Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk and Vifor.
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According to an American College of Cardiology survey, 44% of cardiologists from around the world reported being in a hostile work environment.

The definition of hostile work environment included emotional harassment, discrimination and sexual harassment.

According to an American College of Cardiology survey, 44% of cardiologists from around the world reported being in a hostile work environment. Data were derived from Sharma G, et al. J Am Coll Cardiol. 2021;doi:10.1016/j.jacc.2021.03.301.
Garima Sharma

A hostile work environment has a pronounced and pervasive adverse effect on professional satisfaction and professional activities, a finding suggesting that hostile work environment is both a professional issue and a patient care issue,” Garima Sharma, MD, assistant professor of medicine at Johns Hopkins University School of Medicine, and colleagues wrote. “Our findings have important implications for organizations and individuals seeking to optimize clinical well-being.”

On behalf of the ACC, the researchers sent a survey to approximately 71,000 cardiologists on all continents to determine the prevalence of hostile work environments. Of the 5,931 respondents (77% men), 44% reported experiencing a hostile work environment.

Differences by race, sex, region

The percentage of those reporting a hostile work environment was higher in women than in men (68% vs. 37%; OR = 3.58; 95% CI, 3.14-4.07; P < .001), Sharma and colleagues wrote.

The percentage of cardiologists reporting a hostile work environment was higher among Black respondents than white respondents (53% vs. 43%), but the difference was not significant; however, compared with all other races and ethnicities combined, white cardiologists were less likely to report a hostile work environment (P < .001), according to the researchers.

North American cardiologists were more likely to report a hostile work environment compared with South American cardiologists (OR = 1.9; 95% CI, 1.51-2.41) and those from several other regions, Sharma and colleagues wrote.

Among the cohort, 29% reported emotional harassment, 30% reported discrimination and 4% reported sexual harassment.

Women were more likely than men to report emotional harassment (43% vs. 26%), discrimination (56% vs. 22%) and sexual harassment (12% vs. 1%), the researchers reported.

The most frequent causes of discrimination were gender (44%), age (37%), race (24%), religion (15%) and sexual orientation (5%), Sharma and colleagues wrote.

Among those who reported a hostile work environment, 75% said it affected professional activities with colleagues and 53% said it affected professional activities with patients.

After multivariable adjustments, women (OR = 3.39; 95% CI, 2.97-3.86; P < .001) and early-career cardiologists (OR = 1.27; 95% CI, 1.14-1.43; P < .001) had the greatest odds of experiencing a hostile work environment.

Systematic approach needed

Javed Butler
Ileana L. Piña

In a related editorial, Cardiology Today Editorial Board Members Javed Butler, MD, MPH, MBA, and Ileana L. Piña, MD, MS, wrote that the survey response rate was only 8%, but “even if one were to assume that most of the cardiologists who did not respond to the survey actually felt that hostile work environment was not an issue, this is not a reason to ignore the results of this survey and not address the concern of the individuals who did.”

Butler, professor and chairman of the department of medicine at the University of Mississippi, and Piña, professor of medicine at Wayne State University, clinical professor of medicine at Central Michigan University and senior staff fellow and medical officer at the FDA Center for Devices and Radiological Health, wrote: “The prevalence of any reported hostile work environment in and outside of the United States is unacceptable. This was specifically an issue for women and for Black respondents, but no region or demographic group was immune. Considering the widespread nature of problem, a more systematic approach, while focusing on the most vulnerable, is needed.”

Butler and Piña wrote there should be a zero-tolerance policy for egregious infractions and a policy of “safe avenues without negative ramifications” to report infractions.

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