Emergency Medicine Residents Subjected to Discrimination, Abuse, and Harassment

Female emergency residents are more likely to experience most forms of workplace mistreatment compared to their male counterparts.

Workplace mistreatment is relatively common among emergency medicine (EM) residents and the mistreatment is associated with suicidal thoughts, a new research article says.

Earlier research has shown that workplace mistreatment—discrimination, abuse, and harassment—is linked to several negative consequences such as feelings of marginalization, decreased job performance, increased stress, job dissatisfaction, and turnover. Workplace discrimination has been associated with health problems, including anxiety, depression, and cardiovascular disease.

The new research article, which was published by JAMA Network Open, is based on survey data collected from more than 7,000 EM residents enrolled in residencies accredited by the Accreditation Council for Graduate Medical Education. The 35-item survey was conducted in February 2020. Male residents (4,768) outnumbered female residents (2,698) in the survey study.

The research article features several key data points.

• 45.1% of survey respondents reported experiencing workplace mistreatment in the most recent academic year
   
• The most common source of mistreatment was patients and patient family members—among the survey respondents, 1,234 reported gender discrimination, 867 reported racial discrimination, 723 reported sexual harassment, and 282 reported physical abuse by patients or patient family members
   
• Gender discrimination was reported by 2,104 survey respondents, with more women (1,635) reporting this form of mistreatment than men (407)
   
• Racial discrimination was reported by 1,284 survey respondents, including 371 White residents and 907 residents from other racial and ethnic groups
   
• 220 survey respondents reported discrimination based on sexual orientation or gender identity
   
• 1,047 survey respondents reported sexual harassment, with more women (721) reporting this form of mistreatment than men (294)
   
• Verbal or emotional abuse was reported by 2,069 survey respondents, including 32.2% of female residents and 27.0% of male residents
   
• 331 survey respondents reported physical abuse
   
• 178 (2.5%) survey respondents reported having suicidal thoughts, with the incidence rate split evenly by gender
   
• The prevalence of suicidal thoughts was relatively high for residents who identified as LGBTQ+ (odds ratio 2.04)
   
• Divorced or widowed residents had a higher probability (odds ratio 3.36) of reporting suicidal thoughts than residents who were married or in a relationship
   
• Experiencing mistreatment at least a few times per month was associated with a relatively high probability of having suicidal thoughts (odds ratio 5.83)

"In this survey study, EM residents reported commonly experiencing workplace mistreatment, and experiences of mistreatment were associated with suicidality. Identifying and promoting best practices to minimize workplace mistreatment during residency may help optimize the professional career experience and improve the personal and professional well-being of physicians throughout their lives," the research article's co-authors wrote.

Interpreting the data

The researchers identified segments of the EM resident population who are most likely to experience workplace mistreatment. "In this comprehensive survey study, mistreatment of EM residents based on gender, race/ethnicity, and sexual orientation was more common among women, residents from racial/ethnic minority populations, and residents identifying as LGBTQ+, respectively. Discrimination based on pregnancy and childcare status was also more common among women than among men," the co-authors wrote.

Female EM residents carry a heavier burden of most workplace mistreatment compared to their male counterparts, the co-authors wrote. "Women reported higher levels of nearly all forms of mistreatment compared with men, with most of the reported gender-based mistreatment originating from patients and their families. The second most likely source of gender-based mistreatment was nurses and staff."

The research provides insight into physician suicide, the co-authors wrote. "In this study, there was a significant association between the reported frequency of mistreatment and suicidal thoughts. After adjusting for mistreatment, women were less likely to report suicidal thoughts. The results suggest that the higher prevalence of mistreatment experienced by women in medicine may be one factor associated with the higher rates of suicide among female physicians."

Mistreatment interventions

Systemic interventions are a primary strategy to address workplace mistreatment, the co-authors wrote. "Leaders, peers, and other hospital colleagues may be bystanders, perhaps inadvertently, to workplace mistreatment. Healthcare systems, hospitals, and department and residency program leaders should consider training interventions to empower bystanders to intervene and to cultivate workplace norms that prohibit workplace mistreatment."

Boosting cultural competency is also likely to reduce workplace mistreatment, the co-authors wrote.

"An additional strategy is to provide cultural competency training to all emergency department staff with the goal of increasing collective knowledge about marginalized groups (women and individuals who are underrepresented in medicine or LGBTQ+) that are at increased risk of experiencing workplace mistreatment. This increase in knowledge and subsequent self-awareness may create a more open, safe, and supportive workplace for EM residents."

Related: Researchers Find 13.6% of Medical Residents Experience Bullying