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Health Care Workplace Discrimination and Physician Turnover by ProQuest

VIEWS: 47 PAGES: 10

OBJECTIVE: To examine the association between physician race/ ethnicity, workplace discrimination, and physician job turnover. METHODS: Cross-sectional, national survey conducted in 2006-2007 of practicing physicians (n = 529) randomly identified via the American Medical Association Masterfile and the National Medical Association membership roster. We assessed the relationships between career racial/ethnic discrimination at work and several career-related dependent variables, including 2 measures of physician turnover, career satisfaction, and contemplation of career change. We used standard frequency analyses, odds ratios and chi2 statistics, and multivariate logistic regression modeling to evaluate these associations. RESULTS: Physicians who self-identified as nonmajority were significantly more likely to have left at least 1 job because of workplace discrimination (black, 29%; Asian, 24%; other race, 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models, having experienced racial/ethnic discrimination at work was associated with high job turnover (adjusted odds ratio, 2.7; 95% CI, 1.4-4.9). Among physicians who experienced workplace discrimination, only 45% of physicians were satisfied with their careers (vs 88% among those who had not experienced workplace discrimination, p value .01), and 40% were contemplating a career change (vs 10% among those who had not experienced workplace discrimination, p value .001). CONCLUSION: Workplace discrimination is associated with physician job turnover, career dissatisfaction, and contemplation of career change. These findings underscore the importance of monitoring for workplace discrimination and responding when opportunities for intervention and retention still exist.

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Health Care Workplace Discrimination and
Physician Turnover
Marcella Nunez-Smith, MD, MHS; Nanlesta Pilgrim, MPH; Matthew Wynia, MD; Mayur M. Desai,
PhD, MPH; Cedric Bright, MD; Harlan M. Krumholz, MD, SM; Elizabeth H. Bradley, PhD



                                                                           Author Affiliations: Sections of General Internal Medicine (Dr Nunez-Smith)
 Funding/Support: Dr Bradley was supported by the Patrick                  and Cardiovascular Medicine (Dr Krumholz), Department of Internal Medi-
 and Catherine Weldon Donaghue Medical Research Foun-                      cine, Yale School of Medicine; Divisions of Chronic Disease Epidemiology
 dation Investigator Award (grant 02-102). Dr Nunez-Smith                  (Dr Desai) and Health Policy and Administration (Dr Bradley), Yale School
                                                                           of Epidemiology and Public Health, New Haven, Connecticut; Department
 was supported in part by a grant through the Yale Center
                                                                           of Population, Family and International Health, Johns Hopkins Bloomberg
 for Clinical Investigation. The funders did not contribute to             School of Public Health, Baltimore, Maryland (Ms Pilgrim); American Medi-
 the design and conduct of the study; collection, manage-                  cal Association Institute of Ethics, Department of Internal Medicine, University
 ment, analysis, and interpretation of the data; or prepara-               of Chicago School of Medicine, Chicago, Illinois (Dr Wynia); National Medi-
 tion, review, or approval of the manuscript.                              cal Association and Durham VA Medical Center, Department of Medicine,
                                                                           Duke University School of Medicine, Durham, North Carolina (Dr Bright).
 Objective: To examine the association between physician race/             Corresponding Author: Marcella Nunez-Smith, MD, MHS, 333 Cedar St. IE-61 SHM,
 ethnicity, workplace discrimination, and physician job turnover.          PO Box 208088, New Haven, CT 06520-8088 (marcella.nunez-smith@yale.edu).

 Methods: Cross-sectional, national survey conducted in 2006-


                                                                           P
 2007 of practicing physicians (n = 529) randomly identified via                   rior national surveys indicate that physician expe-
 the American Medical Association Masterfile and the Nation-                       riences of workplace discrimination are common
 al Medical Association membership roster. We assessed the                         and consequential. Physician surveys have consis-
 relationships between career racial/ethnic discrimination at              tently found that the majority of racial/ethnic minority
 work and several career-related dependent variables, includ-              physicians state they experience racial/ethnic discrimi-
 ing 2 measures of physician turnover, career satisfaction, and            nation in the workplace.1-3 Other studies have suggested
 contemplation of career change. We used standard frequen-                 that workplace discrimination may contribute to dis-
 cy analyses, odds ratios and c2 statistics, and multivariate logis-       parate career outcomes among racial/ethnic minority
 tic regression modeling to evaluate these associations.                   physicians such as lower rates of promotion and career
                                                                           satisfaction when compared with nonminority physician
 Results: Physicians who self-identified as nonmajority were
                                                                           peers with similar productivity.4-7 Furthermore, research
 significantly more likely to have left at least 1 job because of
                                                                           from non–health care fields has found significant asso-
 workplace discrimination (black, 29%; Asian, 24%; other race,
                                                                           ciations between self-reported experiences of racial/
 21%; Hispanic/Latino, 20%; white, 9%). In multivariate models,
                                                                           ethnic discrimination at work and the likelihood of
 having experienced racial/ethnic discrimination at work was
                                                                           leaving that job, ie, job turnover.8-12 However, this asso-
 associated with high job turnover (adjusted odds ratio, 2.7;
                                                                           ciation has not been investigated in health care, and it
 95% CI, 1.4-4.9). Among physicians who experienced work-
                                                                           is unknown whether physicians who experience racial/
 place discrimination, only 45% of physicians were satisfied with
                                                                           ethnic workplace discrimination are more likely than
 their careers (vs 88% among those who had not experienced
                                                                           those who do not to leave a position or to consider leav-
 workplace discrimination, p value < .01), and 40% were con-
                                                                           ing medicine al
								
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