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In a global survey of nearly 6,000 cardiologists conducted by Johns Hopkins Medicine and the American College of Cardiology, researchers found that as many as 44% of those polled report experiencing a hostile work environment (HWE) at some point in their careers. Based on this finding and others reported in a recent study assessing the survey responses, the researchers suggest that HWE—characterized by emotional harassment, discrimination, sexual harassment or any combination of the three—has an adverse effect on professional and patient interactions and relationships, raises concerns about the well-being of those impacted and may threaten the quality of patient care provided.

The study was published May 10, 2021, in the Journal of the American College of Cardiology.

“Unfortunately, we discovered that the problem of HWE is very widespread, with nearly half of the world’s cardiologists experiencing some form of it at one time or another,” says lead study author Garima Sharma, M.D., assistant professor of medicine at the Johns Hopkins University School of Medicine. “We found HWE in cardiology prevalent across regions, races and ethnicities, and both sexes and all gender identifications.”

The 50-item survey in the study was given between September and October 2019 to 5,931 cardiologists in Africa, Asia, the Caribbean, Europe, the Middle East, Oceania, and North, Central and South America. Participants were queried about their demographics, practice environment, academic rank and experiences with discrimination and harassment. Seventy-seven percent of the respondents were men, 54% were white (followed by 17% Asians, 17% Hispanics and 3% Blacks), 73% were age 54 or older and 75% were married.

Cardiologists from the European Union made up the biggest block of respondents (32%), followed by cardiologists from South America (18%); the Middle East, Eastern Europe and Asia (all 9%); Africa (8%); North America (7%); Central America (6%) and Oceania (2%).

“Based on the responses from the survey, we found incidences of HWE were most commonly reported by women [68%], Blacks [53%] and North Americans [54%],” says Roger Blumenthal, M.D., director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease and professor of medicine at the Johns Hopkins University School of Medicine. “Gender was the most frequent cause of discrimination [44%], followed by age [37%], race [24%], religion [15%] and sexual orientation [5%].”

Seventy-five percent of survey respondents said HWE adversely affected professional activities with colleagues, while 53% reported a negative impact on relationships with their patients.

Looking at each subset of HWE studied, Sharma says that emotional harassment was experienced by nearly one-third of cardiologists, 30% reported at least one form of discrimination, and women endured more incidences of sexual harassment—with 44% stating they had experienced multiple types.

“These data come at a crucial time when harassment and the culture of discrimination in medicine are being openly challenged,” the study states. “These findings support the need to improve the culture within medicine greatly and raise a call to action to address harassment and discrimination.”