Cardiologists and trainees hold varied views of their professional culture and climate, with half desiring change, according to a national online survey conducted by the ACC and published in JACC. These findings “provide granular support for continued targeted interventions and are essential to enhancing the effectiveness of efforts to improve cardiovascular educational, research, and practice environments,” said the authors led by Kevin L. Thomas, MD, FACC, and Laxmi S. Mehta, MD, FACC.
The survey of roughly 1,500 cardiologists spanning all career stages, including Fellows in Training (FITs), asked questions about professional climate in the following four areas: 1) cardiology workforce related to diversity; 2) respect; 3) primary workplace climate; and 4) workplace effectiveness. Nearly 75% of survey respondents were men, 90% were heterosexual/cisgender, and a little more than half self-identified as white, while 23% identified as Asian. Approximately 60% of survey participants were born in the U.S., while 20% arrived before or during training.
Participants were classified into four different profile groups (A-D) based on their responses. Profile A (n=441), representing 29% of respondents, perceived the CV professional climate as empowering, inclusive and no change being needed. Profile B (n=501), representing 33% of participants, felt the professional climate was inclusive, but needed change. Those in Profile C (n=293), making up 19% of survey respondents, perceived the climate as stifling but were unsure about change. The 18% of respondents who made up Profile D (n=278) felt the climate was stifling, exclusionary and in need of change. Across all profile groups, the majority of survey participants (77%) reported experiencing incivility, harassment or discrimination, while 29% reported feeling burned out.
Thomas, Mehta, et al., noted that Profile A was independently associated with Whites and males who were later in their career and with no mistreatment, while in contrast Profile D was associated with families, Blacks, Hispanics, Asians or other race individuals, in their early to mid-career who had experienced mistreatment. In other findings, higher proportions of older career cardiologists and those born in the U.S. or who had immigrated prior to training were in Profiles A and B. Burnout was greatest among those in Profile D at 43%, compared with 25% in Profile A and B and 32% in Profile C.
While mistreatment was high across all groups, specific types of mistreatment were reported up to 3 times more frequently by those in Profile D compared with Profile A and varied by role. For example, among those in Profile D doing clinical work, delayed professional advancement (55% vs. 18%), differing clinical work expectations (43% vs. 16%), hiring practices (36% vs. 11%), and compensation (40% vs. 12%) were common mistreatments. Among those in academic settings, common mistreatments among those in Profile in D included delayed professional advancement (34% vs. 14%), compensation (32% vs. 20%) and access to research opportunities (35% vs. 11%).
“These findings, plus perceptions of organizational ineffectiveness, support a call to action to improve the cardiology climate and identify a need to incorporate climate assessments in national and local efforts to address critical challenges,” write the authors. “Fostering an inclusive and civil climate in cardiology requires systematic action to ensure that positive values are more closely translated into a positive lived experience among the workforce, improved well-being and optimal patient care.”