A new study by researchers at the Yale School of Medicine ,offers a detailed view of race and discrimination in the health care workplace and their negative impact on job satisfaction, career advancement and minority physician retention.

Published in the Jan. 2 Annals of Internal Medicine, the study explored the role of race in the professional lives of 25 practicing physicians of African, African-American and African-Caribbean descent. The participants -- who varied in age, academic and non-academic work settings, and clinical specialties, and who represented all of the six New England states -- took part in a series of in-depth, in-person interviews.

Each participating doctor was asked the broad question: "How do you think race influences your experiences at work?" Specific questions addressed negative and positive work experiences attributed to race and the influence of race on the physicians' career trajectories. They were encouraged to clarify and elaborate on their statements.

"We found that race-consciousness is pervasive in the lives of these physicians. They describe similar experiences regardless of their specialty or where they work," says lead author Dr. Marcella Nunez-Smith, instructor in the Section of General Internal Medicine at Yale and assistant director of the Robert Wood Johnson Clinical Scholars Program. "As a result, some experience 'racial fatigue,' which describes the emotional and psychological effect of feeling isolated in a work environment in which race regularly influences behavior but is consistently ignored. This can result in greater job dissatisfaction and unplanned career change."

Some participants described race as a positive influence, especially in supportive relationships with some colleagues, minority patients and staff. However, most described the influence as negative. Many said they felt devalued, were held to different performance standards and were cast into race-defined roles. Participants described instances where their care was refused by patients who felt they could not do a good job.

They were frequently omitted from key information networks and social situations that can lead to promotion. One internal medicine sub-specialist at a hospital-based practice stated: "I do not see us in those leadership pipelines. We're not in the corridors of power and it has nothing to do with intellectual capacity or ambition."

Nunez-Smith says race permeates the experience of physicians of African descent in the health care workplace, and these experiences can shape interpersonal interactions and define the institutional climate. She adds that responses to perceived racism at work vary from minimization to confrontation and that the health care workplace is often silent on issues of race, resulting in personal and professional consequences for physicians.

Work environments that successfully foster and sustain a diverse physician workforce are unlikely to be created unless sufficient attention is paid to the specific ways in which race shapes physicians' work experiences, according to Nunez-Smith and her co-authors.

"Increasing racial and ethnic diversity in the physician workforce is a national priority and has been offered as one solution to addressing health inequities," says Nunez-Smith. "But any efforts to increase numbers also needs to address the role of race within health care institutions to successfully recruit and retain ethnic and racial minority physicians."

The study was funded by the Robert Wood Johnson Clinical Scholars Program and the Patrick and Catherine Weldon Donaghue Medical Research Foundation through the Donaghue Investigator Award.

Other authors on the study included Leslie A. Curry of the University of Connecticut Health Center; Dr. JudyAnn Bigby of Brigham and Women's Hospital in Boston, Massachusetts; and David Berg, Dr. Harlan M. Krumholz and Elizabeth H. Bradley of Yale School of Medicine.

-- By Karen Peart

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