Half of surgical residents say they have experienced workplace mistreatment, but the problem is even worse for women, according to a new study.
That exposure to discrimination, abuse and harassment in the surgical training environment is associated with burnout and suicidal thoughts, according to the study published in the New England Journal of Medicine.
The study findings were presented on Monday during the American College of Surgeons’ annual clinical congress in San Francisco.
The study included 7,409 residents from all 262 surgical residency programs in the U.S—more than 99% of physicians in training to become general surgeons.
Among the study's findings:
- 31.9% reported discrimination based on their gender
- 16.6% reported racial discrimination
- 30.3% reported verbal or physical abuse
- 10.3% reported sexual harassment
Workplace mistreatment was higher among women on all those measures, with 65.1% of the women reporting gender discrimination and 19.9% reporting sexual harassment. Patients and patients’ families were the most frequent sources of gender discrimination and racial discrimination, but attending surgeons were the most frequent sources of sexual harassment and abuse.
“It’s both sad and validating,” study co-author Yue-Yung Hu, M.D., of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine in Chicago, said in an interview with Fierce Healthcare.
For female surgical residents, the study validates that more frequent discrimination, abuse and harassment in the workplace is responsible for women’s higher prevalence of burnout. “It’s not them, it’s the environment,” Hu said.
Surgical residents who reported any on-the-job mistreatment happening to them regularly—several times each month—were 300% more likely to suffer burnout and suicidal thoughts than residents without personal exposure to mistreatment, the survey showed.
“Preventing these types of mistreatment could reduce the huge problem of burnout in the specialty of surgery,” the study’s lead author Karl Y. Bilimoria, M.D., director of the Surgical Outcomes and Quality Improvement Center, said in an announcement about the study.
The findings will provide data for a further study that will examine ways that surgery residency programs can improve residents’ well-being and learning environment.
Female residents, for instance, can be taught how to respond when a patient makes a discriminatory comment, Hu said.
“I think most women [physicians] have a story,” she said. A pediatric surgeon, she sometimes has parents who ask her when they will see the doctor. She remembers the time a female physician assumed the male intern she was making rounds with, who was seven years her junior, was the senior member of the team.
The findings that patients and family members were the most common source of racial and gender discrimination for residents surprised the researchers, Bilimoria said. “It completely changes how we should intervene. We need to arm residents with the skills and ability to address discrimination from patients and patients’ families affecting them and their colleagues,” he said.
While he said the prevalence of surgical residents’ mistreatment is concerning, he noted that some residency programs had very low or no rates of mistreatment, suggesting there are ways to improve the training environment.