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Discrimination and Harassment in the Cardiology Workplace



Along with the myriad challenges affecting healthcare providers since the coronavirus disease 2019 (COVID-19) pandemic began, some clinicians have the burden of dealing with various forms of discrimination and harassment that may contribute to a hostile work environment (HWE). Findings from 2 recent studies elucidated the extent of these issues within the field of cardiology.

In the first paper recently published in the Journal of the American College of Cardiology, researchers investigated the prevalence of HWE in medicine, addressing not only gender discrimination but also emotional harassment.1  Cardiologists from around the world were surveyed (n=5931, 77% men and 23% women). The survey responders self-identified as White (54%), Asian (17%), Hispanic (17%), and Black (3%). In addition, 73% of responding physicians were ≤54 years of age.

Over 40% of respondents reported experiencing HWE, with the highest rates reported among women (68% vs 37%; P <.001 odds ratio [OR], 3.58; 95% CI, 3.14-4.07) and Black cardiologists (53% vs 43%; OR, 1.46 vs Whites). Specific components of HWE affected women more often than men: Emotional harassment (43% vs 26%), discrimination (56% vs 22%), and sexual harassment (12% vs 1%). The most common reasons for discrimination were gender (44%), age (37%), race (24%), religion (15%), and sexual orientation (5%). Multivariate analysis demonstrated the highest odds of experiencing HWE among women (OR, 3.39; 95% CI, 2.97-3.86; P <.001) and early-career cardiologists (OR, 1.27; 95% CI, 1.14-1.43; P <.001) compared with other physicians surveyed.

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Factors that independently protected against HWE included working in a physician-owned practice (OR, 0.75; 95% CI, 0.63-0.88; P =.001), being married (OR, 0.81; 95% CI, 0.71-0.92; P =.001), and White race (OR, 0.88; 95% CI, 0.79-0.98; P =.017). Respondents reported that HWE had adverse effects on interactions with patients (53%) and colleagues (75%), as well as several aspects of career satisfaction.

In the second study published in the journal Heart2, London-based researchers examined the frequency and types of sexism affecting female and male cardiologists in the United Kingdom. Of the 174 cardiologists (24% female, 76% male) who completed a validated online survey, 61.9 of female physicians had experienced discrimination – most often focused on gender and parenting – compared with 19.7% of male physicians. The survey responses also showed that 35.7% of female cardiologists (vs 6.1% of male cardiologists) had “experienced unwanted sexual comments, attention or advances from a superior or colleague.” Sexual harassment had a greater negative impact on professional confidence in female vs male cardiologists (42.9% vs 3.0%), and 33.3% of female cardiologists (vs 2.3% of males) reported that sexism negatively affected opportunities for career advancement.

The results of these 2 studies are consistent with previous findings, including the American College of Cardiology third decennial Professional Life Survey published in 2017, which indicated that 65% of female cardiologists (vs 23% of males) experienced workplace harassment or discrimination.3 “Women are especially likely to experience gender harassment, which includes both verbal and nonverbal behaviors that treat women or men as inferior through hostility, objectification, disparagement, or exclusion”, noted researchers in the JACC study.1

Given the potential effects of these findings on providers and their patients, organizational structure and system processes should be examined to optimize patient care. We spoke with Laxmi Mehta, MD, lead study author of the JACC study and professor in the division of cardiovascular medicine, director of the Lipids Clinic, and director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center in Columbus about how to address these findings.   

What are some of the factors believed to be driving the high levels of hostility in the cardiology workplace?

Women and minorities are underrepresented in cardiology. Organizational and individual practices and beliefs can contribute to the hostile work environment. Micro- and macro-aggressions also contribute to hostility in the workplace.

What are the potential effects of HWE on patient care and provider well-being? 

Working in a HWE can negatively impact professional activities with colleagues and patient care. HWE may also result in disengagement and burnout for some people when they feel discriminated against or threatened.

What actions are needed on the institutional and employer level to reduce HWE? 

There should be a zero-tolerance policy for egregious acts of discrimination and harassment. For serious incidents of such behavior, human resources interventions and legal interventions are necessary to curb the acts. People need to feel that it is safe to voice their concerns and seek help in a non-threatening fashion, and victims should not be blamed. External review of complaints can mitigate internal suspicion of favoritism. Creation of a culture of workplace wellbeing is essential.

What are suggestions for clinicians in terms of supporting and advocating for colleagues who may be experiencing HWE?  

The American College of Cardiology and the American Heart Association just published an online Professionalism and Ethics document that outlines recommendations to address bias, structural racism, and structural sexism.4 Everyone in the cardiovascular community is responsible and must do their part to recognize and eliminate structural racism and sexism.


  1. Sharma G, Douglas PS, Hayes SN, et al. Global prevalence and impact of hostility, discrimination, and harassment in the cardiology workplace. J Am Coll Cardiol. 2021;77(19):2398-2409.
  2. Jaijee SK, Kamau-Mitchell C, Mikhail GW, Hendry C. Sexism experienced by consultant cardiologists in the United Kingdom. Heart. 2021;107(11):895-901. doi:10.1136/heartjnl-2020-317837
  3. Lewis SJ, Mehta LS, Douglas PS, et al; American College of Cardiology Women in Cardiology Leadership Council. Changes in the professional lives of cardiologists over 2 decades. J Am Coll Cardiol. 2017;69(4):452-462. doi:10.1016/j.jacc.2016.11.027
  4. Executive Committee, Benjamin IJ, Valentine CM, Oetgen WJ, et al. 2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: a consensus conference report. Published online May 5, 2021. J Am Coll Cardiol. doi:10.1016/j.jacc.2021.04.004

This article originally appeared on The Cardiology Advisor

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June 18 Web Event: Asian Immigrant Experiences with Racism, Immigration-related Fears, and the COVID-19 Pandemic



While the country has collectively experienced health and economic difficulties with the COVID-19 pandemic, certain groups have experienced a disproportionate impact. The Asian American community has had to cope with the burden of pandemic-related racism and, as one of the fastest growing immigrant communities in the nation, immigration-related fears due to policy and regulatory action of recent years. Yet, there is often limited data and focus on the experiences of the expanding Asian immigrant community. KFF is hosting a June 18 public web event to highlight and discuss the complex set of challenges facing Asian immigrants and strategies to address them.

The one-hour interactive web event begins at 12 p.m. ET on Friday, June 18, featuring remarks from U.S. Congresswoman Judy Chu, who has been a leading voice on many of the issues to be discussed and chairs the Congressional Asian Pacific American Caucus. Findings from a new KFF survey of Asian American patients from four community health centers will be released at the event with a panel discussion and audience questions to follow.

Welcome and Keynote Remarks

  • KFF Executive Vice President for Health Policy Larry Levitt (moderator)
  • U.S. Congresswoman and Chair of Congressional Asian Pacific American Caucus The Honorable Judy Chu
  • Chief Program Director of Blue Shield of California Foundation Carolyn Wang Kong

Presentation of Survey Findings

  • KFF Vice President and Director of the Racial Equity and Health Policy Program Samantha Artiga

Panel Discussion

  • Director of Policy and Advocacy at the Association of Asian Pacific Community Health Organizations (AAPCHO) Adam Carbullido
  • Vice President of Strategic Initiatives at International Community Health Services Sunshine Monastrial
  • Chief Deputy of Administration at Asian Health Services Thu Quach

The one-hour event will conclude with a question-and-answer session.

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G-7 Leaders Are Set To Pledge 1 Billion Coronavirus Vaccines To Other Countries



President Biden and British Prime Minister Boris Johnson speak during a bilateral meeting ahead of the G-7 summit on Thursday in Carbis Bay, England. Patrick Semansky/AP hide caption

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Patrick Semansky/AP

World leaders of the Group of Seven are expected to announce today a commitment to share 1 billion of their COVID-19 vaccine resources with the lower income countries struggling to control the spread of the virus.

On Thursday, President Biden announced plans for the U.S. to donate 500 million doses of the Pfizer COVID-19 vaccine globally. The first 200 million are expected to be distributed this year and the rest will follow in 2022.

“Our values call on us to do everything that we can to vaccinate the world against COVID-19,” Biden said of the decision. “It’s also in America’s self-interest. As long as the virus rages elsewhere, there’s a risk of new mutations that could threaten our people.”

Canada, France, Germany, Italy, Japan, the United Kingdom and the U.S. make up the G-7.

The move by the wealthy democracies to share their vaccine stockpiles comes as high vaccination levels in those countries have led to a decline in infections, hospitalizations, and deaths. Enough improvements have been made in the U.S. and U.K. for coronavirus-related protocols to ease.

But in South Asia and Latin America, countries are still struggling to contain the virus.

In late May, the World Health Organization urged wealthier countries to contribute more to COVAX and requested at least 1 billion excess doses by the end of 2021. The COVAX program distributes mass quantities of vaccines to countries based on their populations.

“By donating vaccines to COVAX alongside domestic vaccination programmes, the most at-risk populations can be protected globally, which is instrumental to ending the acute phase of the pandemic, curbing the rise and threat of variants, and accelerating a return to normality,” WHO said in a statement in May.

Biden and the other G-7 leaders are in the U.K. for the first meeting in about two years. The meeting is set to open today at Carbis Bay, a seaside resort in Cornwall in southwest England.

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COVID-19 and heart attack risk



COVID-19 and heart attack

Does a positive diagnosis of COVID-19 increase the risk of heart attacks for those with pre-existing atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH)?

It has been shown that higher rates of COVID-19 deaths can be associated with hypertension, heart failure, and cardiovascular disease. However, there were fewer patients reporting acute myocardial infarction (AMI), or heart attacks, when visiting hospitals during the pandemic.

Researchers from across the United States gathered the data from approximately 55 million individuals for this study. They were divided into six categories based on the information available, which included combinations of diagnosed FH, probable FH, diagnosed ASCVD, and none of the above. Differences amongst individuals were examined, and included variables such as sex, age, ethnicity, and education levels. Other diseases or medical conditions, cholesterol prescriptions, and any history of cardiac issues were all taken into account to develop a baseline for the study.

Establishing these factors and taking them into consideration accounted for any baseline differences among the participants. Those conducting the study were then able to compare the six groups, and more effectively compare who tested positive for COVID-19 among the groups, and who did not.

When testing positive for COVID-19, it was found that there was a higher risk of AMI for those individuals with both diagnosed and probable FH and those with pre-existing ASCVD. There was also a higher risk of AMI observed when compared to other COVID-19 positive patients without ASCVD or FH.

The complete medical history wasn’t available for all of the participants included in this study, resulting in some notable limitations. Individuals that had a history of ASCVD or FH may have not been placed in the correct group for comparison due to missing data.

Although many variables were taken into account to establish baseline difference amongst group members, other factors such as obesity were not considered. The researchers also investigated whether there were any correlations between lipid lowering therapies (LLT) and people with FH who did and did not test positive for COVID-19. There wasn’t a significant relationship between people taking LLT and those not, as the analyses lacked statistical power.

These findings may encourage those with ASVD and FH to receive a COVID-19 vaccination due to the increased risk of AMI. Additionally, this highlights the importance of diagnosing familial hypercholesterolemia, which could help to improve the health of the individual and providing proper treatment.


Myers, K, D., et al. (2021) COVID-19 associated risks of myocardial infarction in persons with familial hypercholesterolemia with or without ASCVD. American Journal of Preventive Cardiology.

Image by PIRO4D from Pixabay 

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Hey Washingtonians! Get A Vaccine. Smoke A Joint.



Washington is offering free, pre-rolled joints to adults who get the COVID-19 vaccine. Here, a person smokes a joint in The Netherlands. Robin Van Lonkhuijsen/AFP via Getty Images hide caption

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Robin Van Lonkhuijsen/AFP via Getty Images

Still anxious about getting the COVID-19 vaccine? Washington state is offering adults a relaxing new incentive — marijuana joints.

The program, launched by the state’s Liquor and Cannabis Board and named “Joints for Jabs,” runs until July 12 and allows state-licensed dispensaries to give qualifying customers one pre-rolled joint at an in-store vaccination clinic.

Eligible participants must be 21 years old or older and have to have received their first or second dose during that visit.

This is only the latest among Washington’s abundant vaccination incentives, which include free tickets to sports events and a lottery totaling up to $1 million. Just a few weeks ago, the Liquor and Cannabis Board announced an incentive that allows breweries, wineries, and restaurants to offer free drinks to vaccinated adults.

Washington’s newest promotion reflects a multitude of unique vaccination incentives being offered across the country, and the state isn’t the first to offer weed.

In exchange for proof of vaccination, an Arizona dispensary’s “Snax for Vaxx” campaign provides free joints and edibles. In Washington, D.C., cannabis advocacy group D.C. Marijuana Justice distributed joints at vaccination sites on April 20.

As of June 9, nearly 49% of Washington residents have been fully vaccinated.

Josie Fischels is an intern on NPR’s News Desk.

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