Discrimination Within the US Ophthalmology Workforce

Abstract

Discrimination in the workforce is a barrier to achieving diversity, equity, and inclusion. A previous study of ophthalmologists in Australia and New Zealand reported high rates of discrimination, but little is known about discrimination among ophthalmologists in the US. To describe the frequency, nature, and outcomes of discrimination experienced by US ophthalmologists and trainees. This cross-sectional study collected anonymous online survey responses from May 5 to July 22, 2022, from ophthalmologists and ophthalmologists in training from 10 US-based ophthalmology organizations. Main outcomes included (1) the frequency of discrimination based on gender, race and ethnicity, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) status; (2) the bases, negative consequences, and sources of discrimination; and (3) the association of discrimination with job satisfaction and achieving career goals. Of 463 respondents (249 women [53.8%]), 194 (41.9%) reported experiencing discrimination. Women more commonly encountered discrimination based on gender than men (73 of 108 [67.6%] vs 2 of 21 [9.5%]; difference, 58.1 percentage points [95% CI, 42.7-73.4 percentage points]; P < .001). Among women, pregnancy (27 of 108 [25.0%]) and maternity (12 [11.1%)] were the most frequently cited bases of discrimination outside of gender. Women (19 of 108 [17.6%]) reported discrimination due to race or ethnicity less frequently than men (13 of 21 [61.9%]; difference, -44.3 percentage points [95% CI, -66.3 to -22.3 percentage points]; P < .001). Reported negative consequences of discrimination included disrespect or passive aggression (44 of 129 [34.1%]), loss of employment opportunities (24 of 129 [18.6%]), and misrepresentation (eg, mistaken for nurse, janitor, etc; 18 of 129 [14.0%]), with loss of income being reported exclusively by women (25 of 108 [23.1%]). Those who reported at least 1 encounter of discrimination experienced significantly lower job satisfaction than those who did not (3.9 [1.0] vs 4.3 [0.8] on a scale of 1-5, where 1 indicates very dissatisfied and 5 indicates very satisfied; difference, -0.4 [95% CI, -0.7 to -0.2]; P < .001), as well as lower achievement of current career goals (3.9 [1.1] vs 4.3 [0.8] on a scale of 1-5; difference, -0.4 [95% CI, -0.6 to -0.2]; P < .001). This study suggests that discrimination remains prevalent among ophthalmologists in the US, with gender-based discrimination being reported most frequently. Discrimination was negatively associated with income, employment opportunities, job satisfaction, and achievement of career goals for respondents. With increased recognition of the prevalence and outcomes of discrimination in the workplace, ophthalmologists can advocate for policy changes and model appropriate behavior to improve the working environment and promote diversity, equity, and inclusion goals.