INTRODUCTION

Physicians experiencing harassment, discrimination, and retaliation frequently feel isolated and have increased rates of burnout and attrition.1,2,3,4 Perpetrators often hold leadership positions, making reporting unsafe due to retaliation and lack of accountability.1 Navigating workplace injustices (WI) is stressful, adding layers of interpersonal, procedural, and structural complexity to an inherently demanding profession.

There is a paucity of effective resources to help physicians navigate WI. Physician Just Equity (PJE), a non-profit organization, enlists physician volunteers to provide free, individualized peer support (PS) to physicians seeking help navigating WI. Peer support includes active listening, empathy, and advice in a confidential, interactive virtual setting. Presented are pilot data from the PJE peer support initiative to further characterize WI in medicine.

METHODS

PJE conducted an IRB-approved interventional pilot study of self-reported, de-identified data collected from physicians (“peers”) experiencing WI between February and December 2021. Physicians can access PJE PS via direct referrals, social media, webinars, podcasts, publications, and the PJE website. Peers completed an electronic intake survey created in REDCap, a secure web-based platform, and consented to their data being used for research prior to participation. Demographics, career stage, specialty, practice type, geographic location, and the nature of their WI were collected.

All peer supporters underwent an orientation that included education on confidentiality, meeting etiquette, limitations of PS, resiliency strategies, and expectations for follow-up. An individualized PS team of four to six physicians from the PJE collective was assembled upon request. Prior to the PS virtual meeting, the team reviewed the peer’s intake form and the peer received statements of interest from each team member.

Peer support occurred via a secure, password-protected, unrecorded, virtual platform. A 1-hour virtual meeting was held to discuss the WI and develop a strategic plan to achieve the peer’s goals. After the first session, an electronic outtake survey was completed to assess the session’s utility, and a “peer navigator” was assigned as the point of contact. Additional meetings were scheduled upon request.

Quantitative analysis of peer self-reported characteristics was performed and reported as frequency (%). A qualitative summary of comments from the peer outtake surveys was also compiled.

RESULTS

All thirty-five peers included in the study completed intake and outtake surveys. Most peers were women (86%) and identified as non-white (63%). Peers resided in 17 states, represented 19 specialties and/or subspecialties and 51% were in practice versus in training (Table 1). The most common injustices reported were discrimination (92%), retaliation (78%), and harassment (69%). Of those reporting discrimination, gender (77%), race (46%), and disability (26%) were the top reasons cited. Twenty-two percent of respondents changed their specialty due to WI.

Table 1 Peer Demographics (n=35)
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Qualitative feedback from all peers was positive and affirmed that the PJE initiative provided four primary areas of value: strategic support, emotional support, resource provision, and importance of the work filling a gap in available resources to help navigate WI (Table 2).

Table 2 Peer Feedback Summarized from Outtake Forms
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The most common goals articulated by peers for WI resolution were career progression and/or reinstatement (37%), systemic change (26%), restoration of reputation (21%), support/guidance (9%), and feeling safe at work (9%). Two (6%) respondents wanted the offending behavior exposed and one (3%) sought disciplinary action towards the perpetrator.

DISCUSSION

This pilot study demonstrates that under-represented physicians in various specialties and geographic locations experience workplace injustices such as discrimination and retaliation.

Previous reports addressing gender discrimination in medicine, including the 2018 NASEM Report, recommend support for the target. However, such support has been severely lacking.1,5,6 Based on peer feedback, PJE PS filled a gap that was not available elsewhere. We found that individualized PS external to one’s workplace empowered physicians experiencing WI and alleviated some of the adverse consequences imposed.

Although descriptive feedback from peers was favorable, the nature of WI portends it may take years before resolution is achieved. Long-term follow-up of WI outcomes, timelines, and career progression is needed to assess the efficacy of this PS initiative. Additionally, the sample size reported limits generalizing these results to all physicians involved in WI.

Comments from PJE peers reinforce the value of an external, individualized peer support initiative while navigating workplace injustices. Therefore, peer support for the target of WI may represent an important mitigation strategy to retain talented under-represented physicians.