Effect of race, gender identity, and their intersection on career satisfaction: A cross-sectional survey of academic physicians

Abstract

Purpose

Ensuring a representative workforce is a matter of equity and social justice and has implications for patient care and population health. We examined the relationship of the binary gender identity and race of physicians who felt comfortable to self-identify, with workplace experiences and career satisfaction in academic medicine.

Methods

The outcome of interest of a cross-sectional survey of full-time clinical faculty members within the Department of Medicine, University of Toronto, was physician’s self-reported career satisfaction. Using logistic regression, we examined relationships of binary gender identity (female/male) and race [under-represented minority (URM) versus over-represented in medicine (ORM)] to: workplace experiences (respectful interactions, perception of having to work harder, exclusion from social networks, witnessing/experiencing unprofessionalism, and confidence in taking action to address incivility without reprisal); and career satisfaction, controlling for age, rank, protected time, and workplace experiences.

Results

Female gender and URM status were associated with younger age, lower rank, and less positive workplace experiences. 132 respondents (44.4%) strongly agreed they had career satisfaction. Compared with ORM men, career satisfaction was significantly lower for URM and ORM female physicians (OR 0.30, 95% CI 0.14–0.65, and 0.48, 95% CI 0.27–0.85, respectively) and non-significantly lower for URM male physicians (OR 0.62, 95% CI 0.32–1.19). Adjustment for academic rank and workplace experiences fully attenuated these relationships.

Conclusions

URM female academic physicians had lower career satisfaction than their ORM male counterparts, largely explained by systematic differences in workplace experiences, particularly perceptions of exclusion from social networks and having to work harder to be perceived as legitimate scholars. This suggests a role for institutions and leaders to build inclusive, anti-racist, and anti-oppressive cultures to support the flourishing of all faculty.

Keywords:

• Gender identity
• race
• academic medicine
• career satisfaction

Acknowledgements

We wish to acknowledge the Faculty Survey Working Group including Drs. Andrea Page, Shail Rawal, Lisa Richardson, Malika Sharma, Kathryn Tinckam, and Ms. Lilian Belknap.

Disclosure statement

GAH receives support as the Sir John and Lady Eaton Professor and Chair of Medicine, University of Toronto; SES is funded by a Tier 1 Canada Research Chair in Knowledge Translation. The other authors declare no conflicts of interest.

Notes on contributors

Reena Pattani, MDCM, MPH, Department of Medicine, University of Toronto, Toronto, ON, Canada. Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada.

Karen E. A. Burns, MD, MSc, Department of Medicine, University of Toronto, Toronto, ON, Canada. Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada.

Edmund Lorens, Med, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Sharon E. Straus, MD MSc, Department of Medicine, University of Toronto, Toronto, ON, Canada. Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada.

Gillian A. Hawker, MD, MSc, Department of Medicine, University of Toronto, Toronto, ON, Canada. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Notes on contributors

Reena Pattani

Reena Pattani, MDCM, MPH, Department of Medicine, University of Toronto, Toronto, ON, Canada. Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.

Karen E. A. Burns

Karen E. A. Burns, MD, MSc, Department of Medicine, University of Toronto, Toronto, ON, Canada. Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.

Edmund Lorens

Edmund Lorens, Med, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Sharon E. Straus

Sharon E. Straus, MD MSc, Department of Medicine, University of Toronto, Toronto, ON, Canada. Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.

Gillian A. Hawker

Gillian A. Hawker, MD, MSc, Department of Medicine, University of Toronto, Toronto, ON, Canada. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada.