Gender discrimination among healthcare workers (HCWs) negatively impacts their mental health and career development; however, few studies have explored how experiences of gender discrimination change during times of health system strain.
Methods:
This survey-based study assesses the associations between gender discrimination and four stress-related mental health outcomes (posttraumatic stress, depression, anxiety, and burnout), as well as the qualitative experiences of gender discrimination in healthcare during the COVID-19 pandemic.
Results:
Among women, increased gender discrimination was associated with heightened symptoms of posttraumatic stress, depression, anxiety, and burnout after adjusting for demographics and pandemic-related stressors; however, among men, increased gender discrimination was only associated with heightened symptoms of depression. Using thematic analysis, we identified five themes that describe experiences of gender discrimination faced by women in healthcare, including differential valuing of work and contributions, gendered roles and assumptions about roles, maternal discrimination, objectification, and “old boys club.” We also identified two themes describing how men perceived gender discrimination, including instances of symbolic discrimination and woman provider preference.
Conclusion:
These findings suggest that experiences of gender discrimination persist during times of health system strain and negatively impact women HCWs' mental health.
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References
1.
SchlickCJR, EllisRJ, EtkinCD, et al.Experiences of gender discrimination and sexual harassment among residents in general surgery programs across the US. JAMA Surg, 2021; 156:942–952.
2.
WangLJ, TaniousA, GoC, et al.Gender-based discrimination is prevalent in the integrated vascular trainee experience and serves as a predictor of burnout. J Vasc Surg, 2020; 71(1):220–227.
3.
VargasEA, BrasselST, CortinaLM, et al.#MedToo: A large-scale examination of the incidence and impact of sexual harassment of physicians and other faculty at an academic medical center. J Womens Health (Larchmt), 2020; 29(1):13–20.
4.
Lo SassoAT, RichardsMR, ChouC-F, et al.The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women. Health Aff (Millwood), 2011; 30(2):193–201.
5.
MuenchU, SindelarJ, BuschSH, et al.Salary differences between male and female registered nurses in the United States. JAMA, 2015; 313(12):1265–1267.
6.
RichterKP, ClarkL, WickJA, et al.Women physicians and promotion in academic medicine. N Engl J Med, 2020; 383(22):2148–2157.
7.
ChenW, SchillingBK, BourneDA, et al.A report of gender bias and sexual harassment in current plastic surgery training: A national survey. Plast Reconstr Surg, 2021; 147(6):1454–1468.
8.
LuL, DongM, LokGKI, et al.Worldwide prevalence of sexual harassment towards nurses: A comprehensive meta-analysis of observational studies. J Adv Nurs, 2020; 76(4):980–990.
9.
AdesoyeT, MangurianC, ChooEK, et al.Perceived discrimination experienced by physician mothers and desired workplace changes: A cross-sectional survey. JAMA Intern Med, 2017; 177(7):1033–1036.
10.
BarnesKL, DunivanG, SussmanAL, et al.Behind the mask: An exploratory assessment of female surgeons' experiences of gender bias. Acad Med, 2020; 95(10):1529–1538.
11.
SudolNT, GuaderramaNM, HonsbergerP, et al.Prevalence and nature of sexist and racial/ethnic microaggressions against surgeons and anesthesiologists. JAMA Surg, 2021; 156(5):e210265.
12.
HenneinR, BonumweziJ, Nguemeni TiakoMJ, et al.Racial and gender discrimination predict mental health outcomes among healthcare workers beyond pandemic-related stressors: Findings from a cross-sectional survey. Int J Environ Res Public Health, 2021; 18(17):9235.
13.
AndersonN, LettE, AsaborEN, et al.The association of microaggressions with depressive symptoms and institutional satisfaction among a national cohort of medical students. J Gen Intern Med, 2022; 37(2):298–307.
14.
MooreLR, ZieglerC, HesslerA, et al.Burnout and career satisfaction in women neurologists in the United States. J Womens Health (Larchmt), 2019; 28(4):515–525.
15.
BerwickS, CalevH, MatthewsA, et al.Mistaken identity: Frequency and effects of gender-based professional misidentification of resident physicians. Acad Med, 2021; 96(6):869–875.
16.
MaoA, CheongPL, VanIK, et al.“I am called girl, but that doesn't matter”—perspectives of male nurses regarding gender-related advantages and disadvantages in professional development. BMC Nurs, 2021; 20(1):24.
17.
KoM, DorriA. Primary care clinician and clinic director experiences of professional bias, harassment, and discrimination in an underserved agricultural region of California. JAMA Netw Open, 2019; 2(10):e1913535.
18.
LuDW, LallMD, MitzmanJ, et al.#MeToo in EM: A multicenter survey of academic emergency medicine faculty on their experiences with gender discrimination and sexual harassment. West J Emerg Med, 2020; 21(2):252–260.
19.
BhandariS, JhaP, CooperC, et al.Gender-based discrimination and sexual harassment among academic internal medicine hospitalists. J Hosp Med, 2021; 16(2):84–89.
20.
TurrentineM, RamirezM, StarkL, et al.Role of physician gender in the modern practice of obstetrics and gynecology: Do obstetrician-gynecologists perceive discrimination from their sex?. South Med J, 2019; 112(11):566–570.
21.
SearsDO, HenryPJ. Over thirty years later: A contemporary look at symbolic racism. Adv Exp Soc Psychol, 2005; 37(1):95–125.
22.
HenneinR, TineoP, BonumweziJ, et al.“They Wanted to Talk to a ‘Real Doctor’”: Predictors, perpetrators, and experiences of racial and ethnic discrimination among healthcare workers. J Gen Intern Med, 2021:1–9.
23.
CerdeñaJP, RehmanT, HardemanRR. Why bias matters in medicine: Qualitative insights from anonymous, online reports. J Natl Med Assoc, 2020; 112(1):6–14.
24.
HenneinR, GormanH, ChungV, et al.Gender discrimination among women healthcare workers: Findings from a mixed methods study. PLoS One, 2023; 18(2):e0281367.
25.
HenneinR, MewEJ, LoweSR. Socio-ecological predictors of mental health outcomes among healthcare workers during the COVID-19 pandemic in the United States. PLoS One, 2021; 16(2):e0246602.
26.
DongE, DuH, GardnerL. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis, 2020; 20(5):533–534.
27.
VuM, LiJ, HaardörferR, et al.Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: Insights from the intersectionality framework. BMC Public Health, 2019; 19(1):1–13.
28.
CameronRP, GusmanD. The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Prim Care Psychiatry, 2003; 9(1):9–14.
29.
KroenkeK, SpitzerRL, WilliamsJB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med, 2001; 16(9):606–613.
30.
SpitzerRL, KroenkeK, WilliamsJB, et al.A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med, 2006; 166(10):1092–1097.
31.
WestCP, DyrbyeLN, SloanJA, et al.Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. J Gen Intern Med, 2009; 24(12):1318–1321.
32.
PappaS, NtellaV, GiannakasT, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav Immun, 2020:88;901–907.
33.
LaiJ, MaS, WangY, et al.Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open, 2020; 3(3):e203976.
34.
MataDA, RamosMA, BansalN, et al.Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA, 2015; 314(22):2373–2383.
35.
JacksonT, ProvencioA, Bentley-KumarK, et al.PTSD and surgical residents: Everybody hurts… sometimes. Am J Surg, 2017; 214(6):1118–1124.
36.
ChutiyamiM, CheongAMY, SalihuD, et al.COVID-19 pandemic and overall mental health of healthcare professionals globally: A meta-review of systematic reviews. Front Psychiatry, 2021; 12:804525.
37.
PeccoraloLA, PietrzakRH, FeingoldJH, et al.A prospective cohort study of the psychological consequences of the COVID-19 pandemic on frontline healthcare workers in New York City. Int Arch Occup Environ Health, 2022:1–13.
38.
FrankE, ZhaoZ, FangY, et al.Experiences of work-family conflict and mental health symptoms by gender among physician parents during the COVID-19 pandemic. JAMA Netw Open, 2021; 4(11):e2134315.
39.
National Health and Nutrition Examination Survey. Available from: https://wwwn.cdc.gov/nchs/nhanes/Search/variablelist.aspx?Component=Questionnaire [Last accessed: October 17, 2020].
40.
IBM. SPSS statistics for windows [computer program]. Version 26.0. IBM Corp.: Armonk, NY; 2019.
41.
BraunV, ClarkeV. Using thematic analysis in psychology. Qual Res Psychol, 2006; 3(2):77–101.
42.
HallWA, CalleryP. Enhancing the rigor of grounded theory: Incorporating reflexivity and relationality. Qual Health Res, 2001; 11(2):257–272.
43.
WeaverAC, WetterneckTB, WhelanCT, et al.A matter of priorities? Exploring the persistent gender pay gap in hospital medicine. J Hosp Med, 2015; 10(8):486–490.
44.
GeorgiM, MorkaN, PatelS, et al.The impact of same gender speed-mentoring on women's perceptions of a career in surgery: A prospective cohort study. J Surg Educ, 2022; 79:1166–1176.
45.
GargiuloDA, HymanNH, HebertJC. Women in surgery: Do we really understand the deterrents?. Arch Surg, 2006; 141(4):405–407; discussion 407–408.
