APSA Members experience bias and discrimination in training and practice

Jack Vernamonti, University of Michigan, Division of Pediatric Surgery, Ann Arbor, MI, United States. Electronic address: jack.vernamonti@mainehealth.org.
Kanika Bowen-Jallow, Texas Christian University School of Medicine, Cook Children's Medical Center Prosper, TX, United States.
Anghela Paredes, The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, United States.
Hannah Cockrell, Seattle Children's Hospital, Division of General and Thoracic Surgery, Seattle, WA, United States.
Zach Morrison, Marshfield Medical Center, Department of General Surgery, Marshfield, WI, United States.


INTRODUCTION: Bias and discrimination remain pervasive in the medical field and increase the risk of burnout, mental health disorders, and medical errors. The experiences of APSA members with bias and discrimination are unknown, therefore the APSA committee on Diversity, Equity and Inclusion conducted a survey to characterize the prevalence of bias and discrimination. METHODS: 1558 APSA members were sent an anonymous survey, of which 423 (27%) responded. Respondents were asked about their demographics, knowledge of implicit bias, and experience of bias and discrimination within their primary workplace, APSA, and APSA committees. Data were analyzed using Fisher's Exact test, Kruskal-Wallis test, and multivariable logistic regression as appropriate with significance defined as p<0.05. RESULTS: Discrimination was reported across all levels of practice, academic appointments, race, ethnicity, and gender identities. On multivariable analysis, surgical trainees (OR 3.6) as well as Asian American and Pacific Islander (OR 4.8), Black (OR 5.2), Hispanic (OR 8.2) and women (OR 8.7) surgeons were more likely to experience bias and discrimination in the workplace. Community practice surgeons were more likely to experience discrimination within APSA committees (OR 3.6). Members identifying as Asian (OR 0.4), or women (OR 0.6) were less likely to express comfort reporting instances of bias and discrimination. CONCLUSION: Workplace discrimination exists across all training levels, academic appointments, and racial and gender identities. Trainees and racial- and gender-minority surgeons report disproportionately high prevalence of bias and discrimination. Improving reporting mechanisms and implicit bias training are possible initiatives in addressing these findings.