As a woman of color who was fortunate to be accepted to medical school 29 years ago, I thought that if I had the intelligence, grit, and credentials, I would succeed. I thought that the profession of medicine operated within a system of meritocracy: work hard and you will be rewarded. I learned the hard way that it isn’t like that.
My post-graduate professional journey has spanned a general surgery residency, fellowships in hospice and palliative medicine and clinical medical ethics, all of which has led me to a rare but much needed integrated clinical practice. But like the trajectories of so many other women and people of color, mine has been encumbered by factors beyond my control, like my gender and the color of my skin. I was aghast to learn that the skills I worked so hard to develop would later be used against me because I didn’t look like a surgeon.
It took me years to understand how the culture of medicine and the structural barriers within that culture impeded my efforts to belong, contribute, and succeed.
It was only when commiserating with other under-represented physicians and surgeons that I recognized my experience was not unique. Learning about the scope of harms that have been inflicted upon generations of physicians and surgeons has compelled me to understand why — especially in the context of physicians’ oath to “do no harm” and at a time when justice, equity, diversity, and inclusion (JEDI) have risen to become a workforce focus to better care for the country’s diverse population and reduce health care disparities.
To that end, I founded the organization Physician Just Equity to study the who, what, where, why, and how of workplace injustices, and to support those who have been targeted. The organization, rooted in the stories of physicians and surgeons in training and practice (we call them peers), identifies patterns of leadership behavior during workplace conflict, and offers peers emotional and strategic support by harnessing the collective wisdom of Physician Just Equity peer supporters. The goal is to empower clinicians with information and resources to mitigate the harms of workplace injustices.
Since launching the organization in February 2021, 82 peers have reached out for support. Most are women with intersectional identities — defined by race, ethnicity, color, gender, sexual orientation, or disability thus creating overlapping and interdependent causes for discrimination or disadvantage. Half are physicians in training, half are pursuing surgical specialties, and most have been forced out of their positions under the pretense of deficiencies in professionalism, competency, and/or productivity. The reasons given are colloquially known as “not being a good fit” that has little to do with their work product.
What is striking about these cases is the similarity in how workplace conflicts arise while doing one’s job in an honorable and upstanding way. These clinicians aimed to improve the quality and safety of patient care by bringing discriminatory clinical practices to light or reporting a work-related injustice. The response by their organizations’ leadership, however, was retaliation, which led to a hostile work environment often ending in a constructive discharge or termination without cause and often the loss of one’s job, career, financial security, identity, purpose, and well-being.
In all of these cases, the response of leadership to the conflict was to make the clinician the problem, rather than the clinician’s valid concern(s). The inciting event(s) were followed by a well-architected sequence of actions designed to intimidate and create a false narrative that discredited the clinician. Due process was not adhered to either because of ignorance and the lack of accountability and/or a preconceived notion of what outcome was desired.
I and many of my colleagues now refer to the precision and consistency of this institutional strategy as the corporate medical playbook.
Trusting and well-meaning clinicians aren’t aware of this covert playbook. They believe that when given the chance to tell their side of the story, the conflict will be viewed through a factual lens and resolved rationally. Many fail to understand that their viewpoint is never going to be heard or taken seriously. Reality sets in when the consequences of the conflict derails progress and upends their career trajectories.
These cases illustrate why the underlying problems with the culture of medicine and medical workplaces aren’t getting fixed: The reason is that talented under-represented clinicians are systematically eliminated, preventing substantive and sustainable progress in justice, equity, diversity, and inclusion.
The inability of leadership to lean into the work required for real change perpetuates a culture of violence against those who are trying to change it. This vicious cycle precludes the medical profession from achieving justice, equity, diversity, and inclusion, and therefore prevents the population from achieving health equity. Many clinicians work in a culture of fear that rewards their silence by invoking nondisclosure agreements. Keeping these injustices hidden behind closed doors is detrimental to change and therefore progress.
The lack of transparency around workplace injustices thwarts the medical profession from exposing the pervasiveness of these experiences. Meaningful action must be taken to prevent them from happening again and again. Physician Just Equity has been accumulating data, including the demographics of targets, the nature of workplace injustices, how conflicts are handled, and their outcomes. To date, the data reveal a disproportionate number of targets self-identify as underrepresented in medicine and characterize their workplace injustice as harassment, discrimination, and retaliation without the benefit of due process, resulting in resignation or termination.
Until there is external and neutral oversight of these processes and a system of accountability and transparency in medical workplaces, I fear these injustices will continue with impunity.
Pringl Miller is a general surgeon and a hospice and palliative medicine physician, the founder and executive director of Physician Just Equity, and a cofounder of the Surgical Palliative Care Society.