By Linda Carroll

(Reuters Health) – Even as rural America struggles to attract enough healthcare providers, women and minority health professionals are sometimes driven out of rural communities by the discrimination and harassment from colleagues, a new study finds.

In interviews for the study, many of the healthcare professionals who were female, nonwhite, and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment and hostility from their colleagues, researchers report in JAMA Network Open.

“We’re trying very hard to bring healthcare providers to underserved rural communities,” said study leader Dr. Michelle Ko from the University of California, Davis. “But we have to be very cognizant of how bias, harassment and institutional discrimination can be barriers to that. These issues affect not only the wellbeing of the health professionals but also patients’ access to care.”

Ko said she was surprised by the findings. The study started out “with broad open-ended questions about practice challenges, strategies for dealing with those challenges and about personal journeys,” Ko explained. “Very quickly these issues came up.”

Ko and colleague Armin Dorri interviewed 26 physicians, nurse practitioners and clinic directors practicing in primary care settings in California’s San Joaquin Valley, which is predominantly agricultural and rural.

Of the 26, 16 identified as female, 12 as non-Latinx white (a gender neutral term for those of Latin-American decent) and three as SGM. Those who identified as female, nonwhite and SGM talked about feelings of isolation caused by the way they were treated by colleagues.

Most of those interviewed stressed that the vast majority of the problems were with fellow healthcare providers and not patients.

Twelve of the 16 female healthcare professionals said they were frustrated by negative comments about women’s family obligations, lack of scheduling flexibility, and general disrespect, the researchers report. Three women reported harassment from male colleagues including inappropriate sexual jokes, degrading comments about women, and use of medical practice and hospital computers to view pornographic materials.

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Three study participants talked about feelings of fatigue from dealing with colleagues’ racial biases. The African American participant reported persistent racial microaggressions from other physicians, staff and patients; this physician had also been told, You don’t look like a real doctor.

Two of those who identified as sexual or gender minorities talked about overt hostility, including receiving expletive laden notes and vandalism of their cars. They said hospitals in the area were known to deny doctors admitting privileges once someone’s SGM status was known. One was asked to step down from leadership of hospital boards and medical organizations after their SGM status became known.

While a third who identified as sexual or gender minority reported no issues, this person wasn’t sure if colleagues or other staff knew of their status.

“The results are disheartening but perhaps not surprising given the persistent climate of intolerance, particularly in pockets across the United States,” said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “Too frequently physicians who start out in rural practices find that they are unable to fit in.”

Confronted with both indirect and overt discrimination, women and sexual and gender minorities may “realize there is no hope,” Wu said. “Many have resorted to relocating to more accepting practices and communities.”

Wu would like to see national and state agencies work to identify and reduce the kind of mistreatment described in the new study. “Although this is difficult, education and other interventions can help,” he said.

SOURCE: and JAMA Network Open, online October 23, 2019.