Religious Identity Discrimination in the Physician Workforce: Insights from Two National Studies of Muslim Clinicians in the US.

BACKGROUND: Discrimination negatively impacts physician career trajectories and well-being. OBJECTIVE: Quantify perceived religious discrimination among US Muslim physicians and compare trends over time. DESIGN/PARTICIPANTS/MAIN MEASURES: Two national surveys tabulated discrimination. The 2013 survey involved a mailed questionnaire to a random sample of 746 Islamic Medical Association of North America (IMANA) members, while the 2021 survey was administered online to subscribers of IMANA, American Muslim Health Professionals, and the US Muslim Physician network. Eligible participants had to be practicing US Muslim physicians, and English-proficient (the 2021 sample was further restricted to physicians in academic medicine). Questionnaires assessed experiences of religious discrimination and accommodation. KEY RESULTS: In 2013, the 255 participants had a mean age of 52 years, were mostly male (70%), Sunni (91%), South Asian (70%), and adult immigrants (65%). In 2021, the 264 participants had a mean age of 39.5 years, were mostly male (65%) and Sunni (75%). In contrast to 2013, the majority were born in the USA (59%; p<0.01), and respondents were more diverse with 33% South Asians, 22% Arabs, and 16% African Americans. Greater proportions of the 2021 sample reported facing religious discrimination frequently in their career (24 to 53%; p<0.01), experiencing job turnover (7 to 32%; p<0.01), and having patients refuse their care (9 to 33%; p<0.01). A higher proportion of South Asians, Arabs, and participants under the age of 40 reported discrimination and job turnover in 2021 when compared to 2013. Higher proportions of South Asians and Whites reported being passed over for professional advancement and having patients refuse their care in 2021 relative to 2013. CONCLUSIONS: Many American Muslim clinicians encounter religious discrimination at the workplace, and these experiences appear to be on the rise. Healthcare workforce diversity, inclusion, and equity programming should include a focus on accommodating the religious identities of physicians.

Relationships Between Religious Commitment, Workplace Experiences, and Professional and Psychological Outcomes Among U.S. Muslim Physicians.

PURPOSE: To examine relationships between religiosity, workplace discrimination, religious accommodation, and related professional and psychological outcomes among US Muslim physicians. METHOD: In 2021, the authors surveyed 264 physicians from 3 U.S.-based Muslim clinician organizations. Religious commitment, as measured by multiple items, was evaluated as a possible predictor of workplace discrimination and accommodation; job turnover; career satisfaction; workplace motivation; and belonging, burnout, and depression. Bivariate regression models were used to identify possible significant relationships between predictor and outcome variables. Predictors with meaningful bivariate analyses were included in separate multivariate regression models for each outcome. RESULTS: Participants' mean age was 39.5 years (standard deviation, 10.03). Most were male (160/246; 65%), U.S.-born (146/244; 60%), completed medical school in the United States (190/243; 78%), and wore a beard/hijab (135/235; 57%). Participants identified as African American (40/247; 16%), Arab (55/247; 22%), South Asian (82/247; 33%), and White (70/247; 28%). Multivariate models demonstrated that religious importance was positively associated with discrimination from patients (odds ratio [OR] = 3.78; P = .02) and depression (OR = 5.36; P = .002), and negatively associated with prayer accommodation at work (OR = .20; P = .001). Engaging in congregational religious activities was negatively associated with discrimination from patients (OR = .64; P = .006) and job turnover (OR = .63; P = .02) and positively associated with accommodations for prayer (OR = 1.42; P = .008) and general religious identity accommodation (OR = 1.47; P = .01). Additionally, participant race and ethnicity were variably associated with these outcomes. CONCLUSIONS: This study demonstrates how religious identity may negatively associate with workplace experiences and well-being among U.S. Muslim physicians and highlights the buffering role of religious practice. It spotlights an urgent need for academic medical centers to ameliorate religious discrimination and implement workplace accommodation policies for Muslim physicians.

Muslim American physicians' experiences with, and views on, religious discrimination and accommodation in academic medicine.

OBJECTIVE: To assess Muslim physician experiences with religious discrimination and identify strategies for better accommodating Muslim identity in health care. DATA SOURCES AND STUDY SETTING: Interviews were conducted with Muslim physicians from three US-based Muslim clinician organizations between June and August 2021. STUDY DESIGN: In-depth, semi-structured qualitative interviews used a phenomenological approach to describe experiences of religious discrimination and accommodation. A team-based framework approach to coding was used to inductively generate themes from interview data. DATA COLLECTION/EXTRACTION METHODS: Physicians from the Islamic Medical Association of North America, American Muslim Health Professionals, and the US Muslim Physicians group were invited to participate using closed organizational listservs. Inclusion criteria sought English-speaking, self-identifying Muslims with current or past affiliation with a university hospital in the United States. Potential participants were segmented into groups based on responses to questions about perceived religious discrimination and accommodation. Purposive sampling was used to iteratively approach participants within these groups in order to capture a diverse respondent pool. Interviews stopped after thematic saturation was reached. PRINCIPAL FINDINGS: Eighteen physicians (11 women and 7 men; mean age: 41.5 [standard deviation = 12.91] years) were interviewed. Nearly all (n = 16) held Islam to be important in their lives. Three overarching themes, with several subthemes, emerged. Participants (1) struggled to maintain religious practices and observances due to unaccommodating organizational structures; (2) experienced religious discrimination, which, in turn, impacted their professional trajectories and, at times, their personal well-being; and (3) believed that institutions could implement specific educational and policy interventions to advance the religious accommodation of Muslims in health care. CONCLUSIONS: Muslim physicians frequently encounter religious discrimination, yet there are concrete ways in which health care workplaces can better accommodate their religious needs and combat discrimination. To improve workforce diversity, equity, and inclusion, educational forums and policies that support the religious practices of physicians need to be established.

Cultural and Social Challenges of Diabetes Self-Management Education Through Physicians' Voices.

OBJECTIVE: The aim of this study is to understand how the physician-patient relationship is related to referral practices for diabetes self-management education and physicians' perceptions of culturally competent health care delivery at a large health system affiliated with an academic medical center in a Midwestern city. METHODS: Sixteen physicians (6 family medicine, 6 internal medicine, 4 endocrinology) participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded. Data were thematically analyzed using MAXQDA software. RESULTS: All physicians considered diabetes self-management education a very important part of diabetes treatment, but physician referral patterns to diabetes education varied. Study findings indicated that both high and low referring physicians reported providing care that was responsive to personalized patient needs, including cultural beliefs, attitudes, and behaviors that affect health/health care. Building relationships and rapport with patients led to discussions of understanding barriers to diabetes management. CONCLUSION: This study highlights physicians' perceptions of and concerns about referrals to diabetes self-management education and the treatment of type 2 diabetes. Physicians understood the personal, environmental, and health care factors that limit the number of racial/ethnic minorities from participating. PRACTICAL IMPLICATIONS: In addition to diabetes education, physicians suggested that additional resources or programs will help them address socioeconomic factors beyond their control and to understand cultural preferences.

Nurses' perceptions of a novel health information technology: A qualitative study in the pediatric intensive care unit.

The purpose of this study was to evaluate the use of a novel health information technology (HIT), a large customizable interactive monitor (LCIM), implemented in a pediatric intensive care unit (PICU). Specifically, we explored nurses' perceptions of this novel HIT application and its perceived effect on family engagement. We used a qualitative research design to collect and analyze data from 55 PICU nurses in seven focus groups. A trained moderator followed a semi-structured discussion guide with questions related to perceptions, attitudes, and care team interactions with the LCIM. Groups were audio-recorded, transcribed, and coded using content analysis procedure. Six major themes emerged from the nurse focus groups, which include familiarity and use routines, positive perceptions with the LCIM, negative perceptions with the LCIM, privacy, training, and suggestions for improvement. Insights into nurses' perceptions of the LCIM has the potential to improve family-centered care.

Use of secondary clinical data for research related to diabetes self-management education.

BACKGROUND: Diabetes self-management education (DSME) is a key component of ensuring optimal diabetes outcomes. Electronic medical record (EMR) systems have transformed diabetes management by providing organized and useful data. However, important gaps remain in the process of how practice settings track referrals and attendance to DSME. PURPOSE: The purpose of this study was to use EMR data to examine patients' demographic, behavioral, and diabetes risk factors by referral pattern to a DSME program in a large midwestern Academic Medical Center. METHODS: A retrospective cross-sectional design using 2006-2013 EMR data from a Clinical Research Data Warehouse (CRDW). Data on 10,000 patients with type 2 diabetes mellitus (T2DM) were randomly extracted from the CRDW for analysis. Multiple logistic regression analysis was employed to explore adjusted associations with referral to DSME. RESULTS: Seven hundred forty patients with T2DM were referred to DSME. Results show that age at diagnosis, insurance status, race/ethnicity, language, alcohol use, use of insulin, HbA1c, LDL, systolic blood pressure, ophthalmology appointment, coronary artery disease, neuropathy, diabetic-retinopathy, and nephropathy were found to be factors significantly associated with a referral to DSME. Language emerged as a significant result; non-English speakers were more likely to receive a referral to DSME. CONCLUSIONS: Patients referred for DSME had appropriate medical complications or social needs that would benefit from intensive education; however, there remains a considerable opportunity for improving the DSME referral process. Aspects of the physician decision-making process to refer or not refer patients to DSME warrant further investigation.

Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM).

OBJECTIVES: The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS: We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. RESULTS: Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. CONCLUSION: It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.

The Influence of Patient and Provider Communication on Diabetes Care Delivery.

PURPOSE: To elicit the perspective of patients with type 2 diabetes, specific to communication with providers and health care teams. METHODS: We conducted 21 focus groups with 115 adults in Midwestern primary care, endocrinology, and bariatric surgery clinics. Facilitators analyzed the transcripts using an iterative coding method. RESULTS: The themes of encouragement and motivation, relationship building, compassion, and communication preferences highlighted effective strategies consistent with the core components of patient-centered care. CONCLUSIONS: Patients and providers benefit from systems in which patients are efficiently and compassionately supported in self-management within their abilities and in partnership with their support networks.

Chronic care model as a framework to improve diabetes care at an academic internal medicine faculty-resident practice.

We implemented a quality improvement project for diabetes care in a faculty-resident internal medicine practice, using the Chronic Care Model framework. We created a planned visit clinic, used a stepwise medication algorithm, and self-management support. The intervention was effective for patients with glycohemoglobin A1c levels 10 or above (P = .0075) when compared with usual care after adjusting for all significant predictors. Compliance with foot examinations increased by 72% (P < .0001) and pneumococcal vaccinations by 25% (P = .0115). We believe that the Chronic Care Model can be successfully integrated into faculty-resident practices and provides a model for further exploration into disease management education in academic settings.