Gender discrimination among women healthcare workers during the COVID-19 pandemic: Findings from a mixed methods study

Background: Gender discrimination among women healthcare workers (HCWs) negatively impacts job satisfaction, mental health, and career development; however, few studies have explored how experiences of gender discrimination change during times of health system strain. Thus, we conducted a survey study to characterize gender discrimination during a time of significant health system strain, i.e., the COVID-19 pandemic. Methods: We used a convenience sampling approach by inviting department chairs of academic medical centers in the United States to forward our online survey to their staff in January 2021. The survey included one item assessing frequency of gender discrimination, and an open-ended question asking respondents to detail experiences of discrimination. The survey also included questions about social and work stressors, such as needing additional childcare support. We used ordinal logistic regression models to identify predictors of gender discrimination, and grounded theory to characterize themes that emerged from open-ended responses. Results: Among our sample of 716 women (mean age = 37.63 years, SD = 10.97), 521 (72.80%) were White, 102 (14.20%) Asian, 69 (9.60%) Black, 53 (7.4%) Latina, and 11 (1.50%) identified as another race. In an adjusted model that included demographic characteristics and social and work stressors as covariates, significant predictors of higher gender discrimination included younger age (OR = 0.98, 95%CI = 0.96, 0.99); greater support needs (OR = 1.26, 95%CI = 1.09,1.47); lower team cohesion (OR = 0.94, 95%CI = 0.91, 0.97); greater racial discrimination (OR = 1.07, 95%CI = 1.05,1.09); identifying as a physician (OR = 6.59, 95%CI = 3.95, 11.01), physician-in-training (i.e., residents and fellows; OR = 3.85, 95%CI = 2.27,6.52), or non-clinical worker (e.g., administrative assistants; OR = 3.08, 95%CI = 1.60,5.90), compared with nurses; and reporting the need for a lot more childcare support (OR = 1.84, 95%CI = 1.15, 2.97), compared with reporting no childcare support need. In their open-ended responses, women HCWs described seven themes: 1) belittlement by colleagues, 2) gendered workload distributions, 3) unequal opportunities for professional advancement, 4) expectations for communication, 5) objectification, 6) expectations of motherhood, and 7) mistreatment by patients. Conclusions: Our study underscores the severity of gender discrimination among women HCWs. Hospital systems should prioritize gender equity programs that improve workplace climate during and outside of times of health system strain.