Overview
Workplace discrimination obstructs fairness and negatively impacts employee health, while policies that accommodate (i.e., support) worker identities foster respect and hospitality. There has been increasing interest in diversity and inclusion within healthcare, and this study builds upon our prior national survey of American Muslim physicians. Run out of the Medical College of Wisconsin, and in partnership with the Initiative on Islam and Medicine, Islamic Medical Association of North American, and American Muslim Health Professionals, our study aimed to further understand how religious identity impacts workplace experiences. These data will be used to suggest best practices and policy enhancements for reducing discrimination and improving the accommodation of physician religious identity in healthcare systems. This project was funded by the Greenwall Foundation Making a Difference Award.
Objectives
Assess how religious identity impacts workplace discrimination, accommodation, and several psychological and professional outcomes among Muslim physicians.
Examine Muslim physicians’ experiences with discrimination and accommodation, and identify barriers to the inclusion of Muslim physicians.
Objectives
- Assess how religious identity impacts workplace discrimination, accommodation, and several psychological and professional outcomes among Muslim physicians.
- Examine Muslim physicians’ experiences with discrimination and accommodation, and identify barriers to the inclusion of Muslim physicians.
Methodology
To obtain a sample of physicians who self-identify with Islam, we sought out national Muslim clinician organizations that explicitly integrated religious and professional identities in their organizational title and mission statements. Our sample was recruited from the Islamic Medical Association of North America (IMANA), American Muslim Health Professionals (AMHP), and the US Muslim Physician Network. In collaboration with these groups, we conducted an online cross-sectional survey and interviewed a purposive sample of respondents from March-August 2021.
To be eligible for participation, physicians had to be:
- English-speaking.
- Self-identify as Muslim.
- Currently work and affiliated with a university-hospital in the US in the past 20 years.
This study was approved by the institutional review board at the Medical College of Wisconsin. Informed consent was obtained from all subjects involved in the study.
Survey Participants
The 264 participants who completed the survey had a mean age of 39.5 years. Most were male (61%), born in the US (55%), completed medical school in the US (72%), and had a visible marker of Muslim identity, i.e., beard or hijab (51%), and Sunni (70%). Fifteen percent identified as African American/Black, 21% as Arab/Arab American, 31% as South Asian, and 27% as European/White.
A majority (63%) attended congregational religious services greater than a few times a month, engaged in private religious activities (53%) two or more times per week, experienced the presence of the Divine in their lives (73%), based their whole life approach on their Islamic beliefs (75%), tried to carry Islam into all dealings in their lives (74%) and considered religion to be of high importance in their lives (74%).
Interview Participants
When completing the survey, 186 participants met the eligibility criteria and indicated an interest in an interview. Of those participants, 18 were interviewed.
The average age of interviewees was 41.5 years, and over half of the group (11/18) were female. Most of the participants interviewed were South Asian (13/18), and half (9/18) were born in the United States.
To better situate their experiences in the context of the interviewees, a couple of survey items were used to categorize interviewees as experiencing either high religious discrimination or low religious discrimination; nine participants fell into each group. Similarly, they were categorized as experiencing either high religious accommodation or low religious accommodation; there were 12 participants in the first category and 6 participants in the second category.
Results
Over the past 10 years, an increased number of Muslim physicians are experiencing religious discrimination, job turnover, and having patients refuse care.
The following results reveal the impact of religious discrimination on the professional and psychological outcomes for Muslim physicians in the healthcare workplace.
The following results video the impact of religious Discrimination and the professional and Psychological outcome and the Symphysition and health care work.
A greater proportion of Muslim physicians confront discrimination at work.
- In 2013, 19% of participants reported sometimes experiencing religious discrimina¬tion in the workplace, while 5% reported often or always encountering discrimination during their careers.
- In 2021, 41% of participants reported sometimes experiencing religious discrimination in the workplace, while 12% reported often or always experiencing discrimination.
A similar increase was seen in a question about participants’ current workplace:
- In 2013, 14% of participants reported currently experiencing religious discrimination at work.
- In 2021, 36% of participants reported currently experiencing discrimination at work.
Muslim physicians increasingly perceive that they have been passed over for professional advancement because of their religious identity.
- In 2013, 24% of participants reported they have been passed over for professional advancement because of their religion.
- In 2021, 57% of participants reported that they have been passed over for professional advancement because of their religion.
Interviewees echoed this phenomenon and shared specific instances. For example, a South Asian female physician stated:
- In 2013, 9% of participants reported experiencing patient(s) refusing to be cared for by the participant due to the participant’s religious identity.
- In 2021, 33% reported experiencing patient(s) refusing to be cared for by the participant due to the participant’s religious identity.
Aside from being rejected by patients, participants also encountered discriminatory comments from patients; for example, a South Asian female interviewee reported that patients made comments such as:
Muslim physicians are increasingly leaving their jobs due to workplace discrimination.
- In 2013, 7% of participants reported leaving a job due to discrimination.
- In the 2021 survey, 32% of participants reported the same.
Interview participants noted cumulative stress compelled them to leave. As one South Asian male participant shared:
Participants felt ‘accommodated’ through their own efforts at managing prayer or getting holidays covered by colleagues.
Almost three-fourths of respondents in both surveys (72% in 2013 and 76% in 2021 respectively) agreed with the statement that their workplace accommodates their religious identity. While this statistic appears encouraging, interviewees revealed that notions of accommodation focused on their own initiatives rather than the institutional outreach. This ‘self-accommodation’ may have started at the beginning of their careers with their choice of specialty. As one Arabic female interviewee noted:
Nearly half of respondents struggled to find time for prayer at work.
Prayer Accommodations
Muslims are obligated to pray five times a day during certain time slots. Each prayer takes about five minutes, and several prayer times fall within a standard workday. About half of respondents on each survey said they struggled to find time to pray at work.
One South Asian male participant explained how he managed prayer time into his workday:
Accommodations for Islamic Dress and Appearance
Islamic identity is also connected to dress and appearance. Aside from modest dress, Muslim men may wear a beard as it is highly recommended religious practice, while Muslim women may wear a ḥijāb (a headscarf) or niqāb (face covering) as part of their commitment to religious mores. Wearing the ḥijāb in sterile environments was particularly difficult in the absence of institutional guidelines. A South Asian female participant shared her practice:
On the other hand, one South Asian male participant decided to avoid all criticism from colleagues who perceived beards to be unprofessional by deciding not to have beard altogether as it “will draw more attention.”
Accommodations for Religious Holidays and Ramadan fasting
Interview participants identified several challenges related to work schedules and Ramadan fasting, as well as the Eid holidays. Ramadan occurs during the ninth month of the Islamic calendar, and is marked by obligatory ritual fasting, e.g., abstaining from food, drink and sexual intimacy, from dawn to dusk. It also includes special nightly prayer vigils held at mosques. Fasting can be physically demanding, and some physicians might require less demanding clinical schedules especially when Ramadan falls in summer months. Two principal holidays mark the Islamic calendar. Eid al-Fitr is the celebration directly following Ramadan and consists of special congregational prayers in the morning. Eid al-Adha, on the other hand, is contemporaneous to the obligatory religious pilgrimage to Mecca, the Hajj. That holiday is also marked by special congregational prayers in the morning as well as ritual sacrifice. As with any holiday, these days are celebrated with friends and family. Participants shared that adjusting clinical schedules and securing time off posed some challenges.Illustrating the issue, one South Asian female participant reflected that he could never be sure to get his work schedule adjusted despite asking for accommodation:
In the 2021 study, participants reported symptoms of depression and burnout.
- In the 2021 survey, 49% of participants reported having little interest or pleasure in doing things over the past two weeks.
- On the 2021 survey, 47% of participants reported feeling down, depressed, or hopeless in the past two weeks.
- Twenty-one percent of participants screened positive for depression.
- On the 2021 survey, 29% of participants stated they were feeling some degree of burnout and had one or more symptoms of burnout, such as physical or emotional exhaustion.
Interview participants further clarified the psychological and health toll of workplace discrimination. Out of the 18 participants, 12 feared revealing their religious identity; 10 harbored stress due to microaggressions; and 10 experienced depression/anxiety. As one South Asian female interviewee noted, their religious identity put them at risk:
Muslims Physicians Increasingly Experience Religious Discrimination in the Healthcare Workplace
In the 2021 survey:
- 53% reported frequently encountering religious discrimination in their career.
- 36% currently experience discrimination at work directed at their religious identity or otherwise.
- 33% reported patients refusing their care on account of the treating clinician, e.g., the survey participant, being Muslim.
- 57% believed they had been passed over for professional advancement due to their religious identity.
Multivariate data analysis revealed that :
- Religious importance was positively associated with discrimination from patients.
- Engaging in congregational religious activities was negatively associated with discrimination from patients and job turnover.
Furthermore, interviews with 18 physicians revealed that this physician group experienced discrimination from all corners, including colleagues, administration, and patients, and that these experiences included being subject to additional scrutiny and Islamophobic comments.
For example, one South Asian female participant noted a lack of support from leadership:
Muslim Physicians are Experiencing Depression, Anxiety, and Burnout
Survey participants reported experiencing symptoms of depression, anxiety, and burnout. Forty-eight percent of participants noted having little to no interest in doing things over the past two weeks. Participants who felt religion was important to their lives had higher rates of depression. Moreover, experiencing greater levels of religious discrimination over one’s career correlated with depressive symptoms.
Forty-seven percent of participants reported feeling down, depressed, or hopeless in the past two weeks. Twenty-one percent of participants screened positive for depression.
Twenty-nine percent of participants acknowledged one or more symptoms of burnout, such as physical or emotional exhaustion.
Interview participants shared the psychological health toll of workplace discrimination. Out of the 18 participants, 12 feared revealing their religious identity; 10 harbored stress due to microaggressions; and 10 experienced depression/anxiety. One South Asian female participant noted:
Muslim Physicians’ Religious Identity is Inadequately Accommodated at Work
In the 2021 survey, almost three-fourths of respondents agreed with the statement that their workplace accommodates their religious identity. Multivariate data analysis revealed that:
- Religious importance was negatively associated with prayer accommodations in the workplace.
- Engaging in congregational religious activities was positively associated with accommodations for prayer and general religious identity accommodation.
Interview participants shared that notions of accommodation focused on their own initiatives rather than the institutional outreach. In other words, many participants felt ‘accommodated’ through their own efforts at managing prayer or getting holidays covered by colleagues. Participants did not find a proactive and welcoming environment where they were being granted religious accommodations by their employers. This ‘self-accommodation’ may have started at the beginning of their careers with their choice of specialty. As one Arabic female participant mentioned:
Physician interviews revealed that not having a designated neutral prayer space at hospitals was a barrier and that the burden fell on them to secure time and space to pray. For example, participants noted being fearful of negative outcomes should they ask supervisors or administrators to accommodate their need to pray, fast, or observe holidays and religious dress codes. This fear of judgment was most pronounced during training, when medical students and residents were evaluated, in part, on how well they meshed within workplace hierarchies. Interview participants also identified being unable to routinely secure scheduling accommodations for Ramadan fasting and the holidays of Eid, and challenges in maintaining Islamic dress codes, for example the ḥijāb.
The following suggestions were provided by interview participants for how their religion could be better accommodated at work (see infographic for more details):
- Providing support and designated spaces for daily and Friday prayer.
- Acknowledging the practice of Ramadan fasting and Islamic holidays.
- Recognizing Muslim dietary preferences and restrictions.
- Creating policies to protect Muslim dress code in the workplace.
- Instituting a faith community liaison position.
- Medical education should account for religious identity.
Summary and Implications:
The survey data revealed that religious importance was positively associated with discrimination from patients and depression, and negatively associated with prayer accommodations in the workplace. However, engaging in congregational religious activities was negatively associated with discrimination from patients and job turnover. Arabs, South Asians, and Whites had lower odds of experiencing workplace discrimination, job turnover, burnout, and depression than African Americans.
Qualitative analysis of physician interviews (n=18) revealed that American Muslim physicians regularly face discrimination because of their religious identity and lack adequate institutional accommodation for their religious practices (e.g., time or space for prayers). These experiences link to several negative downstream outcomes including low sense of belonging in academic medicine, job turnover, and abandoning religious practices.
This study highlights how religious identity and religiosity negatively impact workplace experiences and well-being among Muslim physicians and highlights the deep psychological and career effects of working in a space perceived to be non-accommodating of religious practices. This research calls attention to the urgent need for academic medical centers to ameliorate workplace discrimination and pursue policies of workplace accommodation for physicians with strong religious identities.
Publications
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Studies of Muslim Clinicians in the US. Journal of General Internal Medicine. 2023.
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Studies of Muslim Clinicians in the US. Journal of General Internal Medicine. 2023.
- The Impact of Practicing Both Medicine and Religion: Muslim Identity as a Predictor of Discrimination, Accommodation, and Career Outcomes in Academic Medicine. AAMC. 2022
- Muslim American Physicians’ Experiences With, and Views on, Religious Discrimination and Accommodation in Academic Medicine Journal of Health Services Research. 2023..
Presentations
Community Conferences
- Muslim Clinicians in the Medical Academy, Anesthesiology Grand Rounds DEI, Medical College of Wisconsin, Milwaukee, WI, 2/2022.
- Being Muslim in Academic Medicine, Nagamia Institute of Islamic Medicine and Sciences (NIIMS), Rolling Meadows, IL, 7/2022.
- Health Policy & Advocacy Priorities for American Muslims Centering Equity, National American Muslim Policy Conference, Virtual, 6/2022.
- Religiosity Predicts Discrimination, Accommodation, and Career Outcomes for Muslim Physicians in Academic Medicine , The Academy for Professionalism in Health Care, Philadelphia, PA, 6/2022
Academic Conferences
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Surveys of Muslim Clinicians in the US, Conference on Medicine and Religion, Portland, OR, 3/2022.
- Religious Accommodation or Professional Indoctrination? Experiences of Muslim Physicians in Academic Medicine, Conference on Medicine and Religion, Portland, OR, 3/2022.
- Advancing Institutional Workforce Equity: Insights From Muslim Physicians in Academic Medicine , The Academy for Professionalism in Health Care, Philadelphia, PA, 6/2022.
- Religiosity Predicts Discrimination, Accommodation, and Career Outcomes for Muslim Physicians in Academic Medicine , The Academy for Professionalism in Health Care, Philadelphia, PA, 6/2022
- The Impact of Practicing Both Medicine and Religion: Muslim Identity as a Predictor of Discrimination, Accommodation, and Careers Outcomes in Academic Medicine, The Association of American Medical College, Nashville, TN, 11/2022.
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Surveys of Muslim Clinicians in the US, American Muslim Medical Students Association, Ann Arbor, MI, 8/2022. Poster
- Advancing Equity for Muslim Physicians in the Healthcare Workforce, 31st Annual Wisconsin Emergency Medicine Research Forum, Madison, WI, 3/2023.
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Surveys of Muslim Clinicians in the US, Conference on Medicine and Religion, Portland, OR, 3/2022.
- Religious Accommodation or Professional Indoctrination? Experiences of Muslim Physicians in Academic Medicine, Conference on Medicine and Religion, Portland, OR, 3/2022.
- Advancing Institutional Workforce Equity: Insights From Muslim Physicians in Academic Medicine , The Academy for Professionalism in Health Care, Philadelphia, PA, 6/2022.
- Religiosity Predicts Discrimination, Accommodation, and Career Outcomes for Muslim Physicians in Academic Medicine , The Academy for Professionalism in Health Care, Philadelphia, PA, 6/2022
- The Impact of Practicing Both Medicine and Religion: Muslim Identity as a Predictor of Discrimination, Accommodation, and Careers Outcomes in Academic Medicine, The Association of American Medical College, Nashville, TN, 11/2022.
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Surveys of Muslim Clinicians in the US, American Muslim Medical Students Association, Ann Arbor, MI, 8/2022. Poster
- Health Policy & Advocacy Priorities for American Muslims Centering Equity, National American Muslim Policy Conference, Virtual, 6/2022.
- The Impact of Practicing Both Medicine and Religion: Muslim Identity as a Predictor of Discrimination, Accommodation, and Career Outcomes in Academic Medicine. AAMC. 2022
- Religious Identity Discrimination in the Physician Workforce: Insights from Two National Studies of Muslim Clinicians in the US 04 January 2023
Media Highlights
Links to Resources
- Know Your Rights – A fact sheet describing religious rights in the workplace and what steps to take if your rights have been disregarded, Muslim Advocates.
- Filing a Conscience and Religious Freedom Complaint – File a complaint online about religious discrimination. Federal Conscience and Religious Freedom Laws help to protect you from coercion, discrimination on the basis of conscience or religion, and burdens on the free exercise of religion, Office of Civil Rights.
- Ḥijāb in the OR – A guide to ḥijāb in the operating room, written by Dr. Deena Kishawi.
Employee Resources:
- An Employer’s Guide to Islamic Religious Practices – A pamphlet designed to aid employers in formulating and implementing policies to create a culturally inclusive workplace, Council on American-Islamic Relations.
- Religious Diversity Manager Training – A session designed for managers to learn how to respond to accommodation requests and foster an inclusive work environment, Tanenbaum Foundation.
- TAHSN Standards for Religious Attire for Health Care Workers, Learners and Volunteers in Hospital Areas with Sterile Procedure – Standards and shared expectations related to clothing worn by religiously observant individuals working in hospital areas with sterile procedures, The Toronto Academic Health Science Network (TAHSN)
- Muslim Resident Cases– A chapter in the book, Diversity and Inclusion in Quality Patient Care: A Case-Based Compendium (pgs. 305-314), that presents four cases of ethical challenges in healthcare provision for Muslim patients.
Policy Reports
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The opinions expressed in this publication are those of the authors. They do not reflect the opinions or views of the grant funding organizations.
Gallery
Meet The Project Team
Aasim I. Padela, MD, MSc
(Medical College of Wisconsin & The Initiative on Islam and Medicine)
Laila Azam, PhD, MBA
Research Scientist
Benish Baqai
Medical Student at the Medical College of Wisconsin
Sohad Murrar, PhD
Research Scientist
Aasim I. Padela, MD, MSc
(Medical College of Wisconsin & The Initiative on Islam and Medicine)
Laila Azam, PhD, MBA
Research Scientist
Benish Baqai
Medical Student at the Medical College of Wisconsin
Sohad Murrar, PhD
Research Scientist
