• Contact@medicineandislam.org
Follow us on:
Latest News
II&M successfully attended the ISNA convention and had engaging discussions from the 1st to the 4th of September.
Announcing Final Cohort: 'Introduction to the Field of Islamic Bioethics' Course Starts in September! Enjoy 50% off using the 'BIOETHICS50' Code.
initiativemedicine
Latest News
II&M successfully attended the ISNA convention and had engaging discussions from the 1st to the 4th of September.
Announcing Final Cohort: 'Introduction to the Field of Islamic Bioethics' Course Starts in September! Enjoy 50% off using the 'BIOETHICS50' Code.
initiativemedicine

Discrimination, Accommodation & Inclusion: Examining Muslim Clinician Experiences within Academic Medicine

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

1

Assess how religious identity impacts workplace discrimination, accommodation, and several psychological and professional outcomes among Muslim physicians.

2

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:

“I[t] did come to a point when my juniors were being given those administrative positions… These [positions] were not advertised or anything. No other faculty were consulted. These positions were just announced.”
  • 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:

“How do I know you’re not ISIS” or “How do I know being a Muslim, you are really treating me and giving me the right meds and not actually trying to harm me?”
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:

“It [the discrimination] got escalated to the point where it was making me feel nervous…things accumulated to the point where I had to change my job.”
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:

“I guess it was a component in my choices…of specialty and the likelihood of discriminatory issues. Like, in which specialty is it hard to get to take a day off or to take 10 minutes for yourself to pray….”
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:

“So it kind of depends on whether the prayer times line up with when I get breaks. So, if I get a break from 12:00 to 1:00 for lunch…I go pray (the midday prayer). Otherwise, I’ll (have to) try to find time in the middle of a busy clinic.”
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:

“I wear a turban headscarf before going into the OR and then I’d wear a bonnet, a hair covering on top of that… For sanitary reasons I would wear long sleeves and sometimes I’d get away with it… I would wear—a button-down scrub that was also sanitary and hygienic, and I would wear that to keep my arms covered, and then I would sometimes wear a beard covering for my neck.”

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:

“I usually ask them (supervisors)… ‘This is going to be Ramadan from this time to this time, can you put me on an easier rotation?’…Some years it will happen, some years it doesn’t.”
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:

“Being Muslim, or visibly Muslim, or a practicing Muslim, is going to impact [us] in some way.”
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:

“I went to our university’s dean of faculty affairs, and I complained to them about it and then I actually went to HR and I was like, “I feel like I’m being discriminated [against],” but no one did anything about it ”
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:

“They created a hostile work environment for me. I was close to having a nervous breakdown with everything that they were doing to me. I’m so anxious.”
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:

“I guess it was a component in my choices…of specialty and the likelihood of discriminatory issues. Like, in which specialty is it hard to get to take a day off or to take 10 minutes for yourself to pray. ”

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

Presentations

Community Conferences

  1. Muslim Clinicians in the Medical Academy, Anesthesiology Grand Rounds DEI, Medical College of Wisconsin, Milwaukee, WI, 2/2022.
  2. Being Muslim in Academic Medicine, Nagamia Institute of Islamic Medicine and Sciences (NIIMS), Rolling Meadows, IL, 7/2022.
  3. Accommodating Muslim Values in Healthcare, Medical College of Wisconsin, Milwaukee, WI, 8/2022.
  4. Health Policy & Advocacy Priorities for American Muslims Centering Equity, National American Muslim Policy Conference, Virtual, 6/2022.
  5. Advancing Equity for Muslim Physicians in the Healthcare Workforce, 31st Annual Wisconsin Emergency Medicine Research Forum, Madison, WI, 3/2023.

Academic Conferences

Media Highlights

Media Highlights

Links to Resources

  1. 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.
  2. 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.
  3. Ḥijāb in the OR – A guide to ḥijāb in the operating room, written by Dr. Deena Kishawi.

Employee Resources:

  1. 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.
  2. 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.
  3. 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)
  4. 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

Stay Informed

Subscribe to our monthly newsletter

    Dissemination Products

    Videos

    Muslim Clinicians in the Medical Academy

    Healthcare Workforce Webinar

    Being Muslim in Academic Medicine

    Religiosity Predicts Discrimination, Accommodation, and Career Outcomes for Muslim Physicians in Academic Medicine Conference

    National American Muslim Policy Conference

    Healthcare Workforce Webinar

    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

    Initiative on Islam and Medicine © 2022 - All Rights Reserved. Designed and Powered By Digaptics

    Mufti Nazim Khutbah

    Padela Khutbah

    Shkifah Khutbah

    Intervention Study

    Qualitative Study and Interviews

    Fifty Muslim multiethnicity women (40 years old and above) were interviewed (6 focused group) and 19 in individual interviews. We found religious beliefs did informed mammography intention, which includes (1) the perceived religious duty to care for one’s health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care.

    Quantitative Study and survey

    240, 40 years of age or older, were surveyed (72 respondents were Arab, 71 South Asian, 59 African American, and 38 from another ethnicity). We found that positive religious coping and perceived religious discrimination in health settings significantly (negatively) affected mammogram adherence among Muslim women in Chicago.

    American Cancer Society mammogram recommendations

    Mammogram recommendation for women at average risk or breast cancer

    • Women between 40 and 44 have a choice to have a mammography every year.
    • Women 45 to 54 should get mammograms every year.
    • Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms.

    3R model

    Reframing “switch train tracks”
    • Keep the barriers belief intact but change the way one thinks about it so it is consonant with the desired health behavior
    • Normalizes the barrier belief
    Reprioritize: “show them a better train”
    • Introduce a new belief and create higher valence for it than the barrier belief
    • Normalization of the barrier belief is optional
    Reform: “breakdown the train carriage”
    • Negate the barrier belief by demonstrating its faults by appealing to authority structures

    Login To View Video