What does professionalism mean to you? What does it look like? No matter your vision, it probably focuses on how one carries oneself, speaks to others, presents oneself in dress and deed, and upholds standards. How much you value professionalism could differ from others you know and possibly work with.

In healthcare, women, minorities, and LGBTQ workers value professionalism more than their white male counterparts. According to a large-scale survey of staff, faculty, and students in an extensive academic health system published in JAMA Network Open, they are more likely to leave a position because of professionalism issues.

How Professionalism Was Measured

First, researchers surveyed 3,506 people: 64.4% were women, 10.5% identified as gender or sexual minority groups, and 11.3% were non-Hispanic Black individuals.

Respondents were asked to rate their responses (from strongly agree to disagree strongly) to three statements related to professionalism:

1. “I have considered changing jobs due to inappropriate, disruptive, or unprofessional behavior by a coworker or supervisor.” Respondents who self-identified as female, LGBTQ, non-Hispanic Black individuals, compared to white, heterosexual men, were statistically significantly more likely to report considering changing jobs because of “unprofessional” behavior.

2. “I value institutional initiatives, policies, and/or educational resources related to professional behavior in the workplace.” In response to this statement, 52% of women and 54% of Black individuals agreed or strongly agreed, compared to 45% of male and 49% of white respondents.

3. “My institution supports a culture of professionalism.” No statistically significant differences were found among respondents who agreed with this statement.

To follow up on these responses, the research team solicited narratives via email about professionalism. They asked respondents to answer: “Tell us a time that you felt valued or devalued, or welcomed or not welcomed by your organization.”

Many of the 52 narrators who self-identified as members of marginalized populations expressed infringement on their professional boundaries during interactions at work or learning environments. These ranged from microaggressions to blatant racism, sexism, xenophobia, and homophobia.

Other narratives stated that professional standards were applied differently to certain groups, and those groups perceived that they were subject to greater scrutiny. Experiences cited ranged from facing differential disciplinary practices and feeling unwelcome to experiencing pressure to conform and being asked questions about childbearing, living situations, and tattoos.

What This Means for the Healthcare Workplace

A consistent theme throughout the stories was that the respondents from underrepresented groups felt they were subjected to greater scrutiny while reporting more significant infringements of their professional boundaries.

These findings suggest that healthcare institutions must reevaluate and redefine professionalism standards to successfully make the academic medicine culture more inclusive and improve the retention of minorities and women.