(Reuters Health) - Minority doctors in training routinely deal with bias, sometimes subtle, sometimes not so subtle, a new study suggests.

Researchers found that resident physicians from racial and ethnic minorities face a daily barrage of microaggressions as well as overt prejudice, according to the study published in JAMA Network Open.

“Minority residents appear to face extra challenges during a time already marked by considerable stress. Residency program leaders and accreditation bodies should work to address these challenges not only as an important wellness issue, but also to minimize potential damage to the minority pipeline,” said the study’s lead author, Dr. Aba Osseo-Asare, an assistant professor of medicine at the Yale School of Medicine in New Haven, Connecticut.

Although blacks, Hispanics and Native Americans together make up one third of the nation’s population, these three minorities constitute just nine percent of physicians, the researchers noted. And part of that disparity may be due to biases minorities encounter in the pipeline, Osseo-Asare said in a phone interview.

By writing about the residents’ experiences, the researchers hope to raise awareness, Osseo-Asare said. “Awareness can go a long way to help,” she added. “Sometimes people feel they are not racist because they’re not aware of their unconscious bias.”

Osseo-Asare and her colleagues conducted in-depth one-on-one interviews with 27 minority residents from 21 residency programs.

A common issue for these residents was being mistaken for support staff, even for janitors, despite wearing a white coat, stethoscope, and identification badge showing they were physicians.

One young physician described such an encounter. A patient’s aunt had been visiting and when the mother came in, the aunt told her about the “janitor” who had been taking care of the patient. The mom told the resident about her conversation with the aunt: “She told me, ‘Oh the janitor was so smart. He was telling everybody else what to do. He really knew his stuff.’”

Other residents talked about how people somehow couldn’t manage to tell them apart: “Six of us are black women. They’re constantly interchanging our names, constantly interchanging people that don’t even look alike.”

Sometimes the aggression was more overt. One Hispanic resident talked about an encounter with a xenophobic patient, who said, “someone like you should go back to where you came from. You’re taking advantage of our resources, and there’s all these students that would like to get into medical school that are here and from the U.S. and don’t get in. And then you people come, and you take our places, and you take our jobs. And you don’t even have citizenship, and you don’t even speak English.’”

The study’s findings didn’t surprise Dr. Anthony Watkins, an assistant professor of surgery at New York-Presbyterian/Weill Cornell Medical Center in New York City. Watkins, an African American, said, “it’s the kind of story we discuss among ourselves. A lot of what I read (in the study) I’ve experienced either personally or learned about from shared experiences.”

And, Watkins said, it’s not just something that medical students and residents have to deal with. He remembers one surgeon’s story in particular. “When he walked into the operating room, they started telling him what needed to be cleaned,” Watkins said. “He told them, ‘I am the surgeon.’”

As recently as a few days ago, Watkins himself had a similar experience. “I walked in to talk to a patient,” he told Reuters Health in a phone interview. “I introduced myself and as soon as I finished taking the history and doing the physical, the patient asked, ‘When am I going to see Dr. Watkins?’”

While Watkins and others have learned to live with the bias, it does take its toll. “I don’t take it personally, he said. “But the challenge is the high attrition rate among minorities, whether they’re medical students, residents, even faculty. Some do get jaded when dealing with all the microaggressions. They have trouble finding a mentor. They feel socially isolated. And there’s an effect on the whole health care system when individuals drop out.”

For Watkins, though, the problem doesn’t end with medicine. “It’s a smaller piece of the bigger issue we face in America,” he said.

SOURCE: bit.ly/2KVMa1V JAMA Network Open, online September 28, 2018.