Table 2.

Framework Analysis and Exemplar Quotations About Racism in the Medical Workplace

Theme/code	Exemplar quotation
Experiences/lack of racism	“I am married to a (BIPOC) individual… some of my colleagues have directly demonstrated micro and macroaggressions towards (them) at informal gatherings (which shocked me to hear).” [P12, White cisgender woman, leader] “Academic racism is obvious and it is the elephant in the room that some want to ignore.” [P376, BIPOC cisgender man] “There was an incident when I was ‘taught a lesson’ but I was not targeted, rather it was said ‘may be its your CULTURE’. I would have appreciated reprimanding me rather than my culture. Maybe culture was used as a polite gesture, but it did hurt more. I still feel that pain. Had it been a white person, it would have been his fault and if it’s a (person of color) it’s his culture's fault. I have been very surprised to see that even highly educated, open-minded white people (not all) still think that way.” [P430, BIPOC cisgender woman] “A (family member) of a white physician needed surgery. The white (physician) insisted that a white anaesthesiologist do her anaesthesia… the (physician family member) insisted not to let any non-white health care provider touch (their family member). (This) cause(d) a lot of problems and delayed several patient(‘s) care. However, the hospital administrator accommodated (their) request, approving (their) conduct and compromised several patient(s) care (and) no action was taken against (them).” [P906, BIPOC cisgender man] “As (an) IMG, I have worked in several countries and I never seen the level of racism as (I have) in rural Alberta, and worse, they are supported by the (health system) and (regulatory body) administrations. I have seen first-hand… a physician who raised concerns about racism … and was harshly punished, humiliated and (their) career was destroyed. This why I stop(ped) doing locum(s) in rural Alberta and soon I will leave to a better place.” [P979, not provided] “Generally, Albertans do a good job in workplace to ensure equal opportunity for everyone despite race, sex etc.” [P295, BIPOC cisgender man]
Rationalizing racism
Denial & uncertainty	"More likely discrimination academically due to specialty of anesthesia for academic promotion compared with internal medicine rather than skin color" [P564, cisgender man] “From the point of view of a minority, I think this modern fashion of fixating on race, gender, sexuality is wrongheaded and regressive. I wish to make it clear that I feel fortunate to live in this country, and I have rarely ever felt discriminated against. As often, I think Canadians go out of their way to be inclusive, even if it equates to reverse discrimination. I truly hope that the medical profession resists the apparent urge to jump on the regressive and dangerous politically correct bandwagon.” [P389, BIPOC participant] “It is a dangerous mistake to filter all interactions through race. For example, if I don't get a promotion because another candidate is more qualified and I happen to be a minority if there is a lot of information (such as this survey) that implies that all interactions are racism, then I will be more likely to perceive it as so even if there is not racism in play. Some people are jerks to everyone. If they are a jerk to a white person, they are often just considered a jerk, but if they are a jerk to a non-white person, it is easily perceived as racism, even though the underlying problem is one of jerkiness, not necessarily racism.” [P522, White cisgender man] “Caucasians sometimes accuse other Caucasians of racism as a weapon when an act of racism has not occurred, and it is a difficult smear to get rid of.” [P902, White cisgender man]
Colorblindness	“I feel the same about everyone." [P414, White cisgender woman] “I respond to the person, not their gender, race, religion, or orientation.” [P468, White cisgender man]
Whataboutism	“Why did you not ask about sexuality, which is where my discrimination experience lies?” [P630, White cisgender man, leader] “I'm surprised and disappointed that there were (no) questions about age discrimination.” [P582, cisgender man]
Meritocracy	“Exactly equal participation in the various aspects of medicine (clinical, leadership, etc.) is not the desired outcome. The fact that a physician chooses to spend more time with family vs. administration is not an indication of systemic bias, but of individual choices and values. Insisting on racial/gender/geographic equity in every aspect of medicine actually induces a negative bias of selecting individuals based on something other than suitability for the position.” [P488, White cisgender man, leader] “In Canada, at least as far as my experience in (specialty) goes, I cannot think of another profession that demonstrates equality better... we are treated as equals, regardless of gender, race or orientation, at least in private practice. You work hard, you do the job well, you treat people with respect... and you're paid exactly the same every Friday via fee-for-service. That's my experience; your study is very rigid and doesn't allow for variables.” [P435, White cisgender man]
Discomfort
“Reverse racism”	“I would be concerned about reverse discrimination of white Canadians.” [P278, White cisgender man] “In some environments there is racial discrimination against white skinned faculty.” [P455, White cisgender woman] “Your questions about race were designed in several cases in a way that asked if the minority group had as much opportunity as Caucasians. One possible scenario that was omitted is if the minority group had experienced more opportunity than Caucasians. While suspected to be less likely this may happen in some cases as well, such as in some medical school admissions processes.” [P469, White cisgender man]
Skepticism about change	“Many organizations I work for only pay lip service to gender and diversity. I do not believe they are capable of the long-term work that needs to happen to address these issues. Diversity and inclusion is having its moment in the sun and will fade again… the rank and file physician and learners also know that this is all just a flash in the pan and true power structures and systems will not change. They just have to imitate the current mantra and will be given a pass and move on to hoard the powers they will amass.” [P63, BIPOC cisgender woman, leader] “Universities do nothing serious to address harassment. They talk the talk, not walk the walk.” [P279, White cisgender man] “Racism is a problem in medical field and cannot be fixed.” [P891, BIPOC participant]