Gender Equality in Medicine
Suffering in Silence
About 7 percent of physicians report personally experiencing sexual abuse , harassment , or misconduct , according to Medscape ’ s recently released “ Sexual Harassment of Physicians Report 2018 ,” which included responses from more than 6,200 U . S . physicians and clinicians – both men and women .
Survey respondents were asked about specific harassing behavior they experienced or witnessed within the past three years , as well as where the harassment occurred , how they reacted , and how it affected them . These behaviors included : deliberately infringing on body space ; sexual comments about anatomy or body parts ; unwanted physical contact ; and offer of a raise , promotion , or other advantage in exchange for “ a sexual favor .”
Fourteen percent of respondents reported witnessing these types of behavior , and 2 percent said they had been accused of it . However , more women than men said that they had personally experienced harassment ( 12 % and 4 %, respectively ), and fewer women than men were accused ( 0 % and 3 %).
Together , experiencing those behaviors adversely affected the wellbeing of half of the men and women who reported experiencing sexual harassment at work .
About half of the affected physicians “ suffered in silence ” and did not report the behavior , according to the survey . Forty percent reported the offensive behavior ( typically to colleagues ), but the results of the reporting were disheartening : 27 percent said “ the perpetrator ’ s behavior was trivialized ” and 16 and 15 percent , respectively , said they were retaliated against by the perpetrator or management .
“[ Our ] company has a harassment policy , but it ’ s a joke that anything will be done about it . … When the boss brings millions of dollars to the company , no one cares ,” said one female physician . “ Those who do report are looked down upon for it .”
A Cultural Shift
Dr . Abbuhl also conducted a long-term intervention study to understand what elements are necessary to create a work culture “ conducive to women ’ s academic success ” and to study whether a multi-part intervention could improve the success of junior women faculty at the University of Pennsylvania Medical School . 8 First , the researchers developed a measure of how conducive to women ’ s success an academic workplace culture was . Then , in a three-year study they tested the measure in half of a sample of 133 participating female assistant professors within 27 departments at the Perelman School of Medicine .
They determined that , to promote a culture conducive to women ’ s academic success , programs should prioritize four distinct but related dimensions : equal access to resources and opportunities , work-life balance , freedom from gender biases , and supportive leadership .
At the end of the three-year period , academic productivity and work self-efficacy improved in both the intervention and control groups , and the average hours worked per week decreased . Dr . Abbuhl attributed both outcomes to the likely school-wide intervention effects . Because the study was not blinded , Dr . Abbuhl said there was a reported positive improvement in the supportiveness of the work culture among all 27 departments . “ Our research provides valuable empirical evidence for the importance of change efforts targeted at the culture at the department / division-level ,” the authors concluded . “[ Still ], it remains to be seen whether improving the [ scores on the conducive culture measure ] will be associated with enhancing the scholarly success and leadership of women in academic medicine .”
Dr . Abbuhl acknowledged that unconscious or implicit biases – the social stereotypes about certain groups of people that individuals form outside their own conscious awareness – are a pervasive part of gender inequality for both men and women . “ That ’ s a bit hard to swallow because you want to believe that women won ’ t have any biases that prevent them from viewing other women as not fully capable and successful ,” said Dr . Abbuhl . “ But we are part of the same society , so we all can internalize the same stereotypes , even if they are at odds with our stated values .”
One way to combat both the explicit and implicit bias is by “ witnessing the successful women in medicine who are bringing incredible talent and leadership to our workplaces ,” said Dr . Abbuhl . “ The more successful women there are in our midst , the more the old stereotypes fade away .”
Mind the ( Wage ) Gap
In a recent survey report of 36,000 physicians across the U . S . by the social networking site Doximity , pay for female clinicians varied widely geographically , but was always substantially lower than for their male counterparts . 9 Even after controlling for hours worked and other factors that might account for variations in pay , female physicians earned about 26.5 percent less , or about $ 91,000 less , than male physicians .
For Dr . Burns , the question of why this gap exists – and how to close it – is clear . “ The leaders are aware of the wage discrepancy , and that ’ s what is so disappointing ,” she said . “ There is often a complete lack of transparency to faculty members in how salaries are set .”
She also suggested potential corrections , including mentoring for early-career female trainees and fellows and counseling about the gender wage gap , how to ask for more transparency , and how to negotiate salary and other support during an annual review .
“ Women believe that they are being treated fairly and equally , but , unfortunately , that is not always the case ,” she observed . “ When I speak with female trainees , I always tell them that they need to not assume anything and to speak up for what they feel they will need – not just financially , but in other aspects of support that will be critical to their career success . Think of it as a business in which people expect you to negotiate .”
Of course , she added , “ it ’ s easier to tell someone else to do it than to do it one ’ s self .”
Reshma Jagsi , MD , DPhil , professor in the department of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan , uncovered a similar gender discrepancy in wages among early-career physician-researchers in a 2013 study . 10 The research showed a 17-percent overall disparity between salaries for men and women that could not be explained by factors like specialty , work hours , and productivity .
Gender inequality was an early focus of Dr . Jagsi ’ s research . While she was a resident at Massachusetts General Hospital , her mentor placed her on a committee of women in medicine , with whom she studied the representation of men and women among authors published in prominent medical journals . 11 Her work revealed that , over a 35-year period starting in 1970 , the proportion of female physicians who were first or senior authors on research papers in the U . S . increased significantly , from 3.7 percent to 19.3 percent ( p < 0.001 ). But , women physicianscientists still made up a minority of authors on original published medical research .
“ Women are a powerful force , and as we bring new strengths to medicine , we are also bringing about needed change .”
— STEPHANIE ABBUHL , MD
“ The study raised many more questions for me than it answered ,” Dr . Jagsi told ASH Clinical News . “ I wanted to understand the mechanism of this discrepancy , whether there were differences in outcomes of similarly situated men and women who were entering medicine , or whether the differences were related to women being tracked as clinician-educators rather than as researchers .”
To dig deeper into these questions , Dr . Jagsi analyzed the career paths of early-career clinician-scientists . She observed that , even among high achievers who received prestigious National Institutes of Health K23 and K08 early-career development awards , women were less likely to go on to obtain coveted R01 grants . The results suggested that more men tended to pursue a grant-based medical research career than women . 12
# MeToo in Medicine
An element of gender inequality in the workplace that cannot be ignored is sexual harassment . The recent # MeToo movement ( spurred by women speaking out about their experiences of sexual harassment in Hollywood ) has opened the door for women in other fields to break their silence .
“ Sexual harassment is one piece among the causal factors that need to be considered when one is looking at the challenges that face women in their professional careers ,” noted Dr . Abbuhl .
Medicine has certainly not been exempt from sexual harassment . A 1995 survey showed that more than half ( 52 %) of women serving as U . S . academic medical faculty reported experiencing harassment in their careers , compared with 5 percent of men . 13
In 2015 , Dr . Jagsi decided to recreate that 1995 survey , thinking that 20 years later the picture would have improved . What she found was surprising – and disheartening : Of more than 1,000 clinician-researchers surveyed about their career and personal experiences , 70 percent of women , compared with 22 percent of men , experienced gender bias in their careers . 14 Thirty percent of women reported a personal sexual harassment experience , compared with 4 percent of men . Among the 150 women who reported harassment , 40 percent classified it as “ severe ” and 59 percent said that
62 ASH Clinical News July 2018