Systematic Reform Needed to End Sexual Harassment in Medicine

Bridget M. Kuehn

September 13, 2018

To put an end to the high rate of harassment of women in medicine, the field must address systematic undervaluing of women and a culture that promotes a hostile work environment, according to a pair of editorials published online September 12 in the New England Journal of Medicine.

The #MeToo movement that has rocked many fields has begun to ripple through medicine, but some women in the field are skeptical that medicine is ready to tackle the systematic undervaluing of women in the field that they say contributes to harassment.

"When women are systematically devalued, promoted later than men, and paid less, this treatment undermines their institutional power and their ability to report or defend themselves against ongoing sexual abuse, particularly at the hands of male superiors, including those in control of their salaries, promotions, and opportunities," write Esther Choo, MD, MPH, from the Center for Policy Research in Emergency Medicine at Oregon Health and Sciences University in Portland; Jan van Dis, MD, from the Ob Hospitalist Group in Burbank, California; and Dara Kass, MD, from the Department of Emergency Medicine at Columbia University Medical Center, New York City, in their editorial. "In this and other ways, persistent disparities in pay and career advancement are an integral part of the machinery that facilitates gender-based abuse of all kinds."

A report released by the National Academies of Science, Engineering, and Medicine in June highlighted that harassment of women is prevalent throughout the sciences, but is highest in medicine. The report cited studies that found up to half of female medical trainees report sexual harassment from faculty or staff.

The most common form of harassment documented in the report, and in medicine particularly, was gender harassment. This includes crude or sexist comments or other behavior that creates a hostile or unwelcoming environment for women. A separate survey by Medscape found that 12% of female physicians have experienced sexual abuse, harassment, or misconduct that was overtly sexual in nature, including unwanted communications of a sexual nature, unwanted physical contact, or sexual coercion.

A second editorial, written by National Academy of Medicine President Victor Dzau, MD, and Paula Johnson, MD, the president of Wellesley College and cochair of the committee that wrote the National Academies of Science, Engineering, and Medicine report, outlines the ways the culture of medicine and the organization of medical institutions contribute to harassment. For example, they note the report's finding that hierarchical, male-dominated organizations with permissive cultures about harassment breed abuse. They note that although more women than men now enter medicine each year, men still disproportionately hold leadership positions, with women making up just 38% of faculty members, 15% of department chairs, and 16% of deans. They are also paid less, are promoted less, and are less likely to be honored by societies.

"Adding to the power differential is a culture that accepts some degree of suffering as a matter of course," they write. Women who speak up about abuse face retaliation or being labeled a troublemaker. These cultural problems likely contribute to physician burnout, Dzau and Johnson note.

But unraveling systematic sexism and abuse in medicine will not be easy.

"If there is anything the report makes clear, however, it is that medicine is ill prepared to take meaningful steps toward actually ending harassment," Choo and colleagues write. They note that it is easier for institutions to blame a few bad actors than to unravel institutional cultures that facilitate poor treatment of women.

"Correcting inequities in salary, career advancement, and leadership positions requires more global fixes than even those who are deeply committed to eradicating sexual harassment in the workplace may be willing to consider," they explain. "Because these problems are inextricably linked, however, it may be that our lack of progress on any one of them is in fact rooted in our habit of addressing them one by one, in isolation."

In fact, the National Academies of Science, Engineering, and Medicine has been criticized for failing to revoke membership from individuals who have been sanctioned for sexual harassment, retaliation, and assault. BethAnn McLaughlin, PhD, an assistant professor of neurology and pharmacology at Vanderbilt in Nashville, started a petition urging the academies to correct this; the petition has garnered more than 5000 signatures.

Choo and colleagues recommend the field adopt the same preventive approach they do for chronic diseases to sexism and harassment in medicine and not wait for "metastatic manifestations of harassment."

"In this case, what began as a smoldering fire is now scorching the curtains and the roof, threatening the entire house of medicine," they write, urging colleagues to support the movement to stop it or risk falling behind.

Choo reports receiving other support from Equity Quotient outside the submitted work and is president of the nonprofit Gender Equity Research Foundation, which supports research on the careers of women in medicine. Kass reports receiving personal fees from FeminEM.org outside the submitted work. The remaining authors have disclosed no relevant financial relationships.

N Engl J Med. Published online September 12, 2018. Choo full text, Dzau and Johnson full text

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