Leading Women in Medicine Launch 'Time's Up Healthcare'

Marcia Frellick

March 04, 2019

Women in medicine have joined the national Time's Up movement, and on Friday at the New York Academy of Medicine, leaders announced their mission to end workplace discrimination, harassment, and abuse and create equitable and safe cultures within the healthcare industry.

Time's Up started with women in the entertainment industry on January 1, 2018, and has since spread across industries.

The founders of Time's Up Healthcare assembled together at the launch. John Rodriguez/Medscape

"Time is up in entertainment, it's up in venture capital, in advertising, in media, and in tech, and today time is up in healthcare," said one of the Time's Up Healthcare (TUH) founders, Esther Choo, MD, MPH, as the crowd of about 150 supporters cheered.

TUH has grown in 6 months from a handful of leaders to a group of 50 founding members and 13 senior advisers linked to a network of institutions mobilized to increase safety and equity in the healthcare sector. Members and advisers include physicians, nurses, physician assistants, and clinical pharmacists and span a range of specialties.

Choo, an emergency medicine physician and associate professor at Oregon Health and Science University, Portland, told Medscape Medical News that some people jumped on board and some were hesitant to become so visible.

Dr Esther Choo

"I think some are afraid to step forward in a public space, just as they're afraid to step forward in their institutions. I think that's symptomatic of the problems we're trying to address," she said.

Among the first steps is getting past the stigma and fear of addressing sexual harassment and starting conversations and action plans across healthcare organizations, she said.

She added that too often, healthcare organizations are focused on the legal aspects of harassment, and if someone comes forward with a complaint, the knee-jerk reaction is to bury it.

"We should treat it like any other problem within our health system — view it as a problem of safety and quality and address it openly," Choo said. "When we find our heart failure patients are not getting good outcomes, we create pathways. We do root cause analysis."

Many men have signed on as allies of the group, she said, and will be a part of the TUH leadership in the future.

"It was very important to us that we lead with women who have lived these experiences and whose voices are chronically underheard," Choo said.

Women Just 11% of CEOs

Among the driving principles of the organization is changing entrenched imbalances. For instance, women are well represented in the workforce, but not in positions of power. Although women make up 80% of healthcare workers, only 11% are healthcare CEOs, according to the Center for Health Workforce Studies.

Medscape salary reports continue to show gender pay inequities. The most recent report indicates that male primary care physicians make 18% more than their female counterparts, and male specialists make 36% more.

Medscape's Sexual Harassment of Physicians Report 2018 indicates that 7% of physicians and 11% of nurses, nurse practitioners, and physician assistants said they had experienced sexual harassment within the past 3 years.

"What Happens Next"

The Time's Up Foundation supports the Time's Up Legal Defense Fund, which is housed at and administered by the National Women's Law Center (NWLC).

Fatima Goss Graves, JD, president and CEO of the NWLC, who is a cofounder of the Legal Defense Fund, speaking at Friday's launch, said that since the fund was established, 4000 people have asked for assistance, and the fund has taken on more than 100 cases.

"Today, healthcare professionals represent the second-largest group [behind only the entertainment industry] who have contacted the Time's Up Legal Defense Fund," she said.

Dara Kass, MD, a founding member of TUH and an assistant professor of emergency medicine at Columbia University Medical Center in New York City, where she is a departmental director of equity and inclusion, told Medscape Medical News that TUH is not a "gotcha" movement.

"This is about what happens next. Now that we have these truths and we know they exist, what do we do with that?" she said.

She said that people will start to become more aware of TUH in healthcare workplaces as colleagues, armed with knowledge of how harassment claims should be processed and where to go for support, give that information to harassed coworkers instead of just lending a sympathetic ear. Another sign will be confrontations of perpetrators by those who experience harassment or are witnesses, she said.

Years from now, she said, "we will see a culture in which it is not just unaccepted, but it would be an extraordinary departure to see behaviors that we have accepted as the norm for so long."

Nurse practitioner Tiffany Love, PhD, GNP, regional chief nursing officer at Coastal Healthcare Alliance in Maine, told Medscape Medical News that she had been harassed by a boss at a previous job for 3 years before he was fired.

Dr Tiffany Love

"Because of what I experienced, I decided to devote my career to mentoring and developing other healthcare leaders," she said.

Having more women in leadership positions can help address toxic cultures of harassment at the organizational level, Love said.

"Then women know they have someone they can go to," she said.

She noted that nurses experience additional inequities because they take orders from physicians, and if the harassment comes from physicians, it often has meant suffering in silence.

"When someone who is dominant over you harasses you, you feel as if you don't want to complain, you don't want to be labeled a troublemaker, and you don't want the harassment to get worse from retaliation that you complained," she said.

A Patient Safety Issue

Love said ending harassment is not just a provider issue.

"It is our responsibility to save patients' lives, and when you are working under the stress of sexual harassment, it is a patient safety issue," she said.

Dr Hansa Bhargava

Hansa Bhargava, MD, a senior medical director at WebMD (Medscape is part of the WebMD professional network) and a founding member of Time's Up Healthcare, told Medscape Medical News that the benefits of TUH have implications for reducing burnout and protecting quality of care.

Harassment and inequity in pay and promotions contribute to burnout, she said, and the resulting sadness and fear can affect health organizations' bottom line in quality of care.

"There needs to be a culture of respect and equality in the workplace," she said.

The launch of TUH came a day after the National Institutes of Health (NIH) apologized for its failures to recognize and address entrenched sexual harassment.

NIH Director Francis S. Collins, MD, PhD, noted, "The National Academies' report on sexual harassment of women in science found that 'federal agencies may be perpetuating the problem of sexual harassment.' We are concerned that NIH has been part of the problem. We are determined to become part of the solution."

Choo said the first mark of success will come with broad national support and commitment from healthcare organizations to measure and track harassment and gender inequities in their institutions.

"I would like every health system in the country to come forward and join us as signatories, committing to the fundamental principles of Time's Up Healthcare," she said.

Founding signatories are the Alpert Medical School of Brown University, Drexel University College of Medicine, the Mayo Clinic, the University of Michigan School of Medicine, and Yale Medical School.

TUH partners include the American College of Physicians, the American Medical Women's Association, the American Nurses' Association, the National Medical Association, the Service Employees International Union, and the Council of Medical Subspecialties.

Choo, Goss Graves, Kass, and Love have disclosed no relevant financial relationships. Bhargava is a senior medical director at WebMD.

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