While a revolution against cultures of sexual harassment and inequality has swept through Wall Street, Silicon Valley, Hollywood and other work environments, one field so far has escaped the reckoning: medicine.
Could that be about to change? That's the question pondered by Reshma Jagsi, a professor of radiation oncology at the University of Michigan and director of its Center for Bioethics and Social Sciences. Jagsi was the lead author of a 2014 survey on sexual harassment and gender bias in academic medicine that is getting new attention today.
Female physicians may be more reluctant to come forward to report harassment than professionals in other fields for several reasons, Jagsi told me in an interview Wednesday.
"In medicine, what may be somewhat unique is the absolute length of dedication and training that is required to get to the point of being a female physician," she says. "The sheer number of years that has been devoted to premedical training, medical school, residency training is a very long road, so anything that could distract from their identity as professionals is very threatening."
Medicine also is a very hierarchical field in which the culture militates against challenging a superior or senior. Then there's the nature of medical practice itself. "As physicians, we have been trained to suck it up a bit in terms of how we're treated," Jagsi says. "We're interacting with patients who are facing tremendous challenges, so we're willing to excuse certain behavior. And if we excuse it from patients, perhaps we also excuse it from others."
She adds, "As physicians, we tend to medicalize or pathologize everything, so we feel bad for people who behave badly, because sometimes we can explain it away."
None of that can obscure Jagsi's survey findings, which suggested that medicine is rife with sexual discrimination and harassment in all its classic forms. The survey encompassed about 1,000 recipients of advanced career development awards from the National Institutes of Health. Their average age was 43, and 46% were women.
Nearly 70% of the female respondents said they perceived or personally experienced gender bias in their work, compared to 21.8% of the men who said they perceived bias and only 9.8% who said they experienced it.
Of the 150 female respondents who said they had experienced harassment, 92% said they had experienced sexist remarks or behavior, more than 41% experienced unwanted sexual advances, 6% "subtle bribery to engage in sexual behavior," 1.3% threats to engage in sexual behavior and more than 9% had experienced coercive advances. (Some reported experiencing more than one form of behavior.)
Of those who had experienced harassment, 59% said it had undermined their professional confidence, and 47% said the experiences had interfered with their professional advancement. If these figures demonstrated anything, it was that medicine was hardly unusual among professions or workplaces in the degree or prevalence of sexual harassment or in its psychological impact on the victims.
What may be unusual, Jagsi says, is the degree to which medical professionals had suppressed the recognition of harassment. "Until recently," she says, "many of us thought that overt harassment and discrimination was a problem of the past — something we had actually managed to get beyond." The reason for this misconception may have been that "the conversation was not happening."
It also may have stemmed from the unmistakable advances that women have made in medicine. Last year, for the first time, women accounted for more than half of enrollees in U.S. medical schools, according to the Assn. of American Medical Colleges. As recently as the mid-1990s, the figure was 40%.
But that obscures the challenges still confronting female physicians in advancing into leadership positions in medicine — which is an absolute necessity to change any culture of harassment or discrimination. As of 2015, the AAMC reports, women held only 37% of all faculty positions at U.S. medical schools and only 20% of full professorships.
Even their greater representation in medical school enrollments fails to tell the whole story, for they still choose, or are steered, into certain specialties. In 2015, women accounted for 71% of residents in pediatrics and 82% of those in obstetrics and gynecology, but only 17.3% of residents in neurosurgery and 14.8% of those in orthopedic surgery.
"Women are encouraged to join specialties that seem to embody feminine gender norms," Jagsi says. "Little girls are taught to share and listen to one another, so it makes sense they should go into fields where there's a lot of counseling and hand-holding and taking care of children. Little boys are socialized to 'get something done,' so it's not surprising they're encouraged to join fields like surgery, which is an interventional field." But being sequestered in some specialties rather than others may hamper women's advancement into policy-setting echelons of medicine.
Jagsi says she's beginning to see glimmers of a change in medicine's recognition of sexual harassment. "There's an emerging conversation in medicine thanks to some of the media exposure." She's receiving more invitations to speak about overt harassment rather than unconscious bias and challenges balancing work and family, previously the standard explanations for "why we consider to see a dearth of women in senior leadership positions in academic medicine."
She wrote in the New England Journal that after publishing her survey results in 2016, she received many messages from female physicians recounting "appalling" experiences with male colleagues — but not a single one had reported her experience to her institution. In some cases, it was because the institutions were dominated by male cultures, in some because the experience had deeply eroded their feelings of intellectual achievement and professional success, a special burden when the latter is so closely associated with the former.
The changing landscape even prompted Jagsi to reevaluate her own experience with workplace sexual harassment, an episode in which she was verbally importuned at a professional meeting by a prominent surgeon and rescued by a senior female surgeon who deftly extracted her from the encounter. She thought little of the episode until recently because it seemed trivial.
But as she related in the New England Journal, she has steered clear of the male surgeon since and "even gave up a valuable scholarly opportunity just to avoid him." She also recognizes feeling the same sensation as other women when facing such incidents. "The experience did make me silently question my self-worth: Why was my scholarship not substantial enough for this man to see me as a colleague who has done important research and has worthy ideas, instead of objectifying me?"