Published in the September 2016 issue of Today’s Hospitalist
I WAS LOOKING for some good news,” says Reshma Jagsi, MD, DPhil, when asked what she expected to find in her 2014 survey on sexual harassment and discrimination in academic medicine. A radiation oncologist at Ann Arbor’s University of Michigan Health System, Dr. Jagsi has conducted extensive research on gender-equity issues in medicine. That evidence suggests that women physician-scientists get paid less (June 31, 2012, Journal of the American Medical Association) score fewer independent grants (Dec. 1, 2009, Annals of Internal Medicine) and shoulder more domestic chores than their male colleagues (March 4, 2014, Annals of Internal Medicine).
Despite the persistent gender gap in pay, Dr. Jagsi assumed that the days when women physicians in academic medicine routinely faced explicit sexual harassment at work were long over. “I thought the message was going to be that we’ve made tremendous strides in reducing overt discrimination and harassment, but there’s still work to be done,” says Dr. Jagsi, an associate professor in the department of radiation oncology. “I thought we’d find that some subtle, unconscious biases continue to persist.”
“I suspect this isn’t unique to academic medicine, or even to medicine at all.”
~ Reshma Jagsi, MD, DPhil University of Michigan Health System
But the survey of 1,066 physician-scientists suggested otherwise: Thirty percent of female respondents reported being sexually harassed by a superior or colleague during their professional career, as summed up in a research letter that Dr. Jagsi co-authored in the May 17 issue of JAMA. Among women reporting harassment, 40% had experienced severe forms, including unwanted and coercive sexual advances.
The survey also turned up gender bias, with 66% of female respondents saying they had either definitely, probably or possibly been shut out of opportunities for professional advancement because they were women. Dr. Jagsi hopes those findings will get hospital leaders and physicians to acknowledge sexual harassment and discrimination and start talking about them—key steps to eliminating it.
A lingering societal issue
The survey focused solely on clinician-researchers who had received career development grants (K08s and K23s) from the National Institutes of Health between 2006 and 2009. But Dr. Jagsi does not think the findings apply to only that sub-group.
“I suspect this isn’t unique to academic medicine, or even to medicine at all,” she says. “It’s a sobering reminder of how far we still have to go as a society to achieve gender equity.”
A survey conducted in 1995, with results published in the June 6, 2000, issue of Annals of Internal Medicine, found that 52% of women medical faculty reported being sexually harassed.
Dr. Jagsi was hoping to find an even bigger decrease in the years since. In 1995, she points out, the respondents had begun their careers when women were a minority of medical students. In comparison, those taking her 2014 survey were on average 43 years old, and began working when more than 40% of medical students were women.
“These physicians,” she says, “grew up in a generation when it was recognized that sexually abusive behaviors are unacceptable.”
Power and sex
A power imbalance is often at the core of professional abuse, says Dr. Jagsi.
“Harassment appears to be more common in settings with large power differentials, like there can be in academic medicine,” she notes. “One assumes that younger women who require the support of more senior people can be more vulnerable, but that’s based on a broad gestalt, not on data from our study.”
The survey did not ask respondents to specify whether a superior or a colleague had sexually harassed them. Yet a majority of women who reported harassment said the experience affected their professional life, with 59% saying they had lost confidence in themselves as a professional and 47% reporting that the experience had interfered with career advancement.
The power dynamic theory may partially explain why reports of gender discrimination and harassment were not limited to women. Among male respondents, 4% said they had been sexually harassed, with 10% reporting that they had or may have lost out on advancement opportunities because of their gender.
Dr. Jagsi acknowledges that her findings, which are based on self-reported responses, may be affected by nonresponse bias: Physician-scientists who’d experienced sexual harassment or gender bias might have been more motivated to respond. She and her co-authors tried to minimize the potential for that bias by framing the survey as a 12-page questionnaire about general career experiences, putting the sexual harassment and discrimination questions at the end.
She also points out that it might be hard to draw conclusions based solely on documented cases vs. self-reported ones. While some physicians have formally complained of being sexually harassed, those cases may be only “the tip of the iceberg,” she says. “Many women are unlikely to report because they are concerned about being marginalized, stigmatized or worse.”
Since the study was published, Dr. Jagsi says she has received an outpouring of grateful comments.
“Some messages have been simultaneously heartbreaking and heartwarming,” she notes. “One woman e-mailed me and said, ‘I didn’t even realize I needed closure on my own experience until I read your paper, and I’m so grateful to you for sharing it. If these successful women experienced this, maybe the fact that this happened to me wasn’t really my fault.’ ”
According to Dr. Jagsi, creating safe environments where women physicians can interact with female colleagues should encourage more discussion and greater awareness of sexual harassment and discrimination. At the University of Michigan, for instance, a group called Advance sponsors events such as book clubs for women in science and medicine.
“Women can informally socialize with one another, talk about their experiences and create an informal support network for themselves,” she says.
A cultural challenge
Dr. Jagsi also hopes the rising number of female physicians and academic faculty will help reduce sexual harassment, but she believes a bigger societal shift needs to occur. “Society as a whole and our institutions have to encourage a cultural transformation that recognizes that this behavior is unacceptable.”
To start, she suggests that hospital leaders and physicians encourage more dialogue about gender equity and diversity. Such conversations, she adds, have already begun at the University of Michigan.
One faculty member recently stopped her in the parking lot. “He rolled his window down and said, ‘I want to thank you for that paper. I’ve had some really good conversations with mentees, and it opened a topic we’ve never discussed before.’ ”
In addition to improving gender equity, such discussions could inspire more innovation in medicine, says Dr. Jagsi.
“There’s a huge amount of literature showing that diversity promotes academic inquiry and discourse,” she explains. “When people with very different backgrounds and life experiences interact, they come up with more innovative questions and answers then they otherwise would have.”
Maggie Van Dyke is a freelance writer and editor based in the Chicago area.