Reshma Jagsi, MD, DPhil
The troubling results from a survey1 investigating the sexual harassment and discrimination experiences of academic medical faculty show that such incidents continue to happen with unexpected frequency despite increasing awareness of the problem. The study by Reshma Jagsi, MD, DPhil, and colleagues found that 30% of female physician-scientists experienced sexual harassment compared with 4% of their male counterparts. Moreover, among the women reporting harassment, 40% described more severe forms of intimidation, such as unwanted or coercive sexual advances; 59% said they perceived a negative effect on confidence in themselves as professionals; and 47% reported these experiences negatively affected their career advancement.
Dr. Jagsi’s findings show little improvement over a similar survey2 of gender discrimination and sexual harassment in academic medicine conducted in 1995, which found that 52% of faculty women reported harassment in their careers compared with 5% of men. Furthermore, these more recent findings are especially egregious since 20 years ago women in faculty positions had entered the field when women constituted only a small minority of the medical school class. Today, almost 50% of students in academic medicine are women.3
Dr. Jagsi’s study included responses from 1,066 new recipients of the K08 and K23 Career Development Awards from the National Institutes of Health (NIH) from 2006 to 2009.
The response rate of women and men was nearly equal, 61% men vs 64% women; the average age of the participants was 43 years old; and most, 71%, were white. The participants represented all medical specialties, including oncology. In addition to how sexual harassment affected their career, respondents were asked about gender bias, both perceived in their academic work environment (70% of women vs 22% of men reported perceived gender bias) and personally experienced (66% of women vs 10% of men said they personally experienced gender bias).
Women in Senior Faculty Positions
Dr. Jagsi is Professor and Deputy Chair in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences and Medicine at the University of Michigan in Ann Arbor. She has been an ASCO member since 2004 and began a 4-year term as a member of ASCO’s Board of Directors in June 2017. Dr. Jagsi’s medical research is focused on improving the quality of care for patients with breast cancer, and her social scientific research is focused on female representation in senior positions in academic medicine, barriers to their advancement, and interventions to increase their participation in senior levels of academic medicine.
The ASCO Post talked with Dr. Jagsi about the results of her latest study, why sexual harassment is so prevalent in academic medicine, and what has to happen to change the culture in medical school contributing to explicit and implicit sexism.
Were you surprised that 30% of the female physicians in your survey experienced sexual harassment in the workplace?
I started studying women in medicine and the lack of female leaders in the profession when I was a resident in training at Massachusetts General Hospital over a decade ago after encouragement from a strong mentor of mine, Nancy J. Tarbell, MD [Dean for Academic and Clinical Affairs and the C.C. Wang Professor of Radiation Oncology at Harvard Medical School]. I’m sorry to say that not enough has changed for female physicians since the excellent study by Carr et al on gender-based discrimination and sexual harassment in academic medicine published in 2000.2
Gender Bias in Medicine
Why are sexual harassment and gender bias among female physicians so prevalent in medicine?
Unfortunately, the problem isn’t unique to medicine. It’s a societal issue and can be found in all professions. The broader literature on workplace gender discrimination and sexual harassment suggests there is a greater prevalence of harassment in settings where there is a strong power differential and where you see big differences in the proportion of women represented in a particular field.
“I had expected to see a much lower proportion of sexual harassment and discrimination than we observed in our study. That speaks to a much deeper issue within our society.”— Reshma Jagsi, MD, DPhil
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In academic medicine, obviously, there are power differentials. We are a hierarchal field, and it is only recently that women make up nearly 50% of the students in medical school. But it has been a couple of decades since women constituted over 40% of the medical school class, so I had expected to see a much lower proportion of sexual harassment and discrimination than we observed in our study. That speaks to a much deeper issue within our society.
Commitment to Career in Research
Why did you choose to survey K-award recipients?
We wanted to “Larry Summers”–proof our sample and make it clear that our participants had a demonstrated aptitude and commitment to a career in research. The criticisms of prior studies looking at gender differences in career outcomes were that if you study everyone who enters academic medicine, you are comparing apples and oranges, because men are more likely to enter academic medicine to advance scholarship in the field and through research. Whereas, it is argued, women enter academic medicine because they want to practice clinical care in a cooperative team environment and to teach the next generation of scholars.
Studies have shown that women are less likely to be promoted to associate professor or to advance to a full professorship than their male colleagues from the same medical school graduation–year cohort. [According to the Association of American Medical Colleges, at the senior-level positions, women only account for 24% of division chiefs, 15% of department chairs, and 16% of medical school deans.3] A possible explanation for this might not be that people with the same qualifications are being treated unequally, but rather that medical schools may not value certain aspects of their mission as much as they value other aspects. And we know that that is true. Contributions to clinical care and education are sometimes valued less than research contributions when it comes to promotion processes.
We know that individuals are promoted based on their research, so if men are disproportionately committed to a career in research, you might expect to see some of these differences develop, which is why we focused our survey on K awardees. There is no affirmative action in the K-award program. Only a minority of K awardees are women, but nobody would argue that the women in our sample are less able or less committed to having a research career than the men in our sample.
So when we used this sample to look at career outcomes, such as subsequent grant attainment or salary, and saw differences by gender, even after controlling for many other factors, it was a compelling sample within which to demonstrate that finding—an apples-to-apples comparison. And after we saw those differences in this select sample, it motivated us to ask other questions to better understand the possible mechanisms driving the differences.
The downside of our sample is it did not contain enough ethnic minority participants to examine the very important issues of racial and ethnic discrimination in the setting of academic medical schools.
Changing the Culture
What has to happen to change the culture that contributes to explicit and implicit sexism in medical schools and in the work environment?
We need to establish concrete targeted interventions. In terms of implicit biases, many of the practices that contribute to gender inequity are on their face gender-neutral. For example, there are practices and policies that force the collision of the biologic and professional clocks or magnify the inequities of a society in which we have a gendered distribution of labor, such as child rearing.
Another study4 we did of K-award recipients looked at how they split their time between work and personal life responsibilities. We found that women spend 8.5 more hours per week on parenting and domestic tasks than do men, and what gets squeezed out is the time that would have been spent on research.
To mitigate gender discrepancies in academic medicine and research, we need to recognize the points of vulnerability for women and either take away policies that make it more difficult for them to succeed or provide support to help female medical faculty through difficult times. For example, there are some creative bridge-funding programs to provide temporary financial support to physician-scientists with substantial child care responsibilities who are in need of resources to help them continue to publish their studies and solidify their reputations at a crucial time in their careers.
For example, the Doris Duke Foundation has initiated a grant-funding program of this sort, inspired by pilot experiences at individual institutions. That speaks to the power of trying to understand the mechanisms of the problem and targeting interventions accordingly. There is substantial evidence regarding the importance of implicit bias, and brilliant work is being done by scholars such as Molly Carnes, MD, MS [Jean Manchester Biddick Professor of Women’s Health Research and Director of the Center for Women’s Health Research at the University of Wisconsin] and others to try to target and eradicate the bias habit through interventions.
In terms of eliminating more overt forms of harassment and discrimination in medical schools, teaching hospitals, and research labs, we need a multipronged approach that includes policies for reporting, evaluating, and dealing with offenders and helping and supporting victims.
One way for individual faculty to protect against the potential adverse impact of gender bias and harassment in the workplace is to create a diverse mentorship network that includes both women and men, individuals in senior-level positions, as well as peers. This network can be a powerful way to combat the cumulative effects that may otherwise have a negative impact on women’s careers. That has certainly been my personal experience—mentors matter tremendously.
Ultimately, having a profession that values mentorship as a core component of its mission is likely to foster the kind of cultural transformation we need in oncology and in medicine in general. ■
DISCLOSURE: Dr. Jagsi reported no conflicts of interest.
1. Jagsi R, Griffith KA, Jones R, et al: Sexual harassment and discrimination experiences of academic medical faculty. JAMA 315:2120-2121, 2016.
2. Carr PL, Ash AS, Friedman RH, et al: Faculty perceptions of gender discrimination and sexual harassment in academic medicine. Ann Intern Med 132:889-896, 2000.
3. Association of American Medical Colleges: The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2013-2014. Available at aamc.org/members/gwims/statistics. Accessed May 16, 2017.
4. Jolly S, Griffith KA, DeCastro R, et al: Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med 160:344-353, 2014.