I noticed it on my first few days as a medical student on the wards. I presented a patient next to the taller, male medical student, and the patient looked to him rather than to me. On top of the usual nerves of a new rotation and presenting in front of a clinical team, I thought I was being too shy and that I should stand up taller, speak louder, and assert myself more. The next day, I noticed that many of the patients were looking to this male medical student as the leader of the team, even as our female attending examined them and expertly answered their questions. Later on, as an intern, I once walked into a patient’s room to the sound of a mother on the phone saying, “Oh, I have to go. The nurse is here.” While on another occasion, a patient’s parent complained to the attending that they hadn’t seen a doctor all day, when I had seen my colleague, another female physician, leave the room earlier after sitting down at the bedside with the family to explain the plan.
According to the recent article in the Journal of Hospital Medicine, “Gender-Based Discrimination and Sexual Harassment Among Academic Internal Medicine Hospitalists,” my experience is not unique. In their survey, Bhandari et al found that nearly 100% of female hospitalists reported having been mistaken by patients for a nonphysician health care worker, compared to just 29% of males. Imagine never having your role on a team questioned and never worrying about whether your patients will take you seriously. Instead, these episodes of gender discrimination and still prevalent sexual harassment wear women down, affecting their mental health, career trajectories, and patient care.
During one of our more recent #JHMChat discussions, we were joined by Dr. Arghavan Salles, MD, PhD, surgeon and gender equity researcher, to talk about these issues in our discussion entitled: “Time’s Up: Calling Out Gender-Based Discrimination and Sexual Harassment in Academic Hospital Medicine.” Our discussion was one of the most active #JHMChats we have hosted in months, with 208 participants and 738 tweets. Participants candidly shared personal experiences, frustrations, and fears related to gender discrimination and sexual harassment. Below are some of the pervasive themes that stood out, but I recommend going through the #JHMChat on your own to see how passionate and engaged this community is about gender equity.
1. The visual abstract of the study resonated with participants as it was retweeted 239 times and counting at the time of publication, with shared responses and quotes demonstrating the widespread nature of gender discrimination in hospital medicine.
Nearly 100% of female hospitalists report being mistaken for nonphysician HCP vs 29% of males. Join us Monday Feb 22 at 9p EST for #JHMChat to talk about this and more gender-based discrimination issues in medicine with @arghavan_salles.
100% female doctors reported being confused by non medical staff. This is for those people who say I’m being sensitive! ? https://t.co/i2KmDOwI00
— Claudia Villanueva (@civo05) February 23, 2021
2. Improving gender equity is not just for the women involved; it’s for all of us – men, women, future physicians, and our patients.
Not only that, but women with MIs fare better if their MD is a woman. Black men opt for more preventive care if their MD is Black. Black babies are more likely to survive if their MD is Black. Trust is part of it, but there’s more to it, too! #jhmchat
— Arghavan Salles, MD, PhD (@arghavan_salles) February 23, 2021
A1 – it clearly impacts both women and men alike and for me, now with 2 daughters, I am far more aware of how badly it needs to be addressed and very motivated to do so #JHMChat
— Jeremy Yardley (@YardleyMD) February 23, 2021
A1: because gender discrimination doesn’t just hurt #WomenInMedicine– it impacts the future of #medicine, #science and suppresses the diversity of voices skills and talents that will push discovery and innovation- it hurts the world. #jhmchat
— Sapna Kudchadkar, MD, PhD (@SapnaKmd) February 23, 2021
3. Many also shared how gender discrimination and sexual harassment have negatively impacted career trajectories:
A2: It starts so early- in med school you start to notice there are specialties that are seen as “better for women” … to which the corollary is there are ones that are bad for women. #JHMchat
— Cara J Haberman MD (@CJHaberman) February 23, 2021
A2.2. Women having mentors but inadequate sponsorship for new opportunities. Similarly, women being told about opportunities like committees and councils but not being nominated for leadership opportunities as consistently as our male colleagues. #JHMChat
— Annie Massart (@Annie_Massart_) February 23, 2021
Sexual harassment makes it difficult for womxn to find safe mentorship and sponsorship and makes it harder for us to get promoted. In some cases, it ends careers. #jhmchat https://t.co/QDYOewzPnJ
— Arghavan Salles, MD, PhD (@arghavan_salles) February 23, 2021
A1) because it keeps taking away our mentors #DrDennar. Because only 5 women have ever won the AAMC teaching award.
Because, as an MS4, it enrages me that 7 years from now as an attending I will likely make less than my male peers. Bc there is still no federal FMLA #JHMchat https://t.co/pQVEBkG7r8— Londyn Robinson (rheuminate) (@londyloo) February 23, 2021
A2
Women feel powerless or give up when faced with gender bias. They leave academic medicine or they accept less. They don’t achieve their full potential and rise into leadership. As a result our healthcare institutions, our patients, and our learners suffer. #JHMChat— Jennifer O’Toole, MD, MEd (@BusymomJen) February 23, 2021
And the whole thing about certain subspecialties being “women’s work” that @YJonesMD, @BusymomJen & @DrJessieAllan have talked about and the biases that comes with it. #JHMChat A2
— Sonya Tang Girdwood ? ??, MD, PhD (@STangGirdwood) February 23, 2021
A2. Hmmm. Here’s things I know as I’ve experienced them: being talked over, being thrown mothering or admin work and losing opportunities for career growth, being told I am: outspoken, not a team player, difficult, harsh, nasty, etc. #JHMChat
— Dr. Sujana Chandrasekhar (@DrSujanaENT) February 23, 2021
4. Dismantling our current culture surrounding gender discrimination and sexual harassment starts with creating a culture of zero tolerance and transparency, as well as making these efforts an institutional priority, not just a check box.
A3: Call it out and do not tolerate it. Work to promote systematic changes in policies driving equitable compensation and scheduling. Educate on day to day aggressions and how to mitigate them. Advocate for progressive leave policies #JHMChat
— Jorge Ganem, MD (@jfganem) February 23, 2021
A3.1 #JHMChat: We have to find ways to “call in” (before calling it out) when we see it. I don’t have a strategy for this, but outwardly acknowledging when decision rooms have too many men (race factors here, too). Advocating for specific colleagues in decisions and promotions.
— The (Masked) Bowtie Hospitalist (@DocWithBowtie) February 23, 2021
The response to reporting needs to be support and investigation of the accused rather than retaliation against the target of the behavior.
I don’t care how much money you bring–the toxicity of an aggressor is more costly than whatever funds they’re bringing in. #jhmchat https://t.co/SZKYg0SzXh
— Arghavan Salles, MD, PhD (@arghavan_salles) February 23, 2021
A3: Measuring how we are doing in terms of women in leadership, advancement, publications, etc etc etc and transparency regarding these measures, actively making equity a QI priority in hospital systems #JHMChat
— Melissa Plesac (@MelissaPlesacMD) February 23, 2021
There has to be a fundamental understanding of how allowing sexual harassment to thrive is damaging to individuals and organizations. Addressing this is not a check box, it’s not performative, it’s not superficial. It’s the deep hard work of cultural transformation. #jhmchat https://t.co/q1nqojPLcf
— Arghavan Salles, MD, PhD (@arghavan_salles) February 23, 2021
A4: don’t be afraid of hearing how you and your institution can improve. Continuous improvement is part of QI, make it part of advancement toward equity. We can all do better! Painful process of reflection that helps fuel growth. #jhmchat
— Valerie Vaughn (@ValerieVaughnMD) February 23, 2021
I was so impressed by the community, camaraderie, and outpouring of honesty and support during this #JHMChat. While the field has a long way to go to eliminate gender discrimination and sexual harassment, I see the desire, the drive, and the strategies alive in our #JHMChat corner of the world. If you want to have candid conversations on everything from gender, racism to social media in medicine, join us for an upcoming #JHMChat.
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