Medicine needs to face up to sexism and sexual harassment in medical workplaces

womenmds-300x200The profession of medicine gets mixed reviews in rolling back the centuries of  chauvinism, arrogance, and boorish behavior of top (male) doctors.  It’s now generally if grudgingly recognized that health care, though it may be a life-and-death practice, needn’t be a rude and obnoxious one. Nurses, many of them women but many men, too, shouldn’t be bullied and demeaned by doctors. It makes for mistakes and malpractice and bad patient outcomes, for one thing.

As health care leaders look around at mighty male leaders who are falling left and right in the entertainment, news and political industries, they may wish to look closely at their own talent and its treatment. Women doctors, for example, get a bad deal on a matter as basic as pay: They earn, on average, 20 percent less than men do, even within various specialties, data from 36,000 self-reporting MDs has found. Male vascular surgeons earn $89,000 more than their female counterparts, while male pediatric rheumatologists get about $45,000 more than their female peers do.

The American Medical Association has reported that only 12 percent of internal medicine, 1 percent of surgical, and 22 percent of obstetrics and gynecology department chairs at important, prestigious academic medical centers are women—figures that also are tough to reconcile because 83 percent of obstetrics and gynecology residents are women.

It’s also tough to understand why women aren’t thriving and rising more in medicine and medical science because they do outstanding work. Yusuke Tsugawa and Ashish Jha recently analyzed data on more than 1 million patients, and found that “female physicians had lower … mortality rates compared to male physicians” for hospitalized patients who were studied 30 days later. When they examined patient outcomes for women vs. men doctors, breaking their data down on care for the eight most common conditions treated in hospitals, “female physicians had better outcomes.” This was especially true for patients in bad shape, they found, writing, “The sicker you are, the bigger the benefit of having a female physician.”

But to become doctors and to keep practicing well, women face a relentless gantlet of “bro culture,” in which crude anatomical language is common, where they are addressed as “girls” and sexism long has been rampant, and where they are personally and regularly subjected to inappropriate sexual advances, and coercive or threatening language about submitting to wrong sexual overtures. In a survey of established women faculty at academic medical centers, 52 percent of them reported harassment in their careers compared with 5 percent of men.

Women who leap into elite positions as surgeons also face a crushing bias. A bit of research still under way and based on Medicare data looks at how primary care physicians, when making crucial referrals to surgical colleagues, show a bias against women:

[Referring physicians] become more pessimistic about a female surgeon’s ability than a male’s after a patient death, indicated by a sharper drop in referrals to the female surgeon. However, [referring doctors] become more optimistic about a male surgeon’s ability after a good patient outcome, indicated by a larger increase in the number of referrals the male surgeon receives. [Referring doctors] also change their behavior toward other female surgeons after a bad experience with one female surgeon, becoming less likely to refer to new women in the same specialty. There are no such spillovers to other men after a bad experience with one male surgeon …

In my practice, I see not only the significant harms that patients suffer while seeking medical services but also their giant struggles to access and afford medical care. The United States is a rich nation, gifted with great resources, including abundant talent. But no country on earth can afford to look askance or to mistreat half its population. We have a long way to go to see that women in medicine get paid fairly, treated appropriately, and promoted to make highest and best use of their astronomic skills, talents, and brains. Maybe this also will help ensure that women get more effective, affordable, accessible, and outstanding medical care they deserve, not the distant second, after thought medicine that they too often have gotten before.

By the way, lest anyone think that powerful men in medicine are somehow beyond the reach of a deserved comeuppance for bad conduct, just consider that even the flailing administrators at the well-known University of Southern California got it together sufficiently to fire the hand-picked successor to a drug-troubled, hard-drinking, and ousted medical school dean. USC acted, it is true, only after word began to spread the replacement dean had cost the university $100,000 in a settlement earlier in his career for sexually harassing a young female co-researcher. He, according to news reports, traveled to a medical conference with his colleague but had booked only one hotel room—and expected her to share it and his bed with him. So now USC has fired two deans in quick succession for misbehavior. Will it have learned its lesson? We’re watching.

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