“Her career was ruined by this one guy asking for sex on this night. And, realistically, she would have been much better to have given him a blowjob on that night.”
These words, spoken by Dr. Gabrielle McMullin, a vascular surgeon in Australia, refer to a recent case wherein a female surgical resident won against a surgeon accused of sexually assaulting her in the Melbourne hospital where they both had been working. Ironically, winning this workplace harassment lawsuit has made it impossible for the surgical resident, Caroline Tan, to find a job. In the surgical profession, speaking up against assault has resulted in Tan being labeled, not as a victim or a brave woman who spoke up, but as a troublemaker.
Cases like Tan’s are present in the medical profession worldwide. Arguably, a lot of the sexism in medicine is insidious, part of the inherent sexism that remains ingrained in Western culture. Doctors are humans, after all, living and interacting with the society in which they live. When this pervasive sexism enters the workforce and starts making it difficult for many doctors to do their job, it then becomes a major problem.
I asked an anonymous group of medical students, residents and medical doctors on Reddit about the sexism they’ve encountered during their careers. Their answers were disheartening, but not surprising.
“You have the general problem of a significant number of patients thinking female medical students are nurses, despite how they introduce themselves. Personal experience would put that at…3/10 patients, probably higher.”
Many contributors chimed in with similar sentiment. A male nurse recounted how a female doctor gave a family bad news, and the father pointed to the male nurse and demanded that he get the female doctor in check. In another situation, a female doctor had a patient tell her “she’d make a lovely nurse,” although she had already been an attending for two years.
Patients mistaking female doctors, residents and students for nurses is relatively innocuous. While it is evidence of the sexism that pervades our society as a whole — a woman can only be a nurse — it will hopefully stop with future generations and is not currently career threatening or very emotionally harmful. But, what about sexism within hospitals and programs?
“Residency programs (discounting maybe pediatrics or OB/GYN, probably Family and internal medicine, too) during interviews really, really, really do not want a female resident to get pregnant. They’re legally not allowed to ask your marital status or if you plan on having children. They do anyway. If they don’t straight out ask, they’ll get as close as possible to asking. That’s always a super fun position to be in.”
How does one handle a situation like this? Point out that asking these questions is illegal and risk rejection to the program? Or, as many female residency applicants do, lie or deflect the question? As one anonymous contributor pointed out, “the fact that the [subject] has to be brought up at all is pretty telling.”
Some of the comments I received on Reddit were truly shocking, such as an account of an attending telling a pregnant resident that “if you spent less time on your back you might be a good doctor.” However, fear of being kicked out of a program, being fired or starting a conflict with someone whose goodwill can advance a career silences many women in medicine.
Sexual harassment experiences are not limited to internet anecdotes. A study conducted by the Royal Australasian College of Surgeons in response to Dr. McMullin’s statement found that nearly half of all surgeons had experienced bullying or sexual harassment. One surgeon surveyed stated that they were expected to trade sexual favors for tutelage. Another Australian study found that a large proportion of female medical students at a medical college in Australia experienced sexual harassment from fellow students, patients and physicians. Importantly, the female students stated that these experiences were detrimental to their learning experiences.
Many of the above real-life stories single out surgery as an especially bad offender. One female surgeon theorizes that the nature of the surgical field demands detachment from emotions and the ability to withstand long hours and grueling procedures. These facets can easily be thought of as traditional male gender roles — to be stoic, toughen up and soldier on. Indeed, even though the number of women enrolled in medical school became nearly equal to the number of men in the years following Title IX and the Public Health Service Act, surgery is still very much a male-dominated field. These aspects of the surgical field can make it an unwelcoming environment for women who want families because women might want to take maternity leave or presumably work less hours to raise their child. Women may also be unfairly passed up for leadership positions and tenure because they have families or they will want families in the future. This particular form of gender discrimination may not be motivated by misogyny, but by financial reasons. A woman who takes maternity leave will cost the hospital money in lost productivity and possibly in paid medical leave — the United States does not have federal laws regarding maternity leave and so whether a mother gets paid during maternity leave is at the hospital’s discretion. This decision can be made by male or female faculty. Interestingly, a study conducted at the University of California in San Francisco found that patients do not have a preference for male surgeons or female surgeons — suggesting that the gender bias female faculty face comes directly from faculty.
Fighting back against sexual harassment is often a Pyrrhic victory because women are punished for speaking up and filing lawsuits. Caroline Tan states that after she filed a case against her harasser, she was rejected for positions at eight public and private hospitals, despite having an exemplary record. Her academic work also suffered as her accuser and his peers attempted to undermine her credibility, and their complaints led to Tan being denied a fellowship for almost a year while their claims were investigated. “They can always say you weren’t good enough,” Tan said. She believes she was branded a troublemaker. She is currently a clinical lecturer for an Australian medical school and a practicing neurosurgeon. While her career is far from ruined, as Dr. McMullin postulated, Tan was certainly unfairly penalized for pursuing legal action.
Another high profile case involved Dr. Carol Warfield, the former anesthesiology chair at Beth Israel Hospital, when she filed suit against the surgery chief Dr. Josef Fischer and the chief executive Paul Levy for forcing her out of her position when she complained that Fischer demonstrated gender discrimination against her. Warfield won the case, but the trial dragged on for years as both Beth Israel Hospital and the defendants denied any wrongdoing. Warfield did not regain her position as anesthesiology chair. She currently practices part time in a pain clinic she helped establish. Fischer, the doctor accused of discrimination, no longer performs surgery, but has an “endowed professorship through Harvard Medical School and the hospital [even] provides him an office.”
From a business standpoint — and hospitals are multi-million dollar businesses — maximizing productivity is the bottom line because it protects their financial interests. From a purely financial standpoint, it may not be worth the cost to spend resources on protecting sexual harassment victims. A trained, working surgeon is more valuable than a resident who is still learning, and especially a resident who costs the hospital money in a lawsuit.
However, long-term, hospitals will lose out by not defending their female staff. Women are enrolling in medical school in nearly equal numbers as men, but more female physicians consider leaving residency, in particular general surgery residency. Hospitals make an investment when they choose to train residents, and they stand to lose a significant number of those physicians. Male physicians can certainly replace the female physicians who leave, but female physicians are a necessity. The idea of cultural competence is highly regarded in medicine concerning race and ethnicity, and the AAMC notes that more minority physicians are required in order to best serve a diverse population. The same holds true for women — female physicians will be better able to serve women’s issues. Female physicians may, for example, take their female patients’ pain complaints more seriously, as women experience pain differently than men do. Elizabeth Blackwell, founder of the first women’s medical college in the United States, entered medicine because of a dying friend’s statement that she wished she could have had a female doctor to treat her uterine cancer. Female physicians who can relate to their female patients better than male physicians may be especially needed in surgical fields, given recent trends such as women with breast cancer asking for double mastectomies when chemotherapy may be sufficient and women receiving hysterectomies even when they are not strictly necessary.
There is no easy solution to sexism. The solution could lie with men — if male physicians and residents do not play along with sexist comments, the people making those comments may be inclined to stop. What is more likely to happen, however, is that male medical students’, residents’, and physicians’ careers could suffer if the offender is in a position of authority and decides the person who does not play along is not a team player. Another solution could be to wait it out. Sexism may decrease as older surgeons retire and the new attending surgeons, who have attended medical school and residency with an equal number of male and female students and who have grown up in a society that values gender equality more than previous generations, take over. However, waiting doesn’t help the women, like Tan and Warfield, who will risk their careers if they speak up now.
What the medical profession needs is a drastic culture shift. Sexist comments and inappropriate behavior in the medical field are evidence of a much larger problem of insidious misogyny in our culture. Doctors do not exist in a bubble, and we are to a large extent products of our society. This includes the people who make sexist jokes or commit sexual harassment and the people who laugh along or accept them as a fact of life. A shift this great requires courage. It requires people like Caroline Tan and Carol Warfield who stand up to their harassers. Their lives are more difficult for it, but nothing worth fighting for was ever easy. I challenge every one of my fellow medical students to just once, be it for yourself or someone else, say, “that’s not okay.” As medical professionals, we dedicate ourselves to making our patients’ lives better. How can we claim to do this while we allow half of our colleagues to be devalued?
Writer-in-Training
University of Illinois College of Medicine
Karishma is a Class of 2018 medical student at the University of Illinois at Chicago. She majored in English and Psychology at Northwestern University and hopes to go into surgery.