Finding Our Place: Gender Harassment of Women in Academic Psychiatry
Abstract
Women—and men—in medical academia should not tolerate gender harassment or discrimination. Here is some guidance for individuals and institutions to follow to ensure equality and respectful and professional behavior in the workplace.
Consider the following scenario:
You are chatting with a colleague, who is a woman, over a cup of coffee in your hospital cafeteria. Your colleague’s boss, who is a man, walks by. After he is gone, your colleague confides in you that he is making her life and the life of the other women in their department “miserable.” He rolls his eyes and frequently interrupts when a woman colleague shares her opinion about a patient’s diagnosis or treatment. Recently, one woman clinician was in tears after attempting to share her concerns about a patient. This boss spoke over her in a louder voice and reiterated his diagnosis and plan. When you ask your colleague what she plans to do, she shrugs. “He has been this way for years and will not change. It’s not like he is calling people stupid or making sexual advances. If I go to Human Resources, what will they do? I cannot afford to ruin my career.”
Is this behavior illegal? Should a formal complaint be filed? Would anything change if there was an investigation? What are the consequences for women on their team if they stay silent? I’ve heard similar stories from colleagues, and I have been exposed to such behavior myself.
Answer: It could be gender harassment, a form of sexual harassment (see Table 1). This sounds like a hostile work environment. Many cases, such as the example above, can be confusing. Definitive knowledge of whether this behavior meets criteria for discrimination or harassment is not required to report the behavior or file a complaint. The response to the complaint is dependent on the individual institution.
Women have been graduating from medical school since the second part of the 19th century, yet our field is still dominated by men. Although the representation of women among junior faculty has increased in academic psychiatry, numbers diminish with increase in rank. In 2019, 34% of women held the rank of professor, compared with 49% for associate professor, 59% for assistant professor, and 66% for clinical instructor. Only 23% of all psychiatry chairs were women in 2019, and men earned, on average, 11% ($53,400) more than their female peers, according to a 2021 report in Academic Psychiatry.
Table 1: Summary of Key Terms From the Report of the National Academies of Science, Engineering, and Medicine
Discriminatory behavior: An umbrella term that includes biased treatment based upon characteristics such as race, color, ethnicity, age, sex, and so on. This term includes the different forms of sexual harassment, as well as other forms of sex/gender discrimination. (Federal law prohibits discrimination on the basis of race, ethnicity, religion, sex, national origin, age, disability status, pregnancy, and veteran status. Many local jurisdictions offer additional protections on the basis of gender identity, sexual orientation, weight, appearance, and other characteristics.)
Sex/gender discrimination: A broad term that includes discrimination and harassment based upon gender or sex. In addition to sexually harassing behavior, examples of this include pay or hiring discrimination based on one’s sex or gender.
Sexual harassment: A type of sex/gender discrimination that encompasses gender harassment, unwanted sexual attention, and sexual coercion.
Gender harassment: Verbal and nonverbal behaviors that convey hostility, exclusion, or second-class status about members of one gender. Examples include use of language such as “bitch,” jokes such as “Don’t be a pussy,” and comments that denigrate women as a group or individuals in gendered terms. This type of harassment is sometimes further broken down into sexist hostility and crude harassment.
Unwanted sexual attention:Unwelcome sexual advances, which can include assault. Examples include repeated requests for dates and persistent attempts to establish sexual relationships despite rejection.
Sexual coercion: A type of sexual harassment in which favorable professional or educational treatment is conditioned on sexual activity (such as through the use of bribes or threats). Examples include promises of a better grade or a letter of reference in exchange for sexual favors.
Ambient harassment: General level of sexual harassment in a particular setting as defined by the frequency of harassing behaviors of all types and levels of severity. In this type of harassment, the people negatively affected are not directly targeted. Examples include bystanders who witness other students or coworkers repeatedly targeted by unwanted sexual attention.
Hostile environment harassment: A legal term referring to sexual harassment that is “severe or pervasive” enough to alter the conditions of employment, interfere with one’s work performance, or impede one’s ability to get an education. Both gender harassment and unwanted sexual attention can contribute to a hostile environment.
Quid pro quo sexual harassment: A legal term that parallels sexual coercion. It is a type of sexual harassment in which favorable professional or educational treatment is conditioned on sexual activity (such as through the use of bribes or threats). Examples include promises of a better grade or a letter of reference in exchange for sexual favors.
Incivility: Rude and insensitive behavior that shows a lack of regard for others (not necessarily related to sex or gender).
Source: “Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine,” National Academies of Science, Engineering, and Medicine, 2018.
In 2018, the National Academies of Science, Engineering, and Medicine (NASEM) released a comprehensive report examining sexual harassment of women in academic science, engineering, and medicine. This report concluded, “Gender harassment is by far the most common type of sexual harassment,” as opposed to unwanted sexual attention (such as sexual advances, including assault) and sexual coercion (when favorable treatment is conditioned on sexual activity).
Gender harassment involves “[v]erbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status about members of one gender.” It includes “behaviors which communicate women do not belong or do not merit respect.” Although many think of gender harassment as a lighter type of harassment, “gender harassment that is severe or frequent can result in the same negative outcomes as isolated instances of sexual coercion.”
In 2022, the Association of American Medical Colleges (AAMC) published an analysis of sexual harassment among U.S. medical school faculty, with a focus on gender harassment. The AAMC survey collected data between 2019 and 2021 and had over 13,000 faculty respondents. Among psychiatry faculty, 32.3% of women and 14.1% of men endorsed behaviors specifically associated with gender harassment in the past 12 months. The most common experiences reported by women in psychiatry were referring to the female gender in “offensive, insulting, or vulgar terms” (22%) or putting women down or behaving in a condescending way because of their gender (22%).
The AAMC report found that “faculty of all genders who experienced harassment were less engaged, less satisfied with their medical school as a place to work, and less likely to stay at their institution” and “women who reported experiencing harassment had the lowest engagement across all measures.”
Table 2: Interventions to Reduce Gender Harassment
Individual Interventions
All of us can support women. Reporting and enforcement of policies and laws can benefit everyone.
Know about your own institution’s policies and the different entities that can be contacted to report workplace discrimination and harassment.
Male allies can ask questions others may be punished for asking, such as the procedure for reporting concerns.
Offer to accompany someone who is filing a complaint or reporting an incident to the individual’s supervisor, giving his/her words credibility.
Organize or ask for training in your workplace that can provide skills for witnesses to overcome discomfort and intervene when harassment is occurring. Sometimes, problematic behavior may be driven by unconscious bias, making it particularly difficult for targets or witnesses to speak up.
Amplify others. If a woman makes a point and it is overlooked, repeat the individual’s answer publicly and give her credit. Speak up in meetings when something uncomfortable occurs.
Encourage an inclusive workplace so that people can focus and reflect on their own behaviors.
Foster open communication by exploring any disconnect between values and action, and intentions and effects.
Institutional and Departmental Interventions
Department chairs and organizational leaders in psychiatry should read the 2022 AAMC report. The 10 broad strategies and examples below are taken directly from the AAMC report.
Begin with zero tolerance.
Example: Ask candidates to disclose any previous or ongoing investigations related to sexual harassment in the job application.
Take a coordinated approach.
Example 1: Convene a multidisciplinary team from various offices to coordinate sexual harassment prevention work, such as Faculty Affairs, Legal, Human Resources, Chief Medical Officer, Risk Management, Corporate Investigations, Compliance, Title IX, Faculty Ombuds Office, and others.Example 2: Establish an accountable executive team that’s connected to senior institutional leadership with responsibility for sexual harassment work within the context of the institution’s overall diversity, equity, and inclusion (DEI) goals.
Example 2: Establish an accountable executive team that’s connected to senior institutional leadership with responsibility for sexual harassment work within the context of the institution’s overall diversity, equity, and inclusion (DEI) goals.
Hold chairs accountable.
Example: Provide training for department chairs about how to address minor behavior issues early on through counseling conversations with offenders.
Leverage the parent university.
Example: Consider coordinating the medical school’s and the parent university’s efforts to address sexual harassment through the Title IX, Compliance, and Human Resources offices of both institutions.
Hire trained investigators.
Example: Invest in professionally trained investigators to handle reports of sexual harassment cases and other discriminatory or harmful behavior.
Centralize and expand reporting.
Example: Adapt or adopt a system for tracking reports on a broad, yet detailed, level to identify repeat offenders (for example, a Patient Advocacy Reporting System and Co-worker Observation Reporting System.
Address less overt, yet still harmful, behavior problems early and often.
Example: Develop support for perpetrators of less overt, yet still harmful, behaviors to address issues early and often.
Use proportionate sanctions.
Example: Create a scale of sanctions proportionate to the levels of offenses.
Communicate transparently about harassment incidents.
Example: Regularly report to your campus community your institution’s rates of harassment or intentions to begin collecting rates of harassment.
Train beyond compliance.
Example: Offer intervention training that uses real-world scenarios and case studies so participants can practice responding to or discussing events they might realistically encounter.
Gender harassment is not unique to women. Men in our field are also subjected to gender harassment and may be more likely to leave their place of employment compared with women after experiencing harassment. An alliance between all genders and community building can therefore be powerful antidotes to the deleterious effects of gender harassment.
The AAMC and NASEM reports provide a useful starting point. Part of the challenge is the lack of data on gender harassment in academic medicine, including psychiatry. Without specific data, how can we develop evidence-based solutions? If these issues remain shrouded in secrecy, it will be difficult to move forward. The AAMC report outlines strategies, including specific examples at different medical schools, for preventing and addressing sexual harassment at an institutional level (see Table 2). Every department of psychiatry should make an impactful effort to measure and reduce gender harassment in the workplace. Identifying and addressing inequities and barriers to the advancement of women is crucial to reducing gender harassment.
At this time, even when reported, incidents may be handled behind closed doors and do not necessarily receive wider attention within or beyond the academic community. In 2019, in a noteworthy exception, multiple current and former employees, including women physicians, at the Mount Sinai Health System in New York filed a lawsuit alleging workplace discrimination and retaliation (the defendants have denied any wrongdoing). This case provides an opportunity to understand the experience and consequences of gender harassment for women in academic medicine.
The plaintiffs described working under a male superior with relatively few years of experience who had been hired against the advice of a search committee. The plaintiffs alleged there were repeated instances of a male supervisor screaming at them while the director observed without intervening, normal differences of opinion among women staff being cast as “catfights,” and leadership positions being filled overwhelmingly by men compensated with higher salaries than female counterparts, among other allegations. As reported in the October 21, 2020, STAT, the plaintiffs described themselves as having been “demoted from leadership positions and assigned menial tasks” and “emotionally and psychologically scarred” by the experience. They contended that the majority of the eight plaintiffs had their “careers derailed.”
Despite barriers, women psychiatrists continue to provide excellent clinical care, advance the field through research, and train the next generation of practitioners. The situation will change only when we, regardless of gender, demand change.
I share my own perspective on this topic, bearing in mind that my experience is limited, in part, as a cis-gender, heterosexual, Asian American woman in her mid-30s. There are many other identities and experiences to consider in how we can increase inclusiveness and equity.
At my own hospital, I stare up at a wall covered with dozens of photos of past medical directors and framed portraits of pioneers in the field. There is one woman. What happened to the others?
While women in academic psychiatry have made significant strides, gender harassment persists. It is likely that nearly a third of women psychiatrists reading this article have experienced gender harassment. How long will this continue, and what will it take for us to act? National and global trends are suggestive of a potential stagnation or backsliding for the advancement of women. The good news is, and history has showed us, that when women advance, it leads to long-lasting change that improves everyone’s lives.
Additional Recommendations
Departments of psychiatry should survey their workplace climate, including the state of discrimination and harassment to identify a baseline, and make these data publicly available. The 2019 National Institutes of Health Workplace Climate and Harassment Survey, which was designed to identify organizational components related to harassment, provides an excellent roadmap.
Create responsive caregiving programs, enhance mentorship and sponsorship opportunities, and eliminate the gender pay gap, according to Marcy Forgey Borlik, M.D., M.P.H., in a 2021 issue of Academic Psychiatry. ■
Resources
Women in Academic Psychiatry: Inequities, Barriers, and Promising Solutions
Understanding and Addressing Sexual Harassment in Academic Medicine
The Gender Harassment We experienced Sank Our Medical Careers
Sabina Bera, M.D., M.S., is an assistant professor of clinical psychiatry at Weill Cornell Medical College in New York. She was awarded the 2017 Jeanne Spurlock Congressional Fellowship and served as a health policy fellow on the U.S. Senate Committee on Health, Education, Labor, and Pensions. She has also worked on the ABC News Medical Unit as a medical expert.
