As a male surgeon, I am mortified that the profession allows my female colleagues to be treated like second-class citizens. I have watched women surgeons get bullied, harassed and discriminated against by their male counterparts. I have seen a countless number of their careers crumble in front of my eyes. I have seen their tears. I have seen them go into a deep hole of depression and never come back. And I have done nothing about it.
New research is shining light onto the pervasiveness of sexual harassment, bullying and discrimination in our world of surgery—but this is something that doctors have known about for decades. It is deeply engrained in our culture of medicine—and it needs to change. While the rest of the world seems to be embracing the #MeToo movement, we are running from it. As a result, most cases of abuse are going unnoticed. And this is leading to depression and suicidal thoughts among surgeons.
This isn’t good news for patients. When one places one’s life in the hands of a surgeon, one assumes that she or he is singularly focused on the patient’s well-being. But how can surgeons perform at their best if they are battling workplace abuse or being hampered in their ability to provide care because of discrimination? No human, man or woman, would be able to do so. And we all know that women make better surgeons than men. So, if we are all truly in this for our patients, this should be a no-brainer.
I, like many male surgeons, was afraid to speak up out of fear that it would destroy my reputation among senior surgeons in power, who are more often than not men. As it turns out, I am not alone. “Men are bystanders. They know something is wrong. They know someone is taking advantage of the situation. But medical training is hierarchical and most men find it hard to challenge someone with more authority,” says Zeno Franco, associate professor at the Medical College of Wisconsin.
I asked Franco how we could overcome this. “We think of heroics as an individual act. But people can band together especially when the risks for one person are too high. It is very important to form teams. It is the obligation of men to consult with supervisors and get colleagues involved. We often get trapped into thinking we are alone,” he remarks.
So how big a problem is this for women surgeons?
According to a study published in the New England Journal of Medicine, one third of surgical trainees across the country experience gender discrimination or verbal and physical abuse. Among female surgeons-in-training, nearly two thirds experience discrimination, and one in five are sexually harassed—often directly by senior supervising surgeons.
Supervising surgeons “can assault you and get away with it since your career is in their hands,” says a woman surgeon from the Southwest who cannot be identified due to ongoing legal action. And evaluation methods for surgeons-in-training give supervising surgeons’ control without much external oversight, making abuse of power all too easy, she observes.
“I had the highest exam scores in surgical training, but when I became pregnant my evaluations went downhill for no reason. Everyone was angry that my pregnancy left them shorthanded. While pregnant with my second child, I was placed on probation for professional misconduct with no evidence or reasoning,” she says.
Harassment and discrimination also affect surgeons who have completed surgical training and are well into their careers. According to a national survey presented at the 2019 Academic Surgical Congress, 58 percent of U.S. women surgeons experienced sexual harassment within the last year, and most of these incidents were not reported, with the most common reason given for that being “fear of a negative impact on my career.”
Discrimination and abuse are daily occurrences for many women surgeons, and there are multiple perpetrators including co-workers, patients and families, and nurses, says Arghavan Salles, scholar in residence at Stanford University School of Medicine. “Our authority is always questioned. If we ask for anything, even specific instruments during critical parts of an operation, we are called demanding.”
And, says Salles, “no mechanisms exist for surgeons or trainees to confidentially report abuse without suffering severe professional repercussions.” As a result, many women are harassed out of their careers as surgeons. “This is an epidemic,” she says. “Not just one bad actor. Not just one Harvey Weinstein.”
Since women are scarce in academic surgery, says Karyn Butler, professor of surgery at Sidney Kimmel Medical College of Thomas Jefferson University, “they are the minority trying to convince the majority. And getting ahead is based on reputation among colleagues, making it easy for one’s career to be destroyed for speaking out. “Even I am not willing to name people out of fear of what will happen to my career,” she remarks.
With nowhere to go, hopelessness among doctors who have been discriminated against can settle in quickly. “I was very depressed,” says the aforementioned anonymous woman surgeon. “No one was there to help. I went to the only other woman I knew, the chair of surgery, who said she couldn’t help me because it will anger the men and end her career. I would have committed suicide if it wasn’t for my lawyers and family.”
To avoid sexual harassment at work, many women surgeons resort to ground rules. “Always wear a shirt under your scrubs or else male surgeons will look down at your chest.” Just one of many rules Butler was told when she started surgical training. “I still remember the day I didn’t wear a shirt under my scrubs, that exact thing happened.” Butler never wore jewelry or heels as a means to avoid unwanted attention. “We didn’t change the environment, we just adapted to survive.”
So what’s the solution?
We need to start by acknowledging that discrimination and harassment in surgery are a problem, so that we can start to have the conversation, Butler says. Men are also a critical part of the solution and they need to step up, she says.
One thing is crystal clear. Our female colleagues have been suffering for far too long. Time’s up and we male surgeons, myself included, need to help rather than being a part of the problem.
When we witness gender abuse, we need to support the recipient and tactfully call out our colleagues or make sure that leadership is doing something about it. When we see great ideas from women surgeons being discounted or undeservingly credited to men, we can re-direct the conversation back to where credit is due. We can implore our institutions to hire and promote equitably. We can demand that policies include maternity rights. We must do our part to stop discrimination.
And it doesn’t matter if we are low on the totem pole and not in the upper echelons of leadership. We can find like minded colleagues and support one another in doing the right thing. Yes, our careers may be put at risk, but I guarantee we will find more men who are supportive of this than not. After all, our female colleagues wouldn’t hesitate to stick their necks out for us. Let’s show them that they are not alone in this. The future of healthcare depends on it.