t’s 2018. We’re in the wake of the #MeToo moment. Increased reporting is exposing rampant sexism in medicine, media, and beyond. Women are now more empowered than ever to speak up in response to bias and harassment. One could think we’ve come a long way.
And yet, for all our expressed outrage at widespread sexual harassment and our newfound “wokeness” about gender equity, we still find ourselves confronting sexism in what we perceive to be the most progressive, sophisticated spaces.
That was driven home at the Aspen Ideas Festival, where two of us (E.M. and N.N.) were honored to be part of a panel discussing the growing epidemic of clinician burnout in the United States. Needless to say, the room was occupied with accomplished, highly educated individuals.
Which is why, when a question from a member of the audience — an experienced female emergency pediatrician — elicited a comment from moderator and NBC correspondent Dr. John Torres, also an emergency room physician, about her being “good-looking” — jokingly referring to E.R. doctors as attractive — we laughed it off. She continued with her question and the session moved on. And there we sat, in a room infused with well-worn complicity. No one said a thing about the comment.
It was both ironic and fitting that in a session dedicated to the issue of burnout and the drivers of clinician dissatisfaction, Torres’ casual sexism did more to illustrate why so many health care providers — particularly women — feel isolated to the point of depression and suicide. Sexism, power, and a culture of silence is precisely part of the problem. Unbeknownst to him, Torres had hit the nail on the head with his comment.
Later, we raised our concern privately in a phone conversation with Torres, who welcomed what could have been a hostile exchange with both humility and interest. And as we spoke about his time in the media, military, and health care, and how those male-dominated cultures affected him, we also spoke about his daughter, now a medical school student, and how a culture of misogyny in medicine affects her. It was the conversation we should have had in Aspen — that we all need to have when confronted with sexism.
A landmark report published this month by the National Academies of Sciences, Engineering, and Medicine paints a damning picture of sexual harassment faced by women physician trainees and faculty. The 300-page report reveals that the academic workplace has the second-highest rate of sexual harassment (58 percent) when compared with private sector and other workplace environments.
Of the many disturbing quotes from respondents to the National Academies survey, several underscored the systemic and perpetuating nature of the issue, like this one by a young resident: “I still don’t think that the prospect of being sexually assaulted was as bad as watching the next generation of sexual harassers being formed. I think that was the worst part for me.”
In addition to their exposure to sexually harassing behavior as a training and occupational hazard, according to a Medscape report, female physicians have significantly lower wages than their male counterparts. Equally staggering is the minuscule percentage of women who have advanced to leadership positions within medicine compared to men. Similar discrepancies affect people of color and LGBTQ communities. So it seems that even in a field such as health care, which prides itself on evidence, science, and progress, we still miss the mark when it comes to gender issues, cultural diversity, and human equity.
As women, people of color, and members of the LGBTQ community, we’ve learned to silently swallow micro- and macro-aggressions in professional areas dominated by straight, cisgender, white men. We’ve done this despite being aware that for all of these groups, discrimination in the workplace still afflicts approximately 40 percent of individuals. We bite our tongues — not only because we know that a flash of passionate conflict could jeopardize our physical and emotional safety and our professional reputations, but at the end of the day it just feels futile when our calls for action are ignored, buried, or dismissed.
With the fear of being labeled as the woman, the minority, or the gay clinician, we “take the high road” by staying silent and pretending we don’t internalize it. As noted by an assistant professor of medicine in the National Academies report, we don’t want to be “labeled as the troublemaker.”
After the burnout session at the Aspen Ideas Festival, a few folks in the crowd approached us to apologize for their silence. We, too, apologized. The collective silence had hurt us all.
During the closing ceremony, a moderator again brought gender into the dialogue in his interview with Sen. Cory Booker. We had spent the prior 30 minutes listening to filmmaker Ava DuVernay and activist Ai-jen Poo celebrate the powerful role of women as catalysts for social change. After a question about Booker’s opinion of White House press secretary Sarah Huckabee Sanders, the moderator quipped that perhaps Sanders had “a crush” on Booker.
Again, we all laughed. No one seemed to bat an eye at the inappropriateness of the remark.
Make no mistake about the antagonist here. This isn’t the fault of a host or a white man or a conference. Indeed, we’d be well-served with more Aspen Ideas Festivals.
But these remarks and microaggressions are proxy measures of the power and discriminatory culture permeating personal and professional spaces. What we need is for people to listen, to initiate conversations, to be OK with discomfort, to be honest when they mess up, and to challenge each other to do better and do differently.
At the Aspen Ideas Festival, we didn’t quite get there.
We did, however, learn something about ourselves that we hope we all take home.
To the physician who raised your hand during our session on burnout, we apologize for our silence and thank you for your contributions to the field of medicine. And to Dr. Torres, thank you for your willingness to engage with us as we developed this article. We’re all in this space together, and grateful that when mistakes are made, we have an opportunity to learn from and with each other.
Together, let’s break some more glass ceilings — and break the silence.
Elizabeth Métraux is director of external affairs for Primary Care Progress. Nicolas Nguyen, M.D., is director of physician experience at Beth Israel Deaconess Health Care. Kelsey Priest is a fifth year M.D./Ph.D. student at Oregon Health and Science University.