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Gender harassment happens every day in health care organizations, academic medicine, research labs, and other corners of the science, technology, engineering, and math worlds. It’s largely hidden — except to those experiencing it — unlike its more egregious counterpart, sexual harassment, which often makes headlines.

The National Academies of Sciences, Engineering, and Medicine (NASEM) describe gender harassment as “verbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status.” It undermines women, exhausts and demoralizes them, and strips them of their motivation, eventually driving them out of the workforce.

As women physicians working in academic medicine, we know this firsthand.

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With five of our colleagues, we filed a federal lawsuit in 2019 alleging sex, age, and race discrimination by Mount Sinai Health System and four of its male employees, including the dean of the medical school. (Editor’s note: All the documents are public, and the defendants have denied any wrongdoing.)

As our complaint details, we left Mount Sinai emotionally and psychologically scarred after being demeaned by male leadership, denied promotions, underpaid compared to male colleagues, and systematically gaslit by internal reporting structures that were meant to protect us. We were demoted from leadership positions and assigned menial tasks, such as managing a Mailchimp subscription list. Some of us were ignored and frozen out of important work streams, and were forbidden to meet alone with longtime colleagues and mentors. Members of our group were referred to as “bitches” and “cunts” by our colleagues without any repercussions. Those are just a few of the forms of mistreatment we endured at Mount Sinai’s Arnhold Institute for Global Health.

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We believed that our hard work and years of service to the institution would protect us and allow us to be measured on our merits. Instead we struck the “iceberg of sexual harassment,” and it sank our careers.

A 2018 NASEM report on sexual harassment in academic sciences, engineering, and medicine introduced the analogy of an iceberg to describe harassment in these fields. Sexual assault and coercion are the visible and appalling tip of the iceberg. People recognize their severity and the personal damage they wreak, the media often cover these stories, and perpetrators are sometimes held accountable. Gender harassment, in contrast is the huge mass below the surface, largely unseen but nonetheless ruinous.

iceberg_infographic harassment
The National Academies describe sexual and gender harassment as an iceberg, with much of it hidden from view. National Academies of Sciences, Engineering, and Medicine

Women in health care rarely report harassment due to the risk of retaliation. Compounding this, the internal systems that should assist employees all too often make protecting perpetrators and institutional reputations their top priority. Our meetings with Mount Sinai human resources representatives were humiliating and degrading, providing neither safety nor protection, as we recount in our complaint. In one meeting, they referred to a book on “why women think they are being discriminated against when they are not.” Because of these systemic failures, the legal route was our only resort.

Since filing our lawsuit, we are seeing the enormity of the iceberg. Scores of doctors, nurses, staff, and medical students from Mount Sinai and other medical institutions in New York City and across the country have shared their experiences with us. We’ve heard of gaps in pay, lack of promotion, stolen ideas, retaliation for challenging male colleagues, sexualization of learning materials, sexual assault — the list goes on. A common thread is fear of retaliation, which is keeping women silent.

Sexual harassment is pervasive in health care, and gender harassment is the most common type of harassing behavior. It predominantly affects women, with women of color and gender minorities at particular risk. A 2016 study of academic medical faculty reported that 66% of women had experienced gender bias during their careers, and NASEM reported that up to 50% of female students surveyed during medical school had experienced sexual harassment by faculty or staff.

Mount Sinai’s own data reflect this nationwide problem. In a 2019 survey of its faculty, 25% of responding female faculty reported gender-related discrimination and 13% reported sexual harassment in the previous 12 months alone — data that, as detailed in our proposed second amended complaint, leadership scrubbed from the initial report that was released to faculty across the institution.

There are some signs of progress across the country. Time’s Up Healthcare, a nonprofit organization, has recruited 62 health care institutions nationwide so far to commit to core principles for equitable and safe workplaces. But signing a pledge is not the same as doing the work. Mount Sinai, which signed on four months after our lawsuit was filed, committed to “preventing sexual harassment and gender inequity and protecting and aiding those who are targets of harassment and discrimination.” Meanwhile, our experiences were being trivialized and discounted while the defendants in the case were allowed to remain in positions of power as the hospital continues to fight us in court. Today, seven of the eight plaintiffs have left the Arnhold Institute, most with careers derailed, while senior leadership publicly stated that our claims are without merit and that Mount Sinai will “vigorously” defend against them.

According to the NASEM report, “an organizational climate that communicates tolerance of sexual harassment” by “failing to take complaints seriously or to sanction perpetrators” is the greatest predictor for high rates of sexual harassment.

Supreme Court Justice Ruth Bader Ginsburg, whose loss we mourn, wrote in 2016 that, despite many advancements, “we have yet to devise effective ways to ward off sexual harassment at work and domestic violence in our homes.”

It is long past time to hold institutions accountable for their actions — or their lack of action. Foundational steps include creating mechanisms for confidential third-party reporting for people experiencing sexual and gender harassment, robust independent data collection on the incidence of harassment, and public reporting of the results.

Mapping out the base of the harassment iceberg may help fewer women be sunk by it. It will also help institutions recognize how big the iceberg really is.

More women in leadership positions will help propel that cultural shift. So will protecting women who speak out about gender harassment. And institutions need to be convinced that it is more expensive to harbor harassers than to change.

Change won’t be easy. It will take numerous strategies, including authentic discussion, public exposure, and, when necessary, using the law Justice Ginsburg did so much to advance.

Holly G. Atkinson is a clinical professor and medical student advisor at CUNY School of Medicine. Anu Anandaraja is a pediatrician, global public health educator, and founding director of Women Together Global Inc. Stella Safo is an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai and a strategic advisor at Premier Inc.

  • How sad to hear this about Mt Sinai.
    I believe you. I am an older woman in healthcare and have battled sexism for my entire career now to have to also deal with ageism. The latter is becoming more common and is never acknowledged as a prejudice, at least in my experience. How sad that as racism becomes unacceptable, or work culture replaces it with another form of discrimination.

  • 10 22 2020 Please, I have good news for you! You will soon see a major US Constitutional Amendment (#28) that can rise up to end much of the ugly behavior we thought might never end. Its name? The 100-year old Equal Rights Amendment. Many of us women (and men) will be much relieved when sexual harassment becomes an ugly act of the past. It was not an easy project, as there was much hard push-back to make especially us women and girls free to be.

    As a longtime Nurse Practitioner, I can attest to having my body parts snatched to humiliate me, even when the physician was in midst of a surgical case!
    Partly because of that and other instances of harassment during my long career, 21 long, nonstop Years Ago, I was one who with my “Allies”, who took up the yet-unpassed Equal Rights Amendment to our US Constitution with a determination that wouldn’t quit. Plainly, I could not bear the injustice of our sham “democracy” that left whole chunks of the American public without recourse for sex discrimination, male as well as female, but especially girls and women! I naively believed that at least the largest women’s groups would flock to the renewed Cause. I was run off the road in front of our home and issued public death threats! It has been a really tough road to follow. But eventually, and with the advent of the Womens Marches, MeToo movement and the disgusting implanting of the womanizer Kavanaugh, this Amendment began collecting followers! This, after my protesting and marching for this Amendment’s passage during the 1970s, and holding rallies everywhere, ceaslessly, it seemed. We did it unpaid, for 21 nonstop years. At the end, we of our National Equal Rights Amendment Alliance, Inc., 501c3 and thousands of others are proud. It did not just Happen. You can find out much more at our http://www.2passERA.org; please come aboard.

    While all this was going on, we of my National Equal Rights Amendment Alliance Inc., realized that the “Other Political Party’s” future hard objection to its passage could be a stumbling block, four of us created and got launched the first such bill to remove that. We are still working hard at that while we created our own counter-lawsuits to fight off hostage-taking of our long efforts. It’s now SJR 6, struggling through the Other Party Driven US Senate, and we Must Win especially our female case against them by making our case one of demand for Equal Treatment for all on the basis of our Senate bill making sex discrimination, male or female, a Violation of the US Constitution that tends to injure all females’ right to be free of sexual harassment, unequal wages for the same work hours, rape, etc.(see our list of what changes once this Amendment is activated upon being allowed to be codified in our Constitution.

    In short, we are proud, if exhausted with our penurious and taunted work for Justice that gives women cited here, above, and all others, the right to sue for damages based on types of assaults men dare now to commit. Including all those that are mentioned in the main story here, and more!

    Long and the short of it is that we of Natl ERA Alliance Inc, and the thousands of others partnering in this history-making are Proud to offer you this desperately needed strong Constitutional support. All of us now just await the outcomes of the various suits, one of which whose verdict was that essentially NO, that we women “have no standing”!!! to complain that we especially have no Constitutional protections from companies or men who may know that they can perpetrate any kind of sexual abuse they wish…because they used to know that we had no recourse whatsoever ! But they will soon learn otherwise. We can actually even use the offhand untrue device of “no standing” as true testimony that THE CONSTITUTION DID NOT PROTECT WOMEN, despite the first faulty decision ITSELF, leaving us females and some males without humane protections by the courts! But we forge on as we have.

    I am now 86 years old, still giving nationwide speeches and writing extensively about the benefits to men and women of codifying this Amendment IN our Constitution. Meanwhile working alongside the now hundreds of thousands in agreement as “Allies” against this obviously sexist court decision, I refuse to die before this fine Amendment #28, the newest Amendment, is added to our Constitution as is required by it!

    (Yes, we are now Broke, but NOT broken. All who are interested in speeding up this process with your simple check Donation at our http://www.2passERA.org are invited to read also there our 11 ERA TALKING POINTS that point up that there are notable economic gains in GDP, and gains for politicians when they vote for SCR 6!

    There are no similar gains in maintaining the status quo.

    Cheers, Dears, the Best is Yet to Come. Finally!

    Sandy Oestreich, Pres., National Equal Rights Amendment  Alliance Inc. 501c3, 300 000+ corporate members, etc. Partnering with 3 other nationwide ERA organizations in solidarity; Prof. Emerita at Adelphi U.NY; Fmr. elected official
    Co-author, internationally distributed pharmacology reference text
    Nationally certified Nurse Practitioner of 35 years; and Clinical Nurse Specialist
    Member, 3 Nurse Practitioner professional organizations
    Headed a Free Clinic for Seniors; worked for a NY City Hospital clinic
    Brought lawsuit, Atty. Marcia Cohen (and won) vs a local Florida Hospital located on Pinellas County land for actions that abrogated 1st Amendment Church-State separation. One of only two such successful actions in USA
    Biographied in Feminists Who Changed America
    Nat’l ERA Alliance, is a Lead Organization of the nat’l ERA Coalition,
    Member, national ERA Action
    Member, Vision2020, Advisory Board-for women’s empowerment
    2016 Nominee, “WOMEN’S SUMMIT”, DC
    2015 Finalist, St Petersburg FL “Best Nonprofit Business”
    2014 Recipient, AAUW/FL “Woman of Distinction”
    2012 Recipient, County LWVoters Susan B. Anthony”Failure is Impossible”award
      Fbk: Pass the Equal Women’s Rights Amendment  Twitter: @SandyO   SandyO@passera.org
    Wife and mom
    http://www.2PassERA.org (renovation nearly complete–Go See!) 

  • Thank you for writing this. The “under the water issues” are the types of comments and actions that we describe in faculty development and Dean’s Rounds at the FSU College of Medicine to educate faculty and students and prevent occurrences but both teaching about it and holding faculty perpetrators accountable is necessary. Techniques learned from restorative justice and other preventive measures will lead to this change and I am confidant academic medicine is on a corrective arc here in Tallahassee at least.

    • A female faculty member wrote a book on her experiences there back in the late 90s, which is mentioned in the article.

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