Sharing the Pain of Women in Medicine...

I recently learned that a doctor friend had seriously considered quitting her job at her medical school to go into private practice. As long as I have known her, she has talked about her love for teaching new doctors and conducting research while still caring for patients. Nonetheless, I wasn’t surprised to hear the reason she wanted to leave.

“I got tired of being a woman in academic medicine,” she said.

She recounted how, much more than her male colleagues, she would be assigned to work during major holidays, cover for others’ absences and sit on administrative committees that took time away from the research required to advance her career. When she spoke to her chairman about the discrepancies, he listened — but never responded to her repeated requests for a raise or more support.

What surprised me, however, was what finally persuaded her to stay. When she described her situation to some male colleagues, they listened attentively, then began relaying their frustrations with how little support they got from superiors.

“It’s hard being a woman here, but I concluded it’s not that great for anyone else either,” she said.

Sadly, her assessment seems to be correct, according to a recent study on the experiences of women and men working in medical schools.

Academic medical centers — institutions that have as their primary mission the training of new doctors, medical research and comprehensive clinical care – have long played a crucial role in how medicine is practiced in the United States. While historically most doctors were men, medical schools began broadening their admissions policies a little over a generation ago, so that women soon made up anywhere from a third to half of all students and trainees and an increasing percentage of the professors.

But in 2000, a landmark national survey of those working in these institutions revealed that gender bias was widespread. More than half of the women professors surveyed reported being discriminated against or sexually harassed, even as most of their male colleagues believed that such disparities in their institutions did not exist. Other studies found that women faculty memberscontinued to make less money than their male peers, werepromoted more slowly and even fared worse in academia’s most revered expression of meritocracy, the peer-review process.

Some researchers attributed the persistent issue to a “pipeline problem,” insufficient numbers of senior level women in medicine, particularly in certain specialties like surgery. Other experts postulated that women were more sensitive to unfair treatment because they tended to be more relationship-oriented than their male colleagues. Still others offered up what amounted to a tautological zinger: by choosing not to leave academic medicine, women simply had more opportunities to experience harassment.

The latest study, conducted as part of the National Initiative on Gender, Culture and Leadership in Medicine and published in The Journal of General Internal Medicine, offers another reason for women’s discontent in academic medical centers: the organizational culture, or the norms of behavior and implicit values of these institutions. And it’s not just women who are feeling demoralized.

The researchers administered a 20-minute questionnaire to over 2,000 faculty members at more than 25 academic medical centers and asked if their work energized them, if they felt ignored or invisible, if they felt pressure to be more aggressive or compromise their values and if their institution promoted altruistic and public service values.

As in earlier studies, more women than men felt marginalized and discriminated against, despite being as ambitious and engaged in work as their male colleagues. Many of the women also described a lack of trust in their institutions or little confidence that the discrimination they were experiencing would ever be addressed.

But both women and men expressed similarly negative feelings about a lack of support from their institutions for their work. And the men were just as likely as the women to feel what experts have termed “moral distress,” a sense of being trapped and forced to compromise on what one believes is right or just.

“We have this dehumanizing organizational culture in academic medicine that doesn’t allow people to realize their potential or be as vital and productive as they can be,” said the lead author, Dr. Linda H. Pololi, a senior scientist at Brandeis University who is also the director of the initiative. “It’s hard to ignore the far-reaching consequences of a work environment that has trouble modeling compassion and care.”

Based on this study and their earlier work, Dr. Pololi and her initiative collaborators have begun offering mentoring programs for faculty members, both female and male, at a handful of medical schools around the country. The program involves reading, writing and regular group exercises and discussions aimed at developing leadership skills and promoting a more open environment. In the Department of Medicine at Weill Cornell Medical College, a preliminary survey has shown that the mentoring program, which has just begun its third year at the school, has already helped to increase the degree of trust among faculty members.

While it remains to be seen whether these changes will endure, it has become clearer that men, as well as women, stand to benefit from any improvement. “It is shocking that the situation for women in academic medicine hasn’t changed that much in the last 10 years,” Dr. Pololi said. “But it’s not always easy to notice the quality of an organization’s culture.”

She added: “That culture is like the air we breathe or the water that fish swim in. It has the potential, for better or worse, to affect everybody in the same way.”

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