Sexism, Harassment, and Women in Anesthesiology

  • Agarwal, Rita, MD, FAAP, FASA
| Jan 08, 2018

Agarwal-RitaIt seems that almost every day there is a new revelation about a powerful man committing some horrible, criminal, bizarre, or at the very least, stomach-turning act of sexual misconduct. Harassment and even assaults seem to be rampant. Time magazine’s editors awarded the “Silence Breakers”, the women who spoke up about their harassment, their coveted title of 2017 Persons of the Year.

The national conversation is loud and relentless. Most news stories have focused on famous men in politics and entertainment committing sexual misdeeds, but the truth is that this type of behavior is pervasive in many environments. Lately, the lay press, medical blogs, and social media have featured articles on how hard it is to be a woman in medicine. While overt sexual harassment may be rare, prejudice, bias, and micro-aggression seem to be common.

I am part of the generation of women who started medical school in the 1980s. The women I knew were fearless, ambitious, strong, and believed firmly in our equality. We suspected that we would need to work at least twice as hard, and be twice as smart, to get the same level of recognition as some of our male colleagues. We expected and prepared for bias, harassment and possibly even misogyny. We assumed we could deal with it, and looked to our predecessors for examples of how to cope. 

We were lucky; we weren’t the first to forge new entryways into the House of Medicine. Although we were still a minority, women in the 1980s entered medicine in increasing numbers. Approximately 30 percent of all medical school admissions at that time were women. We had some, although not an abundance, of role models, and some, although not an abundance, of support.

I didn’t realize it at the time, but I was luckier than many. I had supportive classmates and faculty (both male and female) throughout my training and career. I had a progressive, forward-thinking, and brilliant residency director who celebrated pregnancy and life, and never made any female resident feel bad for “screwing up the schedule” by getting “knocked up, grumble, rumble, mumble…curse words…damn women in medical school.” In fact, I didn’t realize that my program was not the norm until later, and after discussion with others.

So, what has changed? Unfortunately, not much. The issues women faced 30 years ago appear to be the same now. Despite the fact that women now constitute 50 percent or more of entering medical school classes, they still hold a minority of leadership positions nationally.  

How is that possible? There are plenty of articles by erudite writers who have addressed this topic. Is it that that we don’t “Lean In” enough? That women still carry a disproportionate load of the household chores and child rearing duties? Is it because, on average, women physicians work fewer hours in hospitals or clinics than men physicians? Or that a greater percentage choose to work part-time? All of the above? None of the above?

Is it because many of us still get mistaken for nurses, even after repeatedly introducing ourselves as Doctor? Or, if you are a woman of color, because people may presume you are a nurses’ aide or housekeeper? I still chuckle at the memory of the time I was talking to a family post-operatively about how their child fared during the anesthetic, while another family kept insistently trying to get me to clean up some vomit in a nearby trash can! Ah... good times.

A recent article in the Wisconsin State Journal reported on the results of a survey, taken in the University of Wisconsin-Madison Department of Anesthesiology, showing that the work environment for women there is still challenging. Women were often given less desirable assignments, less responsibility, and fewer leadership opportunities. Women anesthesiologists at the Children’s Hospital, though a larger number occupied leadership roles, were “infantilized”, the report said. This article was posted widely on women physicians’ Facebook groups, and created a great deal of conversation and controversy. Many agreed that the findings applied to their practices, while others were grateful to have leadership that is more forward-thinking and supportive.

The popularity and explosion of the Physicians Mom’s Group, Physician Anesthesiology Mom’s Group (PAMG) on Facebook, and Women in Anesthesiology (WIA) Committees have helped fill voids that most of us knew existed, but didn’t know how to correct. Studies from the business world have shown the benefits of having women as part of product design and marketing groups. There are several studies in medicine showing that women physicians (both surgeons and internists) have better outcomes and lower mortality rates than their male colleagues. Despite this, if a female surgeon has a bad outcome, it has a profound negative effect on her subsequent referrals from other physicians, and also lowers the chance that those physicians will ever make a referral to another female surgeon!

We’ve got a long way to go, baby.

One thing that I have learned from the PAMG and WIA groups is that success and leadership come in many different sizes and forms. Just because a person chooses to cut back hours, or work part-time for a while, that does not eliminate the prospect of leadership opportunities or academic success. It is not all or nothing. It may take some people longer to achieve “success”, but they will accrue other rewards and have different adventures along the way. Everyone should feel supported in their choices.

We all need good mentors, sponsors, advisors, and friends. This is true for all genders, but often much harder for women to find. We in California are incredibly lucky in that we have many outstanding men and women in leadership roles. For young physicians looking for leadership opportunities, looking outside your group, institution or practice can be extremely rewarding and effective. The CSA leadership has both male and female role models. As a junior faculty or newly practicing anesthesiologist, if there are no mentors/advisors/supporters in your home institutions, look elsewhere. Get involved with other organizations; volunteer to help with your local CSA districts or a CSA committee. Complete your tasks well and in a timely manner, then volunteer for more. In medicine, we rarely encounter the same kind of harassment or assault that people in big business, politics, or the entertainment world may face. Our path to success is often as simple as showing up, working hard, being reliable, and making the most of opportunities.

As the motto from my son’s high school says, “We are all in this together.” Let’s start acting that way.

With Thanks to Dr. Karen Sibert for her help and expert editing. 

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