ACR 2019’s Diversity Forum, entitled, “#MeToo Comes to Medicine: Transforming the Culture,” featured a talk by Reshma Jagsi, MD, DPhil, deputy chair of the department of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. The standing-room-only forum centered around the issues of gender inequities, including unconscious biases, gendered expectations of society, and overt discrimination and harassment.
Jagsi started the talk by establishing a baseline with the audience: diversity is good. “We know from considerable social scientific research that diversity promotes collective intelligence,” Jagsi said. “When we bring people together who have vastly different backgrounds and experiences, they actually interact in ways that make them more likely to solve problems.” It’s no secret that the medical field is lagging when it comes to diversity — and particularly in radiology, Jagsi said. She began investigating the issue more seriously when she noticed how many more men published than women in the medical field. “There’s something dysfunctional,” she said. “Something is happening that’s preventing women from ever reaching the point where they submit for publications.”
Jagsi’s research led her to discover example after example of this gender inequity. “Women aren’t entering radiology at the same rate as other specialties,” she said. And when they are, they’re getting paid less for doing the same work. Jagsi cited a study that showed a $12,000 discrepancy between male and female doctors even after controlling for productivity, specialty, and many other factors. Women are also disadvantaged in negotiations. “Women don’t ask. They don’t negotiate as aggressively as men — and if they do, they’re dinged for doing so.”
Then there are our deeply ingrained notions of gender roles, Jagsi said. She referenced a study in which groups of people were sent a single CV with all of the same information, except that one version had a man’s name at the top and the other a woman’s.2 Both the men and the women said the man’s CV was stronger despite no material differences in the content. “We have to continually be aware of our unconscious biases,” Jagsi said.
“We also have to acknowledge that we’re not playing on a level playing field,” Jagsi said. This is especially the case when it comes to caregiving responsibilities. “Women are far more likely to be responsible for child and elder parent care,” she said. In a study where participants were asked how they handle times when their usual childcare plans fall through (like a snow day or a sick child, for example), 43 percent of the women said they mostly deal with it themselves, versus 12 percent of men.
During the second half of her talk, Jagsi discussed sexual harassment and the ways in which it disadvantages and disempowers women. She cited a study in which, when asked the question, “In your professional career, have you encountered unwanted sexual comments, attention, or advances by a superior or a colleague?” 30 percent of the women indicated that they had. “This is a floor, not a ceiling for the rate of this experience,” Jagsi said. “And this is not without consequence. Sixty percent of those who experienced harassment had perceived negative effect on confidence in themselves as professionals, and nearly half reported that the experience negatively affected their career advancement.”
After publishing her studies, Jagsi heard from women who spoke of their harassment and their reluctance to tell anyone out of fear of being stigmatized or perceived as victims.
“Organizational psychologists have shown us that harassment is more common in historically male-dominated fields like medicine, where big power differentials and hierarchies exist,” Jagsi said. “It’s also problematic when institutions are perceived to tolerate the behavior. So there are a lot of challenges in our current system.”
“The first half of this talk was about gender equity, and the second half is about sexual harassment. And how do those two fit together? They fit together as a vicious cycle,” Jagsi said. Gender inequity creates an environment in which sexual harassment can occur, and sexual harassment then contributes to gender inequity, according to Jagsi. “So we have to break this vicious cycle.”
Jagsi recommended we learn from the social scientific studies that have been done on this issue for the past three decades. “What we have to do is we have to gather data specifically within each of our institutions and each of our specialties, both to inform interventions and to demonstrate that lack of institutional and organizational tolerance for these behaviors,” she said. “The act of gathering data demonstrates that commitment. We have to clarify our policies, because the lowest rates of harassment occur in organizations that proactively develop, disseminate, and enforce sexual harassment policy, and we absolutely have to address interactions with patients and families.”
It’s vital that we focus on equity, Jagsi said, because we have to change the very structures that are supporting harassment. “While we see many positive strides that are being made and we are on the right track, there is more work to be done. Ultimately gender equity has to be promoted through recognition and changes at the institutional level,” Jagsi said. “Having groups like your group here to promote conscious consideration of diversity and provide safe space for discussion of these issues is really important.” Jagsi suggests organizations like ACR share lessons learned and experiences as much as possible.
“We must employ women, promote more women, and integrate women into every level of the organization so we have what scholars have described as a ‘well-integrated, structurally egalitarian workplace in which women and men equally share in power,’” Jagsi said.5 “Time really is up and it’s not just in radiology, it’s across the board in medicine.”