In #MeToo era, ‘blind spots’ persist in endocrinology, clinical sciences

Felicia Hill-Briggs

ORLANDO, Fla. — As the #MeToo era brings a heightened awareness to endocrinology, academic medicine and the clinical sciences, key gender disparities and reports of harassment continue to persist, challenging everyone to work harder to tackle the issue, according to two speakers here.

In a 2017 survey of 14,405 medical students attending American medical colleges published May 1 in JAMA, 14.8% of students reported having been subjected to offensive or sexist remarks, 4.3% reported unwanted sexual advances during medical school, and 5.8% reported believing they had received a lower grade or evaluation solely because of their sex, Elizabeth Seaquist, MD, director of the division of diabetes, endocrinology and metabolism and vice chair for clinical affairs in the department of medicine at the University of Minnesota, said during a symposium at the American Diabetes Association Scientific Sessions.

“It’s clear there is a gender gap in clinical sciences, and academic centers can develop successful interventions to close this gap,” said Seaquist, who also is the 2014 president of medicine and science for the ADA. “Sexual harassment does impact job satisfaction, productivity and health, and we need to address this and we all need to take this on.”

Seaquist said women are entering academic medicine — and moving through the ranks — in greater numbers than ever before, but advancement continues to be disproportionate vs. men. Similarly, salary equity has improved for women, but men continue to be paid more than women at many institutions, likely a reflection of men moving through the ranks in greater numbers.

“We have an opportunity to think about what things, other than professional development programs, that we need to think about in order to enhance the environment for junior faculty women trying to be successful in clinical sciences,” Seaquist said.

Impact of female gender

In the behavioral health disciplines, women continue to make up the majority of providers, according to Felicia Hill-Briggs, PhD, ABPP, president of health care and education for the ADA and a professor of medicine, health, behavior and society, and acute and chronic care at Johns Hopkins University School of Medicine. These include nursing (83% women), nutritionists and dietitians (91% women), psychology (70% women), social work (82% women) and health education professions, such as certified health education specialists, in which gender data are not currently available.

In these woman-dominant professions, Hill-Briggs said, gender disparities are felt on a greater scale.

“We’re not experiencing the impact on an individual level,” Hill-Briggs said. “Instead, we see the patterns of gender bias and inequities that occur on a discipline level. These disciplines tend to be assigned a lower priority status and value within academic medicine. Women in these professions as a whole have lower salaries and lower promotion rates in academic medicine. These professions, even though they have individual programs, licensure and certifications, still tend to be given physician oversight — even if the physicians do not have expertise in those disciplines.”

These biases, Hill-Briggs said, are additive with characteristics, such as race, and qualifications, such as PhD vs. MD.

“In order to achieve our scientific and health care goals for diabetes, it will be important for us to examine and be aware of these biases, and to overcome or ameliorate these biases, in order for our patients to receive an optimal benefit from these disciplines,” Hill-Briggs said.

Recognizing ‘blind spots’

Seaquist recalled a moment in 1989 when she was discussing her new faculty position coming out of fellowship with a soon-to-be boss. She learned her salary would be $70,000 — about $20,000 lower than the salary for men in the same position, she said.

“‘You have a husband to support you, so you really don’t need as much money as a man.’ True words,” Seaquist said. “And I was just gobsmacked. I couldn’t even speak, I was so surprised. I was just so grateful to have a job, I said, ‘Well, I guess I should be happy to have a job that lets me do research.’”

Today, Seaquist said, she would approach such a meeting very differently.

“I hope, now that I have a better insight into blind spots, that if this happened in 2018, I would say, ‘Sorry. That isn’t what the [Association of American Medical Colleges] says is the salary I should expect for my position in this part of the country and having a husband should have no bearing on my salary,’” Seaquist said.

Other, everyday blind spots persist in medicine today, Seaquist said: a man receiving praise in a meeting for a suggestion a woman made before him, a woman passed over for a promotion because she seems “so busy” or a male colleague expressing relief that a female colleague is “so much more reasonable” than the other women in the department.

The effect of unconscious bias or harassment can be surprising, Seaquist said. Research suggests those subjected to such biases or harassment report lower job satisfaction, withdrawal from the organization, tend to have lower commitment to the organization and experience reduced productivity.

“These are clearly things you do not want to have happen to our faculty,” Seaquist said. “In addition, there are mental and physical health consequences for people. These are measurable outcomes that come from environments where there is sexual harassment.”

In June, the National Academy of Sciences issued a 311-page report on sexual harassment of women and the climate, culture and consequences in academic sciences, engineering and medicine. The report, Seaquist said, outlines 15 recommendations to improve workplace culture, including moving beyond legal compliance to address culture and climate, improving transparency and accountability, striving for strong and diverse leadership, and making the entire academic community responsible for reducing and preventing sexual harassment.

Additionally, Hill-Briggs said, several “elements of success” are key to move forward in a culture where remnants of gender disparity still exist, including what she called “thick skin.”

“You’re going hear and see — and overhear — things that we think shouldn’t be said or done, but they are,” Hill-Briggs said. “Be aware of institutional channels for accountability. Have a mentor and be aware of what is happening not just at your institution, but outside. Proactively seek leadership because it is rare that women are approached in these disciplines for leadership and create new opportunities for leadership.” – by Regina Schaffer

Reference:

Seaquist ER, et al. Overcoming gender gaps in science. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.

Disclosures: Hill-Briggs is president of health care and education for the ADA. Seaquist reports she is a consultant or serves on an advisory panel for 360 Consulting, Eli Lilly, InfoMed, Novo Nordisk, Sanofi and Zucera.