Oncologist outlines how to navigate through toxic work environments
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Pamela L. Kunz, MD, spoke at the Women in Medicine Summit meeting about navigating a toxic work environment, sharing a mix of her personal journey, concrete data on harassment and steps toward a solution.
In her presentation, Kunz — associate professor of medicine and oncology, director of the Center for Gastrointestinal Cancers and vice chief of Diversity, Equity and Inclusion at Yale School of Medicine, as well as a Healio Women in Oncology Peer Perspective Board Member — sought to use her own story as a “case study in gender discrimination” while also exploring what recent literature has illuminated.
“Talking about this, I am definitely out of my comfort zone,” Kunz said. “I am usually more comfortable with the scientific presentations, but I am going to be vulnerable in hopes of empowering other women and enacting real change.”
Her experience
Kunz explored parts of her early career up to the last few years in which she had held the roles of fellow, instructor and assistant professor at Stanford University, before moving to a position as an associate professor at Yale University in 2020. She stated that although she had a lot of success during her time at Stanford, things began to change, and she found herself in a toxic work environment.
“To be completely honest, it took me quite off-guard, because I didn’t recognize what the problem was, and it took me a while to even acknowledge there was a problem,” she said. “I had grown accustomed to the hierarchical nature of medicine and the power differential, the male-dominated leadership structure and the narcissistic behavior of colleagues, especially leaders.”
She continued that, by mid-career, she was experiencing all of this and other micro-aggression regularly. She felt alone, demoralized, had lost confidence and felt stuck in a cycle of negativity.
Defining the toxic work environment
Kunz moved next to breaking down the causes, characteristics and consequences of a toxic work environment.
Factors that lead to a toxic work environment include gender discrimination, bullying, ostracism, racism, disrespect, ageism, incivility, blame, ableism and cultural insensitivity. Aspects that contribute to this are isolation, hierarchy, lack of role models, lack of accountability, unconscious bias, lack of allies, loss of autonomy and narcissism.
The consequences from these factors can lead to issues with mental health, depression, stress and anxiety, job turnover, burnout, loss of productivity and even a loss of talent throughout the medical field.
Kunz noted that women can face the worst of this at the mid-career point.
“Superiors pay attention to women at the early stages of their career, when they are young, less accomplished and less threatening,” she said. “As women gain experience and accomplishments, they are often dismissed and marginalized based on gender stereotypes. There are many factors at play including bias, macro- and microinequities, pregnancy and motherhood discrimination, and sexual harassment.”
Kunz quoted data that showed the academic workplace has the second-highest rate of sexual harassment at 58% — second only to the military at 69% — and that nearly 50% of medical students experience sexual harassment from faculty or staff.
The ‘iceberg of sexual harassment’
Kunz presented a representative concept she referred to as the “iceberg of sexual harassment,” in which a small amount of discrimination is clearly visible and recognized while a majority is often unseen if not ignored.
“Sexual coercion is the peak of the iceberg outside of the water,” she said. “It’s visible to everyone and what we traditionally think of as sexual harassment and sexual misconduct. However, unwanted sexual attention and gender harassment are often underneath the water — verbal or physical sexual advances. Gender harassment can also include both verbal and nonverbal behaviors that convey hostility and objectification related to one’s gender.”
A 2018 report from the National Academies of Sciences, Engineering and Medicine took a look at “what was in the water.” Workplace factors that silence targets of harassment include dependence of advisors and mentors for career advancement, the system of meritocracy that does not account for declines in productivity and morale, the “macho” culture in some fields, and the informal communications network through which rumors and accusations are spread.
The report also identified five conditions under which sexual harassment is likely to occur: Perceived tolerance for sexual harassment, male-dominated work settings, hierarchical power structures, symbolic compliance with Title VII and Title IX, and uninformed leadership.
Other published literature showed that burnout is a key mediator between a toxic work environment and job productivity.
“I started diving deep into this literature, and disparities for women in medicine have been shown in authorship, in leadership and in speaker positions,” Kunz said. “They have also been demonstrated in rank and salary.”
Getting unstuck
Kunz said that as she was learning the practice of equanimity, she realized the need to put her frustration toward “moving forward and being part of the solution.”
She defined five categories that are integral to fighting discrimination and ultimately dismantling these toxic environments: Research, education, advocacy, connection and healing. She addressed the latter personally.
“I learned the value of, what my executive coach calls, ‘aggressive self-care’ through nutrition, exercise and time-management,” Kunz said. “It’s not always in perfect balance, but it’s something I always strive for.”
Kunz said that she ultimately felt a call to create a respectful, inclusive and collaborative workplace and do what she can to help dismantle some of these disparities.
“It took me 49 years to find my voice, but now that I found it, I’m going to use it loudly,” she said.
Kunz concluded that “we need to start with data collection, educational initiatives, advocate and ally training” to develop excellent systems of accountability and respectful workplace initiatives.
References:
- Ilies R and Hauserman N. Person Psychol. 2006;doi:10.1111/j.1744-6570.2003.tb00752.x.
- National Academies of Sciences, Engineering, and Medicine. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2018.
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Kunz PL. Navigating a toxic work environment. Presented at: Women in Medicine Summit; Sept. 24-25, 2021 (virtual).
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