Female doctors are calling for safer and more equal workplaces for the benefit of the workforce and patients

TIME’S UP Healthcare launches today with a mission to ensure that our healthcare workplaces are safe, equitable, and dignified. It is launching at unique time in history. In 2017, the Association of American Medical Colleges (AAMC) reported that there are more women entering US medical schools than men for the first time ever. A year later, the National Academies of Science, Engineering and Medicine (NASEM) published a report on the culture of sexual harassment in academic institutions. [1] This report that found that sexual harassment is extremely common across all scientific fields, with the highest prevalence in medicine. [2] Nearly 50% of medical students experience gender harassment before they even started their careers as physicians. [3] In addition, over a quarter of nurses have experienced sexual harassment, over a third have been physically assaulted in the workplace, and almost two thirds have experienced verbal abuse. [4]

TIME’S UP Healthcare has been founded by 50 women and over a dozen advisors. It includes a diverse group of women in leadership roles throughout US medicine, nursing, pharmacy, research and healthcare administration. It is affiliated with TIME’S UP, an organization with partners across various industries all committed to working within their areas to drive change and promote equity. TIME’S UP Healthcare’s diversity extends beyond job titles to include representation across race, ethnicity, sexual orientation, and gender identity. The primary goal is to raise awareness about gender inequalities and sexual harassment across healthcare workplaces, and to create a call to action for organizations—and key leadership within these organizations—to address these systemic problems. [3 – 5]

TIME’S UP Healthcare focuses not only on sexual harassment, but also on gender discrimination in healthcare workplaces. [6,7] Since unequal power dynamics are at the root of both harassment and discrimination, these problems are even worse for women from ethnic minorities or for those women belonging to other marginalized groups. One of the clearest manifestations of gender discrimination is compensation. On average, female physicians earn less than men, even after controlling for education, experience and productivity. [8] This is true across healthcare professions. For example, although almost 90% of registered nurses are women, the average salary of male nurses is $5,000 higher than female nurses. [9]

It is important to note that TIME’S UP Healthcare differs from other TIME’S UP initiatives in three key ways. Firstly, healthcare workers are at risk of harassment not only from colleagues or supervisors, but also from patients. In a recent survey of 790 physicians, the perpetrators of harassment were often reported to be patients (32%) or relatives of patients (11%). [2] This creates the inevitable tension of balancing healthcare providers professional role in caring for patients, with their personal need for safety. The potential downstream impact of this tension on the mental health of healthcare professionals, burnout rates, and career satisfaction warrants further study. [10,11]

Secondly, many healthcare workers specialize in provision of direct physical and mental health care to people who have suffered from sexual harassment or assault. This makes them knowledgeable about the resources available and support systems.  As experts in evidence-based treatment, we are uniquely positioned to add to the dialog and work on systemic solutions to address sexual harassment in our own workplaces, and beyond.

Thirdly, solving the problems of gender inequity and harassment in the healthcare workplace has potential downstream benefits not just for the individual women affected, but also for the healthcare system and the patients served.  Diversity in the workforce has been shown—again and again—to benefit creative pursuits in research and patient care. Having women as equal partners in this healthcare setting will mean that the providers more accurately reflect their patient population, and delivery of innovative, high quality, and patient-centered care will improve. TIME’S UP Healthcare is not only an opportunity to support working women in healthcare settings, but also ultimately strives to improve the care their patients receive.

Today’s launch of TIME’S UP Healthcare will no doubt raise awareness about the challenges that women working in healthcare face. But awareness is not enough. It is time for systemic solutions to address gender disparities in the healthcare workforce.  The time is now. We owe it to our patients, to our colleagues, and to our profession as a whole.

Rhonda Acholonu, is a co-founder of Times Up healthcare and an Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA @DrRGAcholonu

Christina Mangurian is a founding member of Times Up healthcare and a Professor of psychiatry at the University of California, San Francisco and the Weill institute for Neurosciences, USA @CMangurian

Eleni Linos is a professor of Dermatology and Health, Research and Policy at Stanford University, USA @linos_eleni

Competing interests: None declared

References:

1] National Academies of Sciences, Engineering, and Medicine 2018. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press. https://doi.org/10.17226/24994
2] Jenner S, Djermester P, Prügl J, et al.Prevalence of Sexual Harassment in Academic Medicine. JAMA Internal Medicine 2019;179:108. doi:10.1001/jamainternmed.2018.4859
3]Jagsi R. Sexual Harassment in Medicine — #MeToo. New England Journal of Medicine 2018;378:209–11. doi:10.1056/nejmp1715962
4] Nelson R. Sexual Harassment in Nursing. AJN, American Journal of Nursing 2018;118:19–20. doi:10.1097/01.naj.0000532826.47647.42
5]Choo EK, Dis JV, Kass D. Time’s Up for Medicine? Only Time Will Tell. New England Journal of Medicine 2018;379:1592–3. doi:10.1056/nejmp1809351
6] Choo EK, Byington CL, Johnson N-L, et al.From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? The Lancet 2019;393:499–502. doi:10.1016/s0140-6736(19)30251-x
7]Halley MC, Rustagi AS, Torres JS, et al.Physician mothers’ experience of workplace discrimination: a qualitative analysis. Bmj Published Online First: 2018. doi:10.1136/bmj.k4926
8] Jena AB, Olenski AR, Blumenthal DM. Sex Differences in Physician Salary in US Public Medical Schools. JAMA Internal Medicine 2016;176:1294. doi:10.1001/jamainternmed.2016.3284
9] Muench U, Sindelar J, Busch SH, et al.Salary Differences Between Male and Female Registered Nurses in the United States. Jama2015;313:1265. doi:10.1001/jama.2015.1487
10] Viglianti EM, Oliverio AL, Meeks LM. Sexual harassment and abuse: when the patient is the perpetrator. The Lancet2018;392:368–70. doi:10.1016/s0140-6736(18)31502-2
11] Girgis C, Khatkhate G, Mangurian C. Patients as Perpetrators of Physician Sexual Harassment. JAMA Internal Medicine2019;179:279. doi:10.1001/jamainternmed.2018.7974