The disproportionate impact of harassment and cyber incivility on women in academic medicine

In a recent editorial in the Journal of the American Medical Association, Pamela Douglas, MD, cardiologist and past president of the American College of Cardiology (ACC), wrote: “Unfortunately, the evidence is overwhelming that respect is often lacking in medicine and science and discrimination is common.”^[]

Women in medicine know this all too well, and this was confirmed by the recent study on workplace harassment and cyber incivility (or, incivility occurring by online/electronic means), also published in JAMA, that prompted Dr. Douglas’ editorial.^[]

High rates of harassment and incivility in academic medicine

The JAMA study focused specifically on the culture in academic medicine and how it relates to the mental health of faculty. In a survey of 830 US medical faculty members who had received National Institutes of Health (NIH) career development awards from 2006–2009, the authors found high rates of sexual harassment, cyber incivility, and negative organizational climates in academic medicine, specifically.

Seventy-two percent of the women surveyed reported experiencing sexual harassment, in the form of sexist remarks and crude behaviors, and 6.4% had experienced it via social media. Women were also more likely than men to encounter cyber incivility in emails, including receiving remarks perceived as hurtful, demeaning, or derogatory.

In terms of cyber incivility, LBGTQ+ respondents reported experiencing more sexual harassment than heterosexual and cisgender respondents when using social media professionally (13.3% vs 2.5%).

Of note, these issues disproportionately affected other minority groups as well. Asian respondents were more likely than White respondents to have racist comments directed toward them when using social media professionally (21.2%), while this was true for 25% of respondents from other underrepresented groups in medicine (which the researchers defined as “race and ethnicity other than Asian or non-Hispanic White”).

The mental health toll

This study was the latest to highlight what has been shown to be a widespread problem in both medicine and science. For instance, a survey of the entire NIH workforce, with approximately 16,000 respondents, found that more than half of respondents had experienced workplace incivility in the past year alone, and 1 in 5 had been subjected to sexual harassment.^[]

In the JAMA study, measures of mental health were worse for women than for men in academic medicine, and, as the researchers noted, “this difference appeared [to be] partly explained by differences in measured cultural experiences,” as noted above.

This has far-reaching implications as well, since the impacts on individual well-being affect that individual’s clinical and scientific work, whether it is in direct patient care or scientific research and innovation. Patient safety can be impacted, and organizational achievement and social justice efforts can be sorely diminished, even reversed.

Indeed, as the JAMA researchers noted, “although women’s representation in medicine has improved, their experiences still reflect marginalization that requires attention.”

Merely having more women in medicine, although a necessary step and a good start, will not by itself overturn an entrenched culture of incivility and harassment.

This should serve as an immediate call to action for successful solutions that focus on systematic changes throughout academic medicine, from civility training to holistic hiring, fair investigations, and appropriate consequences for harassing and disrespectful behaviors. These consequences should come from the academic institutions themselves and be bolstered by compliance requirements from regulatory and funding entities.