Female gynecologic oncologists have reported in a survey that having a department chair of the same gender is no buffer against gender harassment or discrimination in the workplace. The information comes from a survey of the “Women of Gynecologic Oncology” Facebook group and was reported in March 2021 at the Society of Gynecologic Oncology (SGO) 2021 Virtual Annual Meeting on Women’s Cancer by Sarah M. Temkin, MD,¹ a gynecology oncology physician.

Sarah M. Temkin, MD

The questionnaire was answered by 250 female gynecologic oncologists, more than half of whom reported instances of bullying, gender discrimination, or microaggressions. Reports were just as likely to arise when the respondent’s department leader was a woman as when the leader was a man, Dr. Temkin said.

A Systemic Issue

“These experiences impacted the careers of women. Over one-third (36.1%) had been excluded from leadership because of gender. ‘Being written up for speaking up’ was common (32.9%). Significant numbers of women (18.3%) had changed jobs due to bullying and harassment, and some (9.6%) had been the subject of a sham peer review,” Dr. Temkin said.

No association between these occurrences and leadership of the practice environment was identified. “From this study, we know this is not a diversity problem. Women constitute 54% of practicing gynecologic oncologists. It appears this is a systemic issue that we need to change,” said the study’s first author Linda J. Hong, MD, of Loma Linda Medical Center, California.

Linda J. Hong, MD

Given the lack of association between women in leadership positions, organized responses and cultural changes beyond simply putting women into leadership are required, the authors said.

Gender harassment within the medical profession is by no means uncommon, Dr. Temkin pointed out. In obstetrics and gynecology, female physicians constitute roughly 60% of the workforce but have a disproportionately lower share of academic and managerial positions. What is less clear is whether there are associations between these observations and the “leadership gender and practice infrastructure,” according to Dr. Temkin.

Study Population

Dr. Temkin and her colleagues, therefore, examined whether characteristics of leadership and departmental infrastructure impact the work environment for female gynecologic oncologists by conducting a 1-month Internet-based survey of 472 members of the “Women of Gynecologic Oncology” Facebook group. In addition to capturing demographics and practice infrastructure, the questionnaire revealed respondents’ personal experiences with workplace bullying, gender discrimination, and microaggressions based on the validated Sexist Microaggressions Experiences and Stress Scale (Sexist MESS) survey.

The survey was returned by 250 members (53%) of the group. Most respondents were < 50 years old (93.6%), White (82.2%), and non-Hispanic (94.3%). Most were married (84.7%) and had children (75.2%). Their practice environments included academic centers (61.0%), private practices (12.4%), and hospitals (22.9%). Most (89.9%) supervised trainees, and most reported within the department of obstetrics and gynecology (77.5%), followed by surgery (35.7%). For the majority of respondents (60%), the department chair or division chief was male.

Survey Results

The most common experiences are summarized in Table 1. Both bullying and gender discrimination were more likely to have occurred during training than in practice. Respondents were unlikely to share these experiences with others: 24% reported bullying, and 19% reported gender discrimination, Dr. Temkin further reported.

Interestingly, the perpetrators of these acts were “multiple and varied,” she continued. Most commonly, bullying, gender discrimination, and microaggression came from colleagues in authority, but a significant number of women pointed to peers, administrators, staff (including nursing), trainees, and patients.

“Fewer than half of bullying cases were seen as arising solely from male perpetrators. A significant number of respondents [reported] bullying and harassment from women, and a third of responders said that women had impeded their advancing into leadership positions,” she said. “Few felt their male colleagues were similarly negatively impacted by their gender.”

Need to ‘Do Better’

Dr. Hong commented that the first step toward ameliorating this problem for female physicians is to identify and characterize “factors that contribute to hostility in the workplace,” which will help inform strategies to mitigate these issues moving forward.

Dr. Temkin applauded the efforts of a number of other surgical societies in bringing awareness to the problem and creating an environment with greater equity, but, she added, more than 50% of gynecologic oncologists are female. “The gynecologic oncology workforce differs from those of other specialties that are surgical and remain predominantly male…. Despite these large numbers of women practicing gynecologic oncology, the [incidence] of bullying and discrimination [in] this survey was remarkably similar to those reported in other specialties. The most important question is, ‘How can we do better?’”

Dr. Temkin said greater transparency would be one step toward change on the part of individual physicians. “As we wait for organizational change, we as individuals can also improve. Most events of sexual discrimination or harassment are witnessed. The negativity of these events affects not just the target but also the bystander and contributes to the burnout and moral injury we experience working in health care.”

In closing, Dr. Temkin emphasized: “A generation of women has been trained as surgeons for women and should be supported and retained in a workplace and environment where they can thrive.”

DISCLOSURE: Dr. Temkin has served as a consultant or advisor to Cancer Experts Now and Clovis. Dr. Hong reported no conflicts of interest.

REFERENCE

1. Hong LJ, Rubinsak L, Benoit MF, et al: Workplace bullying, harassment and microaggressions: The results of a Women of Gynecologic Oncology survey. Society of Gynecologic Oncology 2021 Virtual Annual Meeting on Women’s Cancer. Abstract 6. Presented March 19, 2021.