Women have made major strides toward careers in medicine in America over the last few decades but continue to face stifling sexism throughout their careers.

“It’s a very well-kept secret," Roberta Gebhard, the former president of the American Medical Women's Association (AMWA), told Yahoo Finance. “We find ourselves trying not to poison our young when they’re coming up. We try and educate them on what to do if you find yourself in a position where you’re either being sexually harassed or you’re being bullied, to take really good notes. Document the date, the time, who was there and who witnessed it, and what exactly happened on an ongoing basis."

A July 2020 study from the Journal of American Medical Association (JAMA) found that “among early career surgical faculty, 50% of women experienced sexual discrimination, and 38.5% reported gender as a barrier to career advancement.” (One of the study's coauthors, Dr. Pringl Miller, subsequently founded Physician Just Equity, a nonprofit foundation aimed at tackling gender and racial discrimination in the medical field.)

Yahoo Finance spoke to several women in the medical field about their own experiences with gender discrimination.

'I don't look like the other surgeons'

UCLA Neurosurgery Department Chair Dr. Linda Liau recalled consistent implicit biases throughout her two decades in medicine.

"If I wanted to pick specific incidences, I could probably write a whole book," Liau told Yahoo Finance. "There were things that could have been perceived as being discriminatory but... I felt that was more on them and I didn't internalize it. I always thought that I could do whatever I wanted to do and whatever obstacles that there were, it's more others' problems and not necessarily mine."

Liau, who noted that "I don't look like the other surgeons quite often," cited an incident from a few years ago that stuck with her.

"I was just walking down the hallway and there was a visiting medical student who didn't know who I was," Liau said. "There was a spill on the floor and he kinda looked around and turned to me and said, 'Can you please wipe that up?'"

She ended up cleaning up the mess because she didn't want anyone to trip and fall. And while she did not think there was any malicious intent, she also wasn't surprised by the behavior.

"As a woman and a minority, I'm also only five foot two, there certainly are stereotypes that people have," she said. "Little things like that, I must say, still occur on a weekly basis."

Another incident occurred in the operating room where, as the neurosurgeon, Liau is generally in charge. As part of neurosurgery preparation, doctors will position the patient's head in specific metal frames.

"I walked in and I guessed I looked a lot younger at the time, and [a male surgeon] was trying to position the frame," Liau said. Once she walked in, "he was like, 'Come over here. Let me show you how to do this.' I just let him go on with it. And then the chief resident came in afterwards and said, 'Bob, let me introduce you to Dr. Liau.' And he just turned beet red."

Neurosurgery is a male-dominated surgical specialty. A 2018 article from the Journal of Neurosurgery found that women represent just 8% of all practicing neurosurgeons in the country and fewer than 20% of applicants to neurosurgery training programs.

"One [thing] I hear quite often at meetings when we're evaluating faculty candidates or people for promotion is when comments keep coming up like, 'We don't want to sacrifice excellence for diversity,'" Liau said. "To me, it's elitist ... Unfortunately over the years, because the majority of professors and deans and people in leadership positions have always been men, there's a perception that that is equated with excellence."

Liau added that this seems to be a form of confirmation bias.

"When they're looking for other faculty members or department chairs, they're looking for themselves," she said. "They're looking for people who are like them, and because we've had so many generations of male dominance in academia, there's this perception that it's also equated with excellence."

'It tends to be dismissed by senior white-adjacent men'

Female medical students were 220% more likely to experience sexual harassment than students in non-STEM fields as of June 2019, according to the Association of American Medical Colleges (AAMC), and "more than 30% of postdoctoral students in academic medicine had personally experienced harassment, with women of color experiencing even higher rates."

More than half of female general surgery residents and faculty surveyed in 2013 had been or anticipated being treated differently because of their gender, and one-third of respondents reported believing that people's opinions about their gender were a barrier to career aspirations.

Dr. Vanessa Grubbs, a nephrologist and associate professor at the University of California, San Francisco (UCSF), alleged that she experienced discrimination because of her gender and her race.

“I don’t think I would have had the issue that I had if I were a white woman or an Asian learner, for example,” Grubbs, who is Black, told Yahoo Finance. “Whenever gender issues come up, I personally don’t know how to divide myself in that way. I was Black before I was a woman. Of course, it’s a very unique experience, even when you think of women of different races, because we think about this racial caste system that we have in this country and then you overlay gender on top of that.”

Grubbs posted a now-deleted tweet about what she perceived to be bias that medical student trainees show toward junior females and faculty of color in a negative way compared to white, male senior physicians.

“I didn’t specify any names,” she said. “I was just talking about a situation in which I felt like my voice was disregarded … It’s not like it’s new, but it tends to be dismissed by senior white-adjacent men. I guess they wouldn’t see it because they’re the ones always treated with respect.”

Administrators at her institution discovered the tweets and “got really bent out of shape,” Grubbs stated, adding that their conversations arose to the levels of various chiefs of departments and divisions. She deleted the tweet after the backlash but has continued to use her platform on Twitter to call out what she perceives to be biased behavior. (UCSF did not respond to request for comment.)

“I feel like had it not been about race, then people wouldn’t have been so upset,” Grubbs said. “I feel like if I had said that the person was incompetent and stupid, then I would have been reprimanded a little bit.”

Once Grubbs was notified that it was a problem, she alleged that she was “basically told I was imagining things.” She emphasized that bias and discrimination are much more prevalent in surgery than in other specialties.

“One of the folks I was alluding to said there was no bias in their actions, which really struck me as ridiculous because one, it’s not like white people have a monopoly on anti-Blackness and two, because that’s what unconscious bias is, that you’re not really aware of it,” she said.

'Ultimately led to her career being derailed'

One New York-based surgeon, whose name is being withheld due to pending proceedings before the Equal Employment Opportunity Commission (EEOC), alleged that she faced retaliation from her hospital after filing complaints to Human Resources over what she described as a pattern of derogatory remarks, bullying based on gender, and favoritism towards others.

“Each time that she made a complaint, it wasn’t just that it was ignored, it was that it was communicated back to this individual, who then escalated a campaign of retaliation against her,” her attorney told Yahoo Finance on her behalf. “And that retaliation culminated at the end of the year when they were told they weren’t going to renew those contracts [with her]. ... The entire history ... made clear this was intentional.”

The surgeon said she was accused of unethical conduct, an accusation described by her attorney as “so transparent and retaliatory it really does defy explanation.”

“It’s incredibly inconsistent and it ultimately led to her career being derailed,” the attorney said. “What we’ve learned since then and what was made apparent throughout her nine-months-long history of complaints is that this isn’t isolated. There were other complaints made against the same individual and they were likewise ignored.”

The surgeon alleged that the hospital filed a report to the National Practitioner Data Bank, which collects information on medical malpractice related to health care practitioners, providers, and suppliers. This has made it virtually impossible for her to obtain credentials at any other institution.

“It harms me every day,” the surgeon said. “I’m not doing what I’ve been trained and excel at because they’re able to basically say anything with impunity at this point.”

The attorney noted that the power dynamic involved "poses a tremendous personal cost to speaking up. What you end up with is a culture of silence. You have a culture of people who weren’t willing to speak up because they weren’t willing to incur that personal cost.”

Whether or not the surgeon will be successful in her lawsuit remains to be seen. According to Alexandra Harwin, co-chair of the Discrimination and Harassment Practice Group at Sanford Heisler Sharp LLP, cases involving physicians "are no more or less successful" than cases involving other types of professionals.

“They often involve the same kinds of issues," Harwin told Yahoo Finance. "In some ways, physicians are maybe more successful because, in some instances, the discrimination is more overt. There are many medical fields that are particularly male-dominated and the more male-dominated the environment, the more risk of overt discriminatory conduct against the females in the field.”

About 29% of surgical residents reported experiencing sexual harassment while training, with the supervising surgeon being the perpetrator more than 50% of the time, according to a 2013 survey published in the American Journal of Surgery.

The 2013 survey also polled general surgery residents and faculty, finding that 54% of women “had or anticipated being treated differently because of their gender,” versus just 16% of men, and 30% of women had or anticipated experiencing discrimination, versus 5% of men.

'Women are paid probably $0.78 on the dollar for physicians'

Another form of gender discrimination relates to compensation.

A 2016 report by JAMA Internal Medicine found that female physicians make approximately 10% less than their male counterparts, "even after adjusting for specialty, hours worked, and other variables." A 2019 report from Medscape found that women in primary care medicine make 25% less than men in the same roles while women specialist doctors earn 33% less than male specialists.

“It’s basically ubiquitous,” said Gebhard, the former head of AMWA. “There are few pockets here and there where there’s salary transparency and there’s at least an attempt to make salary based on objective criteria, like how many years of experience you have, what specialty you are, if you’re full time or part time. There’s no transparency in most places.”

Women in surgical specialties see the largest salary difference, with male surgeons making approximately 36% more money than them, according to the July 2020 JAMA study. For example, female surgeons made roughly $75,000 less than their male counterparts in 2018.

“Most people don’t know what their coworkers are making,” Gebhard said. “In general, women are paid probably $0.78 on the dollar for physicians. It’s every single specialty. And when you compare men to women, women make less than that. Even female-dominant specialties, like pediatrics — the male pediatricians make more than the women.”

So why does this keep happening?

“I really think it’s because it’s like: 'Nothing is stopping me from doing it. Why would you pay somebody more if you didn’t have to?’” she said. “There’s a male network of individuals that are in power that they can get what they want. So what happens in medicine when a male is abusive, sometimes it catches up with them and all they do is get a good letter of recommendation from where they’re at and get a promotion to move someplace else and do the same thing there. That’s the way the system is set up.”

And like what happened with Grubbs and the unnamed female surgeon, women tend to get blackballed when they do speak up about perceived inequities.

“I can tell you stories that would curl your hair,” Gebhard said. A common theme is “they’ve been harassed and they complained about it, and then they are bullied out. Bullying is a very common thing as well.”

'A very toxic work environment'

Dr. Stella Safo, an HIV primary care physician at Mount Sinai Hospital in New York City, currently has a lawsuit pending (along with eight other plaintiffs, including seven women) against the hospital and several doctors working there alleging mistreatment and discrimination based on gender.

“It was a very toxic work environment,” Safo told Yahoo Finance. “That was the kind of culture that we worked in. And then if we ever made any complaints or said anything, we were retaliated against. The environment was very much one that was not healthy.”

In the lawsuit, Safo alleged that one of the doctors began “treating her condescendingly and denigrating her in public.” The doctor would ignore or talk over her during meetings and assign menial tasks “like logistics planning or note-taking” only to women, according to the suit.

"When these issues were brought to our attention, we acted swiftly, responsibly, and decisively to initiate a thorough internal investigation," Mount Sinai Hospital System said in a statement to Yahoo Finance. "We deny in the strongest terms that the plaintiffs were discriminated or retaliated against. The case is without merit and we will continue to vigorously defend ourselves in court." The litigation is ongoing.

Safo claimed that "we went to Human Resources, [and] they essentially tried to convince us that we were imagining it, and they tried to continue to gaslight us and convince us that what we had experienced wasn’t true. From there, we had no solution to go for but to file this federal lawsuit.”

And according to Safo, Grubbs, and the unnamed surgeon, this treatment among women in medicine is still prevalent even with the country in the middle of a pandemic, and it's making it even harder for them to speak up.

“For me and for others, the challenge is if you decide to speak up, you almost have to accept that your career is going to be impacted,” Safo said. “You almost have to accept that other institutions are going to look at you sideways and think: ‘We don’t want someone who’s going to speak up or be trouble.’ That’s really hard, you can imagine, when all you want to do is see patients and do some good work. It’s a real choice, and that’s why there’s so few of us."

Harwin, the workplace discrimination attorney, explained that the law recognizes gender discrimination as various forms of misconduct.

“Courts recognize that employees rarely have a smoking gun that provides insight as to why a boss is treating them worse than others,” Harwin said. There are “many ways that plaintiffs can support the inference of discrimination. For instance, if a female employee is treated differently from a male under circumstances that are essentially the same, that’s a way that a plaintiff can prove that the conduct is discriminatory.”

“If a supervisor uses language that’s gendered, that’s also a way to support the inference that what the employee is experiencing is a product of gender discrimination,” she added. “The civil litigation process provides plaintiffs with access to many documents and other types of information that they can use to build their case.”

Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells and reach her at [email protected].

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