Has #MeToo Changed Surgical Culture?

Sarah Blair, MDOctober 15, 2018 | Sarah Blair, Professor of Surgery and Director, Women in Surgery

Has there ever been a time when issues of gender privilege and sexual harassment have faced such prolonged public scrutiny?

Over the last year, women have come forward with their experiences of sexual harassment and abuse at the hands of powerful men—in the private sector, in government, and in Hollywood. The response has been public soul-searching in some cases; indignation and lashing out at accusers, in others.

It's impossible to observe these events and not think about medicine—a sector that has largely avoided this public reckoning. But the issues could not be more relevant.

So let's talk about us.

2016 study found that 30% of women academic medical faculty have experienced sexual harassment compared with 4% of men, down marginally from 1995, when 52 percent of women in academic medicine said they had been sexually harassed. NBC news profiled female surgeons and nurses who have experienced harassment in hospitals and operating rooms, noting the uphill battle women face when they report incidents—not being believed, inadequate support, and concern that the process stymies their careers.

Talk with women surgeons and trainees, and many will tell you that they have experienced something along the spectrum—from inappropriate remarks, to inappropriate touching, to sexual advances, to coercive behavior. Perpetrators are most often fellow surgeons and trainees, usually those in positions of power.

What drives this? 

Lots of things. Medicine has traditionally been a male-dominated profession. Although 2017 marked the first time the majority of entering medical students were female, there remain are almost twice as many male physicians (623,054) as there are female physicians (326,902) in the United States. In surgery, only 19.2 percent of surgeons are women. Men typically occupy positions of power and influence, and institutional inertia often prevents holding them accountable.

The culture of medicine is also hierarchical—with great deference given to superiors. Speaking out against inappropriate behavior can be intimidating, especially in a culture where victims are not always believed or sympathized with.  

But maybe one of the biggest roadblocks to progress are different perceptions—different starting points for thinking about the problem.

Well-intentioned male colleagues might think the gender equity "issue" is largely solved since half of trainees are women these days. They might take sexual harassment seriously but assume it's mostly a case of a few bad apples, or something that is happening at other institutions, not theirs. They might find it extremely difficult to accept that someone they know personally is a perpetrator (something true for men and women).

Women, by contrast, might see persistent inequity in pay and career advancement, exclusion from male hierarchies, and a ubiquity of power differentials. They might view inappropriate comments (and much worse behavior) as part of a spectrum fundamentally based on an assumption of male power.

We cannot let the challenge of tackling this issue prevent us from moving ahead. Because the issue of sexual harassment is not something happening somewhere else. It is an issue that resonates deeply and personally, even in our own Department. Ten years ago, in an all too familiar narrative, a longtime senior male faculty member who had trained at UC San Diego and was widely admired, was discovered to have been sexually harassing residents and nurses.

It was out of this crisis that the Women in Surgery (WIS) program emerged. Founded by my colleague, Sonia Ramamoorthy, WIS aims to develop a network of resources, mentors, and emotional support for women faculty and trainees to help with the problems we all share.  We want women to have a safe space in which to voice concerns and be directed to appropriate resources—all with the aim of advancing, not only their careers, but their well-being.

More needs to be done.

Leadership is crucial. Sexual harassment policies and hotlines are important, but leadership sets the tone and culture of a Department, and nuance matters. People can spot the difference between vague assurances about the importance of an issue, and leadership that expresses deep concern, seeks out information and suggestions, and takes action. UC San Diego's Department of Surgery is making progress in changing culture under the leadership of Dr. Bryan Clary, our current chair. Our Department is also making strides in female leadership, with four of thirteen women Division Chiefs and two women Vice Chairs, although there is a paucity of women leadership in UC San Diego Health more broadly. 

The issues also need to be discussed openly, in large forums such as grand rounds—and they need to be discussed more than once so that the issues stay in peoples' minds so they think twice about misbehaving or even unconscious bias. The Department also needs to constantly be cognizant to ensure that women and minorities are represented in committees and leadership in the Department where important decisions are being made.  Culture changes slowly and needs continued attention. 

As I have watched women come forward in recent days, what resonates is how intimidating it is to watch one woman testify in a public forum and be attacked publicly by people in positions of power.  It is not surprising more women do not come forward. We want a different culture at UC San Diego.


Learn more about Women In Surgery

UC San Diego Policies on Nondiscrimination, Sexual Harassment, and Sexual Violence