Male Physician Leaders Fail to Combat Gender-Based Discrimination in Emergency Medicine

Maya S. Iyer, MD, Med

Despite gender-based discrimination being an acknowledged burden for female physicians, their male peers may be inconsistent in their own actions responding to such instances of discrimination.

According to new research findings, the rationale of bystander male physicians in leadership positions may vary from their disbelief that the discrimination warranted a response, to them seeking self-preservation in that situation.

In new data reported by a team of US investigators, a small group of male emergency medicine academic department chairs all reported witnessing or learning about ≥1 instance of gender-based discrimination against a female colleague. Though it was a consistently acknowledged issue, the pool of male chairs reported inconsistent response to such issues.

Led by Maya S. Iyer, MD, Med, of the Division of Emergency Medicine at National Children’s Hospital Department of Pediatrics at The Ohio State University College of Medicine, investigators sought to interpret the responses of men in emergency medicine academic department chair positions to gender-based discrimination directed toward woman colleagues.

The prevalence of gender-based discrimination against women—defined as harmful actions or comments including bias, overt or inequitable mistreatment, and sexual harassment—in academic medical specialties including emergency medicine is “well documented,” Iyer and colleagues noted. In emergency medicine, previous research has founded that 52.6% of women have reported sexual harassment, 25% reported disrespect based on their gender—and 9.5% reported ≥1 sexual assault encounter by a colleague or supervisor.

“Despite gender-based discrimination’s prevalence, women physicians report only approximately 5% of incidents, often due to the belief that nothing will be done or changed or the fear of retaliation,” investigators wrote. “Research suggests that cultures that promote inclusivity and support upstanders (ie, persons who intervene on behalf of others) are needed to end gender-based discrimination.”

The team conducted a secondary qualitative analysis via data from a larger descriptive study of the role of gender in leadership at academic medical positions. It originally identified 19 women and 18 men emergency medicine academic department chairs for an 11-item interview on their perceptions around the influence of gender in their leadership positions. Iyer and colleagues derived data relevant to gender-based discrimination from the assessment, specifically using reports from the male chair participants.

Mean participant age among the 18 men was 52.2 years old; individuals had spent a mean 7.2 years’ time as their department chair at the time of the assessment.

Investigators interpreted 3 “themes” from their analysis: emotional response to gender-based discrimination, actions in response to iterations of such discrimination, and their reasons—if any—for not taking action to address gender-based discrimination.

Regarding emotional response, male participants highlighted 4 emotions when witnessing gender-based discrimination:

• Anger toward the entitlement of perpetrating colleagues
• Disbelief that the discrimination was occurring
• Guilt for their lack of responsiveness to the matter
• Shame that they had participated in similar incidents in the past

In one highlighted participant response, a male department chair said, “I have learned that the way women are treated in the world is completely different than the way I am treated in the world…It’s ridiculous the extent of gender disparity in academic medicine.”

Similarly to emotional response, the male participants generally highlighted 4 types of actions taken to address gender-based discrimination:

• Serving as an upstander by speaking up for women colleagues who were discriminated against
• Giving greater praise to maligned women
• Reporting offenders and their actions to designated institution officers
• Focusing on culture change through means of increasing women representation via faculty recruitment, sponsoring and mentoring both women and minoritized faculty, and offering leadership coaching and training designed to support gender equity.

“I think we’ve tried to create a culture where if anything happens, that it’s easily reported, and it doesn’t escalate, and it’s not tolerated,” one participant stated to investigators.

On the subject of reasons given for not acting against gender-based discrimination, participants again generally discussed 4 planes of rationale:

• They did not believe the incident warranted response—that the victim could manage it herself, that the incident was not severe, or that the incident passed before they could respond
• Issues wherein the person perpetuating discrimination was in a greater position of power than them
• A perception of “unsupportive institutional culture”
• A sense of need for self-preservation, or fear that their intervention would cause negative consequences to their own standing

“[And] it’s awful,” one participant stated. “But at the end of the day, when it’s your leader, it is what it is. You gotta fall in line, you know.”

Indeed, investigators noted that the field of academic medicine “often operates on principles of hierarchy, a set of integrated levels within which team members are ranked by their disciplines and levels of authority”—fostering a culture of silence in iterations of discrimination because of a commonly shared belief that taking action or speaking up is likely to be “futile or even dangerous.”

“The findings of the study suggest several approaches to combat gender-based discrimination, such as facilitating the advancement of women in medicine,” investigators wrote. “Cultivating women to become leaders is critical to institutional growth and success through generating increased organizational productivity, improving healthy policy, national prosperity and quality of life, and increasing patient satisfaction.”

“Above all, the literature shows that allyship is supported when allies of any gender are viewed as “critical actor” leaders, who individually and collectively have the commitment and power to create gender-equitable cultures,” they added.

The study, “Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination,” was published online in JAMA Network Open.