Sexism, Harassment, and Women in Anesthesiology

  • Agarwal, Rita, MD, FAAP, FASA
| Jan 08, 2018

Agarwal-RitaIt seems that almost every day there is a new revelation about a powerful man committing some horrible, criminal, bizarre, or at the very least, stomach-turning act of sexual misconduct. Harassment and even assaults seem to be rampant. Time magazine’s editors awarded the “Silence Breakers”, the women who spoke up about their harassment, their coveted title of 2017 Persons of the Year.

The national conversation is loud and relentless. Most news stories have focused on famous men in politics and entertainment committing sexual misdeeds, but the truth is that this type of behavior is pervasive in many environments. Lately, the lay press, medical blogs, and social media have featured articles on how hard it is to be a woman in medicine. While overt sexual harassment may be rare, prejudice, bias, and micro-aggression seem to be common.

I am part of the generation of women who started medical school in the 1980s. The women I knew were fearless, ambitious, strong, and believed firmly in our equality. We suspected that we would need to work at least twice as hard, and be twice as smart, to get the same level of recognition as some of our male colleagues. We expected and prepared for bias, harassment and possibly even misogyny. We assumed we could deal with it, and looked to our predecessors for examples of how to cope. 

We were lucky; we weren’t the first to forge new entryways into the House of Medicine. Although we were still a minority, women in the 1980s entered medicine in increasing numbers. Approximately 30 percent of all medical school admissions at that time were women. We had some, although not an abundance, of role models, and some, although not an abundance, of support.

I didn’t realize it at the time, but I was luckier than many. I had supportive classmates and faculty (both male and female) throughout my training and career. I had a progressive, forward-thinking, and brilliant residency director who celebrated pregnancy and life, and never made any female resident feel bad for “screwing up the schedule” by getting “knocked up, grumble, rumble, mumble…curse words…damn women in medical school.” In fact, I didn’t realize that my program was not the norm until later, and after discussion with others.

So, what has changed? Unfortunately, not much. The issues women faced 30 years ago appear to be the same now. Despite the fact that women now constitute 50 percent or more of entering medical school classes, they still hold a minority of leadership positions nationally.  

How is that possible? There are plenty of articles by erudite writers who have addressed this topic. Is it that that we don’t “Lean In” enough? That women still carry a disproportionate load of the household chores and child rearing duties? Is it because, on average, women physicians work fewer hours in hospitals or clinics than men physicians? Or that a greater percentage choose to work part-time? All of the above? None of the above?

Is it because many of us still get mistaken for nurses, even after repeatedly introducing ourselves as Doctor? Or, if you are a woman of color, because people may presume you are a nurses’ aide or housekeeper? I still chuckle at the memory of the time I was talking to a family post-operatively about how their child fared during the anesthetic, while another family kept insistently trying to get me to clean up some vomit in a nearby trash can! Ah... good times.

A recent article in the Wisconsin State Journal reported on the results of a survey, taken in the University of Wisconsin-Madison Department of Anesthesiology, showing that the work environment for women there is still challenging. Women were often given less desirable assignments, less responsibility, and fewer leadership opportunities. Women anesthesiologists at the Children’s Hospital, though a larger number occupied leadership roles, were “infantilized”, the report said. This article was posted widely on women physicians’ Facebook groups, and created a great deal of conversation and controversy. Many agreed that the findings applied to their practices, while others were grateful to have leadership that is more forward-thinking and supportive.

The popularity and explosion of the Physicians Mom’s Group, Physician Anesthesiology Mom’s Group (PAMG) on Facebook, and Women in Anesthesiology (WIA) Committees have helped fill voids that most of us knew existed, but didn’t know how to correct. Studies from the business world have shown the benefits of having women as part of product design and marketing groups. There are several studies in medicine showing that women physicians (both surgeons and internists) have better outcomes and lower mortality rates than their male colleagues. Despite this, if a female surgeon has a bad outcome, it has a profound negative effect on her subsequent referrals from other physicians, and also lowers the chance that those physicians will ever make a referral to another female surgeon!

We’ve got a long way to go, baby.

One thing that I have learned from the PAMG and WIA groups is that success and leadership come in many different sizes and forms. Just because a person chooses to cut back hours, or work part-time for a while, that does not eliminate the prospect of leadership opportunities or academic success. It is not all or nothing. It may take some people longer to achieve “success”, but they will accrue other rewards and have different adventures along the way. Everyone should feel supported in their choices.

We all need good mentors, sponsors, advisors, and friends. This is true for all genders, but often much harder for women to find. We in California are incredibly lucky in that we have many outstanding men and women in leadership roles. For young physicians looking for leadership opportunities, looking outside your group, institution or practice can be extremely rewarding and effective. The CSA leadership has both male and female role models. As a junior faculty or newly practicing anesthesiologist, if there are no mentors/advisors/supporters in your home institutions, look elsewhere. Get involved with other organizations; volunteer to help with your local CSA districts or a CSA committee. Complete your tasks well and in a timely manner, then volunteer for more. In medicine, we rarely encounter the same kind of harassment or assault that people in big business, politics, or the entertainment world may face. Our path to success is often as simple as showing up, working hard, being reliable, and making the most of opportunities.

As the motto from my son’s high school says, “We are all in this together.” Let’s start acting that way.

With Thanks to Dr. Karen Sibert for her help and expert editing. 


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  1. Ana Maria Crawford | Jan 08, 2018

    Dr. Agarwal,

    Thank you for adding your voice to this discussion and for your continued leadership paving the way for so many of us female physicians.  I certainly respect your journey and your optimistic tone.  You are right in that the conversation is loud and relentless.  I argue it is long overdue, or perhaps not loud enough previously.  

    We should cease to expect and prepare for bias, prejudice, and harassment.  Yes, we should continue to do good work in a timely fashion.  That is the expectation of all physician anesthesiologists.  

    Maybe I was not as lucky as some.  We all have different experiences. I leave a crowded and consistent wake of struggles against bias, physical assault, and sexual harassment, throughout my training and career as an anesthesiologist.  The aggression I have experienced personally and witnessed for others is far from the "micro" levels you suggest. It is also more common than many of us realize, since few choose to be "Silence Breakers."  

    In fact, I would guess that the incidence and prevalence of harassment and assault in medicine is just as high if not higher than that in big business, politics, and the entertainment world.  Why would we be any different when we have the same power hierarchies and inequality of the sexes?  Intimidated by the need for passing scores and recommendation letters, I did not tell anyone about the sexual harassment I experienced in residency until years later.  

    Yes, we should join the organizations that serve us and others.  Yes, there are excellent male and female leaders in medicine. But, the disparity is obvious and great.  This is what must change in order to pave the way for the colleagues and trainees behind us.  This is the greater point of the discussion. We cannot concede since things are better than they were before.  We should not ask for more work.  We should not expect lesser opportunities or have to prepare for misogyny.  

    Gender equality in the workplace can and will eliminate the culture of acceptance for sexual harassment.  Please, let us not confuse "loud" and "relentless" conversations for witch hunts.  Women have an obligation to take as much, or more, responsibility for changing this culture.  Women and men both benefit from a heightened awareness of the problem.  The conversation must continue and ultimately force a change in our behaviors.

    Our colleagues and trainees continue to be victims of the offenses against which you and I still struggle. We need to realize that it will take much more than "showing up, working hard, being reliable, and making the most of opportunities." Those are the basic expectations, but it should not require more work or tolerance of mistreatment and harassment.  

    Many of us may not feel comfortable with "loud" and "relentless" but it is the tone that has the advantage of being heard and leading the way to change - change for ourselves, our colleagues, and our trainees.  We are all in this together.  We are all responsible for changing our culture and ensuring equality in the work place.  However, it requires much more than showing up and doing a good job.  

    I caution that we should not downplay the problem simply because we see improvement.  Not only should the silence be broken, but so should the medical culture allowing harassment, prejudice, misogyny, and inequality.  The use of our words in this conversation is the starting point.  Our actions must follow.


    Ana Maria Crawford, M.D., M.Sc.







  2. Eric Wardrip | Jan 08, 2018

    Dr. Agarwal:

    It is with a great deal of trepidation that I choose to reply to your editorial, but I find it rather sexist.  There is no question that sexual harassment is unacceptable and there has been a tremendous outpouring of concern about men acting like animals.  This is not meant to be a justification of such behavior.  Times have changed and we must change with them.  I do question whether women are entirely blameless in our society, and I believe that recent events will leave both sexes somewhat confused as to how to proceed with romantic interactions, but I think it is likely that powerful women like youself will be happy to let us know how to behave.

    I wonder at the persistence of discrimination against women in our culture; there are some reasons to believe that it has lessened, for example:  females outnumber men in our population, females live longer (almost 5 years!), females make up almost 60% of college students (again, !), females make up a majority of medical students, per capita spending in the US for female healthcare is 25% more than males, and so on.  

    It seems that the only real solution will be to completely eliminate males from society, or perhaps to keep us around only for breeding purposes.  Please let us know when to proceed to the processing centers....


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