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Southfield: For medical students, the path to becoming a licensed doctor is filled with obstacles—brutal classes, insane hours and six-figure debt which can take decades to pay back.

For women, there’s often an additional challenge: the risk of becoming a victim of sexual misconduct. While such wrongdoing can occur in any educational or professional setting, the danger is significantly greater when it comes to the training of American physicians. Much of this is tied to the stakes—medical students have close to a decade of advanced education, critical career opportunities and even financial survival hanging in the balance.

Post-graduate medical education follows an apprenticeship model. Young doctors will spend years working closely with experienced medical professionals—supervisors who have tremendous sway over their future. A recent study by the National Academy of Sciences (NAS) said this teaching dynamic leaves students vulnerable to what Dr. Janis Orlowski, chief health officer for the Association of American Medical Colleges (AAMC), called “the power discrepancy.”

That discrepancy, in a field known for its insularity and opacity, manifests in rates of sexual harassment, assault and retaliation that far outpace other professional disciplines.

#MeTooMedicine

There is some change afoot, though. The national unraveling of sexual malfeasance in the workplace has cracked the medical bulwark. Doctors have even adopted their own hashtag, #MeTooMedicine, to share their horror stories. And in February, the AAMC, which includes 152 medical schools and 400 teaching hospitals, joined 50 other academic and professional groups to form the Societies Consortium on Sexual Harassment in STEMM (science, technology, engineering, mathematics and medicine). The organization pledges to develop model policies that can be used to prevent sexual misconduct.

But victims, especially those whose lives have been derailed, are less than sanguine about such promises. Some who have complained or sued over mistreatment, both in medical school and post-graduate residency, contend there’s much more to be done before women can pursue a medical career free of fear.

In the U.S., there are more than 91,000 students in medical school, 49.5 percent of whom are women. The cost of a medical education leaves the average student at graduation close to $150,000 in debt.

Their path typically begins with a four-year undergraduate degree, usually with a focus on science. A 3.7 grade-point average and a high score on the Medical College Admission Test are mandatory for those looking to land a desirable medical school, said Dr. Kevin O’Brien, a professor at the University of South Florida who has studied medical education for 14 years.

Recent surveys, including one by the NAS, cited “disturbingly” high rates of harassment in medical school—for men and women. The report said “20-50 percent of women students” said they had experienced “sexually harassing behavior perpetrated by faculty [or] staff.” In one study, about half of female medical school students at Penn State University reported being sexually harassed by faculty or staff. An investigation at the University of Texas found 47 percent of female medical school students there had been harassed, versus 22 percent for women students across the university as a whole.

Both studies were conducted as part of university-wide efforts to assess the rate for sexual misconduct, according to the schools. Citing a nationwide survey of graduating medical students in 2018, Orlowski said roughly 35 percent of respondents “experienced a behavior at least once that is categorized as sexual/gender harassment.”

“As soon as you report something, you’re no longer one of us. You’re on the other side.”

After four years of medical school comes residency—grueling training at a hospital that lasts three to seven years. Though medical school graduates are considered doctors, they must complete their residency (which pays an average of $59,300 per year) before they can be licensed. Competition is fierce, as candidates hope to match with hospitals that want them. For graduates who are passed over, the prospects can be grim.

Sexual misconduct intensifies during residency

Researchers and lawyers said sexual misconduct intensifies in the post-graduate setting. In February, a the University of North Carolina survey of more than 1,000 surgeons found 58 percent of female respondents experienced sexual harassment in the previous year. Those women who were in residency programs were more than twice as likely to be victims.

There are about 130,000 medical residents in America. Their supervisors are licensed doctors, medical faculty with little supervision who play a make-or-break role in their future, said Dr. Reshma Jagsi, a professor at the University of Michigan. In her 2016 study of female doctors, most of whom worked as clinical researchers, she found 30 percent said they had been sexually harassed.

Jagsi said she’s regularly contacted by women who said they have been harassed or assaulted during their residency. Almost always they don’t file a complaint for fear of retribution. “One of my colleagues went to a lawyer and asked whether she should file,” Jagsi said. “She was told, ‘If you know what’s good for you, don’t.’”

“In apprenticeship models, there have to be multiple ways to report,” Orlowski said. “It’s the institution’s responsibility to have multiple mechanisms to shield the resident.” Without them, the consequences can be severe. Evaluations turn bad and plum assignments are taken away. Women have been frozen out by professors and supervisors, blocked from moving to a different rotation—or given bad recommendations for prospective employers.

“A single bad evaluation,” Jagsi explained, “can be devastating.”

Philadelphia attorney Patrick Griffin said medicine is different when it comes to the typical hostile work environment. “If you’re working at a company and you’re harassed by the boss, you can just quit and get another job,” said Griffin, a plaintiff’s lawyer. “That’s not an option for medical residents, whether they’re accusing supervisors or colleagues. There’s a very real fear of their careers being derailed.”

Griffin represented just such a resident in a lawsuit against Mercy Catholic Medical Center in Philadelphia. Identified only as Jane Doe, she alleged that when she complained of sexual harassment by a supervisor, she was first ignored, then referred to psychiatric care and ultimately fired, according to court papers filed in federal court in Philadelphia.

Mercy has denied any wrongdoing. The supervisor, who wasn’t identified, never sought to pursue a romantic relationship with Doe, the hospital said in a filing last year. Instead, Mercy cast blame on Doe, accusing her of inappropriate conduct. Andrea Kirschenbaum, an attorney for the hospital, declined to comment. Mercy is seeking dismissal of the case.

Cyndi Herald, a former resident at the University of New Mexico Medical School, said medical students and residents are generally discouraged from reporting sexual harassment. In 2011, she sued UNM, alleging she was kicked out of the program after reporting being sexually assaulted by another resident. Residents in her program had previously been warned by the director not to complain about working conditions or treatment by superiors or colleagues, Herald said in an interview. They didn’t want “whiners or complainers.”

As a result, she didn’t make a formal complaint. Instead, she told a colleague, who brought her allegations to the director, according to court papers. Herald, now 54, was called before a panel of three supervisors—all men, and including the director—who questioned her about the incident.

Herald was told not to say anything about the matter because it would harm recruiting, her attorney said at trial. Another supervisor told her the alleged attacker “‘was young, good looking—all the girls love him,’” Herald recalled. He was “implying that I was lucky that this guy paid attention to me.”

“I could tell by the end,” she said, “they were intending to protect the university instead of me.”

Notes taken at the meeting by a hospital employee were destroyed, according to testimony at a 2017 trial. The supervisors testified that they had been supportive of Herald, and encouraged her to report the assault to the police. They denied telling her to keep quiet. University witnesses also alleged that Herald was dropped from the program because she had been impaired by prescription medications.

Herald, who now lives in a Detroit suburb, settled the case during trial for $800,000. UNM spokeswoman Alexandra Sanchez declined to comment on the case.

‘You’re no longer one of us’

“The tendency to protect your own exists no matter what rules are in place,” said Randi McGinn, Herald’s lawyer. “As soon as you report something, you’re no longer one of us. You’re on the other side.”

The American Medical Association said it has a “longstanding policy and practice of condemning sexual harassment, discrimination and physician misconduct,” with “zero-tolerance for any type of harassment.” But Jagsi contends hospitals don’t sufficiently protect women. Human resources departments, she explained, govern residents as employees, rather than students. Even lawyers who represent medical schools have been criticized for a lack of responsiveness.

The U.S. Department of Justice, after investigating the University of New Mexico, found in 2016 that it was failing in its response to allegations of sexual assault and harassment. The government cited a management structure that “created a conflict between” the stated goal of eliminating and redressing harassment and the Office of University Counsel’s role in limiting liability.

The probe, begun in December 2014, was “in response to complaints from multiple students alleging that UNM did not adequately respond to their reports of sexual assault,” the Justice Department said in a statement. (Herald wasn’t among the complainants, she said.)

The Justice Department found that, while the university had recently strengthened its efforts, it still had “significant gaps” in procedures, training and practices.

“The University of New Mexico, including the Health Sciences Center, takes any report of misconduct, sexual assault or harassment or any other policy violation very seriously,” said Sanchez, the university spokeswoman. “UNM has implemented robust training for all employees and students to aid them in better identifying and responding to allegations of misconduct.”

“I hold your entire future in my hand and I can do whatever I want to with it.”

Even before #MeToo, some parts of medical academia had begun to address sexual misconduct. At the University of Wisconsin Medical School in Madison, administrators created a structure unconnected to the school where students or employees can report wrongdoing. An independent representative works with the student on how to deal with the allegation, including whether to go to the police or administrators, said Associate Dean Elizabeth Petty.

“We want to hold staff and faculty accountable if there’s a sexual assault,” Petty said. Right now, “there is a lot of under-reporting.”

Sometimes the news media can help trigger change. After a series of articles in the Baltimore Sun about female residents who complained of harassment, and a resident who sued, the University of Maryland Medical Center in December announced a “cultural transformation,” one that included promoting multiple women into leadership positions. More broadly, medical schools are now required as part of their accreditation process to have new policies to encourage reporting of harassment, said Orlowski.

Long way to go

But there’s still a long way to go. In 2018, a former dean of Michigan State University’s osteopathic medical school was charged with soliciting nude photos from a student, grabbing two others and offering grade changes for sexual favors, prosecutors said. The defendant, Dr. William Strampel, pleaded not guilty.

Strampel told one student that “she was never going to make it in the profession if she did not dress sexier,” according to a March 2018 affidavit by Ryan Pennell, a Michigan state police detective. Strampel allegedly told a group of students that “I hold your entire future in my hand and I can do whatever I want to with it.”

Strampel’s trial is scheduled for May in state court in Lansing, Michigan. “We’re going to be vindicated,” John Dakmak, his attorney, said in a phone interview.

For those women who turn to the courts, the path to justice can be long and uncertain. The lawsuit by Griffin’s former client was filed over alleged behavior between 2011 and 2013. At first, the hospital succeeded in getting the case thrown out, arguing her claims weren’t covered under federal law governing education because it wasn’t an educational institution. An appeals court disagreed, ruling that medical residents are part of graduate medical training.

The hospital has filed a new motion to dismiss the case, which is pending.

In another case that’s lasted six years, a resident at the University of California Davis Medical Center sued that school after being dropped from its program. She alleged discrimination, sexual harassment and retaliation. The school denied the allegations, claiming she was dismissed for poor academic performance. The university also said it couldn’t be sued because the claim violated its right to investigate or discipline doctors. An appeals court disagreed, finding no bar to the suit. It’s currently set for trial in July.

Herald, in her lawsuit against UNM, endured two trials, four mediations and one appeal after her original court complaint was filed in 2011. Even after her settlement in 2017, the wrangling didn’t end.

For her, the price of coming forward has been high.

“It’s been impossible to get jobs,” Herald said. “I’ve applied to so many residency programs. They just ignore me.” Some have given her cause for hope, but told her to first “straighten out your situation with the university.”

Also read: Women’s heart attack symptoms are different, and medicine needs to catch up

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