Women physician typing on computer

A study published yesterday provides a clear picture of hardships women in gynecologic oncology face: bullying, gender discrimination, and gender-based microaggressions. Findings showed that female gynecologic oncologists reported negative experiences regardless of their age, race, ethnicity, practice setting, or the gender of their leadership.

Authors of the Frontiers in Oncology paper hope the findings spread awareness of the prevalent problems in the field and call for proactive interventions to improve the work environments for gynecologic oncologists nationwide.

Linda Hong, MD, lead author of the paper and a gynecologic oncologist at Loma Linda University Cancer Center, says women gynecologic oncologists in the U.S. continue to experience bullying, discrimination, and microaggressions at “unacceptable” levels — even though women make up over half of physicians in the field.

“The inclusion of women into our specialty has not changed the culture,” Hong says. “The problems this study pinpointed call for a change in the structure of medicine to better support gynecologic oncologists in navigating and hopefully putting an end to these situations.”

To gauge gynecologic oncologists’ experiences, Hong conducted an internet-based survey of members of a Facebook group, "Women of Gynecologic Oncology (WGO).” Two hundred and fifty active WGO members participated by answering questions about their demographics, practice infrastructure, personal experience with workplace bullying, gender discrimination, microaggressions, and outcomes.

Researchers classified the following definitions for bullying, discrimination, and microaggressions in these ways:

  • Bullying is the use of negative and aggressive interpersonal behaviors to intimidate and dominate others. Examples include humiliation, insults, threats, coercion, isolation, and overwork—sometimes involving repetitive or meaningless tasks. Bullying behaviors are often persistent, repeated, and arise in contexts of power imbalance.
  • Discrimination entails negatively charged, differential treatment based on one's characteristics or attributes, including, but not limited to, gender, race, religion, sexual orientation, culture, ethnicity, disability, or age.
  • Microaggressions are everyday verbal, behavioral, or environmental slights that communicate negative attitudes toward marginalized groups, whether intentional or unintentional.

Responses reflected the high prevalence of all three categories: about 53% of respondents reported being bullied, 57% reported having been subjected to gender discrimination, and 83% of respondents reported having experienced gender-based microaggressions, such as being told to smile more or to act more feminine and maternal.

Women who completed the survey also delineated the varied perpetrators of the bullying, discrimination, or microaggressions they’d experienced. Perpetrators could be male or female and included colleagues (84%), patients (44%), staff (41%), administrators (18%), and trainees (16%). Almost half of those bullied reported men to be the perpetrators, while a third said both women and men had bullied them, and the rest pinpointed women to be the perpetrators.

These negative experiences take their toll by creating discomfort and hostility in the workplace and even hindering women’s careers, Hong says. Most women said they have hidden their personal lives or changed their personalities to adapt to their work environment. Some changed jobs due to bullying or discrimination, and over a third of the respondents reported being excluded from leadership because of their gender.

Placing women in leadership positions arises as a popular suggestion to help remedy the negative experiences women in professional fields face, Hong says. And yet, she says this study found that leadership gender did not significantly change the environment of bullying, discrimination, and microaggressions where women gynecologic oncologists worked. The most impactful way to stop these negative experiences from repeating themselves, Hong says, is through implementing systemic change first.

“We need a systems change before a change in leaders,” Hong says. “If leaders are swapped out but placed in the same system as before, that probably won’t achieve the big changes that are needed.”

Study authors call on mentors and educators to actively help women navigate unprofessional behavior, gender bias, and exclusion at work. In a recent presentation for the Society of Gynecologic Oncology’s gender equity task force, Hong spoke of the value of being an “upstander” — someone who intervenes on behalf of a person being bullied or attacked — as opposed to a complacent “bystander.”

There is an idiom in the study’s title, “Gynecologic Oncology and Inclusion of Women Into the Surgical Workforce: The Canary in This Coal Mine,” Hong says: the canary represents gynecologic oncologists, and the coal mine is the field of gynecologic oncology. She says many gynecologic oncologists must navigate their field by weathering behaviors like bullying and risking their well-being with little preparation, support, or tools to make a change.

The study included some limitations that Hong says further research should aim to resolve. Survey studies have selection bias, so people who chose to complete the survey may have been more likely to identify with the experiences being assessed in the survey. Additionally, most respondents were younger than 50 years old, married, white, and had children. Hong says the demographics do not reflect the diversity of all women gynecological oncologists.

She says further research focusing on more extensive surveys with feedback from gynecologic oncologists will provide insights into bullying, discrimination, and microaggressions. Future studies can also focus on intervention methods for these adverse experiences in gynecologic oncology, helping shape better approaches to training and education, Hong says.

“We now have a trained generation of women who care for other women in gynecologic oncology,” Hong says. “They should be supported and retained in workplace environments where they can thrive.”

To learn more about ongoing research at Loma Linda University, visit researchaffairs.llu.edu.