This piece is intended as a resource guide and is not a substitute for legal counsel from an attorney. Legal counsel can be easy to obtain as a medical student or as a resident/fellow through the ACLU and the National Women's Law Center and TimesUp Healthcare.
As a medical student I had what I would consider a positive experience with my pregnancy and postpartum journey prior to starting intern year. I consider myself extremely lucky as this is not the case for many women.
My introduction to maternal discrimination as a resident - a form of gender discrimination that is rooted in the perceived threat of fertility and/or established identity or role as a mother - was painful and left lasting scars.
Trauma can be an extremely fruitful ground for growth and advocacy, however. Lived experiences tend to influence the causes we are passionate about. In my case, my experiences have defined my drive to do the work to create tangible change for women and mothers in medicine at all levels. And if immersing myself in dismantling structures that perpetuate maternal discrimination and learning how to navigate the resources to combat it yields anything I hope it is this: ensuring other women and mothers can take full advantage of the resources at their disposal without fear or gaslighting.
Justice is rare, justification is common.
If you are a woman in medicine, chances are you will experience some form of gender discrimination - female medical students experience sexual harassment more often than students in other STEM fields, more than 50% of women faculty experience sexual harassment, and 80% of women physicians whom are or will become mothers also report experiencing maternal discrimination based specifically on their motherhood status (1). These studies describe what we already know: medicine can be a violent environment towards women and mothers. Protecting vulnerable groups like students and trainees is nuanced and critical.
So what do you do if you experience any spectrum of discrimination or harassment in medical school or training? The answer is varied. The foundational piece that applies to every single case, however, is documentation. Even if you do not wish to pursue action, be diligent about recording times, dates, witnesses, and other women this has likely or definitely happened to.
Documentation is your most important contribution to seeking action and is best performed when the memory is raw. Another initial step of absolute importance is seeking comfort in someone you trust who loves you - a partner or close friend.
From personal experience, sharing your story in those initially painful days with an acquaintance or colleague may lend itself to gaslighting - “oh, he didn’t mean it like that” or “you know how he is.”
Stop there, do not let another’s internalization of patriarchy and acceptance of a violent culture alter your emotions or influence your next steps. You alone can dictate what is best for you and it is better to do this well-supported.
Common themes underscore barriers to reporting for medical students and trainees. Fear of retribution, including actual or perceived threats to one’s career goals, is the most common barrier. Other limiting scenarios include difficulty in reporting subtle forms of abuse or mistreatment (example: microaggressions), convoluted reporting processes, perceived sense of futility in institutional resources, departmental empathy with the source of mistreatment.
The power to derail your career, or at least limit it, is reason enough for most women to abstain from pursuing any action. As an attorney well-versed in medical education once told me - all it takes is a phone call that says so and so just didn’t get along with such and such. And in one sentence an entire allegation of discrimination/harassment/assault is reduced to nothing. All that to say that retaliation in the form of limiting future opportunities, like a fellowship, can be hard to prove beyond a reasonable doubt.
I write this not to dissuade anyone from pursuing justice, but rather to illuminate the maliciously quiet avenues available to those in power that ensure students and trainees remain in a position of vulnerability.
Once you understand the monster in front of you, the better you can fight it.
So what do we do?
The first step is to explore reporting systems at your institutions. Many medical schools and training institutions have anonymous reporting compliance systems. Bare in mind that not all complaints can be kept anonymous depending on the nature of the incident and, ultimately, the victim's desired outcome.
One thing I would like to make very clear for rising and current residents/fellows is that your status as an employee confers a wealth of resources like state and federal protections. We as trainees must move beyond the infantilization that defines medicine and understand that we are employees and deserve protection - we must do away with accepting mistreatment as a norm, we must understand that we are worthy of respect.
As an employee, a trainee may seek out help through Human Resources. Almost always, reporting systems are reviewed by HR. Please note, however, HR bares a burden of proof as they are entrusted with preventing institutional legal exposure and financial risk. This is the problem of too many zeros: established professors and attending physicians are more profitable, salaried, and even tenured. That means their behavior, however negative or even violent, is weighted against the financial risk they carry versus a potential legal threat from an inferior party (a trainee or learner), who, they hope, will not follow through or will at least encounter barriers). Thankfully, HR is not your only recourse as a trainee.
It’s important to consider an Equal Opportunity Employment Claim in conjunction with your HR complaint or even in lieu of it. An EEOC claim must be submitted before a lawsuit can be filed against your employer (i.e. program or institution). The deadline for submission is 180 days - this is something very few trainees know about and it is often too late for many when they reach a point of emotional readiness to pursue action. Even if you do not wish to file a lawsuit, an EEOC claim can at least prompt an investigation and achieve more than an HR investigation may be able to do.
Another powerful option is a Title IX complaint. This avenue is viable for sexual harassment, discrimination and retaliation claims and is a new tool for trainees. A 2017 ruling out of the Third Circuit in Jane Doe v. Mercy held that the discrimination and harassment prohibitions of Title IX apply to a private hospital's medical residency program because the mission is considered to be, at least in part, educational. This claim can be made in conjunction or in lieu of an HR complaint and decisions take about 30 days. A trainee may pursue direct litigation under Title IX, bypassing traditional administrative schemes. Again, the deadline is 180 days.
Your best resource will always be an attorney. If you’ve filled a Title IX or EEOC complaint you may find most attorneys will consider taking you on as a client on contingency. If you’ve missed your deadline contingency may not be an option. You can find an attorney for an initial meeting for reasonable fees. Please seek out the resources at the top of this post. Having an attorney, even if you have missed your filing deadline and options are thus limited, will help give you a strategic plan - for example: if you are denied fellowship, you can file an EEOC/Title IX claim and open a retaliation case.
Change requires solidarity and tangible resources. While the former is a question of personal ethics and internal narratives, the latter is logistically difficult to navigate. Please remember that being in medicine confers privilege even for those of us from marginalized groups.
None of us are powerless in spite of the culture of infantilization that medicine is founded on. Institutions do not change out of benevolence. Pressures in forms that threaten their stability and welfare do, however. It is time we stop gaslighting ourselves and our peers, empowering one another, and pushing forward in tangible ways. That is how we change the game.
Stentz, Natalie Clark, et al. "Fertility and childbearing among American female physicians." Journal of Women's Health 25.10 (2016): 1059-1065.