A recent article by Reshma Jagsi et al entitled “Workplace harassment, cyber incivility, and climate in academic medicine” (JAMA. 2023;329(21):1848-1858. doi:10.1001/jama.2023.7232) sheds light on an academic culture that seems to be stuck in evolution. She and her colleagues surveyed faculty who were the recipients of K awards some 10-15 years earlier; and the results show the ongoing harassment, lack of inclusion, and personally demoralizing behavior that continue to exist in our academic settings.  The accompanying editorial by Douglas (JAMA. 2023 Jun 6;329(21):1829-1831) aptly declares, “we have met the enemy, and it is us”.  She notes that the lack of respect and civility in medicine flies in the face of who we think we are or should be (i.e., our professionalism oath).

When I graduated from medical school several decades ago, I saw few women anywhere:  in my class, my residency, on faculty or practice, and certainly not in those “specialties that would be tough for women”.  I naively believed that with time there would be many more of us, and the culture of our historically male-dominated profession would miraculously adapt to one that was supportive, inclusive, and egalitarian for the generations that followed. And most importantly, once a few women rose to powerful leadership positions, they would be the change-makers. Neither of these beliefs have fully materialized.

While the growing numbers of women in medicine have brought positive changes and opportunities, the work environment continues to present challenges.   Regulators like the ACGME and LCME, as well as influential bodies like the AAMC and medical societies, have spurred significant changes.  Yet, despite these advances, women faculty still experience academic environments as more toxic and less inclusive than their male counterparts.  Sociologists might attribute this to lingering social change, deep-rooted traditions, and the persistence of a strong hierarchy.

With 50% women medical students (even more PhD students) and 50% women assistant professors, we have the opportunity to achieve a benchmark that would mean a better culture for all.  We should seize the opportunity to support these women in the academy, so they reach 50% associate professors, full professors, and leaders (dean, chairs, CEOs).  When academic medicine no longer sees a minority of women throughout the hierarchy, then actions taken by leaders will be seen as important to the entire community.  As we approach this 50% benchmark, we can more easily implement equitable policies, address behavior that is unacceptable, provide equal access to opportunities, and fairly evaluate performance.  We create a norm that benefits faculty, students, and importantly, current and future patients.