publication date: Oct. 2, 2020

Conversation with The Cancer Letter

Pamela Kunz: “In any other industry, if someone had behavior like that, they would be fired.”

Pam_Kunz

Pamela Kunz, MD

Leader,

Gastrointestinal Cancers Program,

Director,

GI medical oncology,

Yale School of Medicine

 

Pamela Kunz said she left Stanford School of Medicine because of years of gender-related microaggressions and verbal abuse she experienced there.

She wasn’t holding back on letting the institution know what was going on every step of the way, she said.

“I let them know, for actually quite a while, that I was unhappy and that I felt that I was being discriminated against for my gender. I gave them examples of what I described as, pervasive microaggressions and verbal harassment,” Kunz said.

Stanford officials declined to comment on Kunz’s account.

“The School of Medicine does not provide public comment on confidential reports brought forward by individuals on behalf of themselves or others,” the school said in a written response to questions from The Cancer Letter. “Stanford Medicine is dedicated to an environment that is free of sexual harassment and discrimination. We have robust policies in place to ensure the fair and respectful treatment of employees. When any violation of any of these policies occurs, our leadership, in collaboration with University leadership, takes immediate action to fully investigate and respond accordingly.”

Stanford’s full response appears on here.

Kunz said she first contacted the office of the dean in 2018, and then just before she left her position in May 2020. Now, she is leader of the Gastrointestinal Cancers Program and director of GI Medical Oncology at Yale School of Medicine.

Kunz said she was verbally harassed over the years, especially when she became a mid-career physician. She often recalls an article, “Is academic medicine making mid-career women physicians invisible?”

“It took me a while to really acknowledge what was happening to me. I think so many women in medicine normalize being mistreated and put down. I think that it was really when I entered the mid-career stage, and achieved a level of success, I recognized that I was perceived as a threat by some of my male colleagues,” Kunz said. “I don’t think I was treated that way my entire training and fellowship. I think really it peaked and became a problem when I was perceived as a threat.” 

The people she confided in were the same ones who make the policies. While Stanford School of Medicine has a human resource department, it does not serve as the central body for reporting harassment as in other industries. Kunz used many of the other reporting mechanisms available to her, however, she said no concrete actions were taken.

[Correction 10/3: An earlier version of this story stated that Stanford School of Medicine does not have an HR department. Stanford does have an HR department, however Kunz said she could not turn to them.]

“In academic medicine we have division and departmental leadership, the dean’s office, and ombudspeople. But, I don’t think it’s the same as traditional HR in another industry who would normally be out to protect the employee,” she said. “I feel like in medicine, those routes are really designed to protect the institution.”

She was called out for her looks rather than her intellect, she said to The Cancer Letter.

“Another example from a colleague, he said, ‘Oh, your good looks helped get you on that panel’—really just undermining my intellect, and saying that I was selected for aesthetic reasons rather than for my knowledge,” Kunz said.

Kunz, who has three children, was pregnant just before fellowship, as a fellow, and as a junior faculty member. One colleague complained about her maternity leave—“really, just derogatory comments about being pregnant,” she said.

“Oh, you’re pregnant again. Oh, I have to cover your maternity leave again?” the colleague said to her.

Kunz was director of a continuing medical education course when a man second-guessed her expertise.

“While answering some questions at the end of the course, an audience member asked a question and then one of my colleagues said, ‘Oh, I’m going to let Pam answer first so that I can correct her,’” she said.

These comments, while they may appear trivial on the surface, add up. They took a psychological toll on Kunz’s mental health, and affected her work. Eventually, they became more pronounced. Some tried to take research opportunities away from her.

“The constant, repetitive nature of the comments just was too much. It became untenable for me to stay,” she said.

At Yale, Kunz is able to breathe again, she said.

“I was talking, actually, with a colleague yesterday about this—and navigating these microaggressions and other forms of harassment takes so much time away from women being productive. I’ve only been at Yale a couple of months, but these concerns are off my plate, which has been great for my mental health and, frankly, adds so much time back to my day,” she said.

 

Kunz spoke with Alexandria Carolan, a reporter with The Cancer Letter.

 

Alexandria Carolan:

All of the women in our survey who experienced an instance of gender bias and reported it wrote that their institutions responded inadequately (100%, n=26). What does this tell us?

Pamela Kunz:

First, I’m not surprised. Some of these things went through my mind as well when I was experiencing gender discrimination and harassment, and I’ve heard that same sentiment from many other women faculty at institutions across the U.S. I think there are multiple factors at play. I think that one, the fear of retaliation is completely real.

Even if women plan to leave their institution, I think they’re fearful that retaliation could affect their reputation and ability to get future jobs. However, not every woman is looking to leave their institution. For them, they’re fearful that speaking up is going to affect their current work environment. Fear of retaliation is one of the biggest deterrents in reporting.

Second, you mentioned the survey finding that institutional responses are not adequate. And I think a lot of it stems from women not knowing where to go.

I had the same experience. In fact, I had a friend outside of medicine ask, “Well, why don’t you just go talk to HR?” And I responded, “Well, HR doesn’t really exist in academic medicine.”

In academic medicine we have division and departmental leadership, the dean’s office, and ombudspeople. But, I don’t think it’s the same as traditional HR in another industry who would normally be out to protect the employee. I feel like in medicine, those routes are really designed to protect the institution.

 

AC:

That’s definitely what we’ve seen from this survey. People even said, it’s like, “Who do I report to? The people I would report to are in leadership,” the ones who control your paycheck. How do you go about that?

PK:

I made a conscious decision to be transparent with leadership about my experiences. I first spoke with division and departmental leadership and later the dean’s office.

I let them know, for actually quite a while, that I was unhappy and that I felt that I was being discriminated against for my gender. I gave them examples of what I described as, pervasive microaggressions and verbal harassment. I was never physically harassed, but all the verbal harassment really added up and created a toxic work environment.

And I think that one of the other challenges with this particular issue is that some of these microaggressions are difficult to prove. And I will admit that. It’s hard to provide objective evidence as the experiences are very subjective by definition.

But when it’s the same person over and over, and there’s a clear pattern of discrimination and harassment, that’s when it becomes a problem and hopefully easier to prove.

I think there’s a reluctance to discipline the perpetrators when they are full professors, bring in a lot of philanthropic money, have many grants, or have longevity at an institution.

I think it’s really difficult to do anything with these people. Again, in any other industry, if someone had behavior like that, they would be fired. In academic medicine, unfortunately, there is a culture of tolerating and enabling bad behavior.

 

AC:

In our survey we asked, “How do you think institutions could have responded better?” Have you considered solutions to the broken system? What might those look like?

PK:

It’s long been recognized that gender discrimination and harassment exist in academic medicine. So, moving and pivoting towards solutions is really important. And I personally have made that pivot in my mind and really want to try to help contribute in a positive way.

I think that there are a few ways of doing that. Number one is contributing to objective data around some of these gender disparities and discrimination in the professional workforce. And I think as we can generate some of that objective data, physicians are scientists and make decisions based on data, and so I think that can be helpful.

There are many physicians doing research in this area for example—Dr. Reshma Jagsi, a radiation oncologist at the University of Michigan, Dr. Julie Silver a physical medicine and rehabilitation specialist at Massachusetts General Hospital, and Dr. Shikha Jain a medical oncologist at the University of Chicago. Of note, both Drs. Silver and Jain have started successful leadership conferences for women to provide skills to navigate some of these challenges.

I’m am personally trying to contribute to the objective data in this field by examining the gender of PIs on clinical trials in GI Oncology. I’m a clinical trialist, so I thought that would be an interesting way to examine if women are given the same leadership opportunities to lead clinical trials as men. We’re in the middle of that project. I don’t have the answer to that yet.

Number two, I agree with the comment that you made about creating clear but trustworthy reporting mechanisms for those who experience harassment.

We’ve mostly talked about gender discrimination, but harassment can also occur due to sexual orientation, race and other protected characteristics. I think there need to be trustworthy places to go. Many of us who reported instances of harassment have felt that the existing mechanisms are not designed to help the people that are experiencing the harassment.

 

AC:

You mentioned there is often no HR in academia, you have deans and leadership. Respondents to the survey said that they wished that there was this ability to be anonymous in their reporting. Was that an option for you?

PK:

I was not aware of an anonymous reporting option at the time. Had there been one, I might have used it.  As we develop anonymous reporting mechanisms in the future, we should strive for ones that lead to concrete changes and remediation for harassers.

Gender discrimination and harassment is such a pervasive issue in medicine. I’m clearly not the first woman to have experienced it.

I was discouraged by the perceived lack of action and I think many women are discouraged from reporting for the same reason. If they feel that they’re going to go through this effort, which requires being brave and courageous to report, and then nothing’s done, that’s one of the biggest deterrents to reporting. It indicates a broken system.

 

AC:

I was speaking with Reshma Jagsi, whom you mentioned briefly, about this a couple of weeks ago, and she described this phenomenon that I didn’t even realize had a name, but it is called “passing the trash.” Have you heard of that?

PK:

I’ve not heard that phrase. But it makes sense.

 

AC:

I’m sure you can assume what it means. You have a harasser at this institution who has either resigned or was let go, but there is no accountability around the matter. There’s no announcement about why this happened. This person can therefore go to another institution and have the same issues. From this, it sounds like the system is broken; right?

PK:

Well, I think that there are a lot of factors at play. One, is the institution, and I think that there’s this unwillingness to call people out, whether they’re still at the institution or even after they leave.

I think there’s also another interesting phenomenon about an unwillingness of bystanders to speak out. I think they have the same fears around risk of retaliation that we spoke about earlier.

If we can, I’d like to get back to discussing solutions. One of my motivators in speaking out was to normalize talking about gender discrimination and harassment. I had a really unique opportunity to speak out with a lower risk of retaliation because I already had a job lined up at a different institution. I did not seek out the media. It sort of all just happened. I was a reluctant spokesperson in the beginning but have since embraced the role and feel very empowered.

Following the initial article in the Stanford undergraduate newspaper, the Stanford Daily, one of the San Francisco Bay area local newspapers, The Mercury News, picked up on that story and did a follow-up piece.

I really hope to inspire other women to speak out and encourage everyone, men and women, to have a conversation about this topic. If you are a leader in medicine, whether male or female ask your female team members, are they experiencing gender discrimination and harassment? If yes, ask what you can do.

Just acknowledging that it’s there, I think, will start those conversations, and create an environment where it’s okay to talk about and it’s okay for bystanders to speak up.

I’ve had things said about me publicly that undermined my leadership. And just I wish someone, whether it had been a male ally, or another leader in the room, had said to the harasser, “Hey, that’s not okay.” And I think we just need to create an environment where it’s okay to do that and call people out on bad behavior.

 

AC:

I’d like to take a step back to clarify some things really quickly. When you reported these microaggressions at Stanford, how exactly did you go about that? Was it an official report that you made, or was it more of a series of conversations?

PK: It was more of a series of conversations. It did get to the point when I spoke to the dean’s office and they launched an investigation on behalf of a series of women who had left Stanford or had also reported some similar things.

Ultimately, that investigation did not happen. I was told that other women were not willing to talk. I think, again, that speaks to this fear of retaliation. I also think that some women didn’t want to relive talking about their painful experiences.

Another very common theme that I hear about is, if someone has experienced harassment at a given institution then left, many women, I’m sure, even though they want to help change culture are just like, “I can’t relive that, it’s like PTSD. I can’t talk about it anymore.”

On a personal note, I felt that I had brought my complaint up the ladder of reporting as far as I could. Despite that, and despite me saying, “Hey, just because they’re not willing to talk doesn’t mean things didn’t happen,” it just didn’t go any further. I felt discouraged and demoralized.

 

AC:

Would you mind giving a few examples of what these microaggressions looked like for you?

PK:

Yes, I’m happy to. Number one, it took me a while to really acknowledge what was happening to me. I think so many women in medicine normalize being mistreated and put down. I think that it was really when I entered the mid-career stage, and achieved a level of success, I recognized that I was perceived as a threat by some of my male colleagues.

I eventually had a realization that I did not like how I was being treated. In retrospect, I was able to look back on how I had been treated in the preceding years—an accumulation of microaggressions.

I don’t think I was treated that way my entire training and fellowship. I think really it peaked and became a problem when I was perceived as a threat. That’s also pretty common among the experiences of women in academic medicine and has been described in the literature.

I’ll give you some specific examples. I’m a mom of three sons and had children at various stages in my career. First, I was pregnant at the end of my chief residency, second during fellowship, and third as a junior faculty member.

I remember one of my colleagues making repeated comments, “Oh, you’re pregnant again.” Or, “Oh, I have to cover your maternity leave again” —really, just derogatory comments about being pregnant. And another example from a colleague, he said, “Oh, your good looks helped get you on that panel”—really just undermining my intellect, and saying that I was selected for aesthetic reasons rather than for my knowledge.

Another example occurred when I served as a course director for a continuing medical education course. While answering some questions at the end of the course, an audience member asked a question and then one of my colleagues said, “Oh, I’m going to let Pam answer first so that I can correct her.”

Lastly, I had colleagues try to usurp research opportunities and undermine my ability to lead a program.

For these examples, you might be able to overlook a single instance. However, the constant, repetitive nature of the comments just was too much. It became untenable for me to stay.

 

AC:

That sounds exhausting.

PK:

Exhausting. I was talking, actually, with a colleague yesterday about this—and navigating these microaggressions and other forms of harassment takes so much time away from women being productive. I’ve only been at Yale a couple of months, but these concerns are off my plate, which has been great for my mental health and, frankly, adds so much time back to my day.

 

AC:

That’s also something our survey touched on. We asked about the impact of this on professional well-being and on mental well-being. We got a few comments about developing depression.

PK:

I think I was clinically depressed at a point, for sure. I was made to feel like I had brought on the harassment. Many harassers have a way of manipulating the situation to make you feel like it’s your fault.

Harassment is really about power. And, medicine is especially prey to these power differentials because of the clear and longstanding hierarchy.

 

AC:

You mentioned earlier, but part of what makes it so difficult is that it’s hard to document or report these microaggressions. How do you make people take it seriously?

PK:

Well, because it’s a he-said, she-said thing. And if you have a very senior faculty member who said, “No, I did not do that,” it’s really, really difficult to prove.

 

AC:

A lot of what we are talking about here is how these instances can really hinder science. You have women working working on teams, and if a harasser is working on these teams, it seems the science is at stake, as well as emotional wellbeing.

PK:

You’re absolutely right. It’s sad that that’s the case, but I think women are juggling a lot of responsibilities on top of childcare, and the second shift at home and all these other things, in addition to then having to deal with discrimination in the workplace.

 

AC:

And in your experience talking with leadership at your own institution, in terms of these microaggressions, what do you wish went right? In an ideal world, what do you think should have happened here?

PK:

I’ve had a lot of time to reflect on this. Now that I’m in a leadership role, I really want to do it right and set a tone and a culture that promotes diversity, that really values diversity of opinion and promotes a culture of mutual respect.

I think it is critical to promote more diversity in leadership roles, in terms of race, gender, and other characteristics. 

I really was disappointed with the lack of action by my prior institution. Nothing happened to my harassers. Nothing. I had really hoped that something concrete would be done including efforts at remediation. But sadly, I had to leave an institution instead of them having any corrective action towards them.

 

AC:

So, in your instance, was it that they were unresponsive or was it that you weren’t even sure that they spoke with your harasser? Do you know what happened there?

PK:

I think that there were some small efforts of speaking to the harassers. To my knowledge, there were no concrete actions taken that indicated the discrimination towards me mattered in a significant way.

Academic medicine is a unique industry and I acknowledge that. What could’ve be done in response to the reports of harassment? Well, I think there’s probably a range of acceptable responses other than nothing.

Could there be executive coaching? Could there be disincentives tied to salary or bonuses? Could there be removal of leadership roles and responsibilities? 

I think that clear expectations and guidelines need to be set by the institution, and, if violated, institutions need to respond with a zero tolerance policy. This is not discussed enough.

PK: I’d like to give an example of one way to promote research in the field of workplace disparities. As I was leaving Stanford, the Department of Medicine developed more leadership roles for women and research seed grants for gender disparities research. This is one way to demonstrate that the institution values such work.

I encourage leaders to think of ways they can encourage that.

 

AC:

Is there anything else you’d like to add or discuss that you think is really important to this conversation?

PK:

Thank you so much. And thank you to the The Cancer Letter for conducting this survey. In doing so, you and your team are help to contribute to the objective data and will hopefully help enact change.

 


 

Stanford School of Medicine responds:

 

How did Stanford School of Medicine respond when first notified of Dr. Kunz experiences with gender bias? 

Stanford School of Medicine: The School of Medicine does not provide public comment on confidential reports brought forward by individuals on behalf of themselves or others.

 

If someone were to report an incident of gender bias now, how would it be different?

Stanford Medicine is dedicated to an environment that is free of sexual harassment and discrimination. We have robust policies in place to ensure the fair and respectful treatment of employees. When any violation of any of these policies occurs, our leadership, in collaboration with University leadership, takes immediate action to fully investigate and respond accordingly.

 

Could you describe the reporting mechanisms that Stanford has in place? (i.e., what steps are taken? What policies are there?)

Stanford Medicine’s process for reporting complaints related to sexual mistreatment follows the process set by Stanford University. Individuals can report to the Sexual Harassment/Assault Response & Education-Title IX Office (SHARE-TIX), to a sexual harassment advisor in the School of Medicine or in any school at the university, to their department chair, to any faculty member, to the office of the vice dean of the School of Medicine, Linda Boxer, or the director of faculty relations, Ellen Waxman. There is no wrong way to report—everyone at the School of Medicine has a duty to take such complaints seriously, and to take appropriate action to advocate for anyone who may be experiencing sexual or gender mistreatment.

 

When a faculty member at Stanford School of Medicine experiences gender bias—how should they go about reporting this?

Please see the answer to question #3 above.

 

What steps did Stanford School of Medicine take to remediate the issue?

The School of Medicine does not provide public comment on confidential reports brought forward by individuals on behalf of themselves or others.

 

What steps has the School of Medicine taken to eliminate gender bias at the institution?

Equal opportunity and a commitment to diversity and inclusion are core to Stanford’s mission. The School of Medicine has promoted the importance of achieving gender diversity on any committee, in faculty searches in the applicant pool—actively reaching out to women in the field—and in leadership roles. Currently 40% of our department chairs are women, the highest ratio among our peer, research-intensive institutions and the third highest of any medical school in the United States. We recognize that more work needs to be done to improve gender diversity at the executive level and across the institution and we are firmly committed to this goal. For example, we’ve taken significant steps to improve gender pay equity, and engaged an external firm to provide department-wide training in the areas of diversity, inclusion, gender equity and unconscious bias. Sexual harassment prevention training is required every two years for all employees.

 

What actions have been taken since then?

The School of Medicine has focused on creating and developing systems of support that will achieve meaningful, lasting improvements and opportunities for women in medicine, especially at Stanford.

The 2019 Diversity dashboard, produced by the Office of Faculty Development and Diversity office, shows improvement in our numbers for both women and under-represented minorities over 2018.

As mentioned in the response to question #6 above, 40% of our department chairs currently are women, the highest ratio among our peer, research-intensive institutions and the third highest of any medical school in the United States.

Several of our departments monitor metrics about women and under-represented minority participation, such as Department of Medicine Grand Rounds speakers (about 50% female in 2019 up from about 25% in 2017). The Department also routinely reports on all diversity metrics in the Annual State of the Department talk by the Chair each year.

We have a new faculty mentoring website with multiple programs that we are rolling out to support our faculty—not only women, of course: http://med.stanford.edu/oaa-mentoring.html

 

Are there future steps the school is planning to take?

We continue to strengthen our existing programs mentioned in answer #7 and monitor and track results. We also recognize that discrimination and injustice do not happen in isolation — they intersect across race, gender, gender identity, and sexual orientation. Sexual harassment and gender discrimination, in particular, remain significant problems within the culture of academic medicine. We cannot accept this and must act swiftly to confront these systemic injustices.

In September, we appointed a Commission on Justice and Equity at Stanford Medicine. The Commission includes independent experts who can provide an objective perspective on our issues. It is charged with conducting a thorough review of our current practices and is responsible for recommending actions, which we will share with our community in full transparency.

 

 

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