Women in Academic Medicine - Stanford University Medical School

"Everyone who's female who's gone to medical school has gotten patted and pinched."

When Stanford University neurosurgeon Frances Conley made public allegations of years of sexual harassment, she briefly became a media celebrity. "Prominent woman brain surgeon says she can't take it anymore" was the tone of many articles about Conley's resignation, later rescinded, from the faculty of Stanford University Medical School.

Public response to Conley's actions and words paralleled the response to Anita Hill, ranging from enthusiastic support to questioning criticism (Why did she wait so long? What other motives does she have?). Publicly and privately, Conley has been described as everything from a heroine of the "new feminism" to an accomplished Machiavellian who used the media and growing national attention to the issue of sexual harassment to destroy a competitor's career.

"I think Fran has gone off the deep end," a nurse who worked with her was quoted in the Washington Post as saying. The same article (November 6, 1991) also hinted, darkly, that issues other than harassment were involved in the "Conley case". Despite almost unlimited access to faculty, residents, students, and staff, however, the reporter failed to do more than make vague insinuations or exasperatedly complain that "everything" was involved in the Conley brouhaha. Well, DataLine doesn't think the m at Stanford is "everything" -- it's much more specific than that.

Frances Conley's story exemplifies the current state of the glass ceiling for women in academic medicine. Her story, and several others very much like it (but which have received virtually no national media attention), also illuminate the relationship between subsets of behavior such as sex discrimination and sexual harassment and the greater standards of behavior and principle that an institution - whether it is a university or a corporation - sets for itself and presents to its larger communit story also raises troubling questions about the fate of high-level women in academic medicine: Conley herself believes that her career is over and that she will be gone from Stanford within the year. She points to numerous other women in academe who "were removed" when they reached certain pinnacles.

Conley's story brought reporters to Stanford when the national media spotlight had already been shining brightly on the campus for some time in the wake of allegations that the University had misused millions of dollars in research funds. In talking about Conley and other women at Stanford, we get the feeling that many people at Stanford just wish all the attention would just stop. One prominent faculty member of the medical school, who is chair of her department, cried "I'm just pained at the o t" of the press and congressional investigation. She and others are angry at Conley for adding to Stanford's woes. They point to the university's track record at recruiting and attracting women and minority faculty members. The Dean of the Medical School, Dr. David Korn, has personally promoted women and has brought nationally and internationally prominent women to Stanford: Dr. Lucy Shapiro in Developmental Biology; Dr. Uta Francke in Genetics; Dr. Mary Lake Polan in Obstetrics and Gynecology; Dr. Carla Schatz in Neurobiology.

"I love this place", Shapiro declares with unmistakable sincerity. "I really think this place has changed dramatically in the last ten years." At the same time, Shapiro acknowledges that sexual harassment of women medical students, interns and residents is common. She insists, however, that Stanford is "not worse" than other top medical schools, and that the "basic sciences" are better for women than the "clinical sciences" because "the medical world is much more old boy network than basic science.

Mary Lake Polan also acknowledges that sexual harassment is a problem in medical schools. "The kinds of problems that happened to Fran [Conley] happened to me," she says in a matter-of-fact tone. "Everyone who's female who's gone to medical school has gotten patted and pinched. That's part of the process. I don't think it's right." Polan sees this as "an added burden" that women have in the severely burdensome life of both male and female medical students and residents, who "get used a lot". In Polan's view, females just have a heavier load because they also get used sexually, but that it's a burden that diminishes as women get older.

Polan seems to see no connection between the sexual harassment of younger women in medicine and the existence of the glass ceiling she also acknowledges exists for women in medicine. Yet she herself says she accepted Dean Korn's offer to head Stanford's Department of Obstetrics and Gynecology, "because I felt my career was pretty much blocked [at Yale University Medical School] in New Haven. I didn't think I'd be promoted - I'd hit a glass ceiling, and I was not going to be able to do the things I ."

Perhaps the fact that women in medicine must deal with harassment as they begin their careers and the glass ceiling as they advance is purely coincidental -- but that's not how Frances Conley sees it. Nor, perhaps, Carla Schatz, a tenured professor who recently left Stanford for the University of California at Berkeley. Schatz says she is "exhausted and disgusted" with the topic of discrimination and harassment at Stanford. "With the people who are involved at Stanford, one can't change them. I want to do my science!"

Schatz's departure from Stanford was primarily due to the University's inability to create a position for her husband, who recently completed his doctorate. She says that it also had to do with "the way women get treated - all of that".

Stanford's leadership did try to find a position for Schatz's spouse, Michael Ignatius, a neurobiologist who had recently received his Ph.D. -- but at the expense of the much senior Dr. Conley. According to Dr. Korn, the only offer that anyone made came from Gerald Silverberg, Acting Chair of Neurosurgery at the Medical School. In addition to "generous start-up funding", Dr. Silverberg offered Ignatius the only research space available, Korn says -- Frances Conley's laboratory at the Veteran's Administration Hospital. Dr. Conley, according to Korn and others at the Medical School, is the only faculty member of Stanford's Neurosurgery Department who has built and maintained a major research effort. Stanford's Department is known for its clinical, not research, expertise. When DataLine first questioned Dr. Korn about this offer of Conley's space to a young Ph.D., he protested that "that was divisional space, and besides, Fran doesn't have any grants." He later agreed that lab space at the VA Hospital was not divisional space, and acknowledged that he was not aware that Conley does have current grant money. And although the University and the VA Hospital are very closely affiliated, facilities at the VA Hospital are government, not University property. They are certainly not under the jurisdiction of the Acting Chair of Neurosurgery at Stanford.

Conley believes that the way her lab space was offered to Ignatius exemplifies the "unacceptable conditions" created by Silverberg's appointment as head of the department -- conditions that were literally forcing her out. Korn discounts this, and vents dramatic frustration with what he calls the "endless" complaining about space by "faculty members with large egos". He does admit, however, that Dr. Silverberg had no official right to give away the space Conley's research grants had built and maintained at the VA Hospital, and that "it could have been handled differently".

Most media accounts glossed over the multiple factors involved in Conley's resignation, and presented her public allegations of sexual harassment and her official resignation as simultaneous. In fact, these were separate events, and linking them served to paint Conley, like Anita Hill, as a woman who was using old and possibly frivolous accusations against a prominent man to deny him a promotion he deserved.

In fact, Conley had privately told Dean Korn that she objected to Dr. Silverberg as Chair of Neurosurgery, and that she intended to resign if Korn promoted him. The reasons she gave centered on her strongly-held conviction that Dr. Silverberg lacked the qualities of leadership that the department needed and deserved. No media attention followed her resignation; nor did she seek any.

Later, Conley was attending a meeting of the Medical School Student Senate, at which women medical students testified about their experiences of sexual harassment. Conley describes sitting in the Senate Room and thinking to herself, "My God, what have I done? What kind of environment have I facilitated?" Weeks later, Conley wrote the op-ed piece that appeared in several major newspapers nationwide, and then the media storm broke.

Another tenured woman at Stanford Medical School, Dr. Margaret Billingham, describes experiences similar to Conley's. Billingham, who has been at Stanford for 25 years and is currently chief of Cardiac Pathology, was named by Dean Korn to head the Women in Medicine committee. "I've gone through life at Stanford toeing the line," she says. Inequities abounded, from having to pay to install telephones in her office and labs to being left out of faculty meetings to being publicly insulted, but " t speak up". Billingham finds herself saddened and very concerned for Conley, whose "career may be finished. It shouldn't be, but it may be. A number of people shun her; we've got a kind of backlash going". Billingham notes that "there are a lot of women who don't agree with Fran, and this is seized upon. But women are still afraid to speak out for fear of being thought of as a troublemaker or a feminist."

Interestingly, one of the criticisms frequently flung at Conley is that she hasn't been a feminist, and if she is one now, then she's not doing it right. Dean Korn makes much of the fact that Conley didn't express adequate concern for classes of women other than highly-educated professionals (cocktail waitresses were mentioned). "Who is the aggrieved party?" Korn demanded. "Is it all women? Women faculty? Women medical students? Or is it Fran Conley?" Other women professors also noted, someti an aside, that Conley hadn't done anything for women at Stanford before, implying that this earlier silence deprives her of any right to decide that she will now speak up.

Conley acknowledges that she became "one of the boys". Everyone we spoke to at Stanford expresses admiration or awe at Conley's unquestioned success in the "most macho" of disciplines, and those who know Conley describe her as "tough". Conley herself has spoken of the daily assaults on her dignity, and how she honed her skill at repartee to defend herself. She hasn't spoken so much about what she did to herself, internally, in daily suppressing the feelings that must have arisen.

She also has not spoken much publicly about her belief that no matter how the faculty members treat each other, or treat their residents, the treatment of patients must always be dignified and respectful. She believes this passionately, and it forms part of the foundation of her objections to Dr. Silverberg as leader of the Department of Neurosurgery. No one that we know of has questioned Dr. Silverberg's skill, even brilliance, as a neurosurgeon. And Dean Korn says he has received "dozens of let rom Dr. Silverberg's patients and colleagues attesting to his good character. Yet there are others, in addition to Conley, who have questioned Dr. Silverberg's fitness for leadership on grounds other than those of sexual harassment.

One of these is Professor Jack Bunzel, formerly President of San Jose State University and currently a Fellow at the Hoover Institution. Professor Bunzel wrote an article for the San Jose Mercury News, where his byline is well-known, in support of Frances Conley. He withdrew the article, and sent it to another paper, when the Mercury News refused to include the following two paragraphs:

A number of hospital employees [said] that Dr. Silverberg lacked sensitivity in his dealings with other people on the staff, almost as if he were unaware of the implications of his own actions and did not fully understand how his treatment of them was demeaning, unfair and painful. These women were not so-called rebels of the world, but serious professionals who came forward, only after long and careful thought, to express their strong reservations about Dr. Silverberg's pattern of behavior.

One incident that the [special investigative] panel was not told about took place five years ago. In front of a dying 14 year old child, Dr. Silverberg suggested that she should receive no further medical attention. When he was told by the nurse that the patient was awake and could hear him, he said he didn't care. The nurse was so upset that she wrote a letter (dated October 30, 1986) to Dr. Irving Shulman, then chairman of Pediatrics, in which she stated that this kind of behavior was unprofessional and unacceptable. (It is reported that last August Dr. Shulman told the Dean of his own adamant opposition to Silverberg's appointment.)

The panel Bunzel refers to is the special investigative committee that Dean Korn created to look into Conley's allegations. Several faculty members, as well as Professor Bunzel, have expressed concern about the rules the committee has set for those testifying: The transcript of their testimony will be made available to Dr. Silverberg, but without protection of confidentiality. A Neurosurgery nurse, for example, knows that her identity will be disclosed, along with her testimony, to someone with wh will not only have to work in the future, but who may be her boss.

Bunzel finds this "unusual" and "regrettable". We questioned Dean Korn about this; he says he was completely uninvolved in the development of the committee's procedures, and that he believes that the University's attorneys worked them out in conjunction with Conley's and SIlverberg's attorneys. Conley says neither she nor her attorney were contacted about this. Neither Dr. Silverberg nor the University attorneys returned DataLine's calls about this.

Concerns that speaking out could result in retaliation appear to have been justified in the case of a young secretary in the Department of Neurosurgery. After the Washington Post reported Conley's comment that the atmosphere at the Medical School had become hostile, including even the departmental administrative staff, the secretary to one professor (who had been publicly critical of Conley) wrote a letter on her department word processor. She told Conley how sorry she was about what had happen offered her encouragement.

Someone removed that letter from the word processor and circulated it throughout the department. The young woman quickly found herself unable to deal with the level of hostility directed at her. On Monday, February 3, she starts a new job at a pharmaceutical company, which, she has heard, has a pretty good track record for its treatment of women.

"I just want to let go of the University," she says. " I stood up and got involved, and I just got hassled. I don't want to be involved anymore. You can't change people or their ethical values." When asked why she had written to Conley, the young woman replies, "She had to know she's not crazy. You start to feel like you're the one who's crazy."

Dean Korn had not heard of the resignation of this young woman, nor, he says, of the complaints of women in other departments in the Medical School. Among the departments of which Dean Korn claims ignorance is his own former department, Pathology. In that department, Margaret Billingham told DataLine, a young woman Assistant Professor was told she would have to buy her own desk for her University office. Billingham has her own complaints about recent developments regarding her lab space. Korn, w to be Chair of Pathology and considers Billingham his protege, dismisses these complaints as "noise. We live in a milieu of inadequate space--that's the commodity that people here would sell their souls for. It's a terribly common complaint." Korn agrees, however, that Billingham has put up with a lot over the years. "I don't doubt that she was treated badly or that she suffered. Or that Fran [Conley] suffered."

In the Department of Radiology, Dr. Sheila Moore says she and two other women faculty members "feel our careers are being blocked." Moore has an international reputation, and impeccable credentials and experience: M.D. from University of California at San Francisco (UCSF); internship at the University of Michigan; residency at UCSF; and three fellowships at UCSF, in Radiology, Pediatric Radiology, and Magnetic Resonance. Yet Moore hears from the Fellows at Stanford that her section chief tel that she doesn't know enough about the technology to guide them. They are advised to wait for the section chief before dealing with a difficult case, rather than seeking Moore's opinion. She says she is consistently refused time to do research that more junior men are granted. Things that seem minor on a daily basis, such as being called "Sheila" by secretaries who address male physicians as "Doctor", begin to add up. "You are not seen as somebody who can take a leadership position. And if you act fi rm, you're seen as a bitch."

Moore describes the trajectory she says women in medicine follow, from overt harassment to blocked professional advancement. "You get sexually harassed in medical school, internship, and residency," she says, recalling her first day of residency at UCSF: Male professors lined the hall outside their offices and critiqued the physiques of the female residents as they made their first entry into the hospital. "Then the harassment subsides, and the 'gender blockade' begins, as you become more threat

Moore says she was told that she would have to be made to "walk on water" to make it through her tenure battle. "Why should I have to walk on water?" she asks. She sees her friends giving up, leaving their careers. Moore herself has two children, aged one and four, and she too thinks about quitting. "But I won't," she says. "When you quit, they say: 'See, you women can't handle it'."

Korn says he has never heard of the issues the women in Radiology raised. Nevertheless, he is willing to interpret their stories. One of his explanations is the basic "pipeline" theory with an academic twist: Women haven't been in the medical school and in faculty positions long enough, and it takes time to change habits and behavior patterns. His second theory is that because the University has a special obligation to preserve and maintain freedom of expression and thought, especially in these f encroachment by political correctness, some forms of "insensitivity" may simply have to be tolerated. Korn points out that "in a university, you have extra freedom to make an ass of yourself".

Korn also offers another explanation: that the incidents described by Conley and others are isolated, not representative, and are more accurately placed in the realm of academic politics than sex discrimination or the law.

The accusation that Conley in particular has used the media, feminism, and concern about sexual harassment as weapons in her fierce competition with a colleague has consistently appeared in the press. Several faculty members raised this issue with DataLine . One of Conley's colleagues in Neurosurgery, Dr. Larry Shuer, accused Conley of this in an op-ed piece published in the San Francisco Chronicle . Another colleague, Dr. George Koenig, told the Washington Post that Conley had "hooked her feel the caboose of feminism" and that he views her actions as "a temper tantrum".

However, the actual process by which Dr. Silverberg was chosen to be Chair of the Department, and Conley's role in it, bear closer scrutiny. This particular branch of the story also brings us back to the larger issues of Stanford's current financial problems, created primarily by the repayment of hundreds of millions of dollars in research funds.

Dean Korn now says that the national search for a prominent Chair for the Department of Neurosurgery was cancelled because of money problems. "This University is facing an enormous trauma. We're struggling," he says. The Washington Post also reported that the money problems beset Stanford only after the search was commenced, and further that Silverberg was selected as "the strongest internal candidate". The Post fails to report, however, that Silverberg was the only internal candidate (Conley clared her lack of interest and wasn't evaluated), and that the outside consultants' first recommendation had been that Stanford should conduct a national search to try to attract someone who would strengthen the department's research arm. Dr. Silverberg, like the other faculty members in Neurosurgery with the exception of Conley, is renowned for his clinical work but does virtually no research.

Korn confirms reports that Conley had removed her name from consideration as a candidate long before the outside consultants entered the picture. He knew that she had become interested in a position as a Dean perhaps, but not Department Chair.

Dr. Les Dorfman, Acting Chair of Neurology at Stanford and head of the search committee for the Neurosurgery Chair, firmly contradicts the Post's claim that Stanford's money woes arose after the search had begun. On the contrary, Dorfman says, "the whole search was undertaken at a time when we were aware of the budget problems. It was such a consideration that we even went to the length of hiring outside consultants to advise us whether we had a likelihood of attracting someone of stature given t tations of the University's resources." The search committee proceeded, Dorfman says, because they accepted the consultants' conclusion that " the Stanford name and the opportunity to collaborate with other distinguished scientists at the University would be sufficiently attractive for someone of stature".

The initial results of the search were promising, according to Dorfman. Over thirty resumes were submitted by interested candidates. Dorfman says this was encouraging, particularly in light of how small a field neurosurgery is. "There are perhaps fewer than 100 programs in the country, and they tend to be small, with three to five faculty each." The committee never got to the point of inviting a single candidate to visit, however, because Dean Korn cancelled the search. The actual cost of com the process may never be known, but Dorfman makes it clear that it was too early to know whether Stanford could have attracted a major figure.

Korn, who has considerable experience with academic recruiting, believes that the University's financial limitations would have ultimately doomed the search, although he also says he has no knowledge of who responded, nor even how many people expressed interest. Korn also expresses annoyance that Conley, who had made her lack of interest in running the department very clear to him for some time, should seemingly sandbag him with her opposition to Silverberg's appointment. For her to do it in the pr ses him personal pain.

Korn is clearly concerned about the status of women at Stanford, and proud of his achievements in enhancing women's careers. But he also wants to continue his work, and the University's progress, on his own terms. He grows visibly distressed, and paces his office in agitation, as he speaks of "this absolutely distasteful circus" and what he calls "an awful lot of political distortion. This whole thing's become a political circus. It's just not my taste".

Although Korn says he will not make a decision about the fate of the Chair of Neurosurgery until the special investigative committee has completed their work, he admits to a "foreboding sense that the issues in this case are such that there will be no happy resolution. I may do away with the Neurosurgery Department as a result of this."

DataLine has sympathy for Dr. Korn, and for the many exceptional people at Stanford who bear no personal responsibility for the University's financial problems. Yet we are tempted to remonstrate that the issues at stake here are not appropriately placed within the realm of tastefulness. The issues belong to many realms, including our national interest.

Further, we do not mean this as consolation when we report that Dr. Shapiro's assessment is correct: Stanford is not worse than other top medical schools. The Congressional Caucus for Women's Issues recently wrote to Louis Sullivan, Secretary of Health and Human Services: "Women scientists and physicians nationwide have now succeeded at the junior levels of research and administration, but there is a sudden loss of these bright and educated women when the time comes for promotion and tenure...W t believe it is because women are less-qualified, but rather that barriers.are put in their way. We believe that women scientists will help correct the lack of research studies into areas of women's health, and also have a great deal to add to policy decisions about the future of science, technology and medicine."

DataLine believes that these "barriers" are more often aggressive actions directed against women scientists. To correct this, universities need, in addition to dancing with fuzzy concepts like "gender insensitivity", to start dealing with hard facts: There is a world of difference between the overwork of a medical resident, male or female, and the loss of personal, physical integrity suffered by the female resident who is additionally "patted and pinched". And there is a loss of integrity for titution that permits it.