In the last year, the Yale School of Medicine has been hit with accusations of harassment, intimidation and bullying. But it is issues like promotion, tenure and largely white, male leadership that women and minorities struggle with on a day-to-day basis.

In one of the Yale School of Medicine’s smaller auditoriums, roughly 50 female faculty members gathered to push the school for answers.

It was around 2008, and promisingly, the Dean’s Office — led by Robert Alpern — had agreed to meet with the women to explain why the findings of the school’s compensation committee report were now being made confidential.

Under former medical school dean David Kessler, everyone knew average salaries by rank and department because the report was published for all to see. But when Alpern took over, the reports became confidential.

According to Senior Research Scientist in the School of Public Health Nancy Ruddle GRD ’68, the data showed clear gender inequities in salaries, but women at least they knew the nature of the injustices they were facing.

The meeting culminated in a resounding wave of disappointment.

Answers to the women’s questions never came, nor did Alpern, who sent his deputy dean for finance and administration in his place, said three senior women who were there that day.

“We didn’t meet with [Alpern]. We met with his posse,” said one woman who was present but did not want to be identified for fear of retaliation she added that Alpern’s disinterest in transparency was evident simply by looking at the room.

An entire row of the auditorium, they said, was lined with lawyers.

EQUAL TREATMENT?

As clinicians in white coats and blue scrubs weaved between the tables of a busy cafeteria at Yale-New Haven Hospital, two senior women — who, between them, had spent over 30 years at the School of Medicine — recounted the early years of Alpern’s tenure.

Over the course of Alpern’s decadelong tenure, women and minority faculty at the medical school have grown accustomed to opacity from the administration.

The most recent example, of course, is the school’s treatment of the Michael Simons MED ’84 case. The former chief of cardiology and former director of Yale’s Cardiovascular Research Center was publicly accused of sexually harassing and intimidating his junior colleagues on the front page of The New York Times in November 2014. The University-Wide Committee on Sexual Misconduct  recommended that Simons be removed from his leadership positions, but Provost Benjamin Polak decided to issue an 18-month suspension instead.

After mounting criticism and media coverage of the incident, the decision was reversed. But, faculty learned, Alpern had been aware of the allegations and had, according to faculty members cited in the Times, swept it under the rug.

Alpert vehemently denies these accusations to this day.

Besides the dismissal of Simons, the UWC findings and subsequent press coverage brought about a more fundamental change. There was a clear shift in how the administration approached women and minority issues at the school, faculty interviewed said.

Since the scandal broke, for instance, Alpern has hosted at least three town halls dedicated to exploring the climate at the medical school and has also implemented a series of initiatives aimed at preventing more abuses of power.

But faculty interviewed said the scandal also highlighted the fact that women and minorities are not well represented in positions of power. Furthermore, they said, the lack of diversity in the school’s leadership has contributed to the persistence of a climate that at best harbors unconscious biases and at worst is downright hostile to women and minorities.

“I definitely feel like there was gender bias in leadership decisions as did my colleagues at the time,” said Director of the Center for Innovation and Global Health at Stanford University Michele Barry, who left Yale in 2009 after 25 years on the faculty for that very reason. Though some behavior is unconscious, she added, it still contributes to a negative climate.

PERFORMING POORLY COMPARED TO OTHERS

The school first started admitting women in 1916, and since then, the number of female medical graduates has increased to roughly half of the class of 100 students admitted each year. But leadership at the school does not reflect its admit pool.

The number of women in high-ranking professorship and leadership positions lags behind the admissions and acceptance rates, as well as the proportion of women in leadership at other medical schools. In 2013, a third of tenured medical professors at Stanford were women. At Yale that year, that figure was just under one in five. Even with the arrival of Mary O’Connor — Olympic rower and professor of orthopedic surgery at the Mayo Clinic College of Medicine — who will become the first director of the school’s new musculoskeletal center, Yale will have one of the the lowest percentages of female medical school leaders as compared to its peer institutions.

For minorities, the picture is even more concerning. Underrepresented minorities — which the National Institutes of Health define as American Indians or Alaska Natives, Blacks or African Americans, Hispanics or Latinos and Native Hawaiians or Other Pacific Islanders — make up a greater proportion at the Yale School of Medicine than at medical schools nationally. Approximately 20 percent of the medical school’s incoming class have been minorities over the past 10 years — elsewhere in the country, that figure hovers around 12 percent. But few of those 20 percent remain at Yale post-graduation.

“With us, our primary goal was to get a medical degree and move on,” said Dean for Multicultural Affairs Professor Forrester Lee MED ’79 Lee, explaining how many minority students in his years at the school viewed Yale as a “stopover.”

“We didn’t think we’d get a strong connection with the University,” he said.

Though he added that student sentiment has been changing over time, the statistics tell a different story.

Only 3.3 percent of tenured professors at Yale medical school are minorities. There were no Hispanic or Latino associate deans at the School in 2014 and there is only one minority department chair currently.

According to professor of child psychiatry and neurobiology Flora Vaccarino, there is a perception that leadership at the medical school functions like an “old boys’ club” with women and physicians of color struggling to gain access to what another faculty member called the “House of Alpern.” Though the majority of faculty interviewed, including Vaccarino, said the bias was unintentional, they still agreed that it was present.

Opinions differed on whether Yale’s climate was uniquely hostile, but all faculty members and administrators interviewed agreed that multiple factors, ranging from unconscious bias to blatant abuses of power, hamper the success of women and minorities in all sectors of working life.

BARRIERS FROM THE BEGINNING

Professor of pharmacology and comparative medicine Anton Bennett reclined in his swivel chair and paused.

He had clearly been asked why so few minorities are in leadership positions many times before.

“When people talk about these problems, they often start at the level they’re interested in, like, ‘Why don’t we have enough minorities applying for a certain faculty position?’ ” he said. “But I think the problem starts way before then.”

Bennett, who sits on one of the school’s appointments and promotions committees, stressed that because there is such a small pool of women and minorities who reach his committee’s desk, it is difficult to promote them in high numbers.

He explained that barriers, such as a low number of role models and potential mentors who have had similar experiences to minority faculty members, make it harder for minorities to be promoted in equal numbers to their white male peers.

Thomas Lynch ’82 MED ’86, the director of the Yale Cancer Center, physician in chief of Smilow Cancer Hospital and head of the search committee that chose O’Connor, sees it similarly.

“If you ask any chair, they would love to find more [women and] minority candidates for positions,” Lynch said.

But almost all of the faculty members and administrators interviewed stressed that academic medicine poses unique challenges to women and minorities that do not exist in the other schools at Yale.

Women often must carry the burden of family care even with the most understanding of spouses said professor of medicine Lisa Sanders MED ’97. This makes it harder for them to do what it takes to be eligible for promotion she added. But, women at Yale medical school are far more poorly represented in leadership positions than they are at Yale’s peer institutions.

Stanford University School of Medicine has almost double the proportion of female tenured professors than Yale. And with only 7 percent of chairs, section chiefs and division chiefs being women, Yale in 2013 had the lowest raw number and percentage of women in administrative positions at its medical school compared to seven similarly ranked schools.

Of those other schools — Harvard, University of Pennsylvania, Columbia, Stanford, Duke, Johns Hopkins University and Northwestern — Duke had the lowest percentage of tenured female professors at 17 percent in 2013, one percentage point lower than Yale that year. The average percentage of tenured female professors at those schools was 26 percent in 2013.

Of the medical school’s 2,433 faculty members, roughly 150 are minorities. Not a single department chair or dean at the medical school is African-American.

THE FALSE SECURITY OF TENURE

At the medical school, faculty members can be required to generate over 75 percent of their salaries from outside sources such as grants. But the ability to do this while working to get promoted depends on how supportive a faculty member’s department chair or section chief is, said multiple faculty members interviewed.

Amy Justice, professor of medicine and of public health and section chief of General internal medicine at the VA Connecticut Healthcare System, listed the potential areas in which unconscious discrimination can negatively affect junior faculty’s chances of getting promoted. Because of the amount of power department chairs and section chiefs have over whether faculty are given the support they need to be promoted, any gender biases held by these senior faculty members are only amplified.

“When you look at who gets resources and who doesn’t, who gets extra salary support as they get their grant revised and resubmitted versus who gets more clinical time if their grant is refused, how do you know if it is because someone is a woman or minority?” Justice asked rhetorically.

One source, who asked to remain anonymous so that it does not sound as though she is complaining, emphasized that she has had to fight for better lab space and an equitable salary. She echoed the importance of these intangible resources.

In order to be able to do the things that promotions depend on, the women said, faculty members need to have both the time off clinical work in order to conduct research, as well as salary support to fill in for the lost wages that would normally be earned through clinical work. 

This leeway is granted by chairs and section chiefs at their own discretion, and while faculty interviewed said it should be in every chair’s interest to make sure their faculty members are doing well, accountability structures are needed to ensure that faculty members are not falling through the cracks is scant, they noted.

That could, technically, be an issue for all faculty members, but those interviewed — including section chiefs and department heads — said women and minorities suffer most from the hierarchical structure and lack of accountability.

“When [processes] are vague, unclear and subject to interpretation, that is when unconscious biases come into play,” professor of psychiatry Cindy Crusto said. “I’m not going to say [unconscious biases] don’t exist — they are what a lot of junior [women and minorities] have to grapple with.”

THE OMNIPOTENCE OF THE CHAIR

Bennett, who serves on the Appointments and Promotions committee, said the promotions process begins long before application packs are presented to his committee.

Prior to this, department chairs and section chiefs, decide whether an applicant should even be up for promotion.

Though Alpern emphasized that promotions committees, which assess scholarly excellence, are typically fair, he also said most faculty wanting a promotion are turned away at the department level, before they are even able to request letters of recommendation to make it to the desk of the promotions committee.

“The main filter for promotions occurs at the department level,” Alpern said. “Ninety-five percent of decisions not to promote people are made by departments,” he added, referring to an anonymous ballot that is cast by tenured faculty members in the candidate’s department before the candidate can move on to the promotions committee.

According to Crusto, as a result of that vote, junior faculty are in a vulnerable position and are dependent on their section chief or chair. Even if the chief or chair has voted against promoting the candidate, they must advocate on behalf of the candidate during promotions committee deliberations.

Justice added that women and minorities also face additional barriers against having their research respected. Compared to men, women tend to be more drawn to applied or clinical research rather than to basic science investigation. The latter is more highly valued in traditional academic settings, including Yale.

WHEN THINGS GO (VERY) WRONG

Crowds swelled in the medical school’s Harkness Auditorium in the town hall that followed the Times’ breaking story on the Simons scandal in November 2014. Faculty members from all demographic backgrounds stood to speak about their own experiences, relaying other instances of abuses of power to the dean that they said contribute to a negative climate at the medical school.

Later, during a phone call with the News, Alpern released a quiet sigh.

He said he was surprised at the number of people who were concerned about the climate at the school when the Simons story broke.

“I have 2,500 faculty,” he said, adding that though he hears anecdotes, he can only address issues that are brought to the attention of the Dean’s Office.

Only a week after the story was published, the Gender Equity Task Force, chaired by professor of medicine and associate dean for faculty development and diversity Linda Bockenstedt, held its first-ever meeting. The Task Force had technically been established in July 2014, but, Alpern said, members had only then found time in their schedules.

Faculty interviewed expressed concern that the school’s recent drive to improve the climate for women and minorities and increase their numbers in leadership positions was motivated by crisis management.

Furthermore, they said, such abuses had happened multiple times before on Alpern’s watch.

“I thought Simons’s behavior was extreme — but was it highly unusual? No,” Ruddle, a woman who was involved in early activism about salary transparency during Alpern’s early years, said frankly.

While the Simons issue was brewing, only one month earlier, a lawsuit alleging racial discrimination was filed against the school’s chair of genetics, Richard Lifton.

The plaintiff in the case left the school in 2004 and claims to have been passed over for more than 70 professional positions following his exit. This is despite the fact, the plaintiff notes, that his speciality area is in high demand nationally. According to the lawsuit, which lists Lifton and the school as defendants, Lifton was preventing the plaintiff from getting future employment due to his ethnic background.

“Dr. Richard Lifton … [was] responsible for my not being hired in my professional clinical cytogenetics field, and for the alleged coercive, ceaseless and reckless retaliation,” the lawsuit read.

Lifton was unavailable for comment.

Then there is the issue of Robert Udelsman, chairman of the board of the Yale Medical Group, the School of Medicine’s chair of surgery and surgeon-in-chief of YNHH.

According to two anonymous sources, Udelsman shoved a female employee in the operating room during a surgical procedure and has thrown surgical equipment in the direction of others. Udelsman later faced disciplinary action for his actions but is still at the school.

One source explained that Udelsman’s actions were due to him becoming annoyed with “inefficiencies” in the operating room.

“I think that in times of extreme frustration with system issues that have not been addressed despite multiple requests -— people blow their stack,” the source said, adding that Udelsman was “unfortunately pushed in an unfortunate situation.”

When these statements were relayed to another faculty member, that faculty member, who asked to remain anonymous to avoid jeopardizing his or her own career prospects, responded by noting, “Whenever [Udelsman] does anything, people say, ‘It’s just Rob.’ They just tolerate it.”

The same faculty member described Udelsman as an “ass,” adding that the medical school leadership is aware of his behavior and has chosen not to act on it.

Another faculty member, in fact, even called Udelsman a “crony” to Alpern’s face, standing up at one of the town hall meetings and alleging that the chair gets away with his behavior because Alpern regularly plays tennis with him.

Kimberly Davis ’85 SOM ’12, section chief of trauma, surgical critical care and surgical emergencies and trauma director at YNHH, acknowledged the existence of this perception.

“I think [Alpern] is perceived of having several cronies that may or may not behave well,” she said. “Having said that, I would caution you that there are two sides to every story, and some people may have an unfair reputation.”

In an interview with the News, Alpern rejected accusations that he grants leeway to administrators with whom he shares sporting interests, adding that the vast majority of chairs and section chiefs recruit people whom they want to see succeed.

They would not intentionally prevent a person from advancing, he said.

Like Lifton, Udelsman was also unavailable for comment.

OPENING THE DOORS TO THE “HOUSE OF ALPERN”

Though the school has had a rocky year, faculty interviewed revealed that they were optimistic that the Dean’s Office is at least aware of the problems with women and minorities in leadership and is looking to fix them.

In a March 25 email to the medical school faculty, Alpern updated faculty on the efforts to improve aspects of the school’s climate, including diversity in leadership positions. He listed the streamlining of mentorship programs across departments as one of the many steps to increase the breadth of individuals leading the school.

Numerous faculty members have also suggested additional measures. Alpern noted that the tenure track for research scientists normally takes 10 years, but can be paused for a year or two for women to take maternity leave and for men to take paternity leave. But professor of cell biology, section chief of digestive diseases and director of the Yale Liver Center Michael Nathanson suggested pausing that clock for longer.

Professor of neurobiology and of obstetrics, gynecology and reproductive sciences and chair of the Section of Comparative Medicine Tamas Horvath has suggested improving anonymous reporting structures. Right now, he said, many people fear that they will suffer from retaliation if they report abuses of power, which may decrease what things end up being reported, he said.

But some faculty members argued that nothing will change until the leadership does.

One female faculty member who left the University after being passed over for a less qualified male candidate for the position they were vying for said she was “shocked” by what has happened at Yale since she left. She added that the stories she has heard about misconduct, harassment, intimidation, bullying and everyday “put downs” make her surprised that Alpern is still dean.

“I think he’s outrageous,” the person said. “I think he should be out.”

But some faculty at the school remain optimistic.

“I think that if I played tennis and asked Dean Alpern to play, he would be more than happy to have me as a doubles partner,” Bennett said with a smile. “But I play golf.”

Alpern was reappointed for a third time as dean in 2014.