Like law and politics, the medical profession began as a men’s-only club. Today, female physicians bring balance to what was once a lopsided gender ratio, but attitudes sharpened by the formerly male-dominated culture remain pervasive. Recently, a movement born on the social media platform Twitter let the world know the kinds of harassment—from the mild to the debilitating—that women in medicine continue to face.

On October 15, actress Alyssa Milano asked Twitter users to respond “me too” (with the hashtag #metoo) if they had ever been sexually harassed or assaulted. The resulting avalanche of responses eventually broke off into subspecialties, including government (#MeTooCongress) and medicine (#MeTooSurgery). Milano sent her tweet amid a maelstrom of news stories that revealed how Harvey Weinstein, a former film studio mogul in Hollywood, had a long-standing habit of paying off sexual harassment accusers.

Women face bullying and harassment in every industry, by and from men, and have to navigate it in ways that men don’t. But, explains Marjorie Rosenthal, MD ’95, MPH, associate professor of pediatrics at Yale School of Medicine, the stakes are different when it comes to hospital and clinic environments. There, the ability to do one’s job directly impacts people—the patients. Rosenthal recalls a salient example. During residency training, a senior resident who was her immediate supervisor asked Rosenthal out to dinner. She declined. “But I didn’t know how it would play out, and I worried I would lose his support to care for newborn patients,” she says.

Writing in The Chronicle of Higher Education last year, Anna Reisman, MD, associate professor of medicine and director of the medical school’s Program for Humanities in Medicine, described a humiliating experience as a third-year medical student. One day, she and her senior attending physician stopped by a radiologist’s office to discuss a patient’s X-ray. “‘She’s a student?’ The radiology professor eyed me up and down. ‘I thought she was your girlfriend,’” Reisman wrote. A serious teaching moment became an unprofessional taunt.

Esther Choo, MD ’01, MPH, an associate professor of emergency medicine at Oregon Health & Sciences University in Portland, says that the #MeTooSurgery tweets have been heartwarming, but also hard to read. “These are women who project such power and confidence in an extremely competitive field,” she says. The topic of harassment in medicine is far from news, says Choo, who sent a tweet that went viral in August about the overt racism she regularly encounters as an Asian American emergency department physician. “We know a ton about organization culture. We hire consulting groups to look at the culture, but we still don’t have metrics around gender equity and harassment.”

Choo explains that women face a unique conundrum in medicine, where the importance of being a team player is mantra drilled into training starting with first-year medical students. “Are you going to ‘make a fuss’ about culture, or suck it up and smile, so that you have a chance at the job you want?” she says. “It’s a tough decision.”

The medical profession still feels male-dominated despite recent admissions trends that favor balanced medical school classes, says Lynn E. Fiellin, MD ’96, associate professor of medicine and the Yale Child Study Center, who also contributed to the #metoo tweets. “We shouldn’t have to stand up and say, ‘me too,’ because this isn’t a secret,” Fiellin says. Rather than go along with excuses like “he doesn’t know any better,” or “he’s part of a different generation,” it’s important for male and female physicians to call out this behavior, Fiellin says.

The four female physicians agreed that more tangible steps need to be taken to move the issue of harassment beyond occasional protests, like the #metoo stories on Twitter, and toward lasting structural changes. As a start, Rosenthal says, the profession could require regular continuing medication education (CME) courses that address harassment and bullying in the workplace. In her essay, Reisman gives a shout-out to an innovative website called SystemicDisease.com, which allows victims to anonymously report behavior. Choo suggested a stronger focus on developing metrics that could assess current medical working environments, and develop ways to track improvements over the longer term.

With the momentum of the #metoo movement, the medical profession has a huge opportunity to bring harassment out of an acute phase and toward incremental, but permanent, healthy changes for the better.