Clinician Insights

Most Female Physicians Report Sexual Harassment at Job

August 24, 2016

Seventy one percent of female physicians and 25% of male physicians report having been sexually harassed in training or medical practice in a recent Medscape poll.

Those numbers, as of July 26, translate into 50% of all physicians saying they've been the target of sexual harassment. Of this group, 32% said it affected their career advancement.

The informal online survey comes on the heels of a research letter published in JAMA in May reporting that 30% of high-achieving female clinician-researchers in academic medicine had experienced sexual harassment compared with 4% of male counterparts.

Sexual harassment takes many forms: sexist comments or behavior; unwanted sexual advances, which may be coercive; sexual threats; and bribery to engage in sexual behavior. Perpetrators can be patients as well as fellow physicians.

Medical students encounter sexual harassment just as much as physicians, the results of the Medscape survey suggest. Fifty-four percent of medical students — including 72% of women and 19% of men — said they had experienced a wayward hand or remark. One in four of this group said these episodes affected their career advancement.

In a worst-case scenario, sexual harassment doesn't just harm a woman's medical career, but kills it, said Kimberly Templeton, MD, president of the American Medical Women's Association (AMWA).

"It may make the workplace environment so hostile that they leave the field," said Dr Templeton, a professor of orthopedic surgery at the University of Kansas School of Medicine, in Kansas City, in an interview with Medscape Medical News. Women in medical practice, she said, have more escape hatches from sexual harassment than medical students and residents, who may not be able to find a new school or training program to continue their education.

The Medscape survey also suggests that the problem apparently doesn't abate once physicians leave their residency program. Readers reporting sexual harassment were asked to identify any and all phases of their career in which it occurred. Post-residency practice (56%) showed up just as much as residency training (54%), with medical school lagging somewhat behind (41%). Almost 50% said sexual harassment occurred in more than one phase.

The survey was completed by 157 physicians and 170 medical students, with women representing 54% of the former and 66% of the latter.

A Wider Definition?

Rates of sexual harassment of both female and male physicians in the Medscape survey are dramatically higher than those reported by the authors of May's JAMA study of academic medicine. They conducted a mail survey of physicians and clinically oriented researchers who had received career development awards from the National Institutes of Health from 2006 through 2009. Physicians constituted 80% of all respondents, said lead author Reshma Jagsi, MD, DPhil, in an interview with Medscape Medical News.

Dr Jagsi, an associate professor of radiation oncology at the University of Michigan Medical School, in Ann Arbor, said that in an online survey explicitly about sexual harassment, such as the one conducted by Medscape, the prevalence of this behavior may be higher, owing to selection bias. "People may be more likely to click on the survey if they've had the experience," she said. To minimize selection bias in her own study, she said, questions about sexual harassment appeared at the end of a 12-page instrument that mostly focused on "general career experience."

"We didn't lead with the sensitive information," Dr Jagsi said.

The results of the Medscape survey are not without precedent. In a study published in the New England Journal of Medicine (NEJM) in 1993, 73% of female residents and 22% of male residents reported experiencing sexual harassment during medical school, residency training, or both. That same year, the NEJM published another study that found that more than 70% of female physicians in Ontario, Canada, had been sexually harassed by patients during their career.

Dr Jagsi said that attitudes about sexuality have dramatically changed since the early 1990s. To get a more up-to-date picture, her study took pains to survey academics who were educated when women constituted a sizable minority of medical school enrollment, exceeding 40%. The assumption here is that when it comes to sexual harassment, there is more safety in numbers.

Rates of sexual harassment in medicine will differ from study to study, depending on who is studied and how, said the AMWA's Dr Templeton. The results of the Medscape survey "ring true," she said, but they may partly reflect a broader definition of sexual harassment these days. Women may feel vexed not only by sexual propositions and crude innuendo but also by comments reflecting traditional gender expectations.

"Women are supposed to be kind and nurturing, and men are supposed to be very vocal, and the leaders," she said. When women exercise strong leadership, "she's a bitch" is the classic put- down.

Male physicians also contend with gender expectations that may lead to complaints of harassment, Dr Templeton said. Think soft voices and knitting, as opposed to loud voices and pro football.

With an expanded definition that factors in gender roles, "perhaps men are becoming more aware that they, too, can be victims of harassment," she said.

One male Medscape reader recalled how he overcame gender expectations in his medical training.

"Forty-seven years ago, when I started medical school, there was less than subtle bias that men were to go into general surgery or internal medicine, while women were to go into pediatrics or [obstetrics-gynecology]," wrote one neurologist in a comment on a story about Dr Jagsi's research. "As a young man interested in children, I felt 'harassment' that actually motivated me to be more intense and specialize in pediatric neurology."

"I Thought It Would Go Away"

Although she questioned the accuracy of the Medscape survey, Dr Jagsi said her study may have underestimated the prevalence of sexual harassment, particularly among women. The reason? She and her coauthors surveyed clinician-researchers in mid career (their average age was 43) with professional accomplishments to their name. Owing to their clout, they may have been less vulnerable to harassment than medical students and residents operating in "strong hierarchies and divisions of power," she told Medscape Medical News.

That caveat aside, even 30% of women in academic medicine reporting sexual harassment during their careers in 2016 "is a higher rate than one would have expected," said Dr Jagsi.

The problem of sexual harassment persists despite years of attempting to combat it through institutional policies and education, said Dr Templeton. "I thought it would go away, but we haven't made any headway," she said. Victims of sexual harassment, whether they are men or women, need to speak up so medicine can address this blight head-on.

"There needs to be an open discussion," she said.

Follow Robert Lowes on Twitter @LowesRobert

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