Exploring sexual harassment in the medical community

Before the recent collective outcry from the #metoo movement even existed, Reshma Jagsi, MD, DPhil, radiation oncologist, University of Michigan Medical School, Ann Arbor, MI, and colleagues conducted a survey among new recipients of the K-awards, to determine whether sexual harassment was experienced by women who were members of academic medical faculties in the United States. Their results were published in JAMA.

“My research for many years has sought to understand the reasons for the persistent underrepresentation of women among leaders in academic medicine (half of the medical student body is female but only 16% of medical school deans and department chairs),” Dr. Jagsi told MDLinx.

Dr. Jagsi and colleagues conducted a postal survey of individuals who had received new K08 and K23 career development awards from the National Institutes of Health between 2006 and 2009. The survey was comprised of a large questionnaire about career and personal experiences, and also included questions regarding gender bias (perceived and experienced), gender advantage, and sexual harassment.

Surveys were sent to all 1,719 K-award recipients, of whom 62% (n=1,066) responded.

Upon analyzing their data, Dr. Jagsi and colleagues found that women were more likely than men to report perceptions (70% vs 22%; P <  0.001) or experience (66% vs 10%; P <  0.001) of gender bias in their careers.

In addition, women were more likely to report experiencing sexual harassment than men (30% vs 4%; P < 0.001). In all, 150 women reported harassment, including:

• Sexist remarks or behavior (92.0%)
• Unwanted sexual advances (41.3%)
• Subtle bribery to engage in sexual behavior (6.0%)
• Threats to engage in sexual behavior (1.3%)

Further, 59% reported negative effects on their confidence as professionals, and 47% reported a negative impact on career advancement.

Dr. Jagsi, for one, was surprised at these results.

“I was indeed quite surprised to see such a high proportion of our study sample of female clinician-researchers reporting harassment.  I had honestly believed until we did that study that the primary challenges to gender equity were unconscious bias and societal expectations for women to perform the bulk of domestic labor.  I hadn’t imagined that so many of our female respondents would have experienced overt harassment,” she said.

When asked if there is anything unique about the academic medical setting that may facilitate or enable sexual harassment more than a clinical setting, Dr. Jagsi responded:

“The literature on workplace harassment suggests it is more common when there are substantial power differentials, and that is certainly the case in academic medicine.”

MDLinx recently conducted a random anonymous sampling of readers about sexual harassment in the health-care workplace. We received 119 responses (58% physicians; 34% other health-care professionals, including nurses, nurse practitioners, physician assistants, and pharmacists; and 8% residents or students). In all, 68% of respondents were male and 30% female.

When queried about having ever been sexually harassed in the health-care workplace, 12% of physicians, 18% of other health-care professionals, and 10% of residents/students reported that they had.

When this was broken down by gender, a full 24%—almost one-fourth—of female physicians had been sexually harassed, compared with 6% of male physicians, as had 19% of other female health-care professionals, compared with 11% of those who were male. Finally, 17% of female residents/students reported that they had been sexually harassed in the health-care workplace, compared with 0% of males.

When asked whether they had witnessed sexual harassment in the health-care workplace, one-fifth of all physicians (20%) reported that they had, as did one-third (33%) of those classified as other health-care professionals and 10% of residents/students.

Broken down by gender, responses showed that almost one-fourth (24%) of female physicians had witnessed sexual harassment in the health-care workplace, compared with 19% of men. Among the other health-care professionals, a full 35% of women had witnessed it, as had 22% of men. Finally, among residents/students, results were strikingly disparate, with 17% of women reporting that they had witnessed sexual harassment in the workplace, compared with 0% of men.

For women in the medical field who may be experiencing sexual harassment, Dr. Jagsi offered the following advice:

“Seek out support and individualized advice from someone you can trust.  Almost every institution and specialty society has an office dedicated to issues of gender equity.  The leaders of such offices can be wonderful allies and can provide much needed counsel about options.”

For Dr. Jagsi, the #metoo movement is a welcome one.

“I think that the most important outcome of the #metoo movement and the attention it has drawn would be the very opening of the conversation on these issues.  Since I wrote my essay, I have received so many heartfelt messages from men who are horrified that such behavior has been going on, without their notice, and from institutional leaders seeking to promote culture change.  I see that as very important progress in its own right,” Dr. Jagsi concluded.