Why is Gender-Based Harassment So Pervasive in Medicine?

Gender-based harassment is pervasive in the medical field. According to a 2018 National Academies of Science, Engineering, and Medicine (NASEM) report, women in medical school were 220% more likely to report sexual harassment by faculty or staff than their counterparts in science, technology, engineering, and mathematics.¹

Around the same time, the American College of Physicians (ACP) released a statement opposing harassment of any kind, explicitly including sexual harassment.² In an Ideas and Opinions article published in the Annals of Internal Medicine,³ Reshma Jagsi, MD, DPhil, director of the Center for Bioethics and Social Sciences at the University of Michigan in Ann Arbor, described the difference between gender-based harassment and sexual coercion; the former is far more common in the medical field. Drawing on social science literature, Dr Jagsi discussed the aspects of the medical field that may tacitly permit gender-based harassment and offered commentary on proper means of intervention.     

As written in the NASEM report, sexual harassment is “best understood as a broad range of behaviors that derogate [or] demean…a person based on…sex.”¹ An important distinction is to be made between sexual coercion and sexual harassment, the authors wrote. Under Title VII of the Civil Rights Act and the Title IX Higher Education Amendments, the use of professional threats or rewards to coerce sexual activity — also known as quid pro quo harassment — is expressly unlawful.

In the medical field, however, an “impermissible work environment” may often develop in the absence of quid pro quo harassment. Specifically, gender-based harassment — referring to “sexist remarks and crude behaviors that derogate people based on [sex]…but imply no sexual interest” — was the primary component of harassment documented in the NASEM report. Of women who reported harassment based on sex, 92% described “exposure to sexist remarks or behavior,” while just 9% expressly reported sexual coercion.⁴ 

Gender harassment, while not expressly predatory, has documented effects on the “physical, psychological, and professional well-being” of women in the field. A meta-analysis combining data from 93 samples comprising more than 70,000 women found that gender harassment “takes a toll on personal and professional health similar to that of unwanted sexual pursuit.”⁵ Additional studies show that of academic medical faculty who report harassment, 59% reported a “decline in self-confidence” and 47% indicated that “these experiences had an effect on their career path.”⁴ 

In addition to quantifying the effect of harassment on women in medicine, Dr Jagsi also explored the context in which sexual harassment is most likely to transpire. Social science studies have indicated that harassment rates are highest in fields that are “dominated by men — numerically, structurally, or culturally.”¹ In response to this finding, other research has indicated that organizations which “recruit and promote more women and appoint more women to leadership positions” may see a reduction in sexual harassment. In addition, “habit-breaking training” has demonstrated efficacy in the medical profession and other fields as well.⁶ Respectful workplace interventions have had promising results in hospital settings: surveys of healthcare workers from 5 Canadian hospitals before and after a 6-month intervention showed significant improvements in “civility, trust, and satisfaction.”⁷

The literature indicates that the pervasiveness of sexual harassment is not a product of “bad actors, but rather [of] broader culture.” Organizations must strictly enforce policies against harassment and carefully document any events. Workshops that promote workplace effect and anonymous reporting technologies may facilitate the development of a safe environment for employees. On the heels of the #MeToo movement, 2018 has witnessed unprecedented attention to the stories of women and the burden of sexual harassment. It is essential that such changes occur in the medical field as well.

References

1. National Academies of Sciences, Engineering, and Medicine Committee on the Impacts of Sexual Harassment. Sexual harassment of women: climate, culture, and consequences in academic sciences, engineering, and medicine. Washington, DC: National Academies Pr; 2018. www.nap.edu/catalog/24994/sexual-harassment-of-women-climate-culture-and-consequences-in-academic. Accessed November 21, 2018.
2. Butkus R, Serchen J, Moyer DV, Bornstein SS, Hingle ST; for the Health and Public Policy Committee of the American College of Physicians. Achieving gender equity in physician compensation and career advancement: a position paper of the American College of Physicians. Ann Intern Med. 2018;168:721-723.
3. Cortina LM, Jagsi R. What can medicine learn from social science studies of sexual harassment? [published online September 12, 2018] Ann Intern Med. doi:10.7326/M18-2047
4. Jagsi R, Griffith KA, Jones R, Perumalswami CR, Ubel P, Stewart A. Sexual harassment and discrimination experiences of academic medical faculty. JAMA. 2016;315:2120-2121.
5. Sojo VE, Wood RE, Genat AE. Harmful workplace experiences and women’s occupational well-being: a meta-analysis. Psychol Women Q. 2016;40:10-40.
6. Carnes M, Devine PG, Baier Manwell L, et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial. Acad Med. 2015;90:221-230.
7. Leiter MP, Laschinger HKS, Day A, Oore DG. The impact of civility interventions on employee social behavior, distress, and attitudes. J Appl Psychol. 2011;96:1258-1274.