Canadian Survey Reveals Sexual Harassment in Medicine

In a new Medscape survey, nearly 1 in 10 Canadian physicians said they’ve personally experienced sexual abuse, harassment, or misconduct at their medical workplace during the past 3 years.

Similarly, 9% said they’ve witnessed sexual abuse, harassment, or misconduct. About 2% said they’ve been accused of sexual harassment or misconduct in recent years.

“It is vital to continue to study harassment in medicine. There remains a strong hierarchy in medicine, and the most junior and underrepresented team members are the most likely to be harassed,” Natashia Seemann, MD, assistant professor of surgery at Western University and pediatric general surgeon at Children’s Hospital at London Health Sciences Center in Ontario, told Medscape Medical News.

Seemann, who wasn’t involved with the Medscape survey, has researched harassment in medicine, particularly in surgery and surgical education. 

“Unfortunately, these are also the team members who are most likely not to report the harassment they experience for fear that it may affect their career progression,” she said. “We must find a way to ensure that the field of medicine is a safe and welcoming space for all.”

Analyzing Harassment 

In the Medscape survey, 454 Canadian physicians across 30 specialties answered questions about their experiences and observations of sexual harassment, as well as its effects on their personal and professional lives.

Overall, 83% of survey respondents said they hadn’t experienced, witnessed, or been accused of sexual harassment or misconduct at work in recent years. But respondents who had experienced, witnessed, or been accused of this behavior were more likely to be women, hospitalists, and under age 45 years.

Canadian physicians reported experiencing numerous types of sexual harassment or assault, including sexual comments about their bodies, unwanted physical contact, undesired sexual texts or emails from coworkers, repeated date requests, and propositions for sexual activity. In a few cases, physicians experienced forced physical contact, offers of a promotion or threats of punishment linked to sexual favors, or even rape.

Witnesses reported seeing similar incidents. In write-in responses, they also spoke about verbal abuse, bullying, and intimidation.

“I am sadly not surprised, based on the results of the survey,” Seemann said. “In our recent study looking at the experience of harassment in surgery, we found that women and junior surgical trainees were most at risk of being harassed. We didn’t see a large report of sexual harassment, but we saw a very high portion of surgical trainees who reported verbal harassment.”

In the Medscape survey, most physicians with personal experience of harassment said that the perpetrator was another physician, and nearly half said that the person was a superior.

In most cases, physicians said they didn’t do anything at the time of the incident, though some told the perpetrator to stop the behavior or explained how they felt. Afterward, about two thirds reported the incident to colleagues, supervisors, human resources, or police. Others didn’t report it because they felt embarrassed, worried about retaliation, or planned to quit.

These experiences led to significant effects, with two thirds of physicians saying it was “very upsetting,” and about one third saying it “interfered significantly” with their ability to do their job.

“These survey results align with results from other studies done worldwide,” said Sharon Straus, executive vice president of clinical programs and chief medical officer at Unity Health Toronto. Straus, who wasn’t involved with the Medscape survey, has researched harassment and discrimination in medical training for more than a decade.

For instance, Straus said, the Association of American Medical Colleges released a 2022 report that found 22% of all medical school faculty and 34% of women faculty experienced sexual harassment in the workplace. 

“Similarly, women were more likely to experience sexual harassment, compared with men,” she said. “It was also not surprising to see in [Medscape’s] survey that most women reported that the perpetrator was in a superior position.”

Harassment by patients is also important to note, Straus said. In the Medscape survey, 16% of respondents reported harassment by patients. However, a recent meta-analysis of studies found about 45% of physicians reported harassment from patients, she said.

Future studies should look at experiences across genders, as well as the intersections among gender, race, ethnicity, specialty, and other subgroups, Straus noted.

“Without data, we don’t know the size of the issue,” she said. “We can’t develop interventions to appropriately address it, nor will we know if we are effectively addressing harassment.”

Patient Care Affected 

In the Medscape survey, Canadian physicians who experienced harassment said that it affected them both professionally and personally. Many physicians said they avoided working with certain colleagues, had difficulty concentrating, and were less engaged. Others missed meetings, had more medical errors, and even quit their job.

On a personal level, Canadian physicians who experienced harassment also reported isolation, poor sleep, and poor eating behaviors. A few increased their use of nicotine, alcohol, marijuana, prescription drugs, or recreational drugs.

“The impact of experiencing harassment should not be underestimated, and it’s clear from the survey and work by others that it can impact patient care and result in medical errors,” Straus said. “It also leads to people leaving their jobs, and given the fragility of our healthcare workforce, this issue cannot be ignored.”

Rather than placing the burden on those who experience harassment, though, system-based changes should include better mechanisms for reporting harassment, such as whistleblower policies, Straus said.

“We need rigorous and fair investigation processes that use trauma-informed approaches,” she said. “We also need to monitor our processes and outcomes over time to ensure that we are effectively addressing harassment.”

Canadian researchers are also working to understand the lived experience of harassment in the workplace and what can be done to address it.

“There are many survey studies documenting the prevalence of harassment in medicine, but I believe the next steps are to qualitatively understand the experience of harassment and how we can improve this experience,” Seemann said. “Sadly, recruitment for this study has been a challenge, we believe because many physicians are worried about self-identifying and telling their stories, even in a confidential research environment.”

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.