White Coat, Black Art·Dr. Brian's BLOG

How harassment of women surgical residents harms well-being of patients

An explosive new U.S. survey finds women surgical residents suffer more mistreatment than men. It may be linked to higher rates of burnout and depression.
Nearly 32 per cent of residents in general surgery in the U.S. reported discrimination based on gender. (Ben Shannon/CBC)

According to the Canadian Institute for Health Information, 27 per cent of this country's general surgeons are women. Now, a U.S. study published Monday in the New England Journal of Medicine puts the spotlight on some of the challenges facing female surgical residents.

It concludes that women training to be surgeons may be getting a rough welcome from mentors and from patients.

Dr. Yue-Yung Hu and colleagues from Northwestern Medicine in Chicago and elsewhere did a national survey of 7,409 residents in general surgery from all 262 surgical residency programs in the U.S. They surveyed everyone, not just women, and got a response rate of over 99 per cent! 

Overall, 31.9 per cent reported discrimination based on gender, 16.6 per cent reported racial discrimination, 30.3 per cent verbal or physical abuse, and 10.3 per cent reported sexual harassment.

However, in every category of mistreatment, the rates were higher among women. Just over 65 per cent of women reported gender discrimination, and 19.9 per cent reported sexual harassment.  

Among women reporting gender discrimination, 17.6 per cent said it came from their erstwhile mentors, the attending surgeons. A further 23.6 per cent said it came from nurses and other staff.

At 31.2 per cent, sexual harassment came most frequently from patients and family members followed closely at 30.9 per cent by attending surgeons, 15.4 per cent by fellow residents and 11.7 per cent by nurses or staff. In the rest, the source was not identified.

Of those women who suffered verbal or emotional abuse, at 52.4 per cent, the biggest source came attending surgeons followed at 20.2 per cent from fellow residents. For instance, female residents were frequently told by higher-ups not to get pregnant during their training.

At just 2.2 per cent, physical abuse was rare. 

Mistreatment a frequent experience

While verbal abuse most frequently came from attending surgeons, gender and racial discrimination was far more likely to come from patients and their families. The survey suggested that patients commonly mistook female physicians for nurses. Sometimes, they doubted the qualifications of female surgical residents. In some cases, that doubt led patients to demand to see a less-qualified male resident or student.

Patients often refused to see residents of certain racial backgrounds or made racially-demeaning comments to them. Sexual harassment by patients included suggestive comments as well as inappropriate touching and jokes.

I have personally witnessed patients sexually harassing women residents and students, and have told patients to stop. I have not directly witnessed attending surgeons harassing women residents. However, we know that this happens.

From a Globe and Mail story, we know that serious allegations of gender discrimination were levelled against Dr. Marko Duic, the former chief of emergency medicine at two hospitals in and around Toronto. Eight female physicians told the Globe that Duic had allegedly made discriminatory comments to or about women. The Globe found that Dr. Duic hired no female physicians during his 16 years as ER chief while hiring at least 23 male physicians.  

On White Coat, Black Art, we interviewed female students and residents who had experienced discrimination and harassment from mentors. These ranged from lewd comments about their appearance to actual instances of sexual assault. 

Suffer in silence

Many of the women who experienced sexual harassment by mentors did not make formal complaints for fear of reprisal and because they felt that complaining might hinder their long-term job prospects. 

Instead, they suffered in silence.

Both the public and the people who work in healthcare must address this because the mistreatment of women is linked directly to rising rates of burnout. In the survey, women residents had higher rates of burnout and more thoughts of suicide. The biggest driver of burnout among female residents was whether or not they experienced discrimination, abuse or harassment.

Burnout has a direct impact on patient care. Physicians who are burned out are more likely to make medical errors. Self-harm can have a direct impact on the supply of physicians.

The authors of the survey say they plan on giving reports to individual residency programs. They hope the data encourages programs with high rates of harassment to do better.

This is a widespread problem that is an embarrassment to health professionals who believe they are among the most ethically-grounded people on the planet. 

It's well-past time to address this.

About the Author

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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