Female clinicians in urology had more than 14 times the adjusted odds of reporting patient-perpetrated sexual harassment or gender discrimination compared with male clinicians in a national survey of the US urological workforce.
In the cross-sectional cohort study, researchers analyzed responses from 1,467 practicing urologists, trainees, and advanced practice providers who participated in the 2023 American Urological Association Annual Census. Overall, 17.9% of clinicians reported experiencing patient-perpetrated sexual harassment or gender discrimination during the prior year, and 29.6% reported witnessing such behavior.
The findings, published in JAMA Network Open and led by Catherine S. Nam, MD, of the Department of Urology at the University of Michigan, showed that 41.8% of female clinicians reported experiencing patient-perpetrated sexual harassment or gender discrimination compared with 6.3% of male clinicians. Among practicing urologists, 51.6% of female physicians reported experiencing such behavior compared with 6.6% of male physicians.
The researchers defined "any patient-perpetrated sexual harassment" as reported sexual harassment and/or gender discrimination, consistent with a National Academies definition that includes gender harassment, unwanted sexual attention, and sexual coercion. When examined separately, 16.5% of clinicians reported experiencing patient-perpetrated gender discrimination, and 11.7% reported experiencing patient-perpetrated sexual harassment specifically. Separately, 17.4% reported witnessing patient-perpetrated sexual harassment specifically.
Trainees and advanced practice providers initially appeared to have higher rates of experiencing patient-perpetrated sexual harassment or gender discrimination compared with practicing urologists. However, that unadjusted pattern reflected important differences in the sex composition of the groups: 40.4% of trainees and 78% of advanced practice providers were female, compared with 19.2% of practicing urologists. Following adjustment for age, race and ethnicity, and sex, trainees and advanced practice providers had lower odds of reporting the outcome than practicing urologists, while female sex remained strongly associated with the outcome (adjusted odds ratio, 14.16; 95% CI, 9.79–20.49).
Reported locations differed by clinician role. Among clinicians who experienced patient-perpetrated sexual harassment specifically, 85.5% reported incidents in clinics. However, 76.6% of trainees who experienced sexual harassment reported incidents in inpatient wards, compared with 21.6% of practicing urologists and 10.8% of advanced practice providers. The researchers noted that these differences may reflect where clinicians spend their clinical time and could inform setting-specific interventions.
The survey also highlighted gaps in reporting transparency. Sixty-seven percent of respondents reported that their primary practice had a formal process for reporting patient-perpetrated discrimination or sexual harassment. However, among those respondents, 60.9% said they did not know whether patients were formally notified following a report. This gap was more pronounced among trainees, 81.2% of whom reported not knowing whether patients were notified, compared with 54.2% of practicing urologists.
The most commonly reported institutional responses included terminating the patient from the practice, adding a note to the patient's medical record, and sending a formal letter to the patient about the behavior.
The researchers wrote that the findings may have implications for clinician well-being, retention, and workforce diversity in urology, a specialty facing projected workforce shortages. They suggested that institutions establish clear patient conduct policies, transparent reporting processes, communication plans for follow-up, and systems to identify repeat behavior.
The study had several limitations. The researchers could not use survey weights or report response rates because population files were unavailable for trainees and advanced practice providers. The survey also did not define sexual harassment or discrimination for respondents, and the findings may be affected by recall bias because participants were asked to report experiences from the prior year. In addition, the census asked about gender using female and male answer choices, so the researchers analyzed the variable as sex and could not assess results by gender identity. They also could not analyze sexual orientation because response rates were too low to maintain anonymity.
Disclosures: Dr. Cameron reported receiving grants from Medtronic and investigator and personal fees from PrimeMD Speaker outside the submitted work. Dr. Viglianti reported receiving grants from the National Heart, Lung, and Blood Institute and from the Agency for Healthcare Research and Quality during the conduct of the study. No other disclosures were reported.
Source: JAMA Network Open
