CMOs Have Key Role to Play Addressing Staff Mistreatment in OB-GYN Field

Zero-tolerance policies and the promotion of reporting incidents of mistreatment such as sexual harassment are essential, CMO says.

A recent JAMA Network Open article found sexual harassment and other forms of mistreatment are common in the obstetrics-gynecology field. CMOs and other healthcare leaders need to address the problem, a CMO says.

The recently published research article conducted a systematic review of 10 studies on harassment and 12 studies on interventions. One study that examined harassment rates in several medical specialties found that OB-GYN was second only to general surgery in specialties linked to the highest rates of sexual harassment.

"This systematic review found that 28% to 71% of participants reported sexual harassment, sexual coercion, or unwanted sexual advances within the field of OB-GYN in surveys," the research article's co-authors wrote. "These events were often not reported to institutional leadership, however, given that individuals experiencing these forms of mistreatment feared retaliation and did not feel that their experiences would be taken seriously. There were also high rates of bullying, gender bias, and microaggressions among trainees and practicing physicians."

The research article has several key findings:

• Workplace discrimination among female gynecologic oncologists ranged from 57.0% to 67.2%
   
• Bullying was reported by 52.8% of female gynecologic oncologists
   
• Sexual harassment such as gender harassment, unwanted sexual attention, and sexual coercion was reported by 69.1% of OB-GYN trainees
   
• The primary perpetrators of harassment were identified as physicians (30.1%), trainees (13.1%), and operating room staff (7.7%)
   
• In a survey of 250 female gynecologic oncologists, 83.2% reported experiencing microaggressions such as being told to smile more, dress in certain ways, and to act more female or motherly
   
• In gynecologic surgery, gender discrimination was the most common form of discrimination for male clinicians (72.3%) and female clinicians (90.1%)

"These findings suggest that there is high prevalence of harassment in OB-GYN," the research article's co-authors wrote.

CMO perspective

The data in the research article reflects the problem of workplace mistreatment and sexual harassment in American society, says Mark Simon, MD, MMM, CMO of Ob Hospitalist Group.

"Unfortunately, gender harassment and sexual harassment is too common in American society in general," Simon says. "The field of medicine is made up of people from society, so you see a continuation in what you see in society at large inside medicine in general and OB-GYN in particular."

OB-GYN has the highest percentage of female clinicians such as physicians and midwives, which underlies the data in the research article, Simon says. "With a large percentage of female clinicians and as is the case in society at large, women are on the receiving end of sexual harassment, which makes OB-GYN prone to sexual harassment."

The finding that nearly three-quarters of OB-GYN trainees experience sexual harassment is disturbing but not surprising, Simon says. "Especially when you are talking about OB-GYN trainees, there is a power dynamic between people who are teachers or other individuals who are responsible for the trainees. This power imbalance can set up a dynamic for a harassment situation. In addition, the data shows that vast majority of trainees and young OB-GYN clinicians are women, which is a component of this problem."

When perpetrators are senior staff members, CMOs need to hold them to the same standards as other staff members, Simon says. "Even if the alleged perpetrator is a powerful individual within an organization, staff members need to see that the alleged perpetrator will be subject to an investigation the same as anybody else and will be held accountable the same as anybody else."

CMOs and other healthcare organization leaders can take actions to reduce mistreatment such as sexual harassment, Simon says.

"It is important for CMOs and other healthcare leaders to take the opportunity to set expectations and have zero tolerance for sexual harassment and other mistreatment," Simon says. "That requires codes of conduct, education, an internal recognition that harassment is occurring, a willingness to hear and be open to any complaints that are lodged, and a commitment to investigate complaints thoroughly and fairly. Then healthcare leaders must hold perpetrators accountable to the expectations."

CMOs must be intentional to alleviate fear of retaliation when mistreatment is reported and to address the concern that complaints will not be taken seriously, Simon says. "The best thing CMOs can do is have an open and transparent process for the lodging of complaints. CMOs should have zero tolerance for harassment when it is identified. CMOs should have clear and transparent policies for retaliation, which is illegal."