Impact of Sexual Harassment and Social Support on Burnout in Physician Mothers

Association of gender-based discrimination and burnout among faculty in an urban academic medical center

BackgroundBurnout in physician and scientist faculty threatens professional satisfaction, mental health, and work quality while impacting women more than men. Women experience gender mistreatment more often than men, which may impact burnout.ObjectiveTo determine the differences in burnout, discrimination and harassment by gender, and whether these variables were associated with burnout in physician and scientist faculty.MethodsAn anonymous cross-sectional survey from November 2018 through February 2019 was conducted in physician and scientist faculty at a large urban hospital. Survey instruments included MaslachBurnout Inventory-2, gender-based discrimination and harassment questions, and demographic and professional characteristics.ResultsOf 4156 faculty, 1497 (36%) provided gender identification and were included in analyses. Women experienced burnout at higher rates than men (30.9% vs. 23.3%, p = 0.002). Women also experienced gender discrimination and gender harassment at 11 (25.0% vs 2.3%, p < 0.001) and 5.7 (13.0% vs 2.3%, p < 0.001) times the rate of men, respectively. In a multivariable analysis, gender-based discrimination and harassment was associated with burnout among women (OR 1.65, p = 0.035) and overall (OR 1.65, p = 0.017), but not among men. In men, those aged 40-60 experienced increased burnout compared to those aged >60 (OR 2.67, p = 0.017). For all participants, burnout was associated with depression symptoms, poor work life integration, and lower leadership scores.ConclusionBurnout is prevalent in both men and women physicians and scientists, but correlates vary by gender. Findings suggest that interventions to reduce burnout should account for gender differences, target leadership behaviors and address gender bias and mistreatment.

Sexual Harassment in Academic Anesthesiology: A Survey of Prevalence, Sources, Impact, and Recommendations

BACKGROUND

A report by the American Association of Medical Colleges (AAMC) showed that academic anesthesiology has the highest prevalence of sexual harassment among specialties for both men and women. We aimed to explore the prevalence, sources, and impact of sexual harassment on anesthesiologists in academic centers in the United States and Canada. We also sought recommendations for its mitigation.

METHODS

An anonymous online survey instrument was designed based on a previously published report, yielding 39 questions, including demographics and 4 open-ended questions. The survey was sent via email to Association of University Anesthesiologists (AUA) members, who were encouraged to share across academic anesthesiology departments in the United States and Canada.

RESULTS

A total of 626 responses were received; after exclusion of incomplete and nonfaculty responses, 484 complete survey responses were analyzed. 52.9% of respondents identified as men and 45.9% as women; 3 respondents (0.6%) identified as nonbinary, and 3 respondents (0.6%) preferred not to answer. 43.6% of respondents perceived there is sexual harassment in academic anesthesiology. Significantly more women than men reported presence of sexual harassment in academic medicine (65.3% vs 38.3%, P < .001), in academic anesthesiology (59.5% vs 30.1%, P < .001), and in their place of work (37.8% vs 18.3%, P < .001). 14.5% of men and 43.2% of women had experienced sexual harassment at least once in the past 12 months (P < .001). 43.7% of women reported ever experiencing unwanted physical contact in the workplace compared to 16.8% of men; 74.3% of women reported ever experiencing verbal or nonverbal conduct in the workplace related to gender that caused embarrassment, distress, or offense compared to 24.6% of men (P < .001). 8.2% of men reported feeling their clinical ability doubted, compared to 87.8% of women (P < .001). Experiences of sexual harassment were most consistent with verbal and nonverbal behaviors that convey hostility, objectification, or exclusion of members of one gender. Colleagues from anesthesiology were most likely to be reported as the source of sexual harassment (44.6% of unwanted physical contact, 59% of verbal or nonverbal conduct). The impact was described along 4 themes: emotional, cognitive, behavioral, and professional. Participants made recommendations for eliminating sexual harassment by raising awareness, providing education, establishing reporting, offering support, and ensuring accountability.

CONCLUSIONS

This survey confirms the high prevalence of sexual harassment in academic anesthesiology. The most common sources are anesthesiology colleagues. The recommendations for leaders and institutions include creating a professional environment free from harassment with support for targets and accountability for instigators.

Organizational Climate Related to Patient-Perpetrated Sexual Harassment: VA Primary Care Provider Perceptions

BACKGROUND

Patient-perpetrated sexual harassment toward health care providers is common and adversely affects provider well-being, workforce outcomes, and patient care. Organizational climate for sexual harassment-shared perceptions about an organization's practices, policies, and procedures-is one of the strongest predictors of harassment prevalence. We conducted a pilot survey assessing provider perceptions of the Veterans Health Administration (VA)'s climate related to patient-perpetrated sexual harassment.

RESEARCH DESIGN

Responding providers completed a survey assessing: (1) experiences with patient-perpetrated sexual harassment; (2) beliefs about VA's responses to patient-perpetrated sexual harassment of staff; and (3) perceptions of VA's organizational climate related to sexual harassment for each of 4 perpetrator-target pairings (patient-perpetrated harassment of staff, patient-perpetrated harassment of patients, staff-perpetrated harassment of staff, and staff-perpetrated harassment of patients).

SUBJECTS

Respondents included 105 primary care providers (staff physicians, nurse practitioners, and physician assistants) at 15 facilities in the VA Women's Health Practice-Based Research Network.

RESULTS

Seventy-one percent of responding providers reported experiencing patient-perpetrated sexual harassment in the past 6 months. Respondent perceptions of VA's responses to patient-perpetrated harassment of staff were mixed (eg, indicating that VA creates an environment where harassment is safe to discuss but that it fails to offer adequate guidance for responding to harassment). Respondents rated organizational climate related to patient-perpetrated harassment of staff as significantly more negative compared with climate related to other perpetrator-target pairings.

CONCLUSIONS

Future work with representative samples is needed to corroborate these findings, which have potential ramifications for VA's ongoing efforts to create a safe, inclusive environment of care.

Professional Experiences and Career Trajectories of Mid- to Senior-Career Women Clinician-Scientists: A Qualitative Study

Importance

Despite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage.

Objective

To investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers.

Design, Setting, and Participants

In this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study, interviews from 31 women were analyzed using the framework approach to thematic analysis. Data analyses were performed between August and October 2023.

Main Outcomes and Measures

Descriptive themes of participant experiences of gender and gender-based barriers in academic medicine.

Results

A total of 31 women clinician-scientists (8 identifying as Asian [25.8%], 14 identifying as White [45.2%], and 9 identifying as members of a minority group underrepresented in medicine [29.0%]; 14 aged 40-49 years [45.2%] and 14 aged 50-59 years [45.2%]) were included. Among them, 17 participants (54.8%) had children who required adult supervision or care, 7 participants (22.6%) had children who did not require supervision or care, and 6 participants (19.4%) did not have children. There were 4 dominant themes identified within participant experiences in academic medicine: the mental burden of gendered expectations at work and home, inequitable treatment of women in bureaucratic processes, subtle and less subtle professional exclusion of women, and value of communities built on shared identities, experiences, and solidarity.

Conclusions and Relevance

This study found that women perceived the institution of academic medicine as a male-centric system misaligned with the needs of women, with associated feelings of exclusion, disillusionment, and loss of trust in their institutions. Findings suggest that the confluence of domestic obligations and unaccommodating institutional environments may make it difficult for women clinician-scientists to achieve established timelines of career progression and productivity; these findings may have long-term implications for the well-being and retention of women in academic medicine.

Perspectives of Rare Disease Social Media Group Participants on Engaging With Genetic Counselors: Mixed Methods Study

BACKGROUND

Social media provides a potential avenue for genetic counselors to address gaps in access to reliable genetics information for rare disease communities. However, only limited research has examined patient and family attitudes toward engaging with genetic counselors through social media.

OBJECTIVE

Our study assessed the attitudes of members of rare disease social media groups toward engaging with genetic counselors through social media, characteristics associated with greater interest, and the benefits and potential pitfalls of various approaches to such engagement.

METHODS

We conducted a mixed methods survey of patients and family members recruited from a systematic sample of rare disease Facebook groups. Patient characteristics and their associations with interest in engagement with genetic counselors were evaluated using univariate and bivariate statistics. Responses to open-ended questions were analyzed using thematic content analysis.

RESULTS

In total, 1053 individuals from 103 rare disease groups participated. The median overall interest in engaging with genetic counselors on social media was moderately high at 7.0 (IQR 4.0-9.0, range 0-10). No past experience with a genetic counselor was associated with greater interest in engaging with one through social media (µ=6.5 vs 6.0, P=.04). Participants expressed greatest interest (median 9.0, IQR 5.0-10.0) in engagement models allowing direct communication with genetic counselors, which was corroborated by the majority (n=399, 61.3%) of individuals who responded to open-ended questions explicitly stating their interest in 1-on-1 interactions. When asked what forms of support they would request from genetic counselors through social media, participants desired individualized support and information about how to access services. However, participants also expressed concerns regarding privacy and confidentiality.

CONCLUSIONS

Patients and family members in rare disease social media groups appear interested in engaging with genetic counselors through social media, particularly for individualized support. This form of engagement on social media is not meant to replace the current structure and content of genetic counseling (GC) services, but genetic counselors could more actively use social media as a communication tool to address gaps in knowledge and awareness about genetics services and gaps in accessible patient information. Although encouraging, concerns regarding privacy and feasibility require further consideration, pointing to the need for professional guidelines in this area.

Linking minority stress to substance abuse in LGB adults: the mediating effect of sexual harassment

OBJECTIVE

Employing a psychological mediation framework, the study investigated the interaction between minority stress and psychoactive substance abuse mediated by sexual harassment among LGB individuals.

METHOD

One hundred and forty-seven LGB individuals answered a questionnaire measuring internalized homophobia, concealment, discrimination, sexual harassment, and psychoactive substance abuse. Logistic hierarchical regression models were conducted to test the proposed relations and mediating hypotheses.

FINDINGS

Incidents of discrimination and internalized homophobia correlated with cigarette smoking and alcohol drinking. Sexual harassment was related to the use of cannabis and hard drugs. Sexual harassment mediated the relationships between the dimensions of minority stress and the use of cannabis and hard drugs.

CONCLUSION

Minority stress appears to be linked directly and indirectly, via sexual harassment, to the use of psychoactive substances by LGB individuals. Interventions addressing the prevention or mitigation of sexual harassment experienced by LGB individuals are likely to attenuate the negative effects of minority stress on their levels of substance use.

A cross-sectional study to assess job strain of emergency healthcare workers by Karasek questionnaire: The SEEK study

BACKGROUND

Emergency healthcare workers (eHCWs) are particularly at risk of stress, but data using the gold standard questionnaire of Karasek are scarce. We assessed the level of stress of eHCWs and aimed to compare it with the general population.

METHODS

This is a cross-sectional nationwide study in French Emergency Departments (EDs), using the job-content questionnaire of Karasek, compared with the 25,000 answers in the French general population (controls from the SUMER study). The descriptions of job demand, job control, and social support were described as well as the prevalence of job strain and isostrain. Putative factors were searched using mixed-method analysis.

RESULTS

A total of 166 eHCWs (37.9 ± 10.5 years old, 42% men) from five French EDs were included: 53 emergency physicians and 104 emergency paramedics, compared to 25,000 workers with other occupations. Job demand was highest for physicians (28.3 ± 3.3) and paramedics (25.9 ± 3.8), compared to controls (36.0 ± 7.2; p < 0.001). Job control was the lowest for physicians (61.2 ± 5.8) and paramedics (59.1 ± 6.8), compared to controls (70.4 ± 11.7; p < 0.001). Mean social support did not differ between groups (23.6 ± 3.4 for physicians, 22.6 ± 2.9 for paramedics, and 23.7 ± 3.6 for controls). The prevalence of job strain was massively higher for physicians (95.8%) and paramedics (84.8%), compared to controls (23.9%; p < 0.001), as well as for isostrain (45.1% for physicians, 56.8% for paramedics, and 14.3% for controls, p < 0.001). We did not find any significant impact of sociodemographic characteristics on job control, job demand, or social support.

CONCLUSION

Emergency healthcare workers have a dramatic rate of job strain, necessitating urgent promotion of policy to take care of them.