How widespread is Sexual Harassment in the Workplace?
And what exactly does it include?
According to federal law, sexual harassment in the workplace is a form of discrimination, enforced by the U.S. Equal Employment Opportunity Commission (EEOC). Yet a look at statistics compiled by the Commission reveals little. The number of complaints has remained virtually unchanged for more than a decade, hovering between about 11,500 and 12,500 per year.
Pretty much everyone agrees, however, that incidents are vastly under-reported. According to the EEOC’s own Select Task Force on the Study of Harassment in the Workplace, “The least common response of either men or women to harassment is to take some formal action—either to report the harassment internally or file a formal legal complaint.” Only a tiny percentage of employees actually file a complaint with the Commission (just 6% to 13% according to research). Not many more even complain to their supervisor. In fact, two separate studies found that about 70% of those who had experienced harassment never told a supervisor, manager or union representative about their experience.
A range of fears lie behind this deafening silence. Many women are afraid they won’t be believed or will even be accused of provoking the harassment themselves. Others worry that once word gets out, coworkers will ostracize or humiliate them. Many are also concerned about the fate of the person who harassed them. According to Fran Sepler, a consultant, trainer and author of the book, Finding the Facts: What Every Workplace Investigator Needs to Know, “One of the reasons people don’t speak up early is that they don’t want the person who is doing the behavior to lose their job.” That’s why Sepler and others are opposed to so-called “zero tolerance” policies. By applying the same extreme punishment to every case—from the worst offender to the barely offensive—these policies discourage people from reporting anything but the most egregious incidents.
But the most common reason women fail to report harassment is fear of retaliation—a well-founded fear, according to the EEOC’s Task Force. In one study from 2003, three-quarters of those who spoke up faced some form of retaliation, and other studies have documented a range of negative outcomes, from trivialization by management to reprisals against the victim.
These fears prevent people from filing complaints, at least for a time—often a very long time. In testimony she gave to the EEOC Task Force, Sepler noted, “Fear of reprisal or retaliation, and the subsequent fear of job loss lengthens the incubation period and the harassment continues until the individual’s calculus is that they cannot bear the harassment for one more minute.” By that point, the victim has suffered serious harm, the case has grown increasingly complicated and the issues at the root of the problem have become firmly entrenched in the organization’s culture.
So how widespread is sexual harassment? The answer depends in part on how you ask the question. In surveys that did not define the term, approximately one in four women (25%) reported being victimized. But when surveys were more explicit—asking women if they had experienced “specific sexually-based behaviors, such as unwanted sexual attention or sexual coercion,” the rate increased to about 40%. When the definition was broadened to include “gender harassment,” which can include sexually crude comments and behavior, as long as they are intended to demean rather than sexually coerce women, 60% of those surveyed reported being harassed.
While terminology influences the statistics, it is largely irrelevant to the effect harassment has on women. More than one study has confirmed that victims suffer the same trauma whether or not their experience is labeled sexual harassment. According to researchers quoted in the EEOC report, “Data from three organizations demonstrate that whether or not a woman considers her experience to constitute sexual harassment, she experiences similar negative psychological, work, and health consequences.”
What about sexual harassment in health care? The recent revelations about gymnastics doctor Larry Nassar have dominated the press, but it is too soon to say whether his offenses will have the same galvanizing effect in health care that Harvey Weinstein’s had in the entertainment world.
In the meantime, when it comes to gauging the extent of sexual harassment in medicine, there is very little to go on. By one definition, the term “sexual harassment in the workplace” limits the issue to those employed by hospitals and other health care institutions. These are the complaints that reach the EEOC, and again, the Commission’s statistics reveal little. The number of complaints filed with the EEOC is vanishingly small: only 3,085 in all U.S. hospitals during the two decades between 1995 and 2016. Independent research during the same period paints a different picture, virtually indistinguishable from the view inside other workplaces. In a 1995 study of women medical faculty in the U.S., 52% reported suffering harassment during their careers, while a 2016 study published in the Journal of the American Medical Association (JAMA), found that 30% of clinician-researchers reported being harassed.
But physicians don’t just work with other hospital employees. They spend most of their work lives treating patients. So while it does not fall within the jurisdiction of the EEOC, sexual harassment of patients by doctors is a significant workplace issue that state medical boards take very seriously.
How extensive the problem is remains unclear, however. For a variety of reasons, boards do not generally publish statistics about sexual harassment of patients. And while the Federation of State Medical Boards (FSMB) reports annually on how many doctors have been disciplined nationwide, it does not detail the charges against them.
How is sexual harassment defined in general and in medicine? Federal law, as determined by the Civil Rights Act of 1964 and subsequent Supreme Court decisions, uses the following overlapping terms to describe sexual harassment in the workplace.
Unwanted sexual advances. Not all sexually-oriented unwelcome actions are equally objectionable. Sepler describes a continuum of behaviors that begin with what she calls “bumbling boundary crossers,” people who annoy or offend others not intentionally but simply because they lack social skills. At the other end of the spectrum is a person who repeatedly makes unwelcome sexual advances, over weeks or months. Even such obvious offenders are not always easy to identify, because the simple definition of “unwanted” can quickly get tangled up in office politics and power plays. A woman who has no qualms objecting to the behavior of a coworker, is far less likely to make her feelings known if the harasser is her boss. “The idea that somebody is going to hold up a sign and say, ‘You just crossed my line’ is a myth,” says Sepler.
Quid pro quo sexual advances can be explicit (“Sleep with me or I’ll fire you”) or indirect (“Let’s go out for a drink and talk about that promotion”). In both cases, the person in power is using his position to pressure an employee for sexual favors. And if the threatened employee is fired, demoted, denied a promotion or feels forced to resign because she refused a boss’s advances, that too is considered quid pro quo sexual harassment.
Hostile work environment. When someone’s unwelcome sexual behavior, whether verbal or non-verbal, so poisons the workplace that it interferes with people’s ability to do their work, the offender is guilty of creating a hostile work environment. Anyone who witnesses the behavior can file a charge.
While these definitions are relevant in all workplaces with more than 15 people, physicians are held to a significantly higher standard. According to FSMB guidelines, state medical boards are obligated to discipline any behaviors, verbal or non-verbal, “that are sexual or that reasonably may be construed by a patient or patient’s surrogate as sexual.” Boards, which exist to protect the public, are predisposed to accept all patients’ views as reasonable.
A physician who fails to use appropriate disrobing or draping practices is guilty of a violation. So is a doctor who conducts an intimate exam in the presence of anyone else, including a spouse or medical student, without the patient’s informed consent. Simply asking a patient for a date is grounds for serious disciplinary action. Even when a doctor and patient engage in what they consider consensual sex, the physician is likely to lose his or her license.
We may not know how extensive these kinds of sexual harassment are, but public awareness of the threat is far from hidden. With sensational stories making local headlines on a regular basis, there is little chance of a dam-busting #MeToo moment in health care. But the pressure for change is as strong today as it’s ever been and likely to continue strengthening for the foreseeable future.