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Harassment of Lesbians as Medical Students and Physicians
Donna J. Brogan, PhD;
Erica Frank, MD, MPH;
Lisa Elon, MS, MPH;
S. Priya Sivanesan
Emory University, Atlanta, Ga
Katherine A. O'Hanlan, MD
Stanford Medical Center, Stanford, Calif
Corresponding Author: Erica Frank, MD, MPH, Department of Family and Preventive Medicine, Emory University School of Medicine, 69 Butler St, Atlanta, GA 30303-3219 (e-mail: efrank{at}fpm.eushc.org).
JAMA. 1999;282:1290-1292.
Despite evidence of discrimination against lesbian physicians, the prevalence of harassment due to sexual orientation is not accurately known. The Women Physicians' Health Study (WPHS) queried the prevalence of harassment among lesbian and heterosexual physicians during premedical school education, medical school, graduate medical education, and medical practice.
Methods
WPHS is a cross-sectional survey of women physicians aged 30 to 70 years who were not in residency training and resided in the United States in 1993.1 A probability sample of 10,000 women physicians was extracted from the AMA Physician Masterfile, stratified by decade of graduation (1950 to 1989), with oversampling of earlier decades. Of this sample, an estimated 23% were ineligible to participate. Among eligible respondents, 59% (4501) completed a 716-item, self-administered questionnaire covering health status, history, and behavior, as well as aspects of medical practice and demographics. A more complete description of the survey methods can be found elsewhere.2
Sexual orientation was assessed by 2 items querying self-identification and sexual behavior: "1. Do you now self-identify as: heterosexual; bisexual; lesbian/gay/homosexual; other; 2. Are you now sexually active with: men/women/both/neither." A woman was defined as lesbian if she either self-identified as lesbian in question 1 or reported current sex with women in question 2 (115 respondents). Heterosexuals were defined as those who self-identified as heterosexual and who did not currently have sex with women or who responded "other" or "no response" but reported current sex with men (4177 respondents). "The remaining 209 respondents included bisexual women (excluding those who identify as bisexual but report current sex with women, n = 41), "other" (n = 24), and not classifiable (n = 144)."
Harassment was assessed by the question "Have you ever been harassed in a medical setting? (ie, received unwanted physical or verbal attention, propositions, hostilities or threats)." Types of harassment (queried as gender-based but nonsexual, sexual, lifestyle-based, and ethnically based) and time of harassment occurrence (before medical school, during medical school, in training, or in practice) were cross-classified. Chi-square tests were used to compare lesbians and heterosexuals in the prevalence of types of harassment; SUDAAN, a sample survey software package, was used for all analyses. Although the word lifestyle was used in the 1993-1994 survey, orientation is used in this report, because sexual orientation is no longer described as a lifestyle.3
Results
Lesbians and heterosexuals did not differ in age, but lesbians were significantly less likely to have ever been married or pregnant, to have had a live birth, to have children, or to be part of a current couple or marriage, or to be politically conservative (P<.01). Lesbian respondents were more likely to be white/Caucasian and less likely to be Asian. Lesbians and heterosexuals were equally likely to be in a primary care specialty.
Lesbians were about 4 times more likely than heterosexual physicians to report ever having experienced sexual orientation–based harassment in a medical setting (41% for lesbians vs 10% for heterosexuals, P< .0001) using the identity definition; results were similar (36% vs 10%, P<.0001) using the identity/behavior definition. However, lesbian and heterosexual physicians reported similar (P>.01) lifetime prevalences of gender harassment (approximately 50%) and sexual harassment (approximately 40%), and reported similar prevalences of gender and sexual harassment in any of the 4 medical settings.7
Lesbians, compared with heterosexual physicians, are significantly more likely to report experiencing sexual orientation–based harassment during graduate medical education (18.2% vs 3.6%, P< .005) and during medical practice (18.5% vs 5.4%, P<.01). Lesbian physicians are significantly more likely than heterosexual female physicians to report sexual orientation harassment in any work setting after medical school (32.6% vs 7.7%, P<.0001).
Discussion
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Our findings indicate that lesbian physicians are about 4 times more likely than heterosexual women physicians to report harassment related to sexual orientation in any medical setting, but primarily during training and medical practice. Also, lesbian and heterosexual physicians did not significantly differ in prevalence of reported gender or sexual harassment, suggesting that higher sexual orientation–based harassment prevalence among lesbians cannot be explained by assuming that lesbians overreport harassment.
This study, based on a nationwide probability sample of women physicians, confirms findings from less scientific reports based on case studies, volunteer opinions, and nonprobability surveys that orientation harassment is experienced at a fairly high rate by lesbian physicians. A survey of San Diego County physicians, in 1982, revealed that 23% of respondents scored in the homophobic range on a scale of heterosexual attitudes toward homosexuality.4 Specifically, 30% were opposed to admitting highly qualified gay or lesbian applicants to medical school, and 45% and 39% opposed admittance to residency training in pediatrics and psychiatry, respectively. The most homophobic specialties were general surgery, obstetrics/gynecology, and general/family practice, in which 30% of physicians scored in the homophobic range. Similarly, a 1994 study found that 25% of family practice program directors "might" or "most certainly would" rank gay applicants lower than heterosexuals in the residency match.5 Also in 1994, the Gay and Lesbian Medical Association published findings that 17% of its physician members felt they had been refused privileges or denied employment or promotion based on sexual orientation, with 34% reporting orientation-related verbal harassment by medical colleagues.6
We have previously established that harassed women physicians are less satisfied with their careers, feel less in control of their work environments, and are more likely to have histories of depression and suicide attempts.7 At present, many universities, medical schools, and medical centers have nondiscrimination policies that include sexual orientation. Some also provide training to familiarize heterosexuals with gay and lesbian health issues and problems associated with homophobia. Such protection and training may reduce the high prevalence of harassment experienced by lesbian physicians.
AUTHOR INFORMATION
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Funding/Support: We acknowledge the support of the Lesbian Health Fund and the American Medical Association Foundation.
REFERENCES
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1. Frank E. The Women Physicians' Health Study: background, purposes, and design. J Am Med Womens Assoc. 1995;50:64-66.
PUBMED
2. Frank E, Brogan D, Mokdad A, Simoes E, Kahn H, Greenberg R. Health-related behaviors of women physicians versus other women in the United States. Arch Intern Med. 1998;158;342-348.
3. Stevens PE, Hall JM. A critical historical analysis of the medical construction of lesbianism. Int J Health Serv. 1991;21:291307.
4. Mathews WMC, Booth MW, Turner JD, Kessler L. Physicians' attitudes toward homosexuality—survey of a California county medical society. West J Med. 1986;144:106-110.
ISI
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5. Oriel KA, MadlonKay DJ, Govaker D, Mersy DJ. Gay and lesbian physicians in training: family practice program directors' attitudes and students' perceptions of bias. Fam Med. 1996;28:7205.
6. Schatz B, O'Hanlan KA. Antigay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay and Bisexual Physicians. San Francisco, Calif: Gay and Lesbian Medical Association; 1994.
7. Frank E, Brogan D, Schiffman M. Prevalence and correlates of harassment among US women physicians. Arch Intern Med. 1998;158:352-358.
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