Sexual Harassment in Neurosurgery: What the Numbers Reveal

Nearly two in three neurosurgeons have witnessed sexual harassment at work, during training or during a professional event, according to a recent survey of neurosurgeons administered by the Congress of Neurosurgeons on behalf of the Society of Neurological Surgeons. More than half of respondents say they have been harassed personally.

Although both male and female neurosurgeons reported concerns about sexual harassment, women were more likely to experience it.

“In recent years, the neurosurgery community has made a concerted effort to attract and retain more bright, competent women,” says Deborah Benzil, MD, Vice Chair of Neurosurgery at Cleveland Clinic’s Center for Spine Health. “Unfortunately, sexual harassment in our specialty — if allowed to persist — will undermine that. Besides steering women away from neurosurgery careers, harassment may contribute to burnout for women already in the field.”

Dr. Benzil led the multicenter team that developed and conducted the sexual harassment survey, an effort initiated by the Neurosurgery Professionalism Taskforce convened by multiple neurosurgery professional societies. It was the first comprehensive evaluation of sexual harassment in the specialty. Survey results were published recently in the Journal of Neurosurgery.

“Even before the #MeToo movement, sexual harassment was a concern in the healthcare community, particularly in specialties like neurosurgery, which is known for male dominance and hierarchical structure,” says Dr. Benzil. “However, the issue needed to be clearly defined before we could begin to address it. Our survey was the first step in measuring the prevalence and severity of sexual harassment, determining which populations are most likely to experience or perpetrate it, and assessing contributing systemic factors.”

Key findings

Out of a survey population of 5,166 individuals, 622 (12%) completed the survey. Of those respondents, 20% were female — a greater representation of women than among neurosurgeons overall (8% female) or among neurosurgery residents (19% female).

Survey results indicated:

• 62% of respondents had witnessed some form of sexual harassment.
• 55% had experienced sexual harassment personally. Of these, more than 80% experienced it during training. Others experienced it during post-residency employment or during a national meeting or educational event.
• The telling of inappropriate jokes was the form of harassment most commonly reported (49%). Two respondents (< 1%) reported rape. Other types of harassment included unwelcome flirtation, inappropriate physical contact, discussion about sex and comments about the body.
• 37% of those experiencing sexual harassment said it has happened more than 10 times. Another 19% said it has happened more than five times.
• 72% identified men as the perpetrator of harassment, although 23% identified both men and women. Superiors (including chairs and supervisors) were identified as offenders by 87% of respondents, although 43% also pointed to colleagues in lateral positions.
• Only 31% addressed the harassment after it occurred, but most didn’t make an official report due to concerns about retaliation, increased stress, or potential impact on their reputation or career. Most of those who officially reported harassment said that doing so either had no impact on the situation (38%) or a negative impact (34%).

“Despite the low response rate to the survey and the slightly disproportionate number of female respondents, these findings are noteworthy,” says Dr. Benzil. “They show that sexual harassment in neurosurgery is real and is quantifiable.”

Offending episodes referenced by survey respondents spanned a wide range of time, from within the past few months to more than 10 years ago. “The problem isn’t just historic; it’s ongoing,” says Dr. Benzil.

Championing the tough issues

It’s not the first time Dr. Benzil has shed light on challenges to diversity within neurosurgery. She was lead author on “The Future of Neurosurgery: A White Paper on the Recruitment and Retention of Women in Neurosurgery,” published in 2008 in the Journal of Neurosurgery. That landmark article, which pointed out gender inequity and called on the American Association of Neurological Surgeons to help end discriminatory practices, positioned her as a champion of women in the specialty.

Dr. Benzil claims that of her most significant work, including as a pioneer of spine stereotactic radiosurgery, the white paper “has probably had the greatest impact on the practice of medicine over time and for the greatest number of individuals.”

“The current study on sexual harassment…carries the same potential and I know will stand at the conclusion of my career as one of the works for which I am most proud to have been a key player,” writes Dr. Benzil in a response to an editorial accompanying her team’s publication of the survey results in the Journal of Neurosurgery.

Culture shift required

Ending sexual harassment in neurosurgery will require a culture shift, Dr. Benzil says. That may include:

• Adoption of a zero-tolerance policy across the specialty
• Standardized guidelines for reporting sexual harassment
• Alternatives to the specialty’s traditional hierarchical structure
• Increased diversity in institutional neurosurgery teams as well as in presenters at industry gatherings
• Established best practices for social events

“Our survey and its results have helped raise awareness of the unconscious bias in our specialty,” says Dr. Benzil. “Challenging the status quo is never comfortable, but I’m encouraged by the responses from both male and female survey participants who are overwhelmingly supportive of bringing meaningful change.”