Prevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media

Women are more likely than men to report being harassed online and are more than twice as likely to experience online sexual harassment.^1,2 Despite broad adoption of social media by medical professionals, there is limited information about physicians’ experiences with harassment on social media. We report on a case series of physicians invited to describe their experiences of harassment on social media.

We developed the survey instrument through a collaborative consensus process (3 meetings to review survey items and achieve consensus as a group) to capture responses, and use of the instrument was piloted by colleagues. Participants self-reported demographic information, including sex, race, and ethnicity. Participants were asked to answer yes or no to 2 questions: Have you ever been personally targeted or attacked on social media? Have you ever been sexually harassed on social media? An optional text box was provided for description of any such incidents. From February 6 to March 20, 2019, each of us posted a standard tweet weekly with a trackable link (bit.ly) to the survey. We tagged 10 physicians asking them to do the same.³ This study followed the American Association for Public Opinion Research (AAPOR) reporting guideline for survey studies and was deemed exempt from review by the institutional review board at Northwestern University.⁴ Findings were determined with 2-tailed χ² analyses with statistical significance defined at P < .01. Statistical analysis was conducted with Stata, version 15.0 (StataCorp LLC).

Of 1103 survey views, 464 participants (42.1%) who self-identified as US physicians completed the survey (196 [42.2%] men, 268 [57.8%] women or nonbinary, 357 [76.9%] White, 73 [15.7%] Asian, and 12 [2.6%] Black). Mean (SD) age was 39.0 (8.6) years. A total of 108 physicians (23.3%) reported being personally attacked on social media, with no significant difference between female and male physicians (65 [24.2%] vs 43 [21.9%], P = .56). In contrast, women were significantly more likely than men (44 [16.4%] vs 3 [1.5%], P<.001) to report online sexual harassment.

Of those reporting personal attacks, 46 physicians (42.6%) reported open-ended responses (Table). Personal attacks were categorized into 4 main domains: advocacy (21), personal (7), work-related (5), and other (13). The 21 advocacy comments were further categorized into vaccines (10), guns (3), abortion (2), smoking (2), and general (4). Work-related attacks were all related to patient care (4) and personal information (1). Personal attacks referred to race (4) and religion (3). In these comments, physicians reported verbal abuse, death threats, contacting employers and certifying boards, and the sharing of personally identifying information on public forums. Of the 18 sexual harassment comments shared, 12 women reported receiving sexually explicit messages, including several receiving pornographic images sent without consent. Two physicians described threats of assault, including a Black woman who reported being threatened with rape from White supremacists owing to her civil rights advocacy.

In what is, to our knowledge, the first study of physician experiences with online harassment, nearly one-quarter of physicians reported being personally attacked on social media. A total of 1 in 6 female physicians reported being sexually harassed. Our findings are consistent with the higher number of reports of female physicians reporting sexual harassment offline.⁵

Individuals who have experienced harassment consistently report emotional distress and fear.⁴ Women who receive online harassment may reduce their online participation or remove themselves from social media, preventing accrual of any professional benefits from those sites, such as networking and scholarly collaboration.⁶

Study limitations include that social media sampling may not be representative of the physician workforce, because fewer minority racial/ethnic group vs White physicians were included. In addition, all data were self-reported.

Because social media plays a substantial role in clinical care, medical education, and research, employers and professional societies should support physicians facing online harassment and work to mitigate its incidence and impact. Future work should focus on understanding and addressing online attacks and harassment for physicians, particularly Black and Hispanic/Latinx physicians who were underrepresented in our sample.

Accepted for Publication: August 31, 2020.

Published Online: January 4, 2021. doi:10.1001/jamainternmed.2020.7235

Corresponding Author: Vineet M. Arora, MD, MAPP, Department of Medicine, University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave, Chicago, IL 60637 (varora@medicine.bsd.uchicago.edu).

Author Contributions: Dr Arora and Ms Pendergrast had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Ms Pendergrast and Dr Jain contributed equally to the study.

Concept and design: Pendergrast, Jain, Trueger, Gottlieb, Arora.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Pendergrast, Trueger, Gottlieb, Arora.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Woitowich, Arora.

Administrative, technical, or material support: Pendergrast, Jain, Trueger, Gottlieb.

Supervision: Jain, Trueger, Gottlieb, Arora.

Conflict of Interest Disclosures: Dr Trueger reported receiving salary support for his role as digital media editor at JAMA Network Open, a stipend for his role as social media editor of Emergency Physicians Monthly, and a stipend for consulting from Level Ex. Dr Arora receives funding from the Journal of Hospital Medicine as a social media editor, the American Board of Internal Medicine, and the Joint Commission, and is a founding member of TIME’S Up Healthcare. No other disclosures were reported.