Abstract
Background:
Much of the data about physician harassment and discrimination come from self-report surveys or qualitative data. We used publicly available sources to systematically identify physician-originating sex- and gender-based harassment and discrimination reported over a 5-year period.
Methods:
We performed systematic searches of Canadian news outlets (Canadian Newsstream), legal decisions (Canadian Legal Information Institute), and regulatory body notifications (websites of colleges of physicians and surgeons) to identify instances of harassment and discrimination involving a physician reported from Aug. 1, 2019, to July 31, 2024, in Canada. Data extraction was performed in duplicate. We performed comparative case analysis to generate insights related to physician-originating sex- and gender-based harassment and discrimination.
Results:
We found 1437 records that described 208 physician respondents involved in concerns of sex- or gender-based harassment or discrimination during the study period. Of the estimated 689 victims, 585 were women or girls (84.9%) and at least 40 were children (5.8%). Sexual-boundary violations or sexual misconduct was the most common category (n = 75, 36.1%) followed by sexual assault (n = 65, 31.3%). A police complaint occurred for 72 cases (34.6%), and 29 physicians were convicted (65.9% of trials). Comparative case analysis generated several important themes, including physicians not self-reporting criminal convictions, resulting in no practice restrictions; news media being an important mechanism for additional complainants to come forward; and a substantial proportion of physician respondents having had a previous complaint (29.8%).
Interpretation:
In our study, most victims of physician-originating sex- or gender-based harassment or discrimination in Canada were women or girls, and many physician respondents were not restricted in their practice. Gaps in remediation and monitoring of physicians with previous complaints are apparent; analysis of current regulatory practices would be more feasible if data reporting by Canadian regulatory bodies were more transparent.
Limited data are available about physician-originating harassment and discrimination in Canada, including descriptive details and outcomes.1 Much of the existing data come from self-reported surveys or qualitative studies from the perspectives of those targeted by harassment and discrimination, which can be limited by selection or recall bias.2–6 Unlike in some other countries where complaints against physicians are centrally monitored, 7 Canadian medical regulatory bodies are provincially siloed and do not consistently capture or transparently report data about physicians involved in harassment and discrimination complaints.1,8,9 Nearly all complaints to a provincial college of physicians and surgeons (“college”), including an estimated 50% of concerns involving sexual harassment, are not publicly reported and do not proceed to full disciplinary tribunal.10 Further, each province differs in the policy and legislation governing physician behaviour,11 including different reporting structures, timelines for posting discipline decisions, and laws that outline mandatory penalties for specific infractions.9
National data are needed to understand the scope of this issue. We aimed to identify patterns across instances of physician-originating sex- or gender-based harassment and discrimination in Canada by systematically searching a variety of documents and reports.
Methods
Study design and setting
We systematically searched publicly available news media reports, legal decisions, and provincial college complaints to identify cases of sex- and gender-based harassment and discrimination involving physicians in Canada over a 5-year period and used comparative case analysis to identify associated patterns. We report on the subset of data related to physician respondents in complaints of sex- or gender-based harassment or discrimination gathered during a mixed-methods observational study of physicians involved in instances of any type of harassment or discrimination in Canada. Data related to physician complainants, racism, anti-Indigenous bias, ageism, ableism, and other forms of harassment or discrimination will be presented elsewhere.
In Canada, physician behaviour is regulated by a provincial college, which requires physicians to register to be eligible to provide medical care in that province.9 Physicians working in Canadian territories are regulated through the territorial governments. Physician behaviours and standards of practice are governed by each college’s by-laws, and concerns are received, investigated, and remediated at the level of the college. Because the provincial colleges set standards of behaviour and consequences for behaviour that fails to meet these standards, physicians are considered a self-regulating profession.11 In addition to college standards, 4 Canadian provinces (Ontario [2017], Quebec [2017], Alberta [2019], and Prince Edward Island [2023]) have enacted legislation on sexual-boundary violations that define sexual misconduct, impose mandatory minimum penalties, or both, for physicians found to have committed sexual misconduct (Appendix 1, eTable 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.251179/tab-related-content).
Search strategy
We searched 3 publicly available databases for records entered from Aug. 1, 2019, to July 31, 2024: Canadian Newsstream (Pro-Quest, Clarivate; a searchable database of more than 400 Canadian news outlets, broadcasters, and newspapers, including archived sources), the Canadian Legal Information Institute (CanLII, Federation of Law Societies of Canada; a publicly accessible database of select court judgments from Canadian judiciary [e.g., provincial health professions appeal and review boards] and list of hearing tribunal decisions for participating provincial colleges), and the 10 provincial college disciplinary history websites. Unlike many medical sciences databases (e.g., PubMed, Web of Science), these databases do not assign subject headings and index records; instead, they use search terms and an internal algorithm to identify relevant records. For this reason, search results in these databases may differ over time as algorithms are updated and by search location. Further, available records depend on news media subscriptions (Canadian Newsstream) and on tribunals and courts submitting documents (CanLII), meaning that the availability of past-dated records may change over time. These limitations are inherent to these databases. Search strategies were co-developed with the assistance of librarians (D.L. and K.C.; Appendix 1, Supplementary Material 1 and 2). Two study team members (S.M.R. and 1 of K.C.L., S.T., or D.O.) independently examined identified records for inclusion. Records were included for data extraction based on the wording or phrasing of the original record — without interpretation from the study team — when the instance was described as sex- or gender-based abuse, assault, discrimination, harassment, or violence; the record mentioned involvement by a physician as either the complainant (referring to the alleged target or victim) or respondent (referring to the alleged source or perpetrator); and the instance occurred in Canada. We included records regardless of whether a final outcome was available (e.g., college complaints under investigation). Disagreements on inclusion were reviewed by a third study team member (S.M.R. or K.C.L.). We required that, to be included, records must have been published during the study period; however, because of delays in reporting by the respondent and criminal investigations, the instance described in the record may have occurred at any time. We excluded records that had fewer than 50 words, as well as letters to the editor, commentaries, and blog posts.
Data extraction
We reviewed records for eligibility and extracted data in duplicate (S.M.R. and 1 of K.C.L., S.T., or D.O.), using a standardized template (Appendix 1, Supplementary Material 3), and reconciled disagreements to ensure accuracy. We developed the data extraction template based on previous studies that examined news media portrayals of sexual violence12–14 and of physicians in general,15 and included information about the record characteristics, complainant and respondent demographic characteristics, and details of the instance.
Data analysis
We present counts of case characteristics and demographic characteristics of targets and physician respondents. We determined comparisons between physician respondents with a single concern and those with repeat concerns using the Fisher exact test for categorical outcomes, using a 2-way p value of less than 0.05 to indicate significance. For significant comparisons, we used post hoc testing with Bonferroni correction to determine significance. We used the Mann–Whitney U test to compare groups for count outcomes. We performed all analyses in Stata (version 18).
We created cases, defined as a narrative describing an instance of harassment or discrimination, by combining all available data on each unique physician identified from the records. If a physician had multiple instances within the study period, the most recent instance was used to define the case, and previous instances were incorporated into the narrative as previous concerns so that each physician was represented in the data only once (Appendix 1, eFigure 1). We classified types of concerns (e.g., assault, abuse) based on how the instance was described in the original record because of a lack of standard definitions across jurisdictions and over time (Appendix 1, eTable 1). We present all outcomes as described in the original record, without an attempt to adjudicate each case (i.e., we did not attempt to determine whether the final outcome was “correct” or “fair”; we accepted the final outcome that was determined by the court or tribunal panel).
We analyzed each case using horizontal comparative case analysis with a process-oriented approach, as described by Bartlett and Vavrus (Appendix 1, eFigure 1).16,17 Comparative case analysis is grounded in critical theories such as critical feminist theory18 that require description of the implicit and explicit power structures in the phenomenon of interest, which is directly relevant to instances of harassment and discrimination. In horizontal comparative case study, cases are compared with each other for outliers, similarities, and differences (horizontally) as opposed to vertically (between cases under different regulations or policy environments) and transversally (across time) to generate themes. In this study, 3 study team members (S.T., K.C.L., and S.M.R.) read all cases and took field notes describing patterns, similarities, or notable outliers in respondent demographic characteristics and behaviours, complainant demographic characteristics and behaviours, case outcomes or investigations, and narrative features (e.g., how the case came to public attention, offence types, previous accusations). We discussed and synthesized field notes into an initial set of codes, which S.M.R. applied to all cases (Appendix 1, eTable 1). Author S.M.R. created initial themes based on reading of cases within each code (e.g., repeat offences, instances that occurred while on practice restrictions) to generate insights about harassment or discrimination involving physicians. Two study team members (S.M.R. and K.C.L.) refined and sorted initial themes by similarity to create final, high-level themes.17 These themes were reviewed with all study team members for agreement.
Reflexivity
All study team members are cisgender women. Authors S.M.R. and K.C.L. are White staff physicians with experience in qualitative analysis and formal training related to workplace harassment and discrimination. Authors S.T. and D.O. are medical trainees (S.T. is a medical resident and D.O. is a medical student) with experience in data extraction.
Ethics approval
This study used publicly available information and was exempt from ethics board review.
Results
We identified 1437 records across the 3 databases. After removing duplicates and exclusions, we included 212 newspaper articles describing 75 physicians, 89 CanLII citations describing 101 physicians, and 194 provincial college complaints for 158 physicians (21.3% of all 773 identified college complaints; Figure 1). Of these, 208 unique physician respondents were involved in instances of sex- or gender-based violence, harassment, or discrimination during the study period (Table 1; Appendix 1, eTable 3).
Figure 1:
Flow of records in the study. Note: CanLII = Canadian Legal Information Institute. See Related Content tab for accessible version.
Table 1:
Demographic and case characteristics for physician respondents in concerns involving sex- or gender-based harassment or discrimination in Canada
| Characteristic | No. (%) | p value* | ||
|---|---|---|---|---|
| Total | Single concern | Repeat concerns | ||
| Total | 208 | 146 (70.2) | 62 (29.8) | |
| Gender | ||||
| Man | 193 (92.8) | 135 (92.5) | 58 (93.5) | 0.8 |
| Woman | 12 (5.8) | 8 (5.5) | 4 (6.5) | |
| Unknown | 3 (1.4) | 3 (2.1) | – | |
| Practice discipline | ||||
| Anesthesia | 6 (2.8) | 3 (2.1) | 3 (4.8) | 0.02 |
| Diagnostic imaging | 2 (1.0) | – | 2 (3.2) | |
| Emergency medicine | 3 (1.4) | 1 (0.7) | 2 (3.2) | |
| Family medicine | 105 (50.5) | 72 (49.3) | 33 (53.2) | |
| Internist | 19 (9.1) | 13 (8.9) | 6 (9.7) | |
| Obstetrician–gynecologist | 8 (3.8) | 3 (2.1) | 5 (8.1) | |
| Pediatrician | 7 (3.4) | 4 (2.7) | 3 (4.8) | |
| Psychiatrist | 12 (5.8) | 11 (7.5) | 1 (1.6) | |
| Surgeon | 21 (10.1) | 17 (11.6) | 4 (6.5) | |
| Trainee or clinical assistant | 7 (3.4) | 7 (4.8) | – | |
| Unknown | 18 (8.7) | 15 (10.3) | 3 (4.8) | |
| Province | ||||
| Alberta | 46 (22.1) | 35 (24.0) | 11 (17.7) | 0.2 |
| British Columbia | 16 (7.7) | 14 (9.6) | 2 (3.2) | |
| Manitoba | 9 (4.3) | 6 (4.1) | 3 (4.8) | |
| New Brunswick | 1 (0.5) | 1 (0.7) | – | |
| Newfoundland and Labrador | 2 (1.0) | 2 (1.4) | – | |
| Nova Scotia | 11 (5.3) | 8 (5.5) | 3 (4.8) | |
| Ontario | 77 (37.0) | 54 (37.0) | 23 (37.1) | |
| Prince Edward Island | 2 (1.0) | – | 2 (3.2) | |
| Quebec | 32 (15.4) | 18 (12.3) | 14 (22.6) | |
| Saskatchewan | 11 (5.3) | 8 (5.5) | 3 (4.8) | |
| Unknown | 1 (0.5) | – | 1 (1.6) | |
| Category † | ||||
| Assault, threats, or battery | 13 (6.3) | 10 (6.8) | 3 (4.8) | 0.4 |
| Sexual boundary violation or misconduct | 75 (36.1) | 57 (39.0) | 18 (29.0) | |
| Sex-based discrimination | 12 (5.8) | 10 (6.8) | 2 (3.2) | |
| Sexual harassment | 23 (11.1) | 16 (11.0) | 7 (11.3) | |
| Child pornography | 2 (1.0) | 2 (1.4) | – | |
| Voyeurism | 1 (0.5) | 1 (0.7) | – | |
| Sexual abuse | 19 (9.1) | 12 (8.2) | 7 (11.3) | |
| Sexual assault | 65 (31.3) | 39 (26.7) | 26 (41.9) | |
| Previous complaint | 62 (29.8) | NA | 62 (100) | |
| College complaint | 165 (79.3) | 114 (78.1) | 51 (82.3) | |
| Outcome unknown | 12 (7.3) | 7 (6.1) | 5 (9.8) | 0.2 |
| Pending | 8 (4.8) | 5 (4.4) | 3 (5.9) | |
| Dismissed | 4 (2.4) | 3 (2.6) | 1 (2.0) | |
| Acquitted | 2 (1.2) | – | 2 (3.9) | |
| Retired, resigned, or died before hearing | 14 (8.5) | 10 (8.8) | 4 (7.8) | |
| Guilty‡ | 125 (75.8) | 89 (78.1) | 36 (70.6) | |
| Reprimand or caution | 12 (9.6) | 9 (10.1) | 3 (8.3) | 0.4 |
| Practice restrictions | 7 (5.6) | 3 (3.4) | 4 (11.1) | |
| Education | 1 (0.8) | 1 (1.1) | – | |
| Licence suspension | 75 (60.0) | 56 (62.9) | 19 (52.8) | |
| Licence revoked | 31 (24.8) | 21 (23.6) | 10 (27.8) | |
| Police complaint | 72 (34.6) | 50 (34.2) | 22 (35.5) | |
| Complaint without charges | 1 (1.4) | 1 (2.0) | – | 0.8 |
| Charged§ | 2 (2.8) | 1 (2.0) | 1 (4.5) | |
| Dismissed, dropped, or withdrawn | 12 (16.7) | 9 (18.0) | 3 (13.6) | |
| Outcome unknown | 15 (20.8) | 9 (18.0) | 6 (27.3) | |
| Trial¶ | 42 (58.3) | 30 (60.0) | 12 (54.5) | |
| Stayed | 5 (11.9) | 3 (10.0) | 2 (16.7) | 0.3 |
| Ongoing or pending | 2 (4.8) | 1 (3.3) | 1 (8.3) | |
| Acquitted | 6 (14.3) | 5 (16.7) | 1 (8.3) | |
| Conditional or absolute discharge | 5 (11.9) | 2 (6.7) | 3 (25.0) | |
| Probation | 4 (9.5) | 4 (13.3) | – | |
| Incarcerated | 16 (38.1) | 13 (43.3) | 3 (25.0) | |
| Convicted, sentence unknown | 4 (9.5) | 2 (6.7) | 2 (16.7) | |
| Human rights complaint | 12 (5.8) | 11 (7.5) | 1 (1.6) | |
| Dismissed | 6 (50.0) | 4 (36.4) | 1 (100) | NC |
| Successful | 5 (41.7) | 5 (45.5) | – | |
| Unknown | 1 (8.3) | 1 (9.1) | – | |
| Civil complaint | 13 (6.3) | 9 (6.2) | 4 (6.5) | |
| Request for class action lawsuit granted | 1 (7.7) | 1 (11.1) | – | NC |
| Dismissed | 1 (7.7) | 1 (11.1) | – | |
| Found liable | 4 (30.8) | 3 (33.3) | 1 (25.0) | |
| Ongoing or pending | 2 (15.4) | 2 (22.2) | – | |
| Settled | 1 (7.7) | 1 (11.1) | – | |
| Outcome unknown | 4 (30.8) | 1 (11.1) | 3 (75.0) | |
Note: NA = not applicable, NC = not calculated.
Fisher exact test; “unknown” categories were excluded from comparison.
Defined based on the original record; several instances resulted in more than 1 description and percentages add up to more than 100%.
Because of an appeal process, 1 participant received 2 consequences for the same event (suspension downgraded to practice restrictions).
Status at the time of data collection.
“Stayed” refers to a pause during trial that may lead to dropped charges or a continuation of the trial. “Acquitted” refers to a court judgment that the defendant is not guilty of the charges. A “discharge” means that the defendant was found guilty but will not have a criminal record (absolute) sometimes requiring the defendant to complete probation (conditional).
The number of victims per physician ranged from 1 to 63, though, for some physicians (n = 16), the number of victims was not reported or was listed as “numerous” (Table 2). Based on available data, we estimated at least 689 victims, of which 585 were women or girls (84.9%) and 40 were children (5.8%). No cases included trans, nonbinary, or gender-diverse victims. Patients or their caregivers were the most common victims (n = 600, 87.1%), and 2 instances involved physician victims (0.3%).
Table 2:
Characteristics of victims, targets, or complainants in cases of sex- and gender-based harassment or discrimination involving a Canadian physician respondent
| Characteristic | No. (%)* | p value | ||
|---|---|---|---|---|
| Total | Single concern | Repeat concern | ||
| Total† | 689 | 470 (68.2) | 219 (31.8) | |
| Numerous or unknown number | 16 | – | 16 (100) | |
| Targets per complainant, median (IQR; range) | 1 (1–2; 1–63) | 1 (1–2; 1–63) | 1 (1–2; 1–56) | 0.9 |
| Role‡ | ||||
| Colleague§ | 88 (12.8) | 18 (3.8) | 70 (32.0) | < 0.001 |
| Nurse | 39 (5.7) | 18 (3.8) | 18 (8.2) | |
| Physician | 2 (0.3) | – | 2 (0.9) | |
| Medical trainee | 3 (0.4) | 2 (0.4) | 1 (0.5) | |
| Patient or caregiver | 600 (87.1) | 409 (87.0) | 191 (87.2) | |
| Personal relationship | 18 (2.6) | 15 (3.2) | 3 (1.4) | |
| Unknown | 8 (1.2) | 8 (1.7) | – | |
| Gender and age | ||||
| Women | 447 (64.9) | 343 (73.0) | 104 (47.5) | 0.001 |
| Women and girls | 120 (17.4) | 41 (8.7) | 79 (36.1) | |
| Men | 8 (1.2) | 5 (1.1) | 3 (1.4) | |
| Men and boys | 0 | 0 | 0 | |
| Girls | 18 (2.6) | 6 (1.3) | 12 (5.5) | < 0.001 |
| Boys | 12 (1.7) | 1 (0.2) | 11 (5.0) | |
| Children¶ | 10 (1.5) | 5 (1.1) | 5 (2.3) | |
| Unknown | 74 (10.7) | 68 (14.7) | 6 (2.7) | |
Note: IQR = interquartile range.
Unless stated otherwise.
The number of victims was unknown or numerous for 16 physicians. The term “unknown” was meant to summarize records with vague wording that referred to more than 1 victim.
When physicians had more than 1 victim, the victims were often described in the record as, for example, “there were 30 complainants, including nurses, patients, and administrators.”
We used “colleague” when the original record used “colleague,” “coworkers,” or other synonyms without more information.
We used “children” when the original record reported that victims included children without specifying gender (e.g., “victims included children”).
The respondents included 193 men (92.8%), 12 women (5.8%), and 3 people of unknown sex or gender (1.4%). No cases included trans, nonbinary, or gender-diverse respondents. Two instances involved multiple physician respondents (Case 67, Case 74). The earliest described instance occurred in the 1970s (Case 67). Family medicine (n = 105, 50.5%) and surgery (n = 21, 10.1%) were the most common disciplines of physician respondents.
Concerns were classified differently based on source format (e.g., news media, human rights concerns) and across provinces (Appendix 1, eTable 1). Sexual-boundary violations or sexual misconduct was the most common category of concern (n = 75, 36.1%) followed by sexual assault (n = 65, 31.3%), though these terms were not often defined or were defined differently8 in each source (Table 1; Appendix 1, eTable 1). For example, 2 physicians used cameras to record their clinic staff in the washroom (Case 143, Case 199) and 1 recorded himself performing pelvic examinations on more than 51 patients (Case 192); despite similarities between these crimes, 2 physicians were convicted of sexual assault (Cases 192, Case 199) and 1 pleaded guilty to a charge of voyeurism (Case 143).
Two respondents were acquitted after a college investigation (1.2%), and 130 respondents received penalties after a disciplinary tribunal (78.8%). These penalties included education only (n = 1, 0.8%), a caution or reprimand (n = 12, 9.2%), practice conditions (n = 7, 5.4%), a permit suspension (n = 75, 57.7%; range 1 mo to 8 yr), or revocation of the practice permit (n = 35, 26.9%). A police complaint occurred for 72 cases (34.6%), of which 44 led to a criminal trial (61.1%) with 29 convictions (65.9% of trials).
Comparative case analysis
Comparative case analysis of the 208 physician-based cases (Appendix 1, eTable 3) identified several important themes, as outlined in Table 3.
Table 3:
Exemplar cases illustrating themes
| Themes and subthemes | Case no. | Case details | Case outcome |
|---|---|---|---|
| Self-reporting and public notification | |||
| Criminal charges without notification to the college* | Case 5 | Criminally charged with 21 counts, including sexual assault, extortion, and forcible confinement. Ten counts were dropped, 5 counts were stayed, and 6 were acquitted at trial. | Active practice permit with no restrictions and no discipline history. |
| Case 48 | Criminally charged with sexual assault of a patient (2021, withdrawn) with no corresponding college record or investigation. Criminally charged with sexual assault related to 1 patient interaction; 4 additional patients came forward and additional charges were laid (2023). | Active practice permit with restrictions. | |
| Case 50 | Newspaper article describing arrest and 4 criminal charges, including sexual assault of a child. Outcome unknown. | Active practice permit with no restrictions and no discipline history. | |
| Public notification resulting in more complainants coming forward | Case 7 | “12 former patients came forward to [newspaper] after the investigation was published, accusing him of similar abuse.” | Criminally charged with sexual assault of 18 patients (withdrawn). Pleaded no contest in a college discipline hearing and resigned his permit. |
| Case 9 | “[She] made a report alleging she had been sexually assaulted during a visit to the clinic … [after which] a number of other patients came forward.” | Sentenced to 7 years in prison for sexual assault of 9 patients. Permit revoked. | |
| Case 185 | “Police subsequently released a photo and information on the suspect and on Friday, cops announced 11 more alleged victims had come forward.” | Sentenced to 9 years in prison for 16 counts of sexual assault and 1 count of sexual exploitation. | |
| Public notification demonstrating that examinations were improper | Case 36 | “She’d had breast exams before by her family doctor, she told the court, ‘and I don’t recall there being cupping’ … “Speaking later on the stand, her husband said they didn’t talk about it much after that day and ‘pretended it never happened’ … “Years later, she read an article in [newspaper] about other people coming forward with allegations against [respondent]. This pushed her to go to the police.” |
College permit has been revoked. Entering fourth year of criminal trial. |
| Case 185 | “One woman who sought his help for depression was asked to lie down and undo her pants. … As she did so, he put his hand inside her pants and pressed on her [genitals] over her underwear.” | Sentenced to 9 years in prison for 16 counts of sexual assault and 1 count of sexual exploitation. | |
| Lack of public awareness of college discipline history | Case 60 | “[Respondent] began treating [complainant] … for depression and anxiety. The plaintiff says that she did not consent to, nor could she consent to, [respondent] engaging in sexual acts with her or the sexual communications with her while he was her physician and prescribing her medications for mental health issues. “[Complainant] says she did not know [respondent] had restrictions on his medical licence at the time — including [that] he could only treat female patients with a chaperone present.” |
Permit now revoked. |
| Recidivism, practice restrictions, and consequences to respondents | |||
| Practice restrictions failing to protect public | Case 31 | “The doctor recorded [the chaperone’s] name in medical records as a chaperone on occasions when she was not present in the clinic.” | College investigation under way over allegations that he sexually assaulted 2 employees and engaged in “sexual impropriety” with 3 patients, 1 of whom was a minor. Permit is active with restrictions. |
| Case 33 | Received a college complaint for sexual abuse of 2 patients (including exchanging narcotics for sex), the fiancée of a patient, and his practice monitor (2024). He was on practice restrictions stemming from earlier complaints, including sexual harassment of 2 patients and a colleague (2011) and sexual harassment of a nurse (2013). | Permit now revoked. | |
| Case 34 | Received a 7-month suspension for sexual misconduct involving a patient (2023). Previously pleaded guilty to criminal charges of simple assault of 4 patients (2015; received a conditional discharge and a 6-month practice suspension). Received a 2-month suspension for an inappropriate sexual relationship with a patient (2019) and had been disciplined in 2020 for not adhering to practice restrictions. |
Active practice permit with practice restrictions. | |
| Repeat offences | Case 8 | Criminally charged with sexual assault, domestic violence, and uttering threats (2021). Pleaded guilty to assault and threats and received 2 years’ probation. Sexual assault charges were withdrawn. Previous criminal charges included sexual assault (1977, withdrawn), assault (1986, withdrawn), assault (2014, pleaded guilty), and uttering threats (withdrawn). |
Active practice permit with practice restrictions. Did not self-report his criminal charges to the college. Received 8-month suspension and fine. |
| Case 21 | After being found not guilty after a criminal trial for 6 counts of sexual assault (2016), the college ordered a 1-year suspension and practice restrictions (2020). He violated his practice restrictions and his permit was permanently revoked (2024). He was again criminally charged with sexual assault (2024). | Permit revoked. Criminal trial pending. | |
| Case 93 | Was restricted from working with medical learners for 2 years after a college panel found that he had sexually assaulted 2 medical trainees (2014). After his practice restrictions expired, he was the subject of a second college complaint related to sexual assault of 2 medical trainees in 2016. He held a house party and provided alcohol. He pressured the medical trainees to sleep in a bed with him and inappropriately touched them. He received a 6-month suspension and practice restrictions. | Currently under college investigation for a professional misconduct complaint related to harassment (2024). Permit is active with restrictions. |
|
| Potentially vexatious complaints | Case 65 | Subject of a human rights complaint related to sexism based on telling a nurse to “work faster.” | Complaint was felt to be vexatious and was dismissed. |
| Case 83 | Subject of a human rights complaint related to sexism based on calling the police on a patient because he was a man. | Complaint was felt to be vexatious and was dismissed. | |
| Case 86 | Criminally charged with sexual assault of an acquaintance and was acquitted at trial as the judge felt that the complainant was trying to extort the respondent for money. | Acquitted at trial. Permit active. |
|
In some cases the college was explicitly not notified, and in some cases we presumed that the college was not notified owing to lack of information on the public registrar about criminal convictions, though it is possible that the college was aware of convictions without updating the public register.
Role of self-reporting and public notification
We identified 13 physicians who had been criminally charged but did not have a corresponding notification on their college registration profiles (3 examples presented in Table 3; more detail in Appendix 1, eTable 4), though it was not clear for all cases whether this was due to lack of self-reporting or due to time limitations on posting disciplinary actions on a college profile, which have varied across time and between provinces. For example, 1 physician respondent had been arrested and charged with sexual assault 4 times (stayed [2017], withdrawn [2019], pleaded guilty [2020], outcome pending [2024]; Case 4) with no disciplinary history on his active college registration at the time of data collection. We identified examples of complainants coming forward years after a physician had retired (e.g., Case 167) or stopped practising (e.g., Case 59), suggesting that resignation or retirement may not be a sufficient reason to remove a disciplinary history or notification from the college website.
Public notification of physicians as respondents in harassment or discrimination concerns served additional purposes beyond public safety. Importantly, newspaper articles describing physician arrests for harassment often led to additional victims coming forward to police or the colleges (Table 3). Complainants commonly stated that they were motivated to come forward with a concern when they learned of other victims.
Recidivism, practice restrictions, and consequences to respondents
Overall, we determined a previous college or police complaint related to a different instance for 62 of the physician respondents (29.8%) (Appendix 1, eTable 5). However, determining the number and nature of previous college or criminal complaints for physician respondents was challenging because of inconsistencies and heterogeneity in how previous complaints are documented. Some college discipline decisions referred to previous complaints that were not listed on the physician’s registration profile and were not fully described; for example, a physician who pleaded guilty to a criminal charge of sexual assault of a patient had at least 4 other “patient complaints,” but the description and outcomes were not available (Case 156). A few respondents had received complaints across multiple regulatory bodies or institutions before the instance identified for this study, and it was not clear whether the college was aware of these concerns. For example, a physician respondent who received a reprimand after pleading no contest to 5 patient complaints related to inappropriate touching during a physical examination had had his practice permit revoked in the United States previously for an unknown reason, in addition to complaints related to sexual misconduct previously made to 2 different colleges (Case 182).
We found wide variation in the number and types of previous complaints for physician respondents. We found 11 respondents whose case occurred during practice restrictions for a previous concern related to harassment or discrimination (Table 3; Appendix 1, eTable 5). A portion of the previous complaints were unrelated to harassment or discrimination; examples included improper documentation (Case 43, Case 49), fraudulent billing (Case 151, Case 172), or dangerous operation of a vehicle (Case 20). More than 20 physicians were identified who had received previous college complaints related to harassment or discrimination (Case 17, Case 22, Case 38, Case 45, Case 46, Case 49, Case 52, Case 55, Case 59, Case 60, Case 109, Case 148, Case 152, Case 153, Case 162, Case 163, Case 165, Case 182, Case 185, Case 186), including 1 obstetrician–gynecologist who had been disciplined by the college 11 times, including two 2-year suspensions for “abusive remarks of a sexual nature” before the case identified in the present study (Case 6). We found 8 physician respondents who been criminally charged with assault or sexual harassment before the case identified for this study (Case 30, Case 32, Case 48, Case 52, Case 57), including 3 who had been previously convicted of sex crimes (Case 2, Case 39, Case 49).
We found no difference in respondent gender, practice location, college outcome, police outcome, or number of targets between physicians with a single concern and those with repeat concerns (Table 1, Table 2). We found an association between practice discipline and having a repeat concern, though numbers were too small in specific disciplines to identify which discipline accounted for this association (Table 1). Target role differed between physicians with single concerns and those with repeat concerns (p < 0.001); compared with physicians with a single concern, the victims or targets of physicians with repeat concerns were more often colleagues than patients (Table 2).
Seven potentially vexatious concerns involving physician respondents occurred (3.4%), 3 of which are detailed in Table 3.
Interpretation
In this mixed-methods study, we used comparative case analysis to synthesize information from publicly available records of 208 physicians involved in a concern of sex- or gender-based harassment or discrimination in Canada. By using a systematic search strategy of multiple sources from 2019 to 2024, we created a comprehensive list of cases, including instances that were not reported on college disciplinary websites, and were able to triangulate outcomes, settings, and physicians with repeat offences or concerns across information sources and between provinces. Our comparative case analysis identified patterns in instances of harassment and discrimination that can inform future study and possible areas for intervention. Most importantly, this study highlights the limitations of current data-management processes by Canadian medical regulatory bodies and raises concerns about the efficacy of current remediation strategies and monitoring practices. Our findings emphasize how the lack of transparent, consistently reported, and accessible data about physicians involved in instances of sex- and gender-based harassment and discrimination restricts assessment of current strategies to address these behaviours.
We found 208 physician respondents involved in concerns of sex- or gender-based harassment or discrimination during a 5-year period in Canada. This represents an estimated 0.2% of physicians registered for practice in Canada, if calculated based on publicly available information.19 This proportion aligns with the reported proportion of US physicians who were the subject of any type of disciplinary concern in 2024 (0.3%); in the US, such data are centrally monitored.7 However, given that an estimated 99% of all college complaints, including about half of complaints involving sexual misconduct, are dismissed or resolved internally without proceeding to a disciplinary tribunal and are therefore missing from public reporting, this is likely an underestimate.10 In Canada, fewer than 1 in 5 instances of sexual harassment are formally reported,20 and in the United Kingdom, fewer than one-third of patients who experience sexual misconduct from a physician formally report.21 Underestimation of prevalence is also suggested by the very few physician complainants in our study; of the 689 complainants in our sample, only 2 were physicians, despite contemporary Canadian data suggesting that sex- or gender-based harassment discrimination from physicians is commonly experienced by physicians, residents, and medical students.2,5,6,22–26
In addition to providing counts of reported instances of sex- and gender-based harassment perpetrated by physicians in Canada, our data show potential gaps in remediation, monitoring, and reporting of instances of sex- or gender-based harassment and discrimination involving physicians. The prevalence of recidivism was nearly 30% in our sample, which is comparable to other settings. For example, of the physicians who were disciplined in the US in 2023, 47% had received a previous discipline order,7 and professionalism concerns during undergraduate medical education strongly predicted future medical board discipline. 28 The effect of education, practice restrictions, and practice suspensions on physician behaviours, in particular those related to sex- or gender-based harassment and discrimination, is not monitored or transparently reported in Canada. Emerging evidence shows that remedial continuing medical education may reduce recurrent complaints for all disciplinary types,29 though there is little evidence to support the wide range of educational programs or workshops used to deter, prevent, or remediate sex- or gender-based harassment or discrimination.30 Though recidivism does not prove that remediation methods are ineffective, it does suggest that additional monitoring of physicians with previous complaints could be justified.31
The data limitations restrict analysis of how policy and legislative changes across provinces and over time have influenced physician behaviour. Though Quebec, Ontario, Alberta, and Prince Edward Island have introduced laws that mandate periods of licence suspension for physicians who commit select sexual boundary violations, it is not possible to assess whether these laws have deterred these behaviours. Comparison between provinces is further limited by varying definitions, procedures, disciplinary actions, and public reporting of concerns across colleges.8,32 A move toward greater transparency by the colleges has been prompted by public pressure,1,9,10 though our data show ongoing limitations that appear to be long-standing.1 For example, many colleges post tribunal decisions as legal documents in CanLII using legal jargon that may not be understandable to the public. Further, college registrants lists are not easily searchable and do not consistently include information on disciplinary history of each physician.33 It is not clear if the general public is aware of or uses college websites to identify whether their doctors have practice restrictions;9,32 whether these current reporting systems are meeting the needs of the general public is an area that requires further study. Our data demonstrate multiple instances of physician respondents failing to comply with public notification or practice restrictions. While some provincial colleges have outlined processes for monitoring adherence to practice restrictions (e.g., Ontario34), data about compliance to practice restrictions are not publicly reported, and it is not known how effective they are.
The need for accountability and transparency from the colleges must be balanced with principles of due process and rights to physician privacy,1 especially since accusations of sex- or gender-based harassment or discrimination can have considerable personal and professional consequences. However, not all measures to improve transparency would necessarily violate physician rights. For example, the proposed move toward a National Registry of Physicians by the Federation of Medical Regulatory Authorities of Canada may facilitate aggregate monitoring of harassment and discrimination concerns without reporting identifiable details. A national repository describing the incidence of physician complaints by category type, the outcomes with explanation (including dismissal without an investigation), and the types of disciplinary actions would facilitate high-quality research to understand types of disciplinary actions that may prevent future offences. Such a registry would address inherent limitations of the databases used in this project, including changes in available records over time and use of nonreproducible search algorithms. A registry would be an opportunity to create formal procedures between law enforcement and medical regulators to ensure that physicians charged with or under investigation for specific crimes are known to the college as a backstop for current self-reporting mechanisms. Though proposed, at present there are no requirements for law enforcement in Canada to share information about accusations, investigations, and criminal charges with medical regulators. Public consultation should guide how regulatory bodies report cases of harassment or discrimination, given that protection of the public is an important mandate of the colleges and considering our finding that public reporting may lead to identification of additional victims. Further, the rights of physicians must be balanced with the risks to victims. The consequences of physician-originating sex- and gender-based harassment and discrimination have been well described elsewhere22,25 and should not be underestimated.
Limitations
We were not able to estimate the annual prevalence of sex- or gender-based harassment or discrimination perpetrated by physicians in Canada. Cases may have occurred in any year but needed only to be reported publicly within the study period to be included in our study. This limitation is inherent to studies of complaints of harassment and discrimination, as delays in the complainant formally reporting harassment or discrimination and criminal investigations into these instances before public reporting are common and unavoidable.
Importantly, we could not account for “guilt” of the physician respondents, only their naming in incidents. Though nearly 80% of physician respondents in our sample received a college discipline action based on the reported concern, we were not able to adjudicate whether individual physician respondents in our sample were “guilty” of sex- or gender-based harassment or discrimination. Moreover, the standard of guilt for a college discipline committee (e.g., “on a balance of probabilities”10) differs from the standard in a criminal court (e.g., “beyond a reasonable doubt”27) — that is, a finding of guilt has different meanings in different settings.
Despite these limitations, our estimates provide a starting point for future research.
Conclusion
This work demonstrates the need for standardized, transparent data collection and reporting of physicians involved in concerns related to sex- and gender-based harassment and discrimination. Improved reporting would facilitate research to better understand prevention and remediation of harassment and discrimination, in particular as provinces implement new legislation addressing this issue. Further, transparent reporting may better protect the general public through clearer messaging on practice restrictions and self-identification of victims, and by promoting accountability for regulators.
Supplementary Information
Acknowledgements
The authors acknowledge Diane Lorenzetti, health science librarian, and Kim Clarke, law librarian and law and society librarian (both University of Calgary).
See related editorial at www.cmaj.ca/lookup/doi/10.1503/cmaj.260574
Footnotes
Competing interests: Shannon Ruzycki reports grants from Alberta Innovates, the Canadian Institutes of Health Research, and the University of Calgary, and payment or honoraria from Queen’s University and Well Doc Canada. No other competing interests were declared.
This article has been peer reviewed.
Contributors: This work was conceived of and designed by Kirstie Lithgow and Shannon Ruzycki. Kirstie Lithgow, Sarah Taylor, Debby Oladimeji, and Shannon Ruzycki contributed to data collection, data analysis, and data interpretation. Shannon Ruzycki wrote the first draft of the manuscript, which all authors revised. All authors approved the final version to be published and agreed to be accountable for all aspects of the work.
Data sharing: The study data are available from the corresponding author upon reasonable request.
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