Surgeons have been told that bullying and harassment will not be tolerated and an action plan is to be prepared and published to end a culture of abuse that is endemic within the medical profession.
Issues of bullying and harassment came to the fore earlier this year when vascular surgeon Dr. Gabrielle McMullin launched her book Pathways to Gender Equality: The Role of Merit and Quotas. In an interview she said, “What I tell my trainees is that, if you are approached for sex, probably the safest thing to do in terms of your career is to simply comply with the request.”
When criticised about the statement, Dr. McMullin said she had been misunderstood. “Of course I don’t condone any form of sexual harassment, and the advice that I gave to potential surgical trainees was irony, but unfortunately that is the truth at the moment – that women do not get supported if they make a complaint,” she told the Australian Broadcasting Corporation (ABC).
Dr. Brad Horsburgh, President of the Royal Australian New Zealand College of Ophthalmologists (RANZCO), said “Dr. McMullin gave voice to the very worst aspects of what we do know does occur, uncommonly, and she gave voice to what needs to change”.
Since then The Royal Australasian College of Surgeons (RACS) has conducted an independent survey of all College Fellows, Trainees and International Medical Graduates. The survey, which attracted a high level of responses, found that nearly half of all surgeons had experienced discrimination, bullying or sexual harassment. RANZCO surveyed its Fellows, unearthing similar results from 658 responses who provided examples of harassment and bullying across the four categories: sexual harassment; non-sexual harassment; gender or discrimination issues and bullying.
Survey Findings
The RACs survey found that across the ten specialties:
- 49 per cent of Fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment
- 54 per cent of trainees and 45 per cent of Fellows less than 10 years post-fellowship report being subjected to bullying
- 71 per cent of hospitals reported discrimination, bullying or sexual harassment in their hospital in the last five years, with bullying the most frequently reported issue
- 39 per cent of Fellows, trainees and international medical graduates report bullying, 18 per cent report discrimination, 19 per cent report workplace harassment and 7 per cent sexual harassment
- The problems exist across all surgical specialties and
- Senior surgeons and surgical consultants are reported as the primary source of these problems.
Discrimination was reported by 18 per cent of prevalence survey participants, and was most commonly about cultural or racial discrimination (33 per cent), followed by sexual discrimination (16 per cent). Discrimination was effectively resolved in only 12 per cent of cases; and was most commonly reported by international medical graduates (27 per cent).
RANZCO Findings Similar
Dr. Horsburgh said results from RANZCO’s survey were similar to those collected by the RACS, although there was less bullying identified in ophthalmology compared to some other specialties.
On a positive note, Dr. Horsburgh reported that RANZCO’s survey found “just over 90 per cent of fellows and trainees had been granted leave for parenting responsibilities; and only 3 per cent had requests for parenting leave or duties denied – so things are not as bad as they were 20 years ago.”
Burning Question
Dr. Horsburgh said issues that had occurred across Australia and New Zealand were in keeping with the number of trainees and consultants. “The situation is no better or worse in any place. It is a problems across all disciplines of medicine. It is an issue we need to deal with, there is no question about that,” he said. He said the survey had highlighted the need for supervisors to take a different approach to teaching.
“It needs to be admitted that teaching by embarrassment or public disclosure, which is the way that medicine has been taught for generations, is also commonplace in the law, the army, in various institutions. And just as the Australian Defence Force has had to change its policies, so will medicine.
“The burning question is how do you differentiate genuine harassment /bullying from issues of poor communication? We are all grappling with what we need to do to improve the situation.”
He said ophthalmologists needed to learn, and make the effort, to give constructive criticism when working with registrars, trainees and junior consultants.
“Giving constructive criticism is hugely difficult and this is one of the most common things that is complained about by registrars and trainees.”
Processes in Place
Dr. Horsburgh said registrars, trainees and junior consultants are often reluctant to voice their experiences.
“The processes have existed for quite some time, they are well set out, but it often seems to fall down in the communication. So registrars who are struggling, feel unsure or insecure in reporting their difficulties to their seniors, and that’s been reported across all specialties including ophthalmology. They feel their career is threatened. A trainee is at an extremely vulnerable point in their life. It’s particularly difficult in specialties like ophthalmology because unlike general surgery it is a surgical sub speciality all of its own – what’s different in ophthalmology is that people head down a particular discipline and once they are on the way, it’s very hard to back out and go in a different direction.”
In the face of heightened awareness of bullying and harassment, RANZCO has put in place both short and long-term plans it hopes will eventually put an end to bullying and harassment within ophthalmology.
“In the short term we have a third-party employee assistance program available for registrars, trainees and junior consultants who feel they are victims of bullying or harassment.
“Longer term we realise we need to invest a large amount of time and significant funds into education programs and the training progress. We need to provide the resources because this is really mission critical – it’s fundamental, it’s an existential requirement for RANCO to be a training organisation that produces a product of a high standard and one that is acceptable to trainees and practising ophthalmologists alike.”
Dr. Horsburgh said he expects the problem to take “years to turn around”.
“We acknowledge there is a problem and we will not leave it unaddressed. We are under no illusions that it will take significant time and effort to do this.”
Complaining Career Suicide
RACs has accepted in full, a draft report and recommendations prepared by its Expert Advisory Group (EAG) into discrimination, bullying and sexual harassment, which, emphasising, “Bullying: Is endemic in surgery; common in training and the surgical workplace; and central to the culture of surgery. There was general consensus that the worst cases were deliberately orchestrated and perpetrated by a small number of people who abused their institutional positions of power.
“Sexual harassment: There is significant gender inequity in surgery, which influences and is influenced by the dominant surgical culture in which inappropriate behaviour is rarely ‘called out’. There are reported instances of sexual harassment, and sexism more broadly is commonplace in surgery.
“Effective change will take sustained commitment from individual surgeons, the College, public and private hospital employers, the healthcare sector and governments.
“It will take a collective recognition that there must be a profound shift in the culture of surgery and an unwavering commitment to achieving this. Long-established traditions that have been inherited and have normalised unprofessional, and sometimes illegal, behaviours must be relinquished. Gender inequity must be addressed. Discrimination, bullying and sexual harassment must become problems of the past.”
College Apologises
Professor David Watters, President of the Royal Australasian College of Surgeons, has apologised, on behalf of Fellows, Trainees and International Medical Graduates, to everyone who has suffered discrimination, bullying or sexual harassment by surgeons.
The College has committed to preparing and publishing an Action Plan by the end of this month (November) that addresses issues raised and recommendations made in the report.
“These behaviours have been too long tolerated and have compromised the personal and professional lives of many in the health workforce,” said Professor Watters. “The College will not tolerate these behaviours and we will not tolerate the abuse of power and authority by surgeons.”
