Bullying in medicine: the biggest losers

4 minute read

RACGP trainees experienced less bullying than almost any other college in AHPRA’s 2021 survey.

A third of medical trainees say they experienced or witnessed workplace bullying and harassment in 2021 – including racism – according to AHPRA’s annual medical training survey. 

RACGP trainees experienced the lowest rate of bullying across all medical colleges.  

The survey of over 21,000 trainees revealed that while bullying rates had dropped in about a third of colleges, there was no overall improvement.

Nationally 35% of trainees said they had experienced some bullying or harassment, but among Aboriginal and Torres Strait Islander trainees the rate was 52%.

These rates were “unacceptably high”, said AMA President Dr Omar Khorshid. 

“Very disturbingly, Aboriginal and Torres Strait Islander doctors in training reported higher levels of bullying, discrimination and harassment, including racism, compared to non-Indigenous colleagues,” Dr Khorshid said in a statement.  

“It is vital that doctors and medical students can practice in a culturally safe environment where cultural differences are acknowledged and respected.”

Nearly half of respondents (49%) rated their workload as heavy or very heavy, and 45% said they were only sometimes or never paid for overtime.  

Public health medicine topped the charts by almost doubling the number of trainees who had been bullied, going from the lowest rate of 9% in 2019, to 17% in the latest survey.   

Trainees in obstetrics and gynaecology, dermatology, palliative medicine and physician training also experienced increased bullying and harassment

RACGP trainees experienced the lowest rate of bullying and harassment at 13%, alongside the radiation oncology chapter of the Royal Australian and New Zealand College of Radiologists. Unlike the RANZCR, which almost halved bullying rates since 2019, the RACGP rates remained largely stagnant.  

Ophthalmology, radiation oncology, and rehabilitation medicine had the some of the biggest drops in bullying. The Royal Australasian College of Dental Surgeons had the biggest drop of all colleges, halving its rates of trainee bullying. Despite the significant improvement the college still has second highest rates of trainee bullying at 28%.  

Many colleges have reached out to the Royal Australasian College of Surgeons for advice on how to reduce bullying, a spokesman said. The RACS began its campaign to build respect in 2016 after a damning report won mainstream media coverage. The RACS currently has the 5th highest rate with 25% of trainees having experienced bullying or harassment, but the rate has been steadily reducing since 2016 through education, leadership and monitoring trainee placements.  

Dr Hashim Abdeen, chair of the AMA council of doctors in training, said that the RACS approach was where most colleges need to start. “The RACS fully acknowledge that bullying is an issue for them. They took responsibility for the situation and owned it,” he said. “There are some colleges who are really doing well in this space and some colleges who just completely ignore it. The hard part is realising that this is a profession-wide issue.” 

But medical training authorities are only one part of the problem. Dr Abdeen said that organisational design also played a dominant role. 

“My true belief is that no doctor or nurse comes into hospital that day thinking ‘I’m going to be a bully today’ and then bully somebody,” he said. “It’s usually in workplaces that are stretched, with limited staff, burnt out staff, that allow this kind of toxic environment. 

“We’re finding more evidence, in other industries as well, that there are actually risk factors for bullying and harassment and that organisations need to start looking at the risk factors that perpetuate those behaviours,” Dr Abdeen said. 

Professor Michelle Tuckey is professor of work and organisational development at the University of South Australia. She has developed a tool for hospitals to prevent workplace bullying.   

“Bullying is an organisational issue, not an interpersonal one,” Professor Tuckey said. “It’s a lagging indicator that happens when other things have already gone.” 

She said pressure points included rosters and working hours, role clarity, task allocations, performance management approaches, and whether there’s good support for mental health and well-being in the workplace, as well as physical safety, she said. 

The AMA is calling for legislative changes, like those passed in SA last year, that hold hospital boards accountable for the psychosocial safety of their employees. Already this year SafeWork inspectors have started auditing South Australian hospitals assessing the management of fatigue and psychological health. 

Dr Adben, chair of the AMA council of doctors in training, said that the proposed legislation changes should go hand in hand with strengthening of accreditation standards for college training. 

“College accreditation, psychosocial safety of staff, cultural safety, the culture of hospital overall are all ultimately a patient safety issue,” he said.  

Resources on bullying can be found on the GP Supervisors Australia website.

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