Five years on, remedies for health workplace bullying, racism and harassment have been tried and have failed. It’s time for something different.
In October 2022, the Commonwealth Department of Health reached an agreement with the Royal Australasian College of Medical Administrators to repurpose some unspent funds from RACMA’s specialist training program.
The repurposing was to address the year-on-year findings of bullying, harassment, racism and discrimination that were reported through the Medical Board of Australia’s Medical Training Survey. The original badging of the project was “The Culture of Medicine”.
For many years, the MBA collected data about work and career plans to support workforce planning. In 2019, for the first time, a comprehensive medical training survey was offered, and was completed by almost 10,000 doctors-in-training.
That first survey demonstrated high levels of bullying, harassment, and discrimination, with 22% of trainees reporting that they had experienced these behaviours directed at them during the previous 12 months, and unfortunately, in the 2023 survey, that number is still 22%, with racism included as a separate item in the 2022 and 2023 surveys.
Across an entire generation of doctors-in-training, and despite significant efforts at addressing the issues, the results remain stubborn. The 2023 data is different in breakdown from 2019 – with improvement in the reported proportion of cases that involve other healthcare staff, but an increase across that period of those experiencing behaviours at the hands of patients/family members or carer. Senior doctors, peers, nursing and allied health staff are, to varying degrees, also identified as sources of adverse behaviours.
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The persistent rate of 22% for all these behaviours can be benchmarked against, for example, Australian Public Service data that reported a base rate of 9.7% self reporting during a 12-month period, but this only included bullying and harassment – the other parameters in the MTS of racism and discrimination are not included.
Notably, the APS has demonstrated a reduction from 13% to 9.7% during the same five years that the MTS has remained stubborn at 22% overall, and bullying at 12%.
It can be inferred from the available data that the situation for medical trainees is at least several percentage points worse than for the APS.
Notably, comparison with Queensland’s public service survey for the Health Department showed a reported bullying rate within the prior 12 months of 14% and NSW Health 16% (which compares to 12% for the Education Department, 10% for the Department of Investment, Enterprise and Trade, and 9% for the department of Premier and Cabinet).
In other words, health services are outliers with higher rates of reported bullying and other adverse behaviours.
While doctors are a large cohort, their numbers are swamped by nursing, allied health and operational staff.
It’s therefore unlikely that the health department results are attributable to a problem only in medicine. Medicine does not operate in isolation – there are some aspects of medical training that are fairly unique to the cohort, but the sheer volume of adverse behaviour reported in the MTS as coming from outside medical training hierarchies drove a rebadging of “Culture of Medicine” to “A Better Culture”.
Fixing the culture of the health ecosystem will require fixing it for everyone, not just focusing on what doctors experience.
At a time when healthcare workforce is a critical strategic priority, it is odd that specific initiatives around retention of workers are not visible.
Eighteen percent of doctors-in-training reported in the MTS that they were considering a career outside of medicine. Discussions on workforce currently focus on “building” (ie, training our own), “borrowing” (short term 1 – 2 year trainees from UK and Ireland) and “buying” (recruitment of international graduates with intended permanent relocation to Australia).
Anecdotally, doctors are opting out, retraining in other fields, retiring early or dropping to the minimum number of hours that will make ends meet. The MTS data suggests that this trend is not going to reverse.
It is also notable that, other than A Better Culture and efforts of individual colleges and the Australian Indigenous Doctors Association, there are no specific initiatives around gender or race discrimination in medicine, yet the data on these is clear – women, non-binary people, Aboriginal and Torres Strait Islander people, and international medical graduates all report higher exposure to adverse workplace behaviours.
A Better Culture as a project is small – it is starting conversations about bullying, harassment, racism and discrimination, but does not have implementation authority nor convening power to bring those with authority to the table. Starting those conversations will not be enough – we need partners who can work with us, and across the system, pulling employers (including state and territory departments), funders and thought leaders together.
And in spite of broad support from other professions, the project has been unable to formally get approval for scope outside of medicine.
Every organisation says on paper that their people are their most important asset. The future of our healthcare system depends on healthcare workers, and we need to do a much better job of creating better workplaces for them.
We need to admit that five years on, the remedies that have been tried, have failed. Online training modules, “wellness” days, and waiting for generational change have not shifted the dial. If the APS can achieve a 25% reduction in bullying, it’s time to ask health employers why they have been unable to do the same. Perhaps part of the answer is to acknowledge that it’s a bigger issue than the “Culture of Medicine”.
Dr Jillann Farmer is a GP and medical administrator. She is former medical director of the United Nations, currently working as a rural emergency department locum, and as CEO of A Better Culture.
