By Roberta Attanasio, Forever Leaders Editor
A viewpoint article published about a year ago in JAMA Surgery highlights a major issue affecting surgeons—”Today the world of medicine in general, and of surgery in particular, is faced with a problem that is severely affecting both trainees and practicing physicians: burnout.” The article also points out: “Unfortunately, the rate of burnout among surgeons is much greater than among the general population (53% vs 28%), and represents a major increase compared with several years ago, when it was closer to 40%.”
Now, a perspective article published in the Annals of Surgery brings up an additional, daunting, and common problem among surgeons, which is likely to be an important factor contributing to the well documented burnout. The problem—workplace bullying—is widespread, but does not receive adequate attention. The authors state: “Bullying at the workplace among surgeons is conspicuously absent from the national conversation.”
According to the Workplace Bullying Institute, “Workplace Bullying is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators.” It is abusive conduct—threatening, humiliating, or intimidating; it may show up as work interference—sabotage—which prevents work from getting done; it may involve verbal abuse. Workplace bullying “Is akin to domestic violence at work, where the abuser is on the payroll.”
The authors of the Annals of Surgery article eloquently describe the culture of silence and the vicious cycle at the basis of bullying among surgeons: “Surgery is particularly susceptible to bullying for several reasons. First, we value hierarchy immensely; other specialties are afraid of us and we are afraid of our leaders. Second, we practice an unspoken code of silence; often loathe to speak up against a colleague for fear of retaliation. Third, we work in high stakes and stressful environments. Whether we are in the operating room, trauma bay, or even at morbidity and mortality conference, people bully while hiding behind the veil of patient care. Lastly, trainees and junior faculty observe and emulate bullying behavior, especially if the bully is perceived as influential and successful. Bandura’s Social Learning Theory posits that we learn aggression and bad behavior from watching role models. Even worse, we have rationalized and normalized bad behavior—the saying goes ‘he’s a surgeon, that’s how they are.’”
Notably, the authors state: “Victims of bullying are targeted because they are brave enough to stand countercurrent to the dominant culture at the institution. Among victims of bullying within surgery are talented, productive, well-liked individuals who demonstrate strong ethical values”
In their article, the authors include a Call to Action and conclude that: “Bullying at the surgical workplace is a real problem and likely contributes to burnout and faculty attrition. Many questions remain unanswered and research in this area will help the important process of eradicating bullying among surgeons.”
In the UK, Simon Fleming, a trainee orthopaedic surgeon and PhD candidate at Barts and the London School of Medicine and Dentistry, recently launched an anti-bullying campaign to change culture in healthcare. He says: “The change has started. It’s going to take time and it’s not going to be easy, but we are talking about it and people, organisations, colleges and regulators alike are making it top of their agendas.”
Copyright © 2016-2019 Forever Leaders.
When people think about workplace bullying, their thoughts immediately go to office disputes, which are often presented on television. However, I would not say that it was shocking to learn that there was workplace bullying present amongst the surgeon. I believe that workplace bullying has no limits to its reach; it is present many different profession, whether it be at the retail store to supermarket or doctor’s office. I have personally witnessed workplace bullying; it happened between a coworker and a manager because the manager did not like the coworker. Instead of maintaining a high standard of professionalism, the manager would often speak poorly about the coworker and sometimes even go as far to keep the coworker off the schedule for long periods. When I learned of the situation, I immediately encouraged the coworker to tell corporate about the ill-treatment of the manager towards her, and I also allowed her to have some of my shifts. I do not condone workplace bullying and believe that everybody should be treated with respect. But, I do realize that it is difficult to stand up against one’s superior, especially if it means that your job is compromised. After reading the article, I believe that Simon Fleming’s organization is crucial to the elimination of workplace bullying; it a start to a greater change.
Workplace bulling amongst medical professionals and specifically surgeons is a controversial topic to address because it directly calls out several root sources of the problem: an intense hierarchical system in which an unspoken code of silence is honored. Objectively, this sounds a lot like the male-dominated, corporate culture in which many women and men are actively addressing in hopes to disengage from. Relatedly, the #MeToo movement is grounded in tearing down the stigma of silence in order promote a healthy work environment for all. Simon Fleming’s anti-bullying campaign is similar in that it advocates for re-defining what is accepted as a societal norm surrounding workplace bullying in medicine. It should not be taken lightly that Fleming is only a PhD candidate stepping up and laying this call-to-action. There is no security in hierarchy for him and there could be future retaliations to his career; to me, he is an inspiration for doing so and sets a necessary example for how our young men and women must speak up and advocate for what is right, especially if in a position of privilege. Furthermore, Fleming suggests that “it’s going to take time and it’s not going to be easy, but we are talking about it”, and in my opinion – initiating the conversation is certainly a great place to start. Initially, it was my dream to be a trauma surgeon, but there are many factors including burnout culture that deterred me from pursuing medicine. Therefore, I’m interested to see how workplace culture in the medical field shifts in these next few decades as we address these major concerns around bullying and burnout. Hopefully, the retention rate among surgeons will rise as we tackle the stigma surrounding the roots of these causes.
I would like to look at this issue by first looking at the causes. I am curious about what the bullying looks like. I would like to look into how is the bulling happening and why its occurring. If it is about the hierarchical structure, then maybe what we need to fix it is a change in the culture. If the culture is changed to allow for less stress, then this issue might get better. I think that making people aware of bullying, and some education on what actions count as bullying and what effect it has on people, might help as well. I agree with the campaign and its mission. Just talking about the issue means progress on solving it. I hope that with these and more possible solutions, this issue can be fixed.
This article is rather interesting. Bullying is not something I typically associate with surgeons: some of the world’s best high-stress performers who are forced to work together in the operating room so efficiently and effectively because the stakes are high and someone’s life may be on the line. For the many listed reasons, I can understand why surgery, as opposed to other sectors of the healthcare field, is a unit highly susceptible to bullying. Across all workforce positions, I feel like the “apex” of each type of industry is often the same way: many of the workers have adapted to operate in highly stressful situations, there’s often a firm hierarchy to stabilize the duties, and speaking up for one’s beliefs against a majority (especially if that majority constitutes your superiors) is often unusual. I think a way to begin mending workplace bullying is to re-frame our outlooks on what work culture should be like. If “being at the top” is the prime example to follow for all employees “below”, then those in high-functioning/leadership positions ought to be extremely mindful of their behaviors to set the standard for the rest of the company/industry. There has to be a break in the cycle so that not every new surgeon is exposed to the same bullying behavioral patterns, of which afterwards, they will express to someone else.
wow, I am shocked that physicians and surgeons bully other people. I have never been in that workplace where I have been bullied or whatsoever. I really do appreciate what Dr Flemming is doing, we need people who work under these physicians to speak up and allow their voice to be heard. Its a job and not prison, I do not understand why people should be afraid to go to work. Most jobs are supposed to bring joy.
Well, I do know that some bosses bully other younger staffs, for the sake of sex. And this goes both ways. Female boss bullies male young staff to have sex with her and vice versa, which should be completely out of the box. It should not be accepted in any way.
Is it male physicians that bully female workers or it is just random? because from the article, I did not get that.
If male physicians bully female workers, then the society and healthcare law should come up with a solution and make rules and regulation.
Susan, I too was shocked at the rampant workplace harassment occurring in the field of medicine. I believe this article is attempting to expose the oftentimes normalized workplace harassment by surgeons among both genders. Remember that harassment is not always sexual in nature but can also be verbal through the use of demeaning, frightening, or condescending statements made by colleagues. There are laws and rules against harassment of any kind in the workplace, but I believe that the culture of surgeons has allowed the verbal harassment to thrive even amidst an era of the “me too” movement. I agree with you that mentors have the power to either aid or prevent further normalization of this harassment. I believe in order to address this problem, it will take both surgeons and their mentors to stop allowing the negative environment and stand up for others being harassed.
I knew workplace bullying existed, but never thought about it in the perspective of healthcare. I read an article once that said bullying is more prevalent in lower-income jobs because people are “competing with each other” or they just don’t want to see other people do a better job than them. In higher-income jobs, people come to work, do their own thing, and leave. They aren’t worried about competing with other because they are more job secure. I don’t know what article this was or how accurate it is but it says the complete opposite of what this article is saying. According to the article I read, doctors and surgeons shouldn’t be bullied because they have high-income jobs. This is inaccurate because these people are competing with each other and they want to make a name for themselves. This is a very stressful job where one mistake can cause the end of a life. While dealing with all this, they shouldn’t have to deal with bullying too. Higher up doctors forget the way they had to fight to get where they are and how their higher ups treated them, causing a never ending cycle of bullying. Or they probably see it as “I was treated this way so these new incomer do too” which is not an ideal situation. These people shouldn’t be afraid to stand up but they are. I am glad Simon Fleming started his campaign so bullying can stop in a surgeon’s workplace. Hopefully, this campaign can lessen the rate of burnout as this is a serious problem.
This is a very interesting article. I hadn’t given workplace bullying any thought until now, but I am glad that I am now aware. In my opinion, this particular agenda needs to be pushed; people should speak out about bullying in Surgeons’ workplace. Burnout is only one thing that is worrying. The bullied workers can suffer from anxiety in the workplace, low self esteem, and a plethora of other things can stem from them being bullied in a place where they should feel empowered. As for the bullies, they should really step back and reconsider what they are really teaching the younger ones. Mentioned by another blogger above, workshops should definitely be implemented to shed light on this situation and let all workers know that what’s going on is not a secret. I applaud the UK trainee for taking the initiative and showing the utmost leadership qualities by launching the anti-bullying campaign.
This is important to me, because I plan on becoming a doctor and maybe even a surgeon. To be quite frank, I do not want to have this problem when I join the workforce. There is a major difference between being humble, and being submissive. I will not be the latter to my colleagues, as no one should have to be!
I think you bring up an interesting idea when you talk about being submissive. Usually, in the workplace, I am not typically the first to speak up against something that I do not agree with because of the fear of getting reprimanded or in trouble with my superiors. However, this should not be the case. I never thought of this intimidation as bullying but I do see now how it could be. I think it’s important to talk about both colleague to colleague bullying along with superior to inferior bullying. Just because you’re someone’s mentor or in charge of someone doesn’t mean you should be allowed to act in a rude manner towards them. As people get older, I think that they start to treat newcomers worse and worse because they think that they are not as qualified, smart and experienced as they are. All of which may be true but I think it’s important to remember that we all have to start somewhere. All of us had to start in a Bio 1103 class and learn about photosynthesis before we became doctors and I think it’s important for us to remember that because one day, we will be the older doctors and surgeons that will probably look down on newcomers.
I personally never gave workspace bullying a lot of thought. I thought when you grow up, everyone matures and knows how to treat one another, especially in a field like medicine. But after reading this article it makes sense that these things still occur. When one gains power and respect, they start to think they are the best and can treat anyone the way they want and then the new trainees look at such behavior and think it is okay for them to do it too. This can be seen in other fields too where mentees rationalize their mentor’s behavior and try to be like them. While some might stand up to the bullying, most people tend not to and decide to just deal with it. But victims need to stand up for themselves no matter how much “fear of retaliation” is present and everyone needs to be taught how to respect one another no matter how successful you become. There needs to be workshops from time to time in all workspaces so that in the future the problem can get better. As for the burnout, rules and regulations need to be placed and they need to be followed by companies.
I agree that workplace harassment is extremely prevalent and possibly even progressed by the highly competitive and stressful environment in which surgeons often work in. I believe that the hierarchical nature that is at the essence of a medical career, is prominently exemplified not only in the medical training and education; but continues into residency and the workplace.
The ambitious personality traits of doctors are oftentimes aggressively intensified in surgeons, thus more easily allowing the social dismissal of their atrocious demeaning behavior.
I am inspired by the antibullying campaign started by Simon Flemming, and I fully agree that tackling this sociocultural healthcare issue has just begun. Unfortunately, before reading this article, I have been resigned to assisting in changing this negative workplace culture for numerous reasons. I believe that the demeanor and tenacity often demonstrated by surgeons is necessary to thrive in such a competitive workplace. I believe that there may be a blurred line between bullying and the healthy competition that allows such individuals to push one another to greatness. I also understand that there is a cultural shift occurring and there are oftentimes blurred lines between playful competitive comments and workplace harassment. I hope to join Dr. Flemming and take action against this prevalent problem so that all surgeons understand the importance of workplace culture.
I agree with your comment. Surgeons work in extremely stressful and competitve environments. Doctors must be very ambitious and driven to thrive in a field such as surgery and their sometimes harsh behavior is normalized as a result. Workplace bullying is an issue that is currently not recieving the attention that is deserves, but as you described, it is a difficult problem to solve in surgery. The job of a surgeon is highly demanding and provokes a certain level of self-assurdness and confidence that can be read as discourteous. It is difficult to draw a line between where beneficial competition ends and bullying begins. I would also like to join Dr. Flemming with the hope that this matter is addressed in a way that helps individuals to recognize where to draw the line between appropriate and inappropraite workplace behavior.