Cut to the Quick

In April 2015, at the launch of her new book, senior surgeon Dr Gabrielle McMullin sent shockwaves through the medical community. She declared that junior female surgeons and surgical students would be better off acquiescing to requests for sexual favours by their senior male colleagues, as refusing requests or taking action against them would be sure to be the end of their surgical careers in Australia.

Although she was criticised for her view, her comments did make everyone sit up and listen.

The story was reported in the media and the powers-that-be also took note. The Royal Australasian College of Surgeons (RACS) commissioned an Expert Advisory Group (EAG) to report on discrimination, bullying and harassment in the practice of surgery. The draft report has now been released.

Draft report findings

The draft report, released earlier in September, confirms that discrimination, bullying and sexual harassment are “pervasive and serious problems in the practice of surgery” and the effects are “significant and damaging.” It also finds that many surgeons do not believe the problems exist.

The report’s key findings are that:

• Almost half of Fellows, trainees and graduates have experienced discrimination, bullying or sexual harassment.
• 54 per cent of trainees and 45 per cent of junior Fellows have experienced bullying. 
• Bullying is the most frequently reported issue in hospitals, followed by discrimination, workplace harassment and sexual harassment.
• The problems occur in all surgical areas.
• Senior surgeons and surgical consultants are reported as the primary source of the problems.
• The most common form of discrimination is cultural, followed by sexual discrimination. 
• The gender inequality in surgery means that the behaviour of senior surgeons and consultants towards more junior females often goes unchecked. 

ABC News has documented the disturbing stories contained in the report, such as one female student who was expected to provide sexual favours in return for tutorship, and another respondent who said “I was subjected to belittling, intimidation and public humiliation.” One woman said that she was required to work 30-hour shifts into the final weeks of pregnancy, and another said “I was told I would only be considered for a job if I had my tubes tied.”

Why not complain?

Why not complain about the bad treatment? The report found that there were plenty of reasons for victims to keep quiet:

• Fear that complaining would be an act of “career suicide” – that future employment prospects would be damaged.
• Lack of trust and confidence in the complaints handling process.
• Surgeons lacked the people and teaching skills to provide adequate education.
• Lack of transparency and independence across the board – for example, complaints handling, data management, feedback and assessment.
• Bad behaviour being passed from teacher to student, abuse of power and bystander silence.
• Conflicts of interest as senior surgeons protect their market share by victimising more junior staff.
• Poor work practices including long hours, unpaid work and inattention to work-life balance.

The response to the draft reporT

In response to the draft report, the RACS issued a statement accepting its findings and saying that:

“The College has apologised, on behalf of all Fellows, Trainees and International Medical Graduates, to everyone who has suffered discrimination, bullying or sexual harassment by surgeons.”

With the final report due in late September 2015, we now wait to see how RACS proposes to deal with the issues. There is certainly much to do – throughout the report there are quotes from doctors who do not recognise the problem, such as “surgery is a stressful speciality. If you can’t deal with the stress, and that includes bullying, you should choose a different profession.”

With bullying, harassment and discrimination being so entrenched in surgical practice, it is clear that a massive cultural change is needed and this will take time to effect. Surgeons perform such important work and their training is so extensive that any attrition because of these behaviours is damaging to the wider community. Let’s hope a solution can be found that has far-reaching and long-term effects.