Four in ten surgeons say they've been bullied, with many too worried about reprisals to report it, a new study finds. In the survey of 775 US surgeons, women were nearly twice as likely as men to report having been bullied, according to the results published in JAMA Surgery. "Workplace incivility is well known among surgeons; there are stories of instrument throwing, verbal tirades, and sexual harassment," Dr. Kevin Pei, associate professor of surgery at the Texas A&M College of Medicine, in Houston, and colleagues write. "Fear of humiliation and bullying is strong among medical students, and examples of student mistreatment almost invariably involve some surgical anecdote. These stories may reflect a specialty culture of acceptance and a code of silence that facilitate bullying in the workplace." To determine whether there is a widespread problem underlying the anecdotal reports, Pei and his colleagues invited US surgeons from four professional societies—the Association for Academic Surgery, the Resident and Associate Society of the American College of Surgeons, the Association for Surgical Education and the Society of University Surgeons—to participate in an anonymous online survey that included the Negative Acts Questionnaire. The NAQ-R contains 22 questions asking about the frequency with which a person has experienced negative acts as well as whether respondents have witnessed others being bullied. The survey also included questions about participant demographics. Out of the 775 surgeons who responded, 180 were residents. Most faculty respondents, 58%, were male and 81% were from universities, with 36% reporting they were professors. A total of 59 residents (39.9%) and 212 faculty members (40.0%) reported being bullied, while 83 residents (58.5%), and 283 faculty (54.3%) said they had witnessed bullying. After adjusting for other participant characteristics, the odds ratio for having been bullied was 1.98 for women. Most residents, 60.58%, said there was no policy to address bullying at their institution as did nearly half, 48%, of attending physicians. Most said they thought bullying occurred because it was part of the accepted culture: 83.94% of residents and 69.2% of attendings. And many attributed it to tradition: 48.9% of residents and 38.1% of attendings. Fear of reprisals stopped many survey participants from reporting bullying, with 20% of residents and 24.4% of attendings saying they had experienced retaliation after reporting bullying. The study team did not respond to requests for comment. "Bullying is a big problem in medicine," said Dr. Scott Wright, a professor of medicine at the Johns Hopkins University School of Medicine, in Baltimore. Wright's own 2019 study of the subject found 14% of medical trainees to have experienced bullying. "These data aren't surprising," said Wright, who was not involved in the new research. "Among the surgeons who responded to the survey, many think it's part of the tradition and an accepted part of the culture. I don't believe it should be. It can lead to a toxic and uncomfortable work environment." Wright is hopeful that studies like the present one and his own will lead to change. "Bullies need to be dealt with and perhaps warned," he said. "If they continue doing it, they should be let go. Then they can go on and do surgeries somewhere where there are no trainees. It's hard enough learning to become a doctor without being bullied and harassed." Institutions need to adopt a zero tolerance for bullying, Wright said. "In medicine as we see today, doctors, healthcare workers and nurses are giving and kind and are trying to help," he added. "If your teachers or your colleagues are bullying and harassing you, using their power to make your life miserable, it affects patient care. How can you turn around and be kind and giving to patients after you've been bullied and harassed?" —Linda Carroll Source
