Senior Physicians Report Bullying From Above and Below

Marcia Frellick

June 29, 2016

Nearly half of obstetrics and gynecology consultants in the United Kingdom who responded to a survey said they had been persistently bullied or undermined on the job, according to a study published online June 20 in BMJ Open.

A UK medical consultant is a senior medical provider who has completed training and is registered on the General Medical Council Specialty Register (usually requiring more than 8 years of postgraduate experience in their specialty).

The most common behaviors reported by survey respondents were persistent attempts to belittle and undermine a physician's work, undermining integrity, persistent and unjustified criticism and monitoring of work, ignoring or excluding a physician, and continual undervaluing of effort, write Tariq Shabazz, a researcher with the Royal College of Obstetricians and Gynaecologists (RCOG) in London, United Kingdom, and colleagues.

"Consultant medical staff are often identified in studies as the main source of bullying and undermining, particularly towards trainees, but no published comprehensive study has examined UK consultants as victims," the authors write.

Wide Range of Perpetrators

Victims report that those at the top of the hierarchy or near it, such as lead clinicians, medical directors, and board-level executives, do most of the bullying and undermining.

Coauthor Joanna Mountfield, MB ChB, FRCOG, consultant obstetrician and chair of RCOG's Specialty Education Advisory Committee, said in an RCOG news release: "This is the first study looking at this issue at a senior level and it provides us with a more holistic view of the situation. We recognise that as the survey was self-selecting the sample may over represent the proportion of victims and those who have encountered bullying and undermining may have been more likely to take part. Despite this, the results still represent a significant segment of the RCOG membership who need more support and we should acknowledge and address the scale of the problem in all grades of staff."

Overall, 664 (28%) of the 2371 surveyed responded. Just less than half of respondents were men (47%); 52% were aged 45 to 54 years, 22% were aged 55 to 65 years, 22% were aged 35 to 44 years, and 3% were aged 65 to 74 years.

Of those participants, 290 (44%) said they had been persistently bullied or undermined. In addition, 19% to 45% of all respondents said that bullying and undermining was a problem in their unit, with the frequency varying depending on their practice setting.

Of those who reported personal harassment, most said the actions came from one or more people acting independently (112 said one; 92 said more than one). Perpetrators included "lead clinicians, clinical directors, clinical secretaries, career grade doctors, patients, administration managers, general practitioners and board-level executives."

The other respondents who reported being bullied or undermined (86 respondents) said the actions came from several people acting together, identified as managers, senior consultants, and medical directors.

Perpetrators crossed sex lines as well: 37% of victims reported their aggressors were predominantly males, and 28% said they were predominately females, with the remainder reporting both equally.

Bullying from juniors, which the authors referred to as "upward bullying," was reported by 12% of those who say they are victims.

US Physician Says Patterns Familiar

Pamela Wible, MD, who runs a family medicine practice in Eugene, Oregon, and is an expert in physician suicide prevention, said the results are not unique to the United Kingdom, and that the patterns are familiar in the United States.

She describes a cycle of making decisions based on fear that starts in medical school with fear of academic failure and continues in a career with an ever-present fear of harming patients.

"It's a cycle of behavior just like family incest," Dr Wible told Medscape Medical News. "Fear-based training has really wreaked havoc on medical professionals."

Some do not even realize they are bullying, she noted. "They're just repeating the way they were treated in training," she said.

She added that often physicians who are being treated poorly know that they are miserable but cannot pinpoint the cause. Some participants in the study reported the abuse had been going on for more than 5 years.

"It didn't surprise me at all when some said that at minimum it's been going on for 3 years before they reported it or tried to do something about it," Dr Wible said.

She said the long list of perpetrators indicates a toxic environment. "I talk to doctors every day who are ready to quit medicine because of this toxic work environment that has to do with this bullying behavior. What I hear most is it's coming from the clinic manager or the administrative team who calls the doctor into the office and beats them up for low production," she added.

Fixing the problem will take a systemwide approach that provides routine psychological support to physicians and encourages them to ask for the help, she said.

The study authors write that the individual consequences of bullying range from a loss of confidence/depression, which can affect a physician's competence and the level of patient care provided, to destruction of health and family life, psychological damage, and thoughts of suicide.

Healthcare organizations see the costly results in work absences, low work satisfaction, and high staff turnover.

"The situation is clearly unacceptable from every point of view," they conclude.

Shabazz was employed by the RCOG and received some financial support for the submitted work. A coauthor is the unpaid RCOG Workplace Behaviours Advisor and is reimbursed for travel and accommodation expenses where appropriate when on RCOG business. The other authors and Dr Wible have disclosed no relevant financial relationships.

BMJ Open. Published online June 20, 2016. Full text

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