Bullying in Academic Medicine: A Pervasive, Hidden Threat

Nick Tate

September 08, 2022

As a young medical student, Ron Young II, MD, knew he'd have to deal with high stress and a punishing workload.

But he didn't expect he'd also have to put up with another major challenge: bullying from other doctors.

The first time it happened to Young, who is Black, was in 1986 when he was interviewing to attend medical school.

During a routine entrance interview at the University of Oklahoma, the general surgeon who had been hired to screen applicants looked him over and flatly said, "I'm not sure you'll get into this school, but you have the Black advantage."

The clear implication: Young's only shot at being accepted hinged on his affirmative-action leg up over White applicants.

Although caught off guard, Young shot back. He pointed to his academic transcript and told him, "That was my advantage and that's why I would get in."

Young did attend medical school at the University of Oklahoma and is now a successful neurosurgeon in South Florida.

He says that wasn't the first time he'd been the target of racial bullying and that, looking back now, he realizes that interview was just a taste of things to come in his medical journey.

Young's experience sheds a personal light on bullying in academic medicine that, even 35 years later, remains an all-too-common reality for many physicians. One study estimates that about 4 in 10 young doctors and medical students experience bullying from colleagues.

The true prevalence of bullying in medicine remains unknown, given how often it likely goes unreported.

For some, sharing past experiences of bullying remains off limits. Nearly three dozen doctors who were contacted by Medscape Medical News declined to comment on their experiences, even when promised anonymity.

"It's ugly, and there is much suffering," says Harriette G. C. Van Spall, MD, MPH, associate professor of medicine, McMaster University, in Hamilton, Canada, who has researched bullying.

The Many Faces of Bullying

Bullying can be challenging to define and identify, in part because it can take many forms.

"It's everything from abusive language down to microaggressions," says Jonathan Hyman, a workplace attorney whose clients include healthcare providers. "It really runs the gamut of potential misconduct."

In an analysis published last year in BMJ Open, Van Spall and colleagues reviewed 68 studies on bullying in academic medical settings. The studies documented the experiences of more than 82,000 medical consultants or trainees.

The authors found that academic medicine was rife with bullying. These behaviors manifested in several central ways: overwork, threats to professional status, isolation, and destabilization.

More than 38% of respondents said they felt pressure to put in unreasonably long hours (overwork). Almost 36% reported being ordered to work below their competency level, while for 31%, information that affected their personal performance was withheld (destabilization). About 30% were subjected to excessive monitoring or faced undue criticism (professional threats). Around the same proportion felt that they were routinely excluded socially and professionally (isolation).

Men were more often the aggressors, representing almost 70% of bullying perpetrators, while women were more often the recipients.

Although she declined to go into specifics, Van Spall says the research was inspired by her own personal experiences.

The trauma, however, remains with her.

"Every day was filled with dread," Van Spall says. "It took sheer will to show up at work to care for patients, to complete research I was leading. My academic output, income, and personal well-being dropped during those years."

Although he never felt isolated, Young says he experienced the other three forms of bullying behaviors during medical school and residency. He routinely worked excessive hours ― his longest work week was about 126 hours. He also experienced episodes of excessive monitoring and destabilization.

As a surgical resident, for instance, Young was mentored by an overbearing surgeon.

"He'd tell me to stand where I couldn't really see what was going on," he says. And then "he'd tell me where to put a surgical instrument and...sort of guide my hand there and then say, 'Okay, now take a [cut there]' ― so I was basically doing it blind."

"I'm in control and you are not" was the message Young received loud and clear.

But Young pushed back, and the surgeon eventually relented and let him perform procedures with less interference.

Young also worked with a surgery resident who routinely peppered his interactions with racial comments, even while examining patients.

"I remember being involved in a case and there was this blood clot we were taking out and the resident said, 'This clot looks like a dead illegitimate black baby,' " Young recalls.

A Shrine of Fear, Secrecy

Young never officially reported these behaviors, believing that doing so would come back to bite him.

He is not alone.

Tauben Averbuch, MD, a co-author on the BMJ Open study, says Young's fears were echoed by many residents and medical students who were bullied. Fewer than 1 in 3 those who experienced bullying said they formally reported it. Of those who did, only 14% perceived an improvement. Almost 36 % found no effect, and 22% endured worse bullying behaviors afterward.

Hyman, the workplace attorney, says fear of retribution is one reason bullying in medicine continues to go unreported and thus underrecognized and underaddressed.

Yet another: Bullying does not violate any workplace laws.

"Businesses, including healthcare providers, have largely ignored bullying because it's not illegal per se," Hyman says. "It's only illegal if it's bullying because of a protected class — if it's sexual, racial, or disability harassment."

Some medical schools and healthcare institutions have moved to institute antibullying policies, but they remain in the minority.

A new study published in Jama Network Open found that only four of the top 91 medical schools have antibullying policies in place. But even policies at those schools fell short. Three schools, for instance, did not include confidential reporting procedures, and one did not include policies that prohibited retaliation.

"Without clear anti-bullying policies, the identification of bullying behaviors is ambiguous, reporting is low-to-absent, and bullies have non-standardized repercussions," the authors write.

Academic medical centers need to do a better job of recognizing the problem, setting clear antibullying guidelines, and taking reports of such incidents seriously.

The biggest takeaway from the BMJ Open study is "the normalization of bullying behaviors," says Averbuch, a cardiology fellow at the University of Calgary, in Alberta, Canada.

As for solutions, he notes, "I don't think it's as simple as just report everyone who bullies and fire them. I believe it's deeper to the culture of academic medicine, and we have to be more thoughtful about how we address it."

Young agrees but notes that medical students and residents can take steps to confront bullies and manage the stress that comes with medical training.

"I think a lot of people feel a bit helpless when [bullying] goes on," he says. "But standing up for yourself at times, even a little bit, can change things significantly."

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