Bullying and harassment in the medical profession
While the focus of this inquiry was on the use of the medical complaints
process as a tool of bullying and harassment within the medical profession, the
committee also received a large number of submissions outlining broader
concerns with the prevalence of bullying and harassment in Australia's medical
profession. As discussed in the first chapter, this level of bullying and
harassment presents a considerable risk to members of the health care sector,
but also to the Australian public as a whole, and for that reason the committee
is concerned by the evidence it has received.
This chapter discusses not just the prevalence and forms of bullying and
harassment evident in the medical profession, but the real and perceived
barriers to reporting these behaviours. It also examines responses to address
bullying and harassment from the medical sector, including medical boards,
government, colleges and hospitals. These responses emphasise the need for a cross-sector,
coordinated approach to addressing these issues.
Prevalence of bullying and harassment
In their submissions to this inquiry, medical administrators and
colleges emphasised that they take a 'zero-tolerance' approach to all forms of
bullying and harassment.
However, as recent research has demonstrated, and as was further illustrated by
evidence submitted to this inquiry, bullying and harassment remains prevalent within
the medical profession.
Within the profession itself, there is general recognition that bullying
and harassment is a significant problem. For example, the AMA acknowledges that
recent reports indicate:
... the hierarchical nature of medicine, gender and cultural
stereotypes, power imbalance inherent in medical training, and the competitive
nature of practice and training has engendered a culture of bullying and
harassment that has, over time, become pervasive and institutionalised in some
areas of medicine.
Mr John Biviano of the Royal Australasian College of Surgeons (RACS)
made a similar point:
The college, or RACS as it is typically known, acknowledges
that there is no doubt that bullying and harassment occurs in the surgical
workplace and takes very seriously the subject of this inquiry.
Dr Catherine Yelland of the Royal Australasian College of Physicians
(RACP) concurred, noting that:
We regard bullying and harassment as unacceptable, and the
college has no tolerance of these behaviours.
There is significant evidence in Australia and overseas that
bullying and harassment are a problem across all healthcare professions. We can
provide more detail if required. We regularly survey trainees, seeking feedback
on the quality of their training, supervision and support. We may include
questions on bullying and harassment in the future.
The Royal Australasian College of Medical Administrators' Professor
Gavin Frost likewise expressed concern about the prevalence of bullying and
harassment and reiterated the College's policies against such behaviours:
As with my colleagues, our college has zero tolerance for
harassment and bullying of any kind and our policies and procedures clearly set
The peak representative group for doctors, the Australian Medical
Association, argued that:
... all doctors have the right to train and practice in a safe
workplace free from bullying and harassment and [the AMA] holds a zero
tolerance approach to all forms of bullying.
Despite the consensus that bullying and harassment is unacceptable, there
is concern that the actual prevalence of such behaviour is unknown or
underreported. The Australian Nursing and Midwifery Federation (ANMF), for
instance, noted that it is difficult to quantify the prevalence of bullying and
harassment in the nursing and midwifery profession due to a lack of national
data. However, the ANMF referred to recent research and submissions from
organisations within the nursing and midwifery profession that all indicated
'significant levels' of bullying and harassment.
The committee particularly notes the 2015 report by the Expert Advisory
Group to the Royal Australasian College of Surgeons (RACS), which highlights
the wide-reaching prevalence and negative impacts of bullying and harassment in
the surgical profession. The key findings of this report are referenced
throughout this chapter and summarised in Box 3.1.
Box 3.1 – Royal Australasian College of
Surgeons – Expert Advisory Group on discrimination, bullying and sexual
In March 2015, the Royal
Australasian College of Surgeons (RACS) established an Expert Advisory Group
to investigate the prevalence of discrimination, bullying and harassment
within the surgical profession. The EAG consultations included over 3,500
participants including fellows, trainees and international medical graduates,
as well as over 100 hospitals.
Key findings of the Expert Advisory
Group's final report to RACS include:
- 49 per cent of fellows, trainees and international medical
graduates report being subjected to discrimination, bullying or sexual
- 54 per cent of trainees and 45 per cent of fellows less than 10
years post-fellowship report being subjected to bullying;
- 71 per cent of hospitals reported discrimination, bullying or
sexual harassment in their hospital in the last five years, with bullying the
most frequently reported issue;
- 39 per cent of fellows, trainees and international medical
graduates report bullying, 18 per cent report
discrimination, 19 per cent report workplace harassment and 7 per
cent sexual harassment;
the problems exist across all
surgical specialties; and
senior surgeons and surgical
consultants are reported as the primary source of these problems.
Source: Royal Australasian College of Surgeons, Submission
113, p. 2.
For the purpose of this inquiry, the committee refers to bullying and
harassment as defined by the RACS Expert Advisory Group.
Box 3.2 outlines these key definitions.
Box 3.2 – Definitions of bullying and
Bullying is unreasonable and
inappropriate behaviour that creates a risk to health and safety. It is
behaviour that is repeated over time or occurs as part of a pattern of
behaviour. Such behaviour intimidates, offends, degrades, insults or
humiliates. It can include psychological, social, and physical bullying.
Harassment is unwanted,
unwelcome or uninvited behaviour that makes a person feel humiliated,
intimidated or offended, Harassment can include racial hatred and
vilification, be related to a disability, or the victimisation of a person
who has made a complaint.
Advisory Group on discrimination, bullying and sexual harassment, Report
to the Royal Australasian College of Surgeons, 28 September 2015, Appendix
1, p. 19, http://www.surgeons.org/about-respect/what-we-have-done/building-respect,-improving-patient-safety/expert-advisory-group/
(accessed 9 November 2016).
Anecdotal evidence from submitters and witnesses to this inquiry
supports the findings of the Expert Advisory Group report that bullying and
harassment is a significant problem in the medical profession, across a range
In many instances, this can be seen as a cultural problem within the
profession; the committee notes considerable evidence suggesting that
particular groups – including medical students and junior doctors, women and
doctors of Indigenous or non-English speaking backgrounds – are more likely to
be the subject of bullying and harassment.
Examples of the different types of bullying and harassment raised by
submitters and witnesses are outlined below.
Medical and nursing students and
The committee heard that many medical and nursing students and trainees
experience a particular form of bullying and harassment during training.
Submitters described either being a trainee or observing a trainee being
bullied and harassed during clinical placements. In some instances, this
resulted in the trainee either:
being failed in assessments;
transferring mid-placement to another hospital and thus delaying
completion of their placement; or
quitting their specialist training programs.
The Australian Medical Students' Association (AMSA) noted that bullying
and harassment is widespread in medical education and includes 'teaching by
humiliation' as well as 'derogatory remarks, inappropriate humour, ignoring
students and setting impossible tasks or deadlines'.
AMSA drew the committee's attention to a recent study of medical
students in Sydney and Melbourne published in the Medical Journal of
Australia that indicated that 74.0 per cent of medical students had
experienced teaching by humiliation, and 83.6 per cent had witnessed it.
Some confidential submitters to this inquiry particularly noted that, as
trainees or junior doctors, they had particular concerns about making a
complaint about this bullying since it would have a negative impact on their
future career. This issue will be further discussed below as a barrier to
reporting bullying and harassment.
Sexual harassment and
The committee is concerned by the reported prevalence of sexual
harassment in the medical profession, perpetrated particularly against female
doctors, students and trainees. Box 3.3 outlines the definition of
sexual harassment defined by RACS.
Box 3.3 – Sexual harassment
Sexual harassment is defined
as unwelcome sexual advances, request for sexual favours and other unwelcome
conduct of a sexual nature, by which a reasonable person would be offended,
humiliated or intimidated. Sexual harassment may include, but is not limited
to: leering; displays of sexually suggestive pictures, videos, audio tapes,
emails & blogs, etc., books or objects; sexual innuendo; sexually
explicit or offensive jokes; graphic verbal commentaries about an
individual’s body; sexually degrading words used to describe an individual;
pressure for sexual activity; persistent requests for dates; intrusive
remarks, questions or insinuations about a person’s sexual or private life;
unwelcome sexual flirtations, advances or propositions; and unwelcome
touching of an individual, molestation or physical violence such as rape.
Source: Expert Advisory Group
on discrimination, bullying and sexual harassment, Report to the Royal
Australasian College of Surgeons, 28 September 2015, Appendix 1, p. 19, http://www.surgeons.org/about-respect/what-we-have-done/building-respect,-improving-patient-safety/expert-advisory-group/
(accessed 9 November 2016).
Miss Elise Buisson, President of AMSA, described to the committee one
example of sexual harassment experienced by female medical trainees:
...a student reported to me that they were
sitting in surgical grand rounds, so that is when all the surgeons in the
hospital come together and have an educational meeting. Someone presents some
research to them. A trainee doctor stood up, gave an absolutely
outstanding presentation—they had put a lot of work into it—and a quite
established male surgeon was very loudly interrupting her as she went on,
saying, 'My, my, my! Haven't they let you out of the kitchen a lot this month!'
and various other statements about her being female ... He laughed,
and everyone laughed, and the head of surgery at a medical school in that city
was sitting in the room and did nothing, as did everybody else.
AMSA drew the committee's attention to a recent survey by the Australian
Medical Association Western Australia which found that sexual harassment is
'endemic' across WA Health and Medicine. The survey found that 31 per cent of
the 950 respondents had experienced sexual harassment in the workplace,
including whilst applying for a job or training program. Of those reporting
sexual harassment, 81 per cent were women.
Alongside sexual harassment and discrimination, recent reports have
suggested that racial discrimination remains a problem in the medical
The committee heard that Aboriginal and Torres Strait Islander doctors
and students experience racial discrimination as part of their training and
The Australian Indigenous Doctors' Association (AIDA) told the committee
that results of a recent survey, Bullying, Racism and Lateral Violence in
the workplace, indicated almost all members reported having witnessed
bullying in their workplace, and over half reported having witnessed racism at
least once a week.
Examples of racism included:
... doubting members' status as Aboriginal and Torres Strait
Islander, experiences of 'unrelenting and systematic bullying', being belittled
and shamed, and verbal racist abuse'.
AIDA submitted that bullying and harassment 'often in the form of racist
remarks or behaviour', together with inadequate reporting mechanisms:
... create a culturally unsafe work environment, lacking in
respect and support, and create a barrier for Indigenous medical students and
doctors to pursue and persist on their medical career.
The Expert Advisory Group final report to RACS found that 27 per cent of
international medical graduates reported either racial or sexual
In its 2012 inquiry into registration processes and support for overseas
trained doctors, the House of Representatives Standing Committee on Health and
Ageing heard that international medical graduates reported bullying and
harassment as they worked through accreditation and registration.
Its final report, Lost in the Labyrinth, recommended that:
... the Medical Board of Australia extend the obligations it
applies to employers, supervisors and international medical graduates in its Guidelines
– Supervised practice for limited registration to include a commitment to
adhere to transparent processes and appropriate standards of professional
behaviour that are in accordance with workplace bullying and harassment
As of November 2016, the government had not responded to this report.
While it was not a major theme of this inquiry, several confidential
submitters noted their own experiences of race-based bullying and harassment.
Media and social media
Following on from the use of the medical complaints process as a tool of
bullying and harassment, as discussed in the previous chapter, some submitters
noted that they had been subject to a further level of bullying and harassment
when the details of complaints made against them were given to the media, or
disseminated via social media.
Submitters state in these instances, the media often report false
allegations, doing irreparable damage to their reputation. Others claim they
have been cyberbullied through social media.
For example, Dr Gary Fettke explained to the committee that during his
investigation by AHPRA, he became aware that the person who lodged the
notification against him had also been posting what he characterised as
'defamatory material on a social media hate site'.
Patients and families
The committee received a small number of submissions from patients or
their families who reported that they had been bullied and harassed by medical
professionals. Most of these submitters have made complaints to AHPRA and were
unsatisfied with AHPRA's response.
Submitters expressed concern that bullying and harassment between
medical practitioners may impact on patients. For example, the Health Care
Consumers Association expressed concern that:
...a culture that accepts and condones bullying is not
conducive to good patient care and must be addressed. Further, where a culture
condones bullying in the staff, there is evidence that this can reduce empathy
towards patients and can led [sic] to disrespect and bullying of patients.
Several confidential submitters argued that the lack of focus on
bullying's impact on patient safety means that there is not appropriate recognition
of the problem or clear lines for patients and members of the public to report
bullying and harassment by medical practitioners. These submitters expressed
concern that their complaints were not taken seriously.
Some confidential submitters noted that questioning any aspect of their
treatment resulted in bullying and harassment and in some cases this affected
their ability to receive further treatment. Conversely, other patients
discussed their problems receiving treatment because their doctor had their
practice restricted because of a vexatious complaint.
The committee expresses deep concern about the reported prevalence of
bullying and harassment in the medical profession and reiterates that bullying
and harassment in any workplace is unacceptable and must not be tolerated.
The committee notes that evidence from submissions supports recent
research that highlights the prevalence of bullying and harassment across
The committee recognises that bullying and harassment in the medical
profession pose threats to public safety and patient wellbeing, and for that
additional reason is particularly concerned by the prevalence of bullying and
harassment in the medical profession.
Barriers to reporting bullying and harassment
Submitters and witnesses identified two key barriers to reporting
bullying and harassment in the medical profession related to:
lack of clarity and trust in the reporting process; and
cultural issues within the medical profession.
Clarity of existing reporting
The committee heard that there is a lack of clarity and awareness in the
medical profession of the appropriate mechanisms for reporting bullying and
harassment. Submitters highlighted that processes for making complaints, or for
subsequently addressing complaints, are not well understood. For example, the
AMA noted in its submission that a 2014 survey of specialist trainees found
that general awareness of bullying and harassment policies across all colleges
is low, with only 30 per cent reporting that they are aware of these.
The committee notes that confusion about the complaints process was one
of key findings of the Expert Advisory Group in its report to RACS, particularly:
... with a lack of coordination or clarity about where to lodge
a complaint or how to raise an issue (between the College, employers and, for
students, universities), if one were brave enough to do so.
Mr John Biviano from RACS told the committee the existing complaints
mechanisms lack coordination across the sector:
... the oversight of health professions is complex and
difficult to navigate. It involves medical colleges, health departments,
hospitals and regulators, including the Medical Board of Australia and AHPRA.
There is a clear lack of coordination between these bodies and fragmentation of
Trust in existing complaints
Submitters expressed a lack of trust in the complaints system's ability
to produce a fair outcome, suggesting that this may discourage victims from
reporting bullying and harassment. For example, AIDA's survey of its membership
found that the majority of members:
... reported that policies and procedures were in place at
their workplace but stated that they did not believe that victims or
perpetrators were adequately supported by the existing policies and procedures,
suggesting a lack of confidence, particularly in complaints procedures and the
actual application of existing policies.
Similarly, the Australian College of Emergency Medicine argued that:
... medical practitioners are less likely to make a report if
they are not confident that the issue will be dealt with in a way that will
bring about meaningful and positive outcomes, and/or if they believe that their
day-to-day lives in the workplace will be impacted upon negatively as a result
of making a report.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) also
submitted that many workplaces that do not have appropriate processes for
... a key question is how the relevant workplace deals with
bullying and harassment claims and how it conducts and resolves investigations
into these claims. If appropriate and supportive mechanisms are not in place,
this represents a clear barrier to medical practitioners reporting bullying and
The committee notes that the Expert Advisory Group to RACS also found:
... there is a lack of trust and confidence in the people
handling complaints and the processes in place at the College and across the
health sector. There is confusion about processes that are often legalistic and
narrowly defined; and a demonstrable lack of consequences for perpetrators.
Despite the recent media and public attention on bullying and harassment
within the medical profession, the committee notes that awareness amongst
practitioners of the existing policies and procedures is not high. While it is
evident that some work has been done to improve this, it is clear that this
remains a problem requiring the attention of medical colleges, workplaces and
The committee was particularly concerned by evidence that suggests that
the culture of the medical profession does not support the reporting of
bullying and harassment.
Accepted culture of bullying
Submitters and witnesses suggested that in some sections of the medical
profession, bullying is accepted as part of the workplace culture. For example,
beyondblue submitted that recent research indicates that there is some concern
... there may be a "culture" that allows bullying and
harassment to occur within the medical profession, and that this may be a
transgenerational phenomenon ingrained in the profession.
The committee notes that submissions to this inquiry support the
findings of the Expert Advisory Group's report to RACS which found that in
relation to the surgical profession, 'bullying has become normalised as a
culturally accepted behaviour' and issues of discrimination, bullying and
sexual harassment are:
... enmeshed with questions about the culture of surgical
practice, as well as the culture of medicine and the healthcare sector more
The committee heard that the culture of bullying particularly affects
medical students and trainees. AMSA highlighted that a recent study of mistreatment
of medical students indicated that 50 per cent of students had come to believe
that mistreatment is 'necessary and beneficial for learning'.
Similar findings were reported by the Victorian Auditor-General, which noted a high
degree of acceptance of bullying and harassment among junior doctors:
Such behaviour was explained as a 'training technique' that
helped motivate them to work harder, or as unfortunate but an inevitable rite
of passage and part of the 'old-school way'.
Fear of repercussions
One of the key barriers to reporting instances of bullying and
harassment reported by submitters and witnesses was fear of negative
repercussions from making a complaint. Many submitters were concerned that
making a complaint against a senior colleague would adversely affect their
future career. Others expressed a fear of reprisals against them for making a
complaint at their workplace against a colleague. As discussed in chapter 2, confidential
submitters who have suffered bullying or harassment are also concerned that the
retaliation would take the form of a vexatious notification being lodged
For example, Dr Artiene Tatian from AIDA told the committee that a
survey of its members found that over half did not report bullying and
harassment due to a fear of negative repercussions.
Dr Ben Armstrong from AIDA also told the committee that for the 40 per cent of
members who had initiated some sort of complaint reconciliation, the vast
majority were ignored or not actioned and 'they often had negative
repercussions, which discouraged them from making further complaints'.
The committee heard that fear of negative repercussions are particularly
acute among students and trainees who are concerned about the impact of making
a complaint on their career progression. Miss Elise Buisson from AMSA told the
committee, that often students are advised not to make reports, due to possible
negative impacts on their careers:
Even very well-meaning clinicians or faculty members will
advise you not to report certain things: 'Look, it's probably not that bad. If
you are to do it, it's going to have a really negative effect on your career.'
And if someone was to come to me and say, 'Should I report X', I would find it
very difficult to know what is the best course of action for them.
Similarly, the Royal Australasian College of Medical Administrators
argued that concern for career progression is the paramount reason why
complaints about bullying and harassment are often not lodged:
The key barrier for medical practitioners taking action is
the belief that it will adversely affect future career options. This is
supported by the survey undertaken by RACMA in 2015 on bullying, harassment and
discrimination and consultations with RACMA’s membership. Additionally reasons
cited are the perceived stress associated with filing a complaint and enduring
an investigation, and the perception there is potential for victimisation as a
result of raising the matter.
Silence of by-standers
The committee heard that the combination of process and cultural issues
contributes to an environment where those by-standers who witness bullying and
harassment are not supported to report the behaviour. The AMA submitted that
there may be two different reasons why by-standers do not speak up when
witnessing 'unacceptable behaviour', they may:
not recognise the behaviour as discrimination, bullying or sexual
harbour distrust in the complaint mechanism – that the complaint
will not be taken seriously, that someone else's word will be taken over
theirs, that victimisation will ensue, or that it would ultimately not be in
the best interests of the victim to raise it.
The 'silence of by-standers' was identified by the Expert Advisory Group
to RACS as a 'critical issue', which:
... stems from fear of reprisal, fear of 'making it worse',
concerns about their position or right to raise an issue given hierarchical
structures and power differences; prominent people are perpetrators, bullies
are seen as untouchable.
Gender inequality and cultural
The committee also heard that gender inequality presents barriers for
reporting bullying and harassment, particularly for women. The AMA pointed out
Gender inequity has a proven causal relationship with the
incidence of discrimination, bullying and sexual harassment of women. It is
important that sexual harassment, discrimination and non-sexualised incivility
is acknowledged as a manifestation of broader gender inequality.
The Expert Advisory Group also highlighted that lack of cultural
diversity, together with gender inequality, contribute to a workplace culture
that does not support the reporting of bullying and harassment:
Gender inequity and limited cultural diversity also featured
as both cause and effect in relation to culture. Both were seen to enable the
continuation of the dominant surgical culture and were a consequence of it.
Addressing bullying and harassment
Submitters and witnesses highlighted that addressing bullying and
harassment in the medical profession will require a cross-sector approach,
including government, medical boards, AHPRA, hospitals and speciality colleges.
Some of the approaches to addressing bullying and harassment undertaken so far
are outlined below.
Medical boards and AHPRA
Submitters highlighted that the formal medical complaints process
administered by AHPRA and the Medical Board of Australia (MBA) and Nursing and
Midwifery Board of Australia (NMBA) is just one mechanism for addressing
bullying and harassment. As discussed in chapter 2, the key focus of the formal
AHPRA complaints process is patient safety.
AHPRA, the MBA and the NMBA acknowledged that they have an important role
to play in addressing bullying and harassment:
Bullying and harassment can be very damaging to the people
who are subject to these behaviours and to the safety of patients. There is no
place for these behaviours in the Australian medical, nursing, midwifery or
registered health practitioner workforce. Through our role in the national
regulation of health practitioners, we are committed to playing our part in
supporting the health and well-being of medical practitioners, nurses and
midwives and ending discrimination, bullying and harassment.
However, the MBA, NMBA and AHPRA emphasised that:
Not all allegations of bullying and harassment that involve
medical practitioners, nurses or midwives are appropriate for action by the MBA
or NMBA as the threshold for regulatory action may not be met.
Dr Joanna Flynn, Chair of the MBA, told the committee that in most
cases, AHPRA and the boards are not the most appropriate place to address
discrimination, bullying and harassment:
... the boards are not the appropriate first point of call for
most matters in relation to bullying, which ought to be dealt with locally and
investigated locally. Most problems should be solved close to the source of
Dr Flynn emphasised that:
While the Medical Board and Nursing and Midwifery Board and
AHPRA have important roles to play, the medical complaints process and our
regulation of health practitioners will not, on its own, address bullying and
harassment and deliver the change in culture that we seek. That is why we work
in partnership with the professions, employers, colleges, health departments
and other health complaints bodies to help end bullying and harassment.
Similarly, the ANMF commented that AHPRA:
... are unlikely to be able to deal with reporting of bullying
in a useful manner, particularly in dealing with the underlying issues which
are usually organisational, rather than individual. A report to AHPRA actually
negates the occupational health and safety nature of bullying, and the need for
a risk management approach to be implemented, as well as investigating the root
cause of the issue.
Codes of conduct
The MBA, NMBA and AHPRA noted that one of their key roles is to provide
guidance on what is expected of registered practitioners through a code of
Such guidance sets out the principles that characterise good
practice and makes explicit the standards of ethical and professional conduct
expected by their professional peers and the community.
The MBA pointed to its publication, Good Medical Practice: A Code of
Conduct for Doctors, which was developed to guide doctors in their
professional practice and roles, and set 'clear expectations on medical
practitioners to act and communicate respectfully to both patients and
The NMBA noted that the Codes of Professional Conduct for midwives
and nurses is currently under review, and expects to conduct a public
consultation on the revised codes in early 2017.
Some submitters suggested that one way that AHPRA and the boards could
assist in addressing bullying and harassment is through the codes of conduct
they administer. The Australian Dental Association (ADA) recommended that the
Code of Conduct for registered health professionals 'should be strengthened to
reinforce the overall duty of care of health professionals, particularly those
in employer positions, to ensure the safety of their colleagues, staff and
Beyondblue recommended that responses to bullying and harassment levels
should be part of a broader focus on mental health, recognising the substantial
impact on mental health that workplace bullying and harassment have. Beyondblue
suggested that action on bullying and harassment should be based on a culture
of 'respectful relationships' and recommended that reference to 'respectful
relationships' be incorporated in the code of conduct administered by the MBA
and those of the individual colleges.
The Australian Indigenous Doctors' Association recommended that a key
measure to reduce the levels of bullying and harassment in the medical profession
would be to mandate cultural safety training for all employees in the health
Following the release of the Expert Advisory Group's report to RACS in
2015, the committee heard that all speciality colleges have undertaken reviews
of their reporting and complaints mechanisms. The Committee of Presidents of
Medical Colleges stated that:
All specialist Medical Colleges are fully committed to
fulfilling their obligations to eliminate or minimise the risk of bullying.
Each has undertaken a system review to ensure appropriate policies and
procedures are in place to manage complaints relating to bullying, which also
includes regular compliance checks to ensure policies and procedures are
up-to-date and staff are provided with information and training.
In particular, the committee heard that RACS has dedicated 'enormous
resources' to responding to the Expert Advisory Group report through its November
2015 action plan, Building respect, improving patient safety.
Mr John Biviano from RACS told the committee that the key actions taken by RACS
to date as part of the action plan include:
working with health departments and hospitals to develop
strategies to address discrimination, bullying and sexual harassment, including
developing memorandums of understanding between RACS and hospitals;
introducing mandated courses for surgeons involved in education
on 'basic adult education principles', building awareness of discrimination,
bullying and harassment, and skills for supervisors; and
devoting more resources to complaints management, including a
centralised database and process to resolve complaints.
The committee heard that while RACS is leading the colleges in
addressing these issues, other colleges are also seeking to address bullying
and harassment. The Committee of Presidents of Medical Colleges (CPMC) noted
... all specialist Medical Colleges have subsequently
undertaken assessment processes to recommend actions their individual College
could take directly and in partnership with hospitals and employers to mitigate
and prevent such behaviours from occurring.
A number of colleges made submissions to the inquiry outlining the
specific measures they have taken to address bullying and harassment. For
example, Mr John Ilott noted that the Australian and New Zealand College of
Anaesthetists (ANZCA) has:
... strengthened the internal professional conduct framework.
We have also established a centralised complaints-handling process, which is
for complaints to the college. While our education program has not been as
extensive as that of RACS, we acknowledge the generosity of RACS in providing
much of the material that they developed at their own cost, which has been made
available to other colleges.
Similarly, the Royal Australasian College of Physicians (RACP) set up
working party in 2015 to 'further ensure our current systems, policies,
procedures and practices were robust'.
Mrs Linda Smith, Chief Executive Officer of RACP told the committee that some
of the changes introduced as a result include:
improved compulsory supervisor training workshops;
education leadership and supervisor support that allows
identification of inappropriate supervisor behaviour and a process of working
with supervisors to change behaviour;
producing 'Creating a safe culture', a new e-learning resource
for fellows, plus online curated learning collections on bullying and
extensive assessment of the resources provided by other colleges;
implemented a 24/7 confidential online support service for
fellows and trainees that is not just limited to problems they may be having in
However, the committee also heard concerns about the efficacy of these
measures by colleges, and whether they are in fact having any real impact on
reducing bullying and harassment. For example, Miss Elise Buisson from AMSA
told the committee:
I do think there has been significant change, but I do not
think it has been all surgeons. And I think that change has been focused within
the College of Surgeons because the other colleges have not had that same
pressure applied to them. We have developed this kind of media idea that it is
the surgeons who are particularly at fault, whereas I think there are quite a
lot of poorly behaving doctors who are not surgeons who are getting away with
it just fine. There absolutely are some surgeons who are still behaving badly,
but I do think it is substantially less than it was a year-and-a-half ago.
Whether that change will be sustained for another 18 months or the 18 months
after that I am a little less certain of.
Similarly, Dr Michael Mansfield, discussing the increase in bullying he
has seen throughout his career, described the professional colleges as
'impotent, with respect to any meaningful action, despite the window-dressing'.
Need for greater coordination
Evidence to the committee highlights the need for coordination across
the medical sector to address bullying and harassment.
Beyondblue submitted that:
Action on bullying and harassment is everyone's
responsibility. Governments have a role through enacting legislation and
funding relevant programs. Statutory authorities have a role in overseeing
adherence to legislation through education, investigation of complaints, and
the enforcement of laws and penalties. Employers are required by law to create
an environment that protects the health and safety of their staff. Employees
are obliged to follow the law and the lawful directions of their employers.
Evidence from the speciality colleges highlights that addressing
bullying and harassment requires cooperation with hospitals and employers. The
Australasian College of Emergency Medicine (ACEM) argued that:
In order to address the culture of bullying, ACEM considers
that hospital management or executives, as well as hospital governing bodies,
must be held accountable for the culture of the organisations that they lead.
Through addressing bullying issues associated with those who are responsible
for establishing the culture of a workplace, positive changes for those working
at all levels within the hospital could be achieved.
Similarly, the CPMC submitted that 'while all Colleges are making a
considerable effort to improve processes they cannot do it alone and there
needs to be agreed principles between all parties'.
Mr Biviano from RACS told the committee:
... the responsibility to end a culture of bullying and
harassment does not reside with any one individual or entity. Employers,
hospitals, governments, health professionals, industrial associations,
regulators and other partners in the health sector must all commit to sustained
action. While each of these groups can and should develop individual solutions,
at the core of the issue is the need for cooperation and collaboration across
the health sector.
Mr John Ilott, CEO of ANZCA, told the committee that:
Lasting improvements can only be achieved with the
cooperation of the health services in both private hospitals and public
A number of submitters suggested that better sector-wide coordination is
an important step to address the lack of clarity and trust in existing
reporting mechanisms. The AMA submitted that:
Greater cooperation between employers and colleges with
respect to the development and implementation of bullying and harassment
policies and in relation to complaints handling would be beneficial to all
parties involved. The current environment discourages effective compliance both
with respect to the development of well understood and effective policies, as
well as in relation to having accessible and trusted complaints mechanisms.
As part of this coordination, RANZCP suggests that:
... there should be further practitioner education in regards
to bullying and harassment as practitioners are often confused about what
should be reported to AHPRA and what should be reported to their workplace.
Similarly, the ANMF noted that its policy statement on bullying and
harassment asserts that 'the first level for raising a bullying complaint is
within the workplace'. When this fails, nurses and midwives are advised to
report the bullying to a range of state and territory based authorities, such
as Occupational Health and Safety Regulators. 
In 2016, the Victorian Auditor-General conducted an audit of four public
health services to assess their effectiveness in managing the risk of bullying
and harassment in the workplace. The Auditor-General's report into Bullying
and Harassment in the Health Sector found that the leadership of health
sector agencies 'do not give sufficient priority and commitment to reducing
bullying and harassment within their organisations' and that the health sector
is 'unable to demonstrate that it has effective controls in place to prevent or
reduce inappropriate behaviour, including bullying and harassment'.
The Victorian Auditor-General made a number of recommendations for
health sector agencies, WorkSafe, the Victorian Public Sector Commission and
the Department of Health and Human Services to better address:
early intervention mechanisms to address bullying and harassment;
management of formal complaints; and
collaboration between agencies that have a role in the safety
culture of the health sector.
The committee acknowledges the work undertaken across the medical
sector, particularly by colleges, to address bullying and harassment. The
professional colleges are uniquely placed to respond to the medical
profession's concerning record of tolerating or ignoring bullying and
However, the committee notes that while work is being done, a genuine
change in the way the profession responds to incidents of bullying and
harassment remains to be seen. Substantial and lasting change is the only
metric on which such efforts will be assessed.
The committee is pleased to see increased recognition that supports
further work to encourage cooperation and coordination across the sector to
eliminate bullying and harassment and remove any barriers to making complaints.
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