In the United Kingdom a growing literature has identified workplace bullying as a major occupational stressor among health professionals. A study carried out in an NHS community trust found that 1 in 3 staff reported being bullied in the previous year,1 while a report by the King's Fund, an independent health think tank, found that bullying, racial harassment, and discrimination were daily experiences for black and Asian doctors. In the United States several studies have reported that medical students suffer high levels of mistreatment or bullying during training, which increase with progression through medical school, spilling over into the early training years.2–4 We report here findings from a study of workplace bullying among junior doctors in the United Kingdom.
Participants, methods, and results
An anonymous questionnaire was sent out with BMA News Review to 1000 doctors with job grades from house officer to senior registrar, randomly selected from the BMA members' mailing list. The questionnaire collected information about the participant's age, sex, job grade, and ethnic group. Participants were presented with a definition of bullying and asked to indicate whether they had been subjected to it in the past 12 months and whether they had witnessed others being bullied. They also completed a bullying scale which asked whether they had experienced 21 bullying behaviours from peers, senior staff, or managers in the past 12 months.1
The response rate was 62%: 594 competed questionnaires were returned and 48 were returned undelivered by the post office. Not all questions were answered by all participants. Fifty four per cent (321) of the participants were house officers or senior house officers, 39% (230) registrars, 3% (18) senior registrars, and 3% (20) other junior grades. Half were men (294 v 296) and 70% (413 v 174) were white. Overall, 220 of the 594 junior doctors (37%) identified themselves as having been bullied in the past year, though 486 (84%) had in fact experienced one or more of the bullying behaviours described on the bullying scale; 407 (69%) had witnessed the bullying of others. Black and Asian doctors were more likely to report being bullied than white doctors (78 (45%) v 139 (34%); χ2=6.3, df=1, n=585, P=0.01; relative risk 1.59 (95% confidence interval 1.11 to 2.28)) and women were more likely to report being bullied than men (43% (126) v 32% (92); χ2=7.7, df=1, n=588, P=0.005; relative risk 1.61 (1.14 to 2.26); see table). Reports of bullying did not vary by job grade or age.
Comment
In this study 37% of junior doctors reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. This should be a cause for concern, particularly since several recent studies show a pattern of discrimination at all levels in the medical profession from application to medical school to examination success, job application, and the allocation of distinction awards to consultants.5 Women were more likely than men to be bullied, and this finding is consistent with a study of university employees by Bjorkvist et al.4
We should interpret these findings cautiously. The study relied on self reports of bullying, and a higher response rate would have been desirable. Nevertheless, the findings suggest that disturbingly high levels of bullying and mistreatment during training are part of many junior doctors' perceptions and experience.
Table.
Rates of reported bullying behaviours and differences by ethnic group and gender
| Overall bullying rate % (No) | Difference in bullying rate between black and Asian and white doctors % difference (95% CI) | Difference in bullying rate between female and male doctors % difference (95% CI) | |
|---|---|---|---|
| Persistent attempts to belittle and undermine your work | 40 (232/582) | +8 (0.98 to 2.03) | +9 (1.06 to 2.08) |
| Persistent unjustified criticism and monitoring of your work | 37 (213/580) | 1−5 (0.56 to 1.20) | +7 (0.95 to 1.87) |
| Persistent attempts to humiliate you in front of colleagues | 34 (198/580) | +4 (0.82 to 1.73) | +13 (1.24 to 2.50) |
| Intimidatory use of discipline/competence procedures | 17 (101/582) | +3 (0.76 to 1.92) | +5 (0.93 to 2.22) |
| Undermining your personal integrity | 30 (174/578) | 0 (0.66 to 1.45) | +16 (1.49 to 3.11) |
| Destructive innuendo and sarcasm | 43 (250/581) | +3 (0.77 to 1.59) | +13 (1.14 to 2.22) |
| Verbal and non-verbal threats | 18 (107/582) | +7 (0.96 to 2.33) | +4 (0.83 to 1.96) |
| Making inappropriate jokes about you | 28 (160/582) | +9 (1.09 to 2.36) | +9 (1.07 to 2.26) |
| Persistent teasing | 21 (122/582) | −4 (0.49 to 1.22) | 0 (0.66 to 1.48) |
| Physical violence | 0 (2/580) | −1 (—) | 0 (—) |
| Violence to property | 2 (10/580) | 0 (0.43 to 5.62) | −3 (0.05 to 1.14) |
| Withholding necessary information from you | 20 (114/580) | +6 (0.97 to 2.31) | −2 (0.58 to 1.32) |
| Freezing out/ignoring/excluding | 31 (179/581) | +7 (0.94 to 2.01) | +2 (0.76 to 1.53) |
| Unreasonable refusal of applications for leave, training, or promotion | 24 (142/582) | +12 (1.25 to 2.80) | −2 (0.62 to 1.34) |
| Undue pressure to produce work | 39 (224/580) | +13 (1.78 to 2.43) | −1 (0.69 to 1.36) |
| Setting of impossible deadlines | 31 (179/580) | +4 (0.82 to 1.80) | +1 (0.75 to 1.51) |
| Shifting goalposts without telling you | 32 (188/582) | −2 (0.62 to 1.36) | +2 (0.77 to 1.55) |
| Constant undervaluing of your efforts | 28 (164/582) | +2 (0.71 to 1.60) | +11 (1.20 to 2.51) |
| Persistent attempts to demoralise you | 17 (96/580) | +4 (0.83 to 2.11) | +9 (1.22 to 3.05) |
| Removal of areas of responsibility without consultation | 13 (73/580) | −2 (0.47 to 1.41) | −2 (0.49 to 1.31) |
| Discrimination on grounds of race or gender | 15 (88/580) | +21 (2.74 to 7.10) | 0 (0.59 to 1.50) |
Acknowledgments
Thanks to Jon Deeks for statistical comments and to Annette Barrett, Sarah Bell, and Lesley Marquis for help with data collection.
Footnotes
Funding: None.
Competing interests: None declared.
References
- 1.Quine L. Workplace bullying in NHS community trust: staff questionnaire survey. BMJ. 1999;318:228–232. doi: 10.1136/bmj.318.7178.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Daugherty SR, Baldwin DC, Jr, Rowley BD. Learning, satisfaction, and mistreatment during medical internship. JAMA. 1998;279:1194–1199. doi: 10.1001/jama.279.15.1194. [DOI] [PubMed] [Google Scholar]
- 3.Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med. 1998;73:1149–1158. doi: 10.1097/00001888-199811000-00011. [DOI] [PubMed] [Google Scholar]
- 4.Bjorkqvist K, Osterman K, Hjelt-Back M. Aggression among university employees. Aggressive Behaviour. 1994;20:173–184. [Google Scholar]
- 5.Esmail A, Everson D. Tackling racism in the NHS: we need action not words. BMJ. 1997;314:618. doi: 10.1136/bmj.314.7081.618. [DOI] [PMC free article] [PubMed] [Google Scholar]