Workplace Harassment: More Common Than You May Think

A new survey has found that sexism and bullying are alive and kicking in orthopedics.

“Oh, the ‘isms’ just won’t go away,” some think. “Sexism, racism, etc…how many people can I be expected to care about?”

Indeed, while some may tire of hearing about the suffering of another, i.e., compassion fatigue, that doesn’t make the underlying problem any less real.

But to rectify the situation one must have data.

No problem, say a group of multicenter researchers, whose work, “Harassment, Discrimination, and Bullying in Orthopaedics: A Work Environment and Culture Survey,” was published in the December 15, 2020 edition of the Journal of the American Academy of Orthopaedic Surgeons.

Co-author Kristy Weber, M.D., vice-chair of Faculty Affairs, Department of Orthopaedic Surgery at Penn Medicine and past president of the American Academy of Orthopaedic Surgeons (AAOS), explained the context surrounding the study to OTW, “While we have substantial data about discrimination and harassment in general, there are not much data on these issues in orthopaedics.”

Co-author Julie Samora, M.D., Ph.D., M.P.H., associate medical director for Quality and the director of Orthopaedic Quality Improvement at Nationwide Children’s Hospital in Columbus, Ohio, added, “In 2021 you would hope that when an orthopedic surgeon goes to work in the morning, she would have zero chance of encountering any type of harassment, discrimination, or bullying. But our data indicate that we are not there yet.”

And this is not limited to only the United States, says Dr. Samora. Their work, in fact, was modeled after a Royal Australasian College of Surgeons survey which found that an alarming number of female trainees had been propositioned for sex, subjected to repeated physical advances, or experienced other types of bullying and harassment.

Using a survey created by the AAOS, the researchers set out to assess workplace safety and overall workplace culture in the United States. Women and underrepresented minority AAOS members and an equal number of randomly selected male non-underrepresented minority members were invited to complete the survey.

Dr. Samora summarized the results from this highly selected group within AAOS, “We had 927 members respond to the survey, with 66% indicating that they have experienced some form of harassment, discrimination, or bullying behavior. Specifically, 79% had experienced discrimination, 55% had been bullied, 47% had been sexually harassed, and 40% had experienced general harassment. Although women were more likely than men to have experienced these behaviors (81% vs 35%), men still were targets of discrimination, bullying and harassment. Only 58% of respondents reported that their workplaces were equipped to deal effectively with these behaviors.”

Hazing

“It seems as part of the surgical culture during training, it is not uncommon to be degraded or humiliated by attendings, co-residents, or even staff. Trainees can be made to appear ill-informed or irresponsible and are expected to simply take these incidents in stride, keep their heads down, and keep quiet.”

“We are just scratching the surface of harassment, discrimination and bullying data in medicine,” she adds. “The National Academies of Sciences, Engineering, and Medicine has recently done a good job in highlighting the prevalence of sexual harassment in the STEM [science, technology, engineering, and mathematics] fields, and these types of behaviors in the UK have recently been underscored.”

“Oh, I thought you were a nurse.”

When OTW asked Dr. Samora about gender based bias in orthopedics, she pointed out that both explicit and implicit bias exist in the work environment. “Recent data have shown that women commonly experience microaggressions in the orthopedic training and work environment. There are certainly biases (many implicit) that affect the training and work environment for women, which many male counterparts are often not attuned to. For example, women in medicine experience verbal and nonverbal reminders of how they differ from the traditional image of the white male physician, often being mistaken for a nurse or a patient care assistant, with many patients being ‘surprised’ that a woman could be a surgeon.”

Dr. Weber also addressed the issue of gender based bias saying, “I imagine men find it hard to understand what it’s like to be the primary caregiver at home in most cases. Women surgeons do the same work at work and more work at home. Given the disparity in numbers, the men are often not around women to even understand this and might consider it a ‘one off’ when they see a woman in the field.”

I just want to treat my patients!

“Unfortunately,” states Dr. Samora, “these microaggressions stem from family members and patients as often as they do from male surgeons and female staff. The difficulty of experiencing these repeated microaggressions over time is that they can lead to undermining of relationships, compromised quality of care, lower self-esteem, anxiety, and even depression.”

“They can also lead to women leaving the surgical workplace over time”, says Dr. Weber.

Clear rules needed.

Dr. Samora states: “The most successful strategy is to have an institution that supports diversity, equity, and inclusion and that has a no tolerance policy for these types of behaviors. I would encourage faculty and staff to undergo implicit bias training, in addition to cultural sensitivity training. The more diverse the environment, the less these types of behaviors occur. Wherever we are on the hierarchy, we need to feel comfortable speaking out, whether we are bystanders, or targets of these behaviors. There need to be adequate reporting mechanisms, clear policies for accountability, and a safety mechanism to protect the target (reporter) from retribution.”

And that target can be a male.

“We were surprised to find that women and men have experienced these behaviors,” says Dr. Samora. “Clearly, no one is immune to the problem.”

“Culture change starts at the top of any organization whether it be an academic institution, a large multi-specialty practice, or a national orthopaedic organization. Leaders need to demonstrate the core values of equity and inclusion and model this behavior in all workplace interactions,” says Dr. Weber.

Hope on the horizon.

Dr. Weber: “The AAOS has a 5-year strategy for diversity as part of our overall strategic plan. It is detailed with accountability and deliverables via our Diversity Advisory Board Repeating this survey over time is part of that plan.”

“Harassment and discrimination are first and foremost local as they occur in the workplace, so the work has to occur there…and I doubt a Diversity, Equity, and Inclusion task force or committee will be effective in name only. They must have access to data, availability of resources, and the power to make changes for committees to be truly effective.”

On paper versus reality.

“The AAOS Board has outlined new core values that touch on inclusion and equity. Having core values and actually living into them with corresponding behaviors are two different things so we have considerable work to do.”

“Organizations such as the AAOS, the American Orthopaedic Association, and specialty societies can all do their part to have a no tolerance policy for harassment. From a discrimination/bias standpoint, we need to address this by removing structural barriers in institutions and national organizations. One example of a structural change for national orthopaedic organizations is to focus on the governance processes by which leaders are selected. Focusing on objective competencies such as strategic thinking and leadership rather than the all-too-common political cronyism will help decrease bias and keep organizations relevant to younger, diverse members. We also need to do the hard 1:1 work, essentially laying the groundwork via individual interactions.”

Dr. Weber: “The problem is real, and the culture and behavior need to change.”