No Justice For Those Who Have Suffered Bullying, Discrimination and Sexual Harassment with Increased Surgical College Subscription Payments.

As Fellows of the Royal Australasian College of Surgeons, we pay annual subscriptions.  There is not a whole lot of practical choice but for us to pay these subscriptions if one wishes to be a practicing surgeon in Australia.  It has just been announced that the subscriptions for 2016 are going up and by a lot.  

Whilst the Consumer Price Index is sitting around 1.5%, it has just been announced that it will be going up by 6% to cover the cost of implementing recommendations of the Expert Advisory Group (EAG). 

As a reminder, the EAG had documented the serious extent to which bullying, discrimination and sexual harassment (BDSH) has existed within the male Anglo-Saxon dominated surgical establishment. 

Text from the RACS email advising of the fee increase

This increase represents a gross injustice for those who have suffered from bullying, discrimination and sexual harassment during their formative years in building a career in surgery.  Having been subjected to such treatment, they now must pay more for having had the privilege to have had such an experience.  

Meanwhile, the main perpetrators of such behavior remain unpunished and will not as they should, bear the brunt of the additional costs for the RACS to make good on their past behavior.  

These are fees that I paid in 2015 for the privilege of being a Fellow.

But the reality is that implementing EAG Recommendations is going to be a costly exercise and it is money that cannot be covered from its financial reserves.  Apart from these costs, the RACS remains at significant risk of litigation and financial settlements in the event individuals find the courage to commence legal proceedings.  The RACS doesn’t really have a choice but to fund the implementation of EAG Recommendations through a significant increase in Fellowship subscriptions and to apply this across the board.  

The fact that the RACS is understandably unable to adjust for who should or should not pay a greater or smaller contribution to cover these costs does not change the fact that it lacks justice.  It will undoubtedly leave a bitter taste for many Fellows who will begrudgingly pay their subscriptions for 2016.

I do have one axe to grind over the manner by which this increase is being applied. Rather than a general revenue surcharge buried into our overall subscription, I strongly believe the increase above CPI should be listed as a separate line entry to send a clear message to all Fellows that they are paying for the indiscretions of past and present surgeons engaging in BDSH.  Without this, the reason for the 'bumped up' subscriptions will be quickly forgotten.  The issue of BDSH and it being addressed by the EAG represents a very significant watershed moment in the history of the RACS.  It should not be devalued by being buried into general business.  I appeal to the RACS to make it a separate line entry.  Call it an "EAG Levy" or "EAG contribution" or whatever.

It is just important to make it transparent. Make it visible.  Do not allow it to be forgotten.  

Maybe it is all just about trying to make a good impression – I’m sure you will agree that the RACS needs to do everything it can do to improve the impression it gives to the general public and its Fellows.  It will cost the RACS nothing to implement this. The cost of giving a negative impression......... 

Related blog pieces

Actions must speak louder than words - RACS and the EAG

Bullying culture in surgery

Cardiac surgeons were the worst perpetrators of bullying behaviour

RACS Elections and Candidate Review

Election results shows that there is appetite for change in the RACS

Do patients contribute to God complex in surgeons?

The recent EAG Report commissioned by the Royal Australasian College of Surgeons suggests that there is a toxic culture of bullying, harrassment and sexual discrimination in surgery.  There are probably multiple reasons why this toxic culture exists.  

One reason that seems to attract less attention is the attitude of self importance and self entitlement and being beyond reproach – or in other words a God complex that surgeons have acquired through their own experiences and being trained to think this way from their mentors. 

Hardly a working day goes by without a patient or their relative telling me how brilliant I was in helping them in their prostate cancer journey. I am always humbled and appreciative of these positive comments.  However, I am a very well trained surgeon who works hard and is obsessive compulsive in trying to do the best for my patients.  I’m just doing my job.  I’m well paid for what I do.  I have amazing job satisfaction.  Often I feel that I have the best job in the world.

But why such adulation for a person who is simply doing their job well?  What we do for our patients is very personal so obviously means a great deal to them.  Additionally there is a significant power imbalance, particular with knowledge and the fact that patients effectively surrender their trust upon us when we perform surgery upon them.

Patients are complicit to the God syndrome acquired by surgeons.  Health reporter Harriet Alexander is on the money when she  writes “For every surgeon who has a God complex, there is a bevy of complicit patients.”  If you keep telling surgeons how brilliant they are, after enough times, they’ll really start believing it.  By all means be appreciative of the work done by surgeons but time to stop the excessive praise for well trained individuals who are simply doing a great job of what they were trained to do.

The Royal Australasian College of Surgeons elections have commenced. Will it result in positive change?

The Royal Australasian College of Surgeons has been rocked by the scandal of there being a culture of bullying, harassment and sexual discrimination in the Expert Advisory Group’s Draft Report that was handed down just over a week ago.  We have seen a formal apology from the President of the RACS and a promise that there is going to be change.  RACS policy and culture is determined by RACS Council which is made up of elected Fellows. 

Without doubt, the EAG Report is the ‘biggest ticket’ item that requires the attention of the RACS Council. The final EAG Report and the recommendations that arise from it will again place the RACS in the public spotlight.  The RACS has been applauded for commissioning the independent EAG Report which had every expectation of producing findings that would be highly damaging to the reputation of the surgical profession. When the RACS announces how it intends on tackling bullying, discrimination and sexual harassment for the future could be a watershed moment in the credibility for the organization and profession.

Right now is an extremely important time for the RACS. Voting in the elections for members of the RACS Council opened on Friday 18 September and will close on Monday 5 October 2015.  How the Fellows of the RACS vote could impact on public confidence on how serious the organization is in tackling bullying, discrimination and sexual harassment.  

There are 38 candidates for the 8 positions that are up for grabs.  The EAG Report should be the biggest ticket item on the agenda, but only 10 candidates have made mention of issues surrounding the findings of this report.  That’s right, only 10 candidates thought the issue important enough to place in their electoral statements.  Of those 10 candidates, 5 are women.  It gets very interesting when we consider that there are only 6 candidates who are women. It is clear that women consider the findings of the EAG Report to be of considerable importance and arguably more so than their male counterparts.

Let’s also look at the ethnicity of the candidates.  Of the 38 candidates, 34 are Caucasian, 2 Chinese and 2 from the subcontinent.  Of further interest, surgeons who either currently hold senior positions within the RACS or have done so in the very recent past have nominated 22 of the 38 candidates.  These nominating surgeons carry very high profiles and are highly respected within the profession and their support of a candidate does carry weight.  If this were not the case, candidates would not seek to have their names listed next to theirs in their electoral statements.  Alternatively, rather than these candidates seeking to have such nominators, could it be a case of like minded candidates being the ones who get the tap on the shoulder?

The average age of the candidates is 56 years, ranging from 34 to 72 years. The majority of candidates are clustered between 50 to 60 years of age. There are only 5 candidates who are less than 50 years of age. There is only one candidate who is less than 40 years of age.  How dare this person run for RACS Council you might ask?

The youngest candidate is Dr Nikki Stamp who has everything working against her in having any chance of being elected.  Apart from being female, she is also by far the youngest candidate and does not have the nomination support of the high profile RACS 'heavyweights'.  She is however, passionate about equality in all aspects of healthcare and determined to see the RACS make a difference with the issue of bullying, harassment and sexual discrimination.  She has her own stories but right now there is a bigger missionat hand and in order to make a difference, she needs to be elected to the RACS Council. She will disrupt the RACS Council but for all the right reasons.

If you are Fellow of the RACS and feel serious about change, do vote for Dr Nikki Stamp.  If otherwise, tell surgeons that you do know, to not just consider her candidature, but to vote for her. 

The RACS needs to change but the demographics of those who seek positions on the RACS Council makes me nervous about what the future holds.



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For those interested, this previous piece "Action Must Speak Louder Than Words" which is  about the EAG Report may be of interest

Action Must Speak Louder Than Words

Medical Oncologist, Dr Ranjana Srivastava wrote on the subject of “how doctors treat doctors may be medicine's secret shame “ in the Guardian newspaper back in February 2015. About a month later, vascular surgeon Dr Gabrielle McMullin used a book launch speech to expose the problems of sexual harassment in the surgical profession.  She highlighted a story of where a neurosurgical trainee had refused sexual advances and subsequent to launching a formal complaint, her career was ruined. Her statement that  “she would have been much better to have given him a blow job” made national headlines in Australia.  This opened a can of worms and numerous stories suggesting a toxic culture of bullying, harassment and sexual discrimination (BDSH) were aired.  Under pressure, the Royal Australian College of Surgeons acted swiftly and appointed an independent Expert Advisory Group to investigate and to make recommendations.  Six months later, the draft report of the EAG  was published and results were “quite frankly shocking” as in the words of the President of the RACS.  The report was released in conjunction with a formal humbling RACS apology that has been uploaded to YouTube.

Prior to the release of the report, I had noticed a lot of discussion on social media and in real life on how the prevalence of bullying, harassment and sexual discrimination was overblown and stated to be no more so than in any other profession. Whilst the EAG Report makes clear that these assertions are absolutely wrong and that there is a special case for surgery that requires serious reflection and action.

On this basis, I then tweeted the following:- 

I followed the above tweet with the following:-

The tweet above generated interest and that evening was aired on the Lateline news program on ABC television.  This tweet does not suggest in any way that individuals with all of these attributes are part of the bullying and harrassment culture but think about it; they are the ones who are least likely to be subjected to it or to see it. If they chose to, they had the best opportunity to be untouchable.

As expected there is some criticism of the EAG Report as well as to my own comments.  The following tweets are more than likely to represent the tip of an iceberg for those who share similar thoughts. It is obvious that the vast majority in this camp have gone to ground since the release of the report but they will be observing closely and we can only hope that time will bring about attitudinal change.  I commend these commentators for publicly sharing their thoughts as it informs those of us who embrace the report as to the battles that lie ahead.

Some of the worst perpetrators of BDSH continue to be in roles of significant power.  We all know who they are and even subsequent to the EAG report, there will be reluctance to report or expose them.  How the RACS intends to deal with these perpetrators and exactly how they propose to change the toxic culture that exists within surgery is the major challenge ahead?  Whilst the RACS has worn the brunt of criticism for BDSH in surgery, hospital administrators have got away scot free.  They are equally, if not more, responsible for the reasons we have come to where we are now.  We eagerly await the final report of the EAG and detail of the proposed path forward.

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Those of you who have read this piece may also be interested on this subsequent piece about elections to the RACS Council.