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

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.