Bullying in the Australian medical workforce: cross-sectional data from an Australian e-Cohort studyDeborah A. Askew A F , Philip J. Schluter B , Marie-Louise Dick A , Patricia M. Régo C , Catherine Turner D and David Wilkinson E
A Discipline of General Practice, University of Queensland, Herston, QLD 4072, Australia. Email: firstname.lastname@example.org
B Department of Public Health and General Practice, University of Otago, Oxford Terrace, Christchurch 8140, New Zealand. Email: Philip.email@example.com
C Discipline of Medical Education, The University of Queensland, Herston, QLD 4072, Australia. Email: firstname.lastname@example.org
D School of Nursing and Midwifery, The University of Queensland, Herston, QLD 4072, Australia. Email: email@example.com
E School of Medicine, The University of Queensland, Herston, QLD 4072, Australia. Email: firstname.lastname@example.org
F Corresponding author. Email: email@example.com
Australian Health Review 36(2) 197-204 https://doi.org/10.1071/AH11048
Submitted: 20 May 2011 Accepted: 21 September 2011 Published: 25 May 2012
Objective. This study aimed to describe the prevalence of perceived workplace bullying in the Australian medical workforce, and investigate the relationship between workplace bullying and job satisfaction, health status, and current and planned medical workforce participation.
Methods. An electronic cross-sectional survey of doctors currently in the paid workforce, conducted between April 2008 and October 2009, was nested within a longitudinal cohort study investigating factors affecting the recruitment and retention of the Australian medical workforce. To address the specific aims of this study, a subset of questions in the survey investigated the prevalence of self-reported bullying; physical and mental health; workforce participation patterns; job satisfaction; and job stressors.
Results. Seven hundred and forty-seven participants responded to the bullying question and were included in this analysis. Twenty-five percent of participants reported being bullied in the last 12 months. There were no differences in the reported rates of bullying across age groups, sex and country of medical qualification. Bullied doctors were least satisfied with their jobs (P < 0.001), had taken more sick leave in the last 12 months (P < 0.001), and were more likely to be planning to decrease the number of hours worked in medicine in the next 12 months (P = 0.01) or ceasing direct patient care in the next 5 years (independent of their age or the number of hours currently worked in patient care) (P = 0.006).
Conclusions. Our findings suggest that Australian doctors, independent of age or sex, have experienced workplace bullying, and although no conclusions can be made about causal pathways, there were strong associations between this exposure and poorer health and wellbeing, and on remaining in the medical workforce.
What is known about the topic? Bullying and harassment have a significant impact on mental health, job satisfaction, and intention to leave the workforce. Workplace bullying in healthcare organisations affects the individuals involved, the organisations and the patients. The prevalence of workplace bullying throughout the medical workforce in Australia or elsewhere has not been investigated, with previous studies focussing on subsets of doctors, particularly junior doctors.
What does this paper add? This paper found that 25% of doctors participating in this study reported experiencing persistent behaviours in the last 12 months that had undermined their professional confidence or self-esteem. There were no differences in the prevalence of bullying observed between sexes, age groups, country of medical qualifications, or employment sector. Victims of bullying had poorer mental health, had taken more sick leave in the last 12 months, were less satisfied with their current jobs and with being doctors, were more affected by job stressors and were more likely to be considering ceasing direct patient care than non-bullied doctors.
What are the implications for practitioners? Practitioners need to be alert for potential bullying and harassment within healthcare organisations and be prepared to act decisively to minimise its impact on staff health, satisfaction and retention, and patient quality of care.
References World Health Organisation. Working together for health: The World Health Report 2006. Geneva: World Health Organisation, 2006.
 Paice E, Aitken M, Houghton A, Firth-Cozens J. Bullying among doctors in training: cross sectional questionnaire survey. BMJ 2004; 329 658–9.
| Bullying among doctors in training: cross sectional questionnaire survey.CrossRef |
 Bentley T, Catley B, Cooper-Thomas H, Gardner D, O’Driscoll M, Trenberth L. Understanding stress and bullying in New Zealand workplaces, 2009. Available at http://www.massey.ac.nz/massey/fms//Massey%20News/2010/04/docs/Bentley-et-al-report.pdf [verified April 2010].
 Rayner C, Hoel H. A summary review of literature relating to workplace bullying. J Community Appl Soc Psychol 1997; 7 181–91.
| A summary review of literature relating to workplace bullying.CrossRef |
 Hicks B. Time to stop bullying and intimidation. Hosp Med 2000; 61 428–31.
| 1:STN:280:DC%2BD3cvjsVKisA%3D%3D&md5=2a731bdefe86d0ae4a8c341ddfa7b849CAS |
 Martin WF. Is your hospital safe? Disruptive behavior and workplace bullying. Hosp Top 2008; 86 21–8.
| Is your hospital safe? Disruptive behavior and workplace bullying.CrossRef |
 McAvoy BR, Murtagh J. Workplace bullying. BMJ 2003; 326 776–7.
| Workplace bullying.CrossRef |
 Van Der Weyden MB. In the wake of the Garling inquiry into New South Wales public hospitals: a change of cultures? Med J Aust 2009; 190 51–2.
 Ahmer S, Yousafzai AW, Bhutto N, Alam S, Sarangzai AK, Iqbal A. Bullying of medical students in Pakistan: a cross-sectional questionnaire survey. PLoS ONE 2008; 3 e3889
| Bullying of medical students in Pakistan: a cross-sectional questionnaire survey.CrossRef |
 Ahmer S, Yousafzai AW, Siddiqi M, Faruqui R, Khan R, Zuberi S. Bullying of trainee psychiatrists in Pakistan: a cross-sectional questionnaire survey. Acad Psychiatry 2009; 33 335–9.
| Bullying of trainee psychiatrists in Pakistan: a cross-sectional questionnaire survey.CrossRef |
 Bairy KL, Thirumalaikolundusubramanian P, Sivagnanam G, Saraswathi S, Sachidananda A, Shalini A. Bullying among trainee doctors in Southern India: a questionnaire study. J Postgrad Med 2007; 53 87–90.
| Bullying among trainee doctors in Southern India: a questionnaire study.CrossRef | 1:STN:280:DC%2BD2s3os1Clug%3D%3D&md5=7eec22ddb41f149a464d02afb9535fc4CAS |
 Quine L. Workplace bullying in junior doctors: questionnaire survey. BMJ 2002; 324 878–9.
| Workplace bullying in junior doctors: questionnaire survey.CrossRef |
 Rutherford A, Rissel C. A survey of workplace bullying in a health sector organisation. Aust Health Rev 2004; 28 65–72.
| A survey of workplace bullying in a health sector organisation.CrossRef |
 Scott J, Blanshard C, Child S. Workplace bullying of junior doctors: cross-sectional questionnaire survey. N Z Med J 2008; 121 10–4.
 Steadman L, Quine L, Jack K, Felix DH, Waumsley J. Experience of workplace bullying behaviours in postgraduate hospital dentists: questionnaire survey. Br Dent J 2009; 207 379–80.
| Experience of workplace bullying behaviours in postgraduate hospital dentists: questionnaire survey.CrossRef | 1:STN:280:DC%2BD1MjhtVShsg%3D%3D&md5=2e43cb6d83e97f974442cc6311c8546cCAS |
 Stebbing J, Mandalia S, Portsmouth S, Leonard P, Crane J, Bower M, Earl H, Quine L. A questionnaire survey of stress and bullying in doctors undertaking research. Postgrad Med J 2004; 80 93–6.
| A questionnaire survey of stress and bullying in doctors undertaking research.CrossRef | 1:STN:280:DC%2BD2c7itV2htg%3D%3D&md5=6cd9335fbe1e0db2ecf0396948c60331CAS |
 Cheema S, Ahmad K, Giri S, Kaliaperumal V, Naqvi S. Bullying of junior doctors prevails in Irish health system: a bitter reality. Ir Med J 2005; 98 274–5.
| 1:STN:280:DC%2BD2MnhvFWitQ%3D%3D&md5=c15fb89c3d79261094681a1c3daabf2cCAS |
 Huntington A, Gilmour J, Schluter P, Tuckett A, Bogossian F, Turner C. The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries. J Adv Nurs 2009; 65 1309–17.
| The Internet as a research site: establishment of a web-based longitudinal study of the nursing and midwifery workforce in three countries.CrossRef |
 Turner C, Bain C, Schluter PJ, Yorkston E, Bogossian F, McClure R, Huntington A. Cohort profile: the Nurses and Midwives e-Cohort Study – a novel electronic longitudinal study. Int J Epidemiol 2009; 38 53–60.
| Cohort profile: the Nurses and Midwives e-Cohort Study – a novel electronic longitudinal study.CrossRef |
 Schluter P, Turner C, Huntington A, Bain C, McClure R. Work/life balance and health: the Nurses and Midwives e-Cohort Study. Int Nurs Rev 2011; 58 28–36.
| 1:STN:280:DC%2BC3M7lslGhug%3D%3D&md5=6e8619097bc0711bf5f1d9bd977a3911CAS |
 Frank E, Segura C. Health practices of Canadian physicians. Can Fam Physician 2009; 55 810–1.
 Røvik JO, Tyssen R, Hem E, Gude T, Ekeberg O, Moum T, Vaglum P. Job stress in young physicians with an emphasis on the work-home interface: a nine-year, nationwide and longitudinal study of its course and predictors. Ind Health 2007; 45 662–71.
| Job stress in young physicians with an emphasis on the work-home interface: a nine-year, nationwide and longitudinal study of its course and predictors.CrossRef |
 Ware J, Kosinski M, Dewey J. How to score Version 2 of the SF-36 Health Survey. Lincoln, RI: Quality Metric Inc.; 2000.
 Australian Institute of Health and Welfare. Medical labour force 2007. National health labour force series no. 44. Cat. no. HWL 42. Canberra: AIHW; 2009. Available at http://www.aihw.gov.au/publications/hwl/hwl-45-10723/hwl-45-10723.pdf [verified October 2009].
 Smith B, Smith TC, Gray GC, Ryan MA. When epidemiology meets the Internet: web-based surveys in the Millennium Cohort Study. Am J Epidemiol 2007; 166 1345–54.
| When epidemiology meets the Internet: web-based surveys in the Millennium Cohort Study.CrossRef |
 Ekman A, Dickman PW, Klint A, Weiderpass E, Litton JE. Feasibility of using web-based questionnaires in large population-based epidemiological studies. Eur J Epidemiol 2006; 21 103–11.
| Feasibility of using web-based questionnaires in large population-based epidemiological studies.CrossRef |
 Nohr EA, Frydenberg M, Henriksen TB, Olsen J. Does low participation in cohort studies induce bias? Epidemiology 2006; 17 413–8.
| Does low participation in cohort studies induce bias?CrossRef |
 Quine L. Workplace bullying in NHS community trust: staff questionnaire survey. BMJ 1999; 318 228–32.
| Workplace bullying in NHS community trust: staff questionnaire survey.CrossRef | 1:STN:280:DyaK1M7hsFeitA%3D%3D&md5=e42f8a77e630caceb805e91b57679dffCAS |
 Dickson D. Bullying in the workplace. Anaesthesia 2005; 60 1159–61.
| Bullying in the workplace.CrossRef |
 Skinner CA, Braithwaite J, Frankum B, Kerridge RK, Goulston KJ, on behalf of the Hospital Reform Group Reforming New South Wales public hospitals: an assessment of the Garling inquiry. Med J Aust 2009; 190 78–9.
 Australian Human Rights Commission. Good practice, good business: eliminating discrimination and harassment from your workplace – workplace bullying. Available at http://www.humanrights.gov.au/info_for_employers/pdf/7_workplace_bullying.pdf [verified August 5, 2001].
 Kieseker R, Marchant T. Workplace bullying in Australia: a review of current conceptualisations and existing research. Australian Journal of Management and Organisational Behaviour 1999; 2 61–75.