Bullying and Harassment Amongst Junior Doctors – Detailed Analysis

Methodology:

An anonymous survey was conducted amongst about 16,000 doctors of the DOBBS forum (facebook group, telegram and web forums) using a Web based survey Questionnaire.
A target sample size of at least 376 to achieve 95% Confidence Interval with a 5% margin of error was aimed for (based on this sample size calculator). The first 535 responses received were evaluated.

Results

We asked respondents if they had experienced Bullying as a Junior doctor, where Bullying in the line of work was defined as "Offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means that undermine, humiliate, denigrate or injure the recipient.”

The overall percentage who reported Bullying as a Junior doctor was 79.63%.

Bullied Yes No %
Female 218 56 79.56
Male 208 53 79.69
All 426 109 79.63
% 79.63 20.37

There was no statistical difference in the incidence of reported bullying comparing female and male doctors (Fisher exact test value = 1)

For those who reported they were bullied, we also asked if they also experienced as a result of the bullying:
- anxiety
- difficulty sleeping
- loss of appetite
- inability to switch off from work
- self-doubt
- loss of confidence
- feeling isolated
- hyper-vigilance or a need to constantly double-check your work.
This would imply the bullying was more "severe" as to cause "symptoms"

Overall 89.2% of reported bullying was "symptomatic", and the Overall symptomatic bullying was 71.03% of respondents.

Symptomatic  Bullying Yes No %
Female 195 23 89.45
Male 185 23 88.94
All 380 46 89.20
% 89.20 10.80
% ALL doctors 71.03

There was also no difference between female and male doctors for Symptomatic bullying (Fisher exact score is 0.8773)

We next asked if those who felt they were bullied if they ever felt Suicidal as a result and the result showed 16.9% of bullied doctors did feel suicidal at some point in time

Suicidal Yes No %
Female 40 178 18.35
Male 32 176 15.38
All 72 354 16.90
% 16.90 83.10

There was also no statistical difference between female and male doctors (Fisher exact score is 0.4398)

We finally asked the doctors if they had ever felt harassed in the workplace as a junior doctor. Workplace harassment is more serious than bullying and in some countries this is illegal.
Harassment was  defined as " unwanted conduct that is related to a protected characteristic (age, sex, disability, gender reassignment, race, religion or belief or sexual orientation) or unwanted conduct of a sexual nature."

44.67% of respondents felt harassed at their workplace. In an earlier poll we asked only about Sexual harassment in the workplace which showed 36% saying they have been sexually harassed. In this extended definition of work place harassment the percentage is higher but includes sexual harassment.

Harassed Yes No %
Female 128 146 46.72
Male 111 150 42.53
All 239 296 44.67
% 44.67 55.33

Although slightly more female doctors than male doctors reported workplace harassment, there was no statistical significance (Fisher exact score = 0.3398)

Addendum

Further analysis was conducted to see if bullying experienced during Junior doctor years, as reported by House officers and Medical officers was the same or different when compared to the experience reported by doctors who are now more senior (GPs, Specialists, Others)
The breakdown is as follows:

Category Bullied Not bullied
GP 54 22
Specialist 94 52
Other 16 4
HO 63 5
MO 200 25

The constructed 2 x 2 table putting GPs, Specialists and Others as Senior and HOs and MOs as junior:

Category Bullied Not bullied
Senior 164 78
Junior 263 30

The Fisher exact test statistic value is < 0.00001. The result is significant at p < .05. This implies there is a statistically significant difference in reported experience of bullying by junior doctors compared with senior doctors. Whether this means bullying was less common when senior doctors were junior or whether the memories of being bullied fade over time, or some other reason is open to speculation.

Conclusion

The Malaysian medical work environment for Junior doctors is indeed toxic with a high percentage of reported bullying and work place harassment. Suicidal thoughts are also worryingly high as a result of bullying.

Link to blog post:
The extent of Bullying experienced by junior doctors in Malaysia