Bullying in surgery: what senior surgeons say and why it matters

What is it about?

What’s it about? This study examines the nature, extent, and impact of workplace bullying in surgical settings, drawing directly on the experiences of senior surgeons across Australia and Aotearoa New Zealand. While surgery is often characterised as a high-pressure, hierarchical profession where stress and blunt communication are seen as unavoidable, this research asks a more fundamental question: what actually happens inside surgical workplaces, and what are the consequences when harmful behaviour becomes normalised? Using in-depth qualitative interviews, surgeons described a wide spectrum of bullying behaviours. These ranged from overt actions such as shouting, public humiliation, and intimidation, to more subtle and persistent practices including exclusion from decision-making, undermining of professional credibility, punitive rostering, and the strategic misuse of authority. Many participants noted that these behaviours are not always recognised as bullying at the time, particularly when they are embedded in long-standing cultural norms or justified as part of “tough” surgical training. The study reveals that bullying in surgery is not an isolated or rare phenomenon. Rather, it is often sustained by rigid hierarchies, entrenched power imbalances, and early professional socialisation that teaches trainees to endure mistreatment as a rite of passage. Several surgeons reflected on how these dynamics discourage reporting, silence bystanders, and allow harmful behaviours to persist across generations of practice. Importantly, the paper documents the impact of bullying well beyond individual distress. Participants described lasting effects on mental health, confidence, and career trajectories, including withdrawal from leadership roles or entire specialties. At an organisational level, bullying was linked to fractured teamwork, poor communication, loss of skilled staff, and diminished psychological safety—conditions that surgeons themselves identified as incompatible with high-quality, safe patient care. Rather than framing bullying as the result of a few “bad actors,” this research highlights how otherwise competent and committed professionals can become both perpetrators and victims within systems that tolerate or reward aggressive behaviour. Surgeons spoke candidly about moral injury, regret, and the tension between professional identity and organisational culture. By centring the voices of senior surgeons, this paper provides a grounded and credible account of why bullying remains so persistent in surgical environments despite growing awareness and formal interventions. It offers an essential evidence base for understanding bullying as a cultural and structural problem, and lays the foundation for reform efforts that go beyond individual behaviour change to address leadership, training, and organisational accountability.

Featured Image

Photo by Olivier Gerbault on Unsplash

Photo by Olivier Gerbault on Unsplash

Why is it important?

Workplace bullying in healthcare is often discussed, but rarely understood in ways that lead to meaningful change. Much of the existing literature focuses on prevalence surveys, junior staff experiences, or individual coping strategies. This study is important because it shifts the lens to where cultural norms, power, and influence are most concentrated: senior surgeons. By capturing the perspectives of experienced surgeons across Australia and Aotearoa New Zealand, this research provides rare insight into how bullying is understood, justified, challenged, and perpetuated at the top of surgical hierarchies. These voices are often absent from bullying research, yet they play a decisive role in shaping workplace culture, training environments, and acceptable behaviour. The study therefore moves beyond describing harm to explaining why it persists. A key contribution of this paper is its refusal to reduce bullying to a problem of individual “bad behaviour.” Instead, it shows how bullying is embedded in structural features of surgical work, such as rigid hierarchies, informal power networks, and early professional socialisation that normalises endurance, silence, and deference. This systemic framing helps explain why bullying can continue even in organisations with formal policies, codes of conduct, and professionalism training. The study is also distinctive in documenting the consequences of bullying as described by surgeons themselves, including moral injury, disengagement from leadership, and erosion of trust within teams. Importantly, participants drew explicit connections between bullying, reduced psychological safety, and risks to patient care—challenging the long-held assumption that aggressive behaviour is compatible with high performance in high-stakes environments. Another unique feature of this research is its geographic and cultural scope. By examining surgical practice across both Australia and Aotearoa New Zealand, the study highlights shared professional norms while remaining sensitive to local institutional and cultural contexts. This strengthens the relevance of the findings for healthcare leaders, professional colleges, and policymakers across the region. Ultimately, this paper is important because it provides a credible, insider account of how bullying operates in surgery, and why surface-level interventions so often fall short. It establishes a foundation for reform that recognises bullying as a cultural and organisational issue requiring leadership accountability, structural change, and sustained attention, rather than relying solely on individual resilience or behavioural correction.

Perspectives