Symposium Acknowledges Workplace Bullying, Harassment, Discrimination as a ‘Today Problem’

When AAOS launched its last Strategic Plan in 2019, it included a goal to evolve the culture and governance of AAOS’ Board of Directors and volunteer structure to become more strategic, innovative, and diverse. In its newly approved Strategic Plan for 2024 to 2028, AAOS aimed to do more than create diversity within leadership. The new Strategic Plan has four overarching goals, one of which is to be committed to diversity in patient care, AAOS leadership, and the orthopaedic profession. The need for greater diversity of all types was discussed in detail during the 2024 AAOS Annual Meeting at Symposium G, titled “Addressing Discrimination, Bullying, and Harassment in the Orthopaedic Workforce: A Leadership Roundtable” and led by AAOS Immediate Past President Kevin J. Bozic, MD, MBA, FAAOS.

Pervasive problem
As a further reflection of its commitment to a diverse profession, the AAOS Board of Directors recently proposed a change to its Standards of Professionalism (SOP), adding wording specifying that harassment, bullying, and discrimination are unacceptable behaviors under the SOP. The amendment went into effect in June 2023 and reads: “An orthopaedic surgeon shall conduct himself or herself in a professional manner in interactions with colleagues or other healthcare professionals. This includes but is not limited to avoiding behavior that is harassing, bullying, or discriminatory.”

“The particular topic of this session first came up 2 years ago at the AAOS 2022 Annual Meeting, and it opened my eyes to how prevalent bullying, harassment, and discrimination are in our profession,” Dr. Bozic said. Dr. Bozic was joined by Anthony E. “AJ” Johnson, MD, FAAOS, past chair of the AAOS Diversity Advisory Board, who discussed some of the somewhat surprising results from a 2022 work environment and culture survey of all AAOS members.

For example, bullying, discrimination, and harassment were more pervasive than they realized. “They were reported by every segment of our respondents,” Dr. Johnson said. Although women were more likely to have experienced negative behaviors than men (84 percent versus 35 percent, respectively), a notable portion of surveyed men also reported negative behaviors in the workplace, especially sexual harassment (55 percent versus 14 percent for women and men, respectively). Both women and men encountered discrimination (87 percent versus 54 percent) and harassment (55 percent versus 39 percent).

Same problem, different views
Following his portion of the event, Dr. Johnson then introduced the panelists for the session, who were each invited to share their thoughts about what tactics could be employed from a leadership standpoint to help combat these issues at the departmental level. Exceptional leadership can create a culture where people feel safe no matter their background and feel safe talking about any problem that might arise, according to Lisa Lattanza, MD, FAAOS, chair of Yale Medicine Orthopaedics and Rehabilitation.

Dr. Lattanza shared a story about an incident that occurred during her first week as chair. “I had an opportunity to address a very public display of bullying at a faculty meeting,” Dr. Lattanza said. “I spent time looking into it, and that person had a long history of this behavior; that faculty member was removed. If I had let that go, and people saw me let that go, it would have set a different tone for the department and for me as the chair.”

MaCalus V. Hogan, MD, MBA, FAAOS, chair of orthopaedic surgery at University of Pittsburgh Medical Center, echoed the importance of promoting what you permit. “Culture is defined by the behavior you accept, not what you actively display,” Dr. Hogan said. “As a leader, the group is looking to you to see if you are going to approach these situations with silence. Addressing [bullying, harassment, and discrimination] is uncomfortable, but we have to be willing to have a conversation about it.”

Finally, Melvyn A. Harrington Jr, MD, FAAOS, director of the orthopaedic surgery residency program at Baylor College of Medicine, said it is important to remember that for trainees reporting bullying, harassment, or discrimination, there are always power dynamics in play. “The one challenge we see is difficulty in reporting,” said Dr. Harrington. “One important thing with trainees is to believe them. Someone may report microaggressions, and one of the key things with microaggressions is not necessarily what was meant by what was said, but how it was interpreted.”

Barriers to progress
Dr. Johnson then asked panelists what barriers they have seen to progress in these areas. Mikalyn DeFoor, MD, a fourth-year orthopaedic surgery resident at Brooke Army Medical Center and chair of the AAOS Resident Assembly Diversity, Equity, and Inclusion Committee, said that residents can be in vulnerable positions. “We show up to work to take excellent care of patients, learn, and perfect skills as a surgeon,” Dr. DeFoor said. “We didn’t think about having to combat some of these issues we are talking about.”

Dr. DeFoor admitted that her experience in residency in San Antonio may be different from someone’s in New York. Each person may be confronted with different issues and concerns, but everyone just wants to be heard and work in an environment where they feel comfortable enough to talk about it.

Speaking up can be difficult. When Jennifer M. Weiss, MD, FAAOS, of Shriners Children’s Hawaii, realized just how large the problem of bullying, harassment, and discrimination was, she worked with colleagues to establish #SpeakUpOrtho, an initiative designed to increase awareness of bias, inequities, and harassment within orthopaedic surgery.

“The number one reason that people do not report any of these behaviors is fear of retaliation,” Dr. Weiss said. “We wanted to harness the power of the anonymous story.” Dr. Weiss said that after connecting with women in the generation before hers, they were shocked to learn these behaviors were still happening. Although #SpeakUpOrtho has been an excellent resource, Dr. Weiss said they do struggle with balancing their commitment to being anonymous against their desire to achieve change.

Change is the goal, according to Dr. Bozic, and he called on the entire orthopaedic specialty to acknowledge this problem and work to be part of the solution. “What I have learned is that this happens everywhere, every day,” Dr. Bozic said. “This is not a historic problem; it is a today problem.”

Leah Lawrence is a freelance medical writer for AAOS Now.