Reputational risk and damage to career prospects keeping doctors silent about working conditions

"Raising concerns about the HSE is like raising concerns about global warming," one intern is quoted as saying. Picture: Pexels

A quarter of hospital doctors say they wouldn't raise concerns about workplace conditions for reasons including a perceived risk to their reputations, a lack of time and energy, and a feeling that nothing would change in any case.

The finding is included in a new study in which the views of more than 1,000 hospital doctors were sought, with the authors claiming that it "highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions".

The report was carried out by researchers from the Royal College of Physicians of Ireland, School of Nursing, Psychotherapy and Community Health at DCU, the DCU Business School, and Cardiff Business School in Wales.

In October–November 2019, some 1,070 hospital doctors responded to a national online survey, hooked around the question: “If you had concerns about your working conditions, would you raise them?”.

In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions.

"Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions," it said. 

"Apathy arose as a change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships."

Of those who said they would not raise workplace concerns, most were Irish, the gender split was almost 50:50 and they worked across a number of grades, from consultant to intern.

Apathy

"Among silent doctors, silence driven by apathy was more common than fearful silence," it said. 

"In the 200 text responses analysed, there were 140 apathetic responses and 78 fearful responses; 18 respondents gave multiple reasons both apathetic and fearful for their silence."

One intern said: "Raising concerns about lack of resources in the HSE would be like raising my concern about global warming."

A consultant said: "Management is well aware of these concerns, and yet have no willingness to do anything about them. Raising them again would not be of benefit."

Another theme identified was the "normalising" of silence. 

One intern said: "Lots of talking but no action, no political will. It’s the Irish way, unfortunately."

Another said: "Junior docs are powerless... nobody wants to hear it, consultants do not support [us]".

Reputational risks

"Non-consultant hospital doctors were highly conscious of the reputational risks of voice, and often saw speaking up as a career risk outweighing any benefit they might gain," the report said, quoting one medic: "It would risk earning me a reputation as being difficult to work with".

A female doctor said: "I would worry about being seen as a nag or troublemaker."

According to the report: "Findings from the responses suggest that junior hospital doctors in Ireland, particularly interns, feel they have less cultural capital within the profession, that their concerns are perceived as less professionally legitimate and are more silent than others."

Others felt vulnerable, and the report said: "Many respondent doctors indicated, without prompting, that their silence led directly to plans or hopes for exit."