"Dr P", an American surgeon, says he was bullied, harassed and discriminated against as he tried to have his skills recognised in Australia. Credit:Brian Cassey The cabal, he says, included representatives of the college of surgeons who were responsible for assessing his skills and judging his application for fellowship – the ticket he needed to freely practise in public hospitals and within Australia's lucrative private medical market. This gave them the ability to block him, and effectively lock him out of the profession in Australia. A Fairfax Media investigation has found two overseas-trained surgeons with compelling claims of bullying, professional mobbing and anti-competitive behaviour that reach into the powerful college of surgeons – a secretive group that largely controls the supply of surgeons in Australia, and allegedly, the level of competition and fees they can charge. A recording of a college exam in another specialty – ear, nose and throat surgery – has exacerbated concerns about the way the college runs tests for overseas-trained doctors. Aspiring surgeons pay nearly $8000 to sit the exam to prove themselves for entry into the Australian market. College rules say candidates should be not be identified to the examiners, and that the assessment should be based only on their scores.

But during the recording, two leading surgeons discuss the candidate's migrant background, talk about the local doctors' views of him, and decide to measure him against how others perform on the day. This last decision leads the examiners to lower his score so he fails. At the time, one of the examiners worked in the same city as the overseas-trained candidate who failed the high stakes exam. British-trained plastic surgeon Patrick Tansley says he was threatened by Australian plastic surgeons. Credit:Jason South An edited version of the recording was made into a video that has since been published online. The college says an investigation of the video and recording found no bias against the candidate, and only "minor breaches" of protocols which did not play a role in whether the person passed or failed. Nonetheless, it has increased oversight of its exams. While the college does not record exams itself, it said its investigation found the published video did not accurately reflect what took place in the exam. No disciplinary action has been taken against the examiners. They were counselled instead. Illustration: Ron Tandberg

While the migrant went on to pass the exam another year, the college's investigation has infuriated an American-trained surgeon who wants to be known only as Dr P for fear of repercussions. Dr P told Fairfax Media that when he listened to the recording, he lost all faith in the college's ability to fairly assess overseas-trained doctors and local trainees. Two other senior ear, nose and throat surgeons who have listened to the recording say they, too, were troubled by the examiners' behaviour and would have passed the candidate. Dr P, who is not the candidate being discussed in the exam in question, complained to the college about the recording in 2015 following years of alleged bullying, harassment and discrimination in his quest to have his skills as a US-trained ear, nose and throat surgeon recognised in Australia. Like Mr Tansley, he says surgeons in his specialty deliberately sabotaged his efforts, so he would not be able to practise in the field, where people pay thousands of dollars for private operations.

Dr P said the first warning came soon after he arrived in Australia five years ago for a one-year training position. He hoped the job would help him transition into the Australian system – his wife is Australian. After applying to the college for recognition, he was told his skills were "partially comparable" and that he would have to sit the same fellowship exam Australian trainees sit. Dr P accepted. The exam requires months, if not years, of intensive study. About a week into his fellowship training position, Dr P says a senior surgeon supervising him asked if he planned to stay in that same city. When he said that he wanted to settle interstate, the senior surgeon allegedly expressed relief, saying if he wanted to be a local, it would have affected his training. "I was quite flabbergasted and at a loss for words," Dr P said.

It was the beginning of a turbulent relationship. Dr P says that same senior surgeon turned out to be a known bully – a professor who frequently berated and humiliated junior surgeons in front of their operating teams. Dr P reported his concerns to one of the college's international medical graduate representatives, who told him he was not alone. Others had expressed similar concerns. Dr P resigned and reported the allegations to the public hospital where they had been working. Despite receiving many supportive messages from colleagues, Dr P was worried his complaint might affect his likelihood of passing the exam. He moved interstate in 2012, but when he turned up for his exam in 2014 he was stunned to find the professor he had complained about was one of his examiners. Under college policy, an examiner who discovers they have an "actual or perceived" conflict of interest when they meet a candidate must raise it with a senior examiner on the day and take a secondary role. The professor did not do that.

Dr P failed. He continued working under supervision on the understanding he would sit the exam again in future. But his new supervisor allegedly told a colleague in late 2014 that he had "many friends" who would ensure Dr P never got fellowship. "I couldn't believe that this statement was made in front of me and my wife," his colleague wrote in a letter to the college, adding that he was "totally incredulous about how one professional could try to destroy the life and career of another". Dr P's colleague felt he was "more than qualified" and had been the victim of "a great deal of injustice". Other surgeons agreed. Dr P, who has young children, contemplated suicide. He was working on patients including vulnerable Indigenous people who had waited years for treatment. And yet, all of his work and study towards the exam seemed doomed.

Throughout 2015, Dr P made complaints to the college about the professor who had examined him in 2014, saying he had a conflict. He also complained about his supervisor's alleged vow to block his progress. The college looked into his claims but the professor insisted he was not conflicted, so the college took no action against him. The college's separate investigation into Dr P's claim against his supervisor was cancelled three days before a panel hearing. Then there was the video. Dr P sent college representatives the video of the secret exam recording. He says the college's investigation was a "sham" that should undermine trust in its processes. Dr P has since returned to the US with his family. This was not the surgical profession's first brush with accusations of anti-competitive behaviour. In the 2000s, the Australian Competition and Consumer Commission monitored the college due to concerns about its assessment of overseas-trained doctors and allegations it was restricting entry to training. But the monitoring stopped in 2009, after which the pass rate for overseas-trained ear, nose and throat specialists dwindled to zero within five years.

Plastic surgery candidate Mr Tansley says he has also experienced sham reviews. The Cambridge-trained doctor, who became a plastic surgeon in the UK in 2010, says the college told him to complete two years' assessment under supervision and the same exam local trainees sit to get his qualifications recognised. He says the senior surgeon who warned him in 2011 about the difficulties ahead was one of the architects of the course. When Mr Tansley appealed this decision and complained to the college that the senior surgeon was biased against him, he says an "extraordinary backlash" began. Over the next four years, Mr Tansley faced multiple complaints to the Australian Medical Board about his competence, none of which have been substantiated. There have also been allegations that one of his supervisors, Sugitha Seneviratne​, had an undisclosed, close personal relationship with him. Dr Seneviratne says she has never been in a romantic relationship with Mr Tansley and that this "smear" has been one of several designed to disturb his efforts to get fellowship. The dispute became so fierce that in 2013 a group of 15 plastic surgeons at the Royal Melbourne Hospital, including the senior surgeon Mr Tansley had accused of bias, wrote a letter to the college accusing Mr Tansley of misrepresenting himself as a surgeon with their unit on a research website.

Mr Tansley, an honorary specialist with the hospital's general surgery unit, took defamation action against the surgeons. The case was settled out of court. The details are confidential, but Mr Tansley says the outcome was "satisfactory" to him. There is an apology letter from four of the 15 surgeons on his website. During the past four years, Dr Seneviratne says she has watched claims of improper conduct delay Mr Tansley's assessment process, drawing it out to make it nearly impossible for him to get fellowship within the four years he has been given to achieve it. "At each turn there has been an act of retribution that comes with the process," said Dr Seneviratne. "It has been almost child-like in its transparency." After paying tens of thousands of dollars in fees to the college, Mr Tansley is locked in a legal battle with it over his treatment. As a result, he cannot work as a plastic surgeon who can bill Medicare. He is currently working in a practice with Dr Seneviratne as a registered medical practitioner who does cosmetic surgery for full-fee-paying patients. He says patients are told he is registered as a plastic and reconstructive surgeon in the UK.

Wai-Ting Choi, a plastic surgeon who has worked with Mr Tansley, says Mr Tansley is an over-confident, potentially dangerous surgeon who has tried to skip very reasonable steps to get fellowship in Australia. Dr Choi says he has raised several concerns about Mr Tansley's competence with the medical board, which chose not to pursue them. During their time together at the Northern Hospital in Melbourne, Mr Tansley accused Dr Choi of bullying, but Dr Choi says an independent investigation commissioned by the hospital cleared him. Fairfax Media understands the Victorian Ombudsman looked into concerns about the way Dr Choi was treated by the Northern Hospital, but the report has never been publicly released. Mr Tansley's supporters say his talents and self-assurance have riled local plastic surgeons who perceive him as a threat to their leadership in public hospitals and in the private cosmetic market, where surgeons can earn more than $1 million a year. His opponents say he should never have challenged the college's decision for him to sit the exam in the first place. His case has been examined by the Australian Competition and Consumer Commission, which says it is working with a number of bodies, including governments, to discuss perceptions of conflicts of interest and partiality.