Unsafe haven: The rise of violence against physicians in the workplace

Violence against physicians in healthcare settings is reaching crisis levels—evidenced by shocking headlines and the sobering realization that hospitals and clinics are not the "safe zones" they used to be. This unacceptable trend is taking a hit on already stressed and disillusioned healthcare professionals, who are speaking out: They urgently need more protections against violence.

MDLinx surveyed 50 practicing physicians to better understand their experiences and insights about workplace violence against HCPs. Commissioned through M3 Global Research, the survey sheds light on the impacts of this violence, the root causes, and possible solutions.

The state of violence against HCPs

The once "safe space" of a doctor’s office is sadly no more, with the rise in workplace threats and attacks a siren call for action to prevent violence against healthcare workers.

According to the US Bureau of Labor Statistics, healthcare workers accounted for nearly three quarters (73%) of all nonfatal workplace injuries and illnesses due to violence since 2018—five times the rate of any other worker in another industry.[1]

Results gleaned from MDLinx's physician survey add to current research on this subject, and highlight the growing trend of violence in healthcare-related work spaces.

In a national poll conducted in 2022 by the American College of Emergency Physicians (ACEP) and Marketing General Incorporated, more than 30,000 ACEP members shared their thoughts on workplace violence in the emergency department (ED).[2][3] Responses from the 2022 survey (2,712) were compared with 2018 results.

The report found a 24% increase in witnessed emergency department assaults in the 4-year span (79% in 2022 compared with 55% in 2018), with roughly 85% of physicians reporting loss of productivity, increased anxiety, and emotional trauma due to violence.

What triggers violence against HCPs?

The National Institute for Occupational Safety and Health defines workplace violence as acts or threats of violence directed against employees while at work or on duty, ranging from verbal abuse and bullying to harassment, physical assault, and homicide.[4]

The triggers for workplace violence are layered and multifactorial. 

Nyema Woart, DO, an emergency medicine doctor at The Brooklyn Hospital Center, New York, says the alarming rise in workplace violence, particularly in the ED, is concerning, and believes socioeconomic stress, patient proximity, and many other factors are to blame.

“Long wait times and a lack of resources have made it hard to take care of patients, especially when they have high demands and want things done a certain way,” Dr. Woart adds. “Their stress plus the high acuity of the ED means patients sometimes misconstrue what we can do, and how quickly we can do it, for them. When their expectations are not met, it leads to frustration, which they sometimes take out on providers.”

But these factors don’t tell the full story, Dr. Woart says.

According to the American Association of Medical Colleges, frustration amid staffing shortages, substance abuse, grief for a declining loved one, racial or ethnic prejudice, and dissatisfaction with a provider—especially those who adhere to stricter prescription guidelines for controlled substances—are among the most common reasons why patients resort to violence.[5]

Add to this, the lingering tensions between patient and provider, which were unmasked during the pandemic, and you have the makings of an explosive situation.

"We [society] have to unpack the root causes of these events, while also assessing the physical, emotional, and psychological toll it’s taken on providers, and their ability to provide quality patient care,” says Dr. Woart.

HCP violence by the numbers

Violence against medical professionals surveyed by MDLinx covers the gamut—from threats and intimidation to physical assaults, and everything in between. One thing is clear: Healthcare workplace violence is on the rise in urban areas, and even more so in the suburbs, according to survey results.

Among the participants in the survey, 92% reported working in traditional healthcare settings such as a private practice, health clinic, or hospital—with over 85% working in an urban or suburban environment. Nearly all respondents (96.1%) reported experiencing some form of verbal insult or abuse, and over half of respondents said they had to deal with discrimination or sexual harassment.

According to a literature review published in the Journal of Public Health (JPH),[6] emergency rooms and psychiatric institutions—not surprisingly—experience the highest volumes of workplace violence, with emergency medicine and psychiatric doctors reporting the highest percentage of violent attacks at the hands of patients.

This was particularly true during nighttime house calls, when perpetrators were more likely to be under the influence of alcohol or drugs. Of note, the majority of studies in the JPH review showed that nurses were more likely to be exposed to violence than physicians, and women more likely to be exposed to violence than men, the authors wrote.

The emotional and physical toll on HCPs

Every day, doctors and nurses put their physical and psychological safety on the line to care for their patients, but at what price? 

The threat of workplace violence compounds the inherent stress of working in the healthcare field, says Dr. Woart, and without adequate resources, it can lead to a deterioration of mental health, burnout for providers, and, in extreme cases, higher rates of depression, PTSD, and suicide.

Indeed, MDLinx survey respondents who experienced violence in the workplace reported a wide range of negative effects in the aftermath. More than half suffered from emotional or psychological trauma, while others reported difficulties with job performance and patient care, relationship challenges, career impacts, legal or financial troubles, and physical injuries.

Fortunately, the vast majority of survey respondents noted they took positive steps to cope, including discussing their feelings with family and friends, focusing on wellness and hobbies, taking time off work, and seeking therapy.

Dr. Woart cautions that hostility in the workplace is taking much-needed focus away from patient care, leads to shortened tempers, low morale, and decisions to leave current employment, Dr. Woart adds. These outcomes are reflected in medicine’s great resignation.[7]

Improving HCP safety

The state of the escalating crisis begs the question: What's being done to ensure safer workplaces for healthcare professionals?

According to the MDLinx survey, 69% of workplaces had established policies, protocols, and training programs to prevent and address violence—but that number leaves plenty of room for improvement. The good news: Of those who said their workplace had policies, protocols, and training programs, 89% of respondents said they followed them.

While most hospitals and health systems have robust protocols in place to detect and deter violence against their team members, instances of workplace violence are likely underreported.

By contrast, there are federal laws—such as the Protection from Abusive Passengers Act—criminalizing assault and intimidation against airline employees, leaving one to wonder why certain groups have federal protections while others do not.[8]

Identifying solutions

Action must be taken now to shield vulnerable caregivers from the threat of verbal and physical assault.

Support for the Safety from Violence for Healthcare Employees (SAVE) Act,[9] sponsored by Reps. Madeleine Dean (D-Pa.) and Larry Bucshon (R-Ind.), would make assault or intimidation against healthcare workers on the job a federal offense, and would help curtail violence against hospital staff. The bill is currently under review by a group of North Carolina legislators.

Additionally, more transparent processes and clearer guidelines for when and how to report cases would reduce barriers to reporting, putting the magnitude of workplace hostility in clear view.

Providing adequate resources to HCPs following an act of violence, such as educational materials and counseling, can reduce the negative mental health impacts. This may ultimately lead to higher job retention in healthcare settings and improve productivity among HCPs.

At the end of the day, the physician who feels happy and safe at work is the one providing the best patient care possible.