The rates of violence against physicians are on the rise, exacerbated by the COVID-19 pandemic.
Psychiatrists, emergency medicine physicians, and geriatricians are at especially high risk for workplace violence.
HCPs across the industry can work together to advocate for federal legislation that protects against workplace violence.
Violence against physicians and other healthcare workers is a rising threat, one that not only harms the physical well-being of healthcare workers but also negatively affects productivity. The threat of violence compromises quality of care and the provision of services, contributing to financial loss.
This article complements MDLinx's exclusive special report, Unsafe haven: The rise of violence against physicians in the workplace. Read the report here.
According to the US Bureau of Labor Statistics, as of 2018, healthcare workers accounted for nearly three quarters (73%) of all nonfatal workplace injuries and illnesses due to violence, five times the rate of any other worker in another industry.
Risk factors for violence against HCPs
The risk of violence extends to healthcare workers worldwide. The WHO estimates that 8%–38% of health workers experience physical violence during their careers. Countless more are threatened or exposed to verbal aggression and harassment. This violence is primarily committed by patients and visitors. Disaster, conflict, and politics can exacerbate such violence.
Physicians who work in emergency medicine, geriatrics, or psychiatry are at greatest risk for workplace violence, due to frequent contact with patients who are intoxicated or exhibiting psychosis, delirium, or dementia. Hospital environments pose a greater risk than ambulatory settings, with psychiatric workers at especially high risk.
Long-term nursing and residential care facilities are other hotbeds of violence, with a rate 75% higher than in hospitals, according to a review in Missouri Medicine.Related: In harm's way: Who is most vulnerable to violence against HCPs?
Violence in the era of COVID
The COVID-19 pandemic was a crucible for workplace violence against physicians, said Dr. Gerald E. Harmon, writing for the AMA.
“Even more disturbingly, though racially and ethnically motivated violence is not new, reports of verbal and physical abuse by white supremacists attacking the personal characteristics of health care professionals from historically and racially marginalized groups represents a deeper layer of racism,” he wrote.
Early during the pandemic, the AMA recognized potential violence and xenophobia aimed at Asian Americans, and sounded the alarm. This renewed bias compounded long-standing concerns stemming from interpersonal and structural racism.
Harmon also stressed that racially motivated attacks against physicians are often minimized by being characterized as merely “disruptive.” Such violence often spills over online, with at least 25% of US physicians experiencing harassment or assault for reasons relating to vaccines, guns, race, religion, or patient care. In one particularly distressing example, a Black female physician was threatened with rape due to her work with civil rights advocacy.
Race was also identified as underlying factor in violence against healthcare workers, in a large, mixed-methods international assessment of pandemic-related stigma and bullying, published in BMJ Open.
“After controlling for a range of confounding factors, [healthcare workers] are significantly more likely to experience COVID-19-related stigma and bullying, often in the intersectional context of racism, violence and police involvement in community settings,” the authors wrote.
Workplace violence may contribute to physician burnout and decisions to leave the field, according to the Missouri Medicine review. The proportion of physicians leaving medicine increased to 1.3% in 2021 from 0.39% in 2019, or an additional 10,000 physicians per year.
“In the high-intensity setting of a hospital during the pandemic, increased violence compounds the burnout experienced by healthcare workers and contributes to healthcare’s increasing resignations,” the authors wrote.
"It is well-established that workplace violence, both verbal and physical, contribute to burnout and drive high turnover rates in medicine."
— Authors, Missouri Medicine
What steps can we take to protect HCPs?
There are no national standards for the prevention of workplace violence in healthcare settings, states the American College of Physicians (ACP) in the background to its Advocacy Toolkit against workplace violence. The Occupational Safety and Health Administration does not require employers to enact workplace violence-protection programs, although it does provide voluntary guidelines. To date, laws establishing workplace violence prevention standards for healthcare employers have been passed by only 10 states. In general, these laws require the implementation of programs and the tracking and reporting of violent incidents.
The ACP has repeatedly spoken out to condemn violence against physicians and other healthcare workers, and the organization’s policy states that “no one should be subject to harassment, physical, or verbal violence at their place of work.”
In September 2021, ACP issued a statement on workplace violence prevention and management. The policy recognizes the full scope of workplace violence and its impact on the healthcare industry, calling for additional research to better understand workplace violence and potential interventions. The policy supports legislative efforts to reduce and prevent instances of workplace violence and bolster workplace safety.
The AMA has also issued a policy on the issue, which includes steps toward building a safer workplace. The authors stress the importance of acknowledging and acting to reduce the incidence rates of “antagonistic actions” against healthcare workers, and note their aim to provide education for the general public about the prevalence of violence both in and outside the workplace, while working with stakeholders to improve workplace safety.
On June 7, 2022, representatives Madeleine Dean (D-Pa.) and Dr. Larry Bucshon (R-Ind.), introduced the Safety From Violence for Healthcare Employees Act, which imposes legal penalties for anyone who knowingly or intentionally assaults or intimidates hospital employees. The bill mirrors protections already in place for aircraft and airport workers.
Work to prevent violence against HCPs must continue
The AMA stresses that hospitals, health systems, solo practices, and other healthcare organizations should work together to share best practices to prevent violence inside and outside healthcare settings. Possible interventions include:
The institution of security and safety protocols to protect physicians and other healthcare workers from hate-based violence.
The development of comprehensive surveillance and data collection systems and technologies to track hate-based violence against physicians and other healthcare workers.
The establishment of solidarity-based strategies to unite healthcare workers and organizations to call out, confront, and resist hate-based violence and intimidation.
What this means for you
To date, legislation to protect HCPs from workplace violence is piecemeal and varies by state and healthcare system. Professional organizations such as the AMA and ACP have sounded the call to institute policies that will protect physicians and other healthcare workers from the rising rates of workplace violence. Their position is essential, as there is no federal law to protect HCPs against violence and intimidation. As advocated by the AMA, it’s important for hospitals, health systems, and healthcare practices to work together to share best practices and strategies to confront this dangerous trend.