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

By Shamard Charles, MD, MPH
Published April 26, 2023

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.

From the author

I'm a public health physician, and I have three rules for early career medical professionals: Be on time; be prepared; and know your patients. But recently I’ve had to add a fourth: Never wear your stethoscope around your neck. This statement invariably confounds my medical students—am I joking, or am I serious?

Unfortunately, it’s the latter—a once tongue-in-cheek “rule” has taken on a more somber tone after a patient attempted to strangle one of my colleagues with the instrument. She detangled herself and ultimately emerged from the situation (physically) unscathed, but she took a 2-week leave to wrap her head around what happened. A year later, she left the field of medicine entirely. 

Attacks on doctors, nurses, and hospital staff have become so commonplace that some have normalized the experience, calling it “part of the job.” And society's quiet acceptance of this growing crisis diminishes the urgency for meaningful conversation on improved safety protocols, new protections, and more conflict-resolution training. I hope this story shines a much-needed spotlight on this critical problem facing medicine.

—Shamard Charles, MD-MPH

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.

Pulse of violence awareness-1

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.

Spotlight on change: IMPACT fights violence against HCPs

The Interdisciplinary Medical & Patient ‍Alliance for ‍Care Transformation, or IMPACT, aims to create a better healthcare system through education and research while fighting corruption within the industry.

IMPACT’s current campaign supports the Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1195). Introduced to Congress in February 2021, the bill failed to pass the Senate but was reintroduced to the House on April 18, 2023.

“I don’t know of any healthcare worker who has not faced violence in the workplace,” said Abby Donley, IMPACT Executive Director.

On October 17, 2023, IMPACT will be in Washington, DC, to raise awareness and support for the workplace violence bill. To get involved, email: hello@impactinhealthcare.org.

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.

"The ED isn’t safe for doctors. There are few, if any, barriers between patients and providers, so we’re constantly in harm's way. "

Nyema Woart, DO, emergency medicine, The Brooklyn Hospital Center, New York

“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.

Patients enter hospitals and clinics with economic, relational, and professional issues that are compounded by poor health. The combination of outside stressors, pain, fear, and undiagnosed medical or psychiatric conditions heightens patient-provider tensions, creating a complex mix of feelings that may be difficult to navigate.

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]

What we heard from HCPs

  • "I think it reflects an increase in violence everywhere in every sector of US society. We value guns and are an aggressive society. We watch it on TV, in the movies, and we are more divided than ever."

  • "Patients suffer from many mental health disorders. They have substance abuse disorders and PTSD from emotional, sexual, and physical abuse. Violence is associated with all of these experiences."

  • "There are several issues: Poor doctor-patient communication, overburdened healthcare system, inadequate security measures, lack of respect for healthcare professionals, and political and social unrest."

  • "Patients have increased financial burdens and their care is not always covered by their insurance so they displace their anger onto healthcare professionals."

  • "False information about the COVID-19 origin and the dangers of the vaccination have resulted in mistrust of healthcare professionals."

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.

"Widening income gaps from the pandemic added fuel to fire."

Nyema Woart, DO, emergency medicine, The Brooklyn Hospital Center, New York

"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.

Types of violence-2

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.

Related: In harm's way: Who is most vulnerable to violence against HCPs?

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.

"Being subjected to abuse is counterproductive to patient care, and our own health as providers."

Nyema Woart, DO, emergency medicine, The Brooklyn Hospital Center, New York

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.

Negative impacts-4

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.

How they coped-3

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]

What we heard from HCPs

  • "Planning for early retirement."

  • "Fired the patient!"

  • "It affects morale, but otherwise we carry on."

  • "Most incidences were short-lived experiences; I recovered quickly; laughter helps."

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.

What we heard

  • "There is a policy but no training—we had active shooter training, which was terrifying."

  • "Yearly training in dealing with difficult patients."

  • "Task force has looked for ways to better protect our staff, including self-locking doors, parking lot lights and emergency notification buttons."

  • "Workplace violence task force has created a training manual which serves as the focal point of the workplace violence refresher course held annually at each of our four work sites."

  • "Training for all new staff on de-escalation as well as how to respond to violence."

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.

There is no federal law that protects healthcare employees from workplace assault or intimidation.

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]

What we heard

  • "Nobody should be alone with a patient, should always have at least 2 people in room at all time."

  • "Patients should know there will be a zero-tolerance policy for any abusive behavior towards any staff member. All staff should get some training in how to defuse situations that arise. No firearms should be allowed in any type of medical facility."

  • "Need to have drills for active shooter."

  • "Sadly I think we need around-the-clock office security. Also getting tactical training or self-defense or firearms training is necessary."

  • "I think we as healthcare providers should have more protection and universal protocols to reports issues. It can be confusing to navigate when every facility has different protocols."

  • "Having stronger policies of not tolerating verbal abuse and discharging patients from practice if violation occurs."

  • "These are societal problems with no easy solutions. I would lean towards a return to earlier values of courtesy that have been lost in recent years."

  • "More education and awareness of evidence-based medicine among lay people. Healthcare providers who spread medical disinformation, which fuels violence from science-deniers, must have licenses sanctioned."

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.

Related: Violence against HCPs: A call for federal protections

If you are the target of violence or threats

  • Keep your distance. Decreasing proximity to patients when you are not actively treating them can keep you out of harm's way.

  • Stay calm, de-escalate and redirect. Aggressive behavior should never be met with an aggressive response. When tensions are high, stay calm (no matter how hard it might be).

  • Seek assistance to prevent or respond to violence. Colleagues, security, and hospital staff are here to help. Never feel like you need to handle a potentially dangerous situation alone.

  • Say something. Violence in clinics and hospitals will remain in the shadows if we remain silent. Reporting these instances is key. Make sure your employer has a clear and consistent reporting structure for workplace violence, and know your workplace’s specific policies and procedures on how to report violent incidents to law enforcement.

  • Press charges. If you are assaulted, it is within your right to press charges so that the perpetrator is not allowed to repeat this behavior. Many states have established laws with enhanced penalties for these offenses.

  • Take a deep breath (and when you’re ready, talk about it). It’s natural to experience anxiety, fear, and intimidation after a threat of violence. Taking a deep breath and talking with someone (a friend, family member, colleague, or trusted healthcare provider) may help.

  • Differentiate between burnout supports and burnout solutions. While self care, like meditating and yoga, is encouraged, relying solely on these methods may not be enough. In fact, self care is sometimes considered victim-blaming (resolving trauma is not a matter of effort or willpower, but an active process that may involve outside help)  and may be counterproductive in the long run. Seek professional help if needed.

  • Take advantage of training. Security staff often hold training on best practices to address workplace violence—attend them.


1.  US Bureau of Labor Statistics. Fact sheet: Workplace violence in healthcare, 2018. April 2020. 

2.  Poll: Increasing Violence in Emergency Departments Contributes to Physician Burnout and Impacts Patient Care. Press release. American College of Emergency Physicians. September 22, 2022. 

3. ACEP Emergency Department Violence Poll Results. American College of Emergency Physicians. September 22, 2022.

4. CDC. National Institute for Occupational Safety and Health (NIOSH). Violence Occupational Hazards in Hospitals. June 6, 2014.

5. Boyle P. Threats against health care workers are rising. Here's how hospitals are protecting their staffs. AAMC News. August 18, 2022.

6. Chakraborty S, Mashreky SR, Dalal K. Violence against physicians and nurses: a systematic literature review. Journal of Public Health. 2022;30(8):1837–1855.

7. Henry TA. Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years. AMA. January 18, 2022.

8. Flight Attendants Cheer Introduction of Protection from Abusive Passengers Act. Association of Flight Attendants-CWA. Media release. April 6, 2022.

9. Reps. Dean and Bucshon Introduce Bill to Protect Healthcare Employees. Press release. June 7, 2022.

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