Almost a quarter of physicians report workplace mistreatment

Almost a quarter of physicians reported workplace mistreatment, according to research from Boston Medical Center and Stanford University School of Medicine. Patients and visitors were the most common source.

While mistreatment was common among all physicians, there were differences in mistreatment by gender and race. Women were twice as likely to report mistreatment than men. There were also significant differences in mistreatment by race.

The mistreatment created higher levels of occupation distress among physicians. Those who perceived there were protective workplace systems in place were associated with lower levels of occupational distress. The researchers said the findings show health care organizations recognize the urgent need to put systems in place that reduce mistreatment.

The research was published in JAMA Network Open. The survey was administered to 1,505 physicians on the clinical faculty at Stanford University School of Medicine in September and October of 2020 to assess the frequency and sources of mistreatment among physicians and the associations between mistreatment, occupational well-being, and perceptions of protective workplace systems. The results of the survey showed that 23.4% of physicians had experienced mistreatment in the last year.

According to the study, the most common form of mistreatment, reported by about 17% of physicians and representing over 70% of all mistreatment, was from patients and visitors, followed by mistreatment by other physicians. The most frequent forms of mistreatment were verbal mistreatment reported by 21.5%, sexual harassment by 5.4%, and physical intimidation or abuse by 5.2%.

The survey found gender disparities in the experience of mistreatment, with women twice more likely to report mistreatment (31%) than men (15%), more likely to experience any form of mistreatment, and more likely to experience sexual harassment and verbal mistreatment. Previous studies have also found higher rates of occupational distress among female physicians, which have been attributed to imbalances in domestic responsibilities and to differences in the work environment.

The survey also found that the prevalence of mistreatment differed by race. The sample size of this study precluded detailed analysis by specific race and ethnicity categories, but the findings point to significant variability in rates of mistreatment by race. These observations are consistent with previous studies showing disparities in the experience of mistreatment by race and ethnicity among medical students and residents, as well as numerous personal accounts of mistreatment shared by physicians from underrepresented groups.

The study was the first to look at the association between the perception of protective workplace systems and occupational well-being for physicians. A strong association was found between mistreatment and decreased occupational well-being, including increased burnout, reduced professional fulfillment, and a higher reported intent to leave the organization.

The researchers said all members of the health care team share responsibility to mitigate mistreatment, but that those in leadership positions must establish policies and expectations of civility and respect from everyone, including patients and visitors.

Prior research found medical students and residents experience frequent mistreatment, but there has been a lack of corresponding data on mistreatment of practicing and attending physicians.

Workplace mistreatment has been associated with increased burnout, lower job performance and depression. National studies of physicians over the last decade have documented occupational burnout rates of 40-60%. Efforts to address burnout may greatly benefit patients, physicians, and health care organizations, decreasing the likelihood of medical errors and improving overall patient outcomes and patient experience as well as physician well-being.