Key points What are the prevalence and common sources of physician mistreatment in the workplace? Is there an association between workplace mistreatment and occupational well-being? Findings A survey of 1,505 doctors conducted between September and October 2020 found that 23.4% had experienced mistreatment in the past year, with patients and visitors being the most common source of mistreatment. Mistreatment was associated with higher levels of job distress, while the perception that protective systems are in place in the workplace was associated with lower levels of job distress. Meaning These findings suggest that systems that prevent workplace mistreatment can improve physicians’ occupational well-being. |
Importance
Reducing physicians’ occupational distress requires understanding mistreatment in the workplace, its relationship to occupational well-being, and how mistreatment differentially affects physicians of diverse identities.
Goals
To assess the prevalence and sources of mistreatment among physicians and the associations between mistreatment, occupational well-being, and physicians’ perceptions of workplace protection systems.
Design, environment and participants
This survey study was administered in September and October 2020 to physicians at a large academic medical center. The statistical analysis was carried out from May 2021 to February 2022.
Main Results and Measures
The primary measures were the Professional Accomplishment Index, a measure of intention to leave, and the Mistreatment, Protection and Respect Measure (MPR). The main results were the prevalence and sources of abuse. Secondary outcomes were associations of mistreatment and perceptions of workplace protection systems with occupational well-being.
Results
Of 1909 invited medical staff, 1505 (78.8%) completed the survey. Among the respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share the gender identity or chose “other”; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as others and 292 (19.4%) did not share race or ethnicity.
Of the 1,397 respondents who answered questions about maltreatment, 327 (23.4%) reported experiencing maltreatment in the past 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%).
Women were more than twice as likely as men to experience abuse (31% [224 women] vs. 15% [92 men]) .
On a scale of 0 to 10, mistreatment was associated with a 1.13-point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional accomplishment (CI 95%, −1.24 to −0.73) and 129% higher odds of moderate or greater intention to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99).
Compared with the perception that workplace protection systems are "largely" implemented, the perception that workplace protection systems are not in place was associated with a 2.41 point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional achievement score (95% CI, −3.44 to −2.18), and 711% higher odds of intend to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35).
Conclusions and relevance
This survey study found that mistreatment was common among physicians, varied by gender, and was associated with job distress. Patients and visitors were the most frequent source, and perceptions of workplace protection systems were associated with better occupational well-being. These findings suggest that healthcare organizations should prioritize reducing workplace mistreatment.
Comments
According to new research from Boston Medical Center and Stanford University School of Medicine, nearly a quarter of doctors who responded to a survey at Stanford Medicine experienced mistreatment in the workplace, with patients and visitors being the source. more common.
The research, published in JAMA Network Open , found that mistreatment was common among all doctors, but there were disparities in mistreatment by gender and race. Women were twice as likely to report abuse as men. This study also showed statistically significant differences in maltreatment by race and suggests that more research is needed in this area.
Mistreatment was associated with higher levels of job distress among physicians, while the perception that protective systems existed in the workplace was associated with lower levels of job distress. The findings call for healthcare organizations to recognize the urgent need to implement systems to reduce the occurrence of mistreatment.
The survey was administered to 1,505 physicians on the clinical faculty at Stanford University School of Medicine in September and October 2020 to assess the frequency and sources of mistreatment among physicians and the associations between mistreatment, occupational well-being, and perceptions of protection systems in the workplace. . The survey results showed that 23.4% of doctors had suffered mistreatment in the last year.
This is the first study to explore the association between the perception of workplace protection systems and physicians’ occupational well-being. Having systems in place to protect physicians from mistreatment was associated with greater occupational well-being, both for those who were mistreated and those who were not. A strong association was found between mistreatment and decreased occupational well-being, including increased burnout, reduced professional fulfillment, and increased reported intention to leave the organization.
"To address the problem of medical mistreatment, organizations must first recognize its prevalence and then know where to look," said first author Susannah Rowe, MD, an ophthalmologist at BMC, chair of the Professional Vitality and Wellness Council at the Medical Group of the Boston University. and assistant professor of ophthalmology at Boston University School of Medicine. “With the strong association of mistreatment with workplace dissatisfaction and physician burnout, it is imperative that healthcare organizations take steps to address these issues as quickly as possible for the well-being of their staff and patients. ”.
“All members of the health care team share responsibility for mitigating mistreatment,” said senior author Mickey Trockel, MD, PhD, clinical professor of psychiatry and behavioral sciences at Stanford University School of Medicine and director of evidence-based innovation, Stanford WellMD/WellPhD Center. “Those who exert leadership influence have a particular responsibility to establish policies and expectations for civility and respect for all members of the healthcare community, including patients and visitors.”
“As an organizational ombudsman for many decades, I am unaware of previous quantitative research in any industry that establishes such a clear connection between perceptions of bystander action and occupational well-being,” said co-author Mary Rowe, an associate professor at the Institute for Research on Labor and Employment at MIT Sloan School of Management, and former MIT Ombudsman. “Together with qualitative research suggesting that bystanders are much more likely to act or show up when organizational leaders are perceived to be responsive, these new findings highlight the great potential for organizations to support occupational well-being by improving employee responsiveness.” leadership towards the spectators.”
While previous research has found that medical students and residents experience frequent mistreatment, there has been a corresponding lack of data on mistreatment of practicing and attending physicians. According to the survey, the most common form of mistreatment, reported by about 17% of physicians and accounting for more than 70% of all mistreatment events, was mistreatment by patients and visitors, followed by mistreatment by other doctors. The most frequent forms of abuse were verbal abuse reported by 21.5%, sexual harassment by 5.4%, and intimidation or physical abuse by 5.2%.
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 maltreatment rates 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.
Workplace mistreatment has been associated with increased burnout, lower work performance, and depression. National studies of physicians over the past decade have documented occupational burnout rates of 40-60%. Efforts to address burnout can greatly benefit patients, physicians, and healthcare organizations by decreasing the likelihood of medical errors and improving overall outcomes and patient experience, as well as physician well-being.
