16 May Mistreatment of Physicians in the Health Care Workplace
MedicalResearch.com Interview with:
Susannah G. Rowe, MD, MPH
Office of Equity, Vitality and Inclusion
Boston University Medical Group
Boston Medical Center
Boston University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: We wanted to learn how frequently mistreatment occurs for clinicians at work and how it impacts their occupational well-being. We began to see more anecdotal reports of workplace mistreatment of clinicians even before the pandemic. In the extraordinarily stressful environment we are currently experiencing, with people feeling exhausted and emotionally threadbare on some level, the problem appears to be growing.
We also predicted that the burden of mistreatment would not borne be equally. It has often been said that we are all in the same storm but in different boats – some of us are riding out the storm in comfortable ocean liners, while others are paddling in canoes without life jackets. What we are learning, though, is that we are not in fact experiencing the same storm. For example, the increasing intolerance and erosion of public civility we have seen in recent years might show up as minor annoyances for some of us, and actual threats of violence for others depending in large part on our gender and racialized identities. Our relationship to privilege and oppression affects our experiences, creating protections or additional burdens, so when studying clinician occupational well-being, it seemed important to consider how these disparities play out in the workplace.
MedicalResearch.com: What are the main findings?
Response: We learned that almost one in four clinicians experienced some form of mistreatment at work in the last 12 months, most often from patients and families. Women were significantly more likely to experience mistreatment. We also saw disparities by race, although our study was too small to directly compare rates based on individual racial and ethnic groups.
MedicalResearch.com: What should readers take away from your report?
Response: This study highlights how important it is to feel that there are systems in place to ensure one is treated with dignity and respect. This is an important finding because it shows that health care organizations have the power to make things better for their workers. Even though organizations cannot control some of the root causes leading to mistreatment, they can create equitable work environments that actively focus on protecting workers from abuse and mistreatment from patients, visitors, and co-workers. Knowing who is bearing the burden of mistreatment can result in more equitable, and therefore more effective, solutions.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: While we saw differences in the incidence of mistreatment by gender and race in this study, we were not able to explore the nuances of these disparities given our sample size. Larger studies will help us better understand workplace mistreatment and its relationship to occupational wellbeing for people who have not been prioritized in health care based on their racial, ethnic, and gender identities that fall outside of the dominant majority (white, male).
We also need to learn how to do better. What can healthcare organizations do to successfully reduce mistreatment and mitigate its effects? The work begins with collecting high-quality data on the problem, then developing and studying initiatives to address it. Promising practices include empowering bystanders and managers to intervene, anonymous reporting systems, equity initiatives, and unconscious bias training. There is no one solution, policy, practice, or initiative – there must be multi-level, ongoing strategies to create meaningful impact and shift culture to one where everyone feels professionally fulfilled, safe, and valued.
I have no disclosures to make.
Rowe SG, Stewart MT, Van Horne S, et al. Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians. JAMA Netw Open. 2022;5(5):e2210768. doi:10.1001/jamanetworkopen.2022.10768
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