Patient Safety and Quality
Background: Most studies examining verbal and physical abuse towards emergency physicians (EP) have focused on patients as the primary perpetrators. We hypothesized that a significant proportion of surveyed EPs would report perceived verbal abuse by other providers, and that this abuse would be felt to have a negative impact on patient care and physician wellness.
Methods: This was a cross-sectional survey among board-certified EPs from a broad-array of practice settings distributed through the ACEP EMPRN. The survey contained questions on several different subjects to reduce response bias, and respondents answered structured questions regarding experience/impact of perceived verbal abuse from consultants. Categorical data are reported as frequency of occurrence; analyzed by chi-square. Continuous data are presented as means (SD); analyzed by t-tests. The primary outcome measure was the proportion of respondents who experienced abuse defined within the prior 12-months. Multivariate logistic regression analyses were performed to control for confounding.
Results: 225 physicians completed the survey; 46% practiced in suburban and 41% urban locations. 30% from academic settings, 47% from EDs with volume < 50,000 patients/year and 72% had > 10 years experience. Respondents and non-respondents were similar with respect to mean age 52+/-11 vs. 50+/-11 years (p=0.97) and % female (25% vs.30%; p=0.12). Non-White race was less common for respondents (11% vs. 29%; p<0.001). 197/225 (87.6%) respondents perceived being abused by a consultant; 36% within the past 12 months. With respect to physician/practice characteristics, only female gender was associated with higher likelihood of reporting abuse (96% vs. 84%; p=0.02). For those reporting abuse, 54% felt it negatively influenced patient care, including: change of patient disposition (10%) and delay in time sensitive treatment (47%). 59% of respondents reluctant to call if consultant viewed as abusive. 85% of physicians who reported abuse agreed/strongly agreed that it contributed to burnout. 8% reported that this was a factor in wanting to leave the field. Academic physicians were more likely to report burnout as a consequence of being abused (p=0.02; OR 0.43; 95%CI 0.21-0.88).
Conclusions: EPs commonly feel verbally abuse by consultants, which contributes to sense of burnout. This adversely impacts patient care.