A national study of workplace aggression in Australian clinical medical practice

Abstract

Objective: To describe the 12‐month prevalence of verbal or written and physical aggression from patients, patients’ relatives or carers, coworkers and others in Australian clinical medical practice. Design, setting and participants: An exploratory, descriptive study of cross‐sectional survey design in the third wave (March 2010 to June 2011) of the Medicine in Australia: Balancing Employment and Life longitudinal survey. Main outcome measures: Proportions of clinicians reporting verbal or written and physical aggression from each aggression source and the significance of differences reported by doctor type, sex, international medical graduate status, age and postgraduate experience. Results: Of 16 327 medical practitioners sampled, a response rate of 60.9% (9951) was achieved and 9449 (57.9%) were in Australian clinical practice. Participants comprised 3515 general practitioners and GP registrars, 3875 specialists, 1171 hospital non‐specialists and 888 specialists in training. Overall, 70.6% of medical practitioners experienced verbal or written aggression and 32.3% experienced physical aggression from one or more sources in the previous 12 months. While patterns of exposure were complex, more female clinicians, international medical graduates (IMGs) and hospital‐based clinicians experienced workplace aggression. Age and postgraduate experience were significantly negatively associated with aggression exposure. Conclusions: This is the first nationwide study of workplace aggression from all sources experienced by all subpopulations of Australian medical clinicians. The findings suggest particular risks for younger and more junior hospital‐based clinicians, and for IMGs in general practice. A failure to address this important professional and public health concern may contribute to ongoing challenges in the recruitment and retention of medical practitioners in an era of increasing shortages internationally.

Differences in risk and protective factors for workplace aggression between male and female clinical medical practitioners in Australia

“…3,[7][8][9]17 Data were collected between March 2010 and June 2011, with 16 327 (27.6%) medical practitioners sampled from the Medical Directory of Australia (MDA). 7,8 The conduct of the study was approved by The University of Melbourne Faculty of Business and Economics Human Ethics Advisory Group and the Monash University Standing Committee on Ethics in Research Involving Humans.…”

“…11,12 The risk of workplace aggression is recognised as being higher in younger and primarily hospital-based clinicians. 3,13,14 To date, however, the body of evidence is equivocal, even contradictory, with regard to differences between males and females in exposure to non-physical 1,3,15 and physical forms of aggression. 1,3,16 It has also been argued that there is a need to more clearly understand these differences in risk and protective factors for exposure to workplace aggression, both to facilitate an understanding of differences in effect and to better target prevention and minimisation measures.…”

“…3,13,14 To date, however, the body of evidence is equivocal, even contradictory, with regard to differences between males and females in exposure to non-physical 1,3,15 and physical forms of aggression. 1,3,16 It has also been argued that there is a need to more clearly understand these differences in risk and protective factors for exposure to workplace aggression, both to facilitate an understanding of differences in effect and to better target prevention and minimisation measures. 1,15,16 Therefore, the aim of the present study was to determine the extent of differences between male and female clinicians in exposure to aggression from sources external or internal to the workplace, and the risk and protective factors for external and internal aggression in a large sample of Australian clinical medical practitioners.…”

“…1,2 In Australian studies, workplace aggression has been identified as an intrinsic part of medical work, with up to 71% of clinicians reporting exposure to non-physical forms and up to 32% of reporting exposure to physical forms in the previous 12 months, with most aggression emanating from patients and their family or carers. [3][4][5] High rates of internal (co-worker) aggression have also been reported in Australian medical settings. 3,6 In addition, there is a growing understanding of key personal, work and patient factors that may increase the risk of exposure to aggression in medical work, 1,7 and the negative effect it may have on clinician health and well being, 8 workforce participation decisions 9,10 and the quality of medical care.…”

“…[3][4][5] High rates of internal (co-worker) aggression have also been reported in Australian medical settings. 3,6 In addition, there is a growing understanding of key personal, work and patient factors that may increase the risk of exposure to aggression in medical work, 1,7 and the negative effect it may have on clinician health and well being, 8 workforce participation decisions 9,10 and the quality of medical care. 11,12 The risk of workplace aggression is recognised as being higher in younger and primarily hospital-based clinicians.…”